Rr 08 Neoplasms Part 2

Front 1

Describe the epidemiology of cancer

Back 1

1. Cancer is the second most common cause of death in the US
2. Risk for developing cancer increases with age
-Most that 75% of cancers are in persons 55 and older

Front 2

Describe the lifetime risk of cancer

Back 2

1. Probability that a person will develop or die from cancer
2. In the US, men have slightly less than 1 in 2 lifetime risk
3. In the US, women have a little more than 1 in 3 lifetime risk

Front 3

Describe the relative risk of cancer

Back 3

1. Measure of the strength of a relationship between risk factors and a particular cancer
2. Compares risk of developing cancer in individuals at risk with those that are not
a. Compares risk for cancer in males smokers versus nonsmokers
b. Male smokers have 23x greater risk than male nonsmokers; relative risk is 23
c. Women with a history of breast cancer in a 1st degree relative have 2x greater risk for developing breast cancer (relative risk 2)

Front 4

Describe relative survival rates

Back 4

1. Refers to percentage of cancer patients alive after a period of time (usually 5 years) relative to persons without cancer
2. Should be interpreted with caution, because some cancers commonly recur after 5 years
-Examples: breast, kidney

Front 5

Describe cancer in blacks

Back 5

1. Greatest risk for cancer and cancer-related death of any other racial group or ethnicity
2. Applies to almost all cancers except malignant melanoma

Front 6

Describe cancers in Hispanics and Asians

Back 6

1. Lower incidence rates for all cancers combined than whites
2. Exceptions are for cancers associated with infections- cervix (HPV), liver (hep B, C), stomach (H. pylori)

Front 7

Describe cancers in Native Americans

Back 7

Highest incidence and cancer-related deaths due to kidney cancer than all racial and ethnic populations

Front 8

Describe cancer incidence in children

Back 8

1. Second most common cause of death in children (accidents most common cause)
2. Acute lymphoblastic leukemia (~33%), CNS tumors (~21%), neuroblastoma (~7%), Wilms’ tumor (~5%)

Front 9

Describe the incidence of cancers in men

Back 9

In decreasing order
1.Prostate
2. Lung
3. Colorectal

Front 10

Describe the incidence of cancers in women

Back 10

In decreasing order
1. Breast
2. Lung
3. Colorectal

Front 11

Describe gynecologic cancers

Back 11

In decreasing order
1. Endometrium
2. Ovarium
3. Cervical
-Least common due to cervical Pap smears detecting dysplasia

Front 12

Describe cancer related deaths in men

Back 12

In decreasing order
1. Lung
2. Prostate
3. Colorectal

Front 13

Describe cancer related deaths in women

Back 13

In decreasing order
1. Lung
2. Breast
3. Colorectal

Front 14

Describe gynecologic cancer-related deaths

Back 14

In decreasing order
1. Endometrium
2. Ovary
3. Cervix

Front 15

Describe cancer and heredity

Back 15

1. Inherited predisposition to cancer accounts for 5% of all cancers
2. Categories of inherited cancers
a. Autosomal dominant cancer syndrome
b. Autosomal recessive disorders involving DNA repair
c. Familial cancers

Front 16

List the autosomal dominant cancer syndromes

Back 16

1. Retinoblastoma
2. Familial adenomatous polyposis
3. Li-Fraumeni syndrome
4. Hereditary nonpolyposis colon cancer (Lynch syndrome)
5. BRCA1 and BRCA2 genes

Front 17

Describe Retinoblastoma

Back 17

-Malignancy of eye in children
-40% are inherited
-Point mutation inactivates RB suppressor gene on chromosome 13
-One gene inactivated in germ cells, remaining gene inactivated after birth (two-hit theory)
-Predisposition for osteogenic sarcoma in adolescence

Front 18

Describe familial adenomatous polyposis

Back 18

-Development of colorectal cancer from malignant transformation of polyps by age 50
-Inactivation of APC suppressor gene

Front 19

Describe Li-Fraumeni syndrome

Back 19

-Increased risk for sarcomas, leukemia, carcinomas (eg breast) before age 50
-Inactivation of TP53 suppressor gene

Front 20

Describe Hereditary nonpolyposis colon cancer (Lynch syndrome)

Back 20

-Increased risk for colorectal cancers without previous polyps
-Inactivation of DNA mismatch repair genes
-Cannot correct errors in nucleotide pairing
-Characteristic finding is alteration in microsatellite nucleotide sequences (normally do not change in cells)

Front 21

Describe BRCA1 and BRCA2 genes

Back 21

Inactivation of genes increases risk for developing breast and ovarian cancer

Front 22

List autosomal recessive syndromes with defects in DNA repair

Back 22

1. Xeroderma pigmentosum
2. Chromosome instability syndromes

Front 23

Describe Xeroderma pigmentosum

Back 23

1. Increased risk for developing skin cancers due to UV light (cross-links adjacent pyrimidine producing pyrimidine dimmers)
2. Examples include basal cell carcinoma, squamous cell carcinoma

Front 24

Describe Chromosome instability syndromes

Back 24

-Chromosomes susceptible to damage by ionizing radiation and drugs
-Predisposition to cancers (eg leukemia, lymphoma)
-Disorders include Fanconi anemia, ataxia telangiectasia, Bloom syndrome

Front 25

Describe familial cancer syndromes

Back 25

-No defined pattern of inheritance, but cancers (eg breast, ovary, colon) develop with increased frequency in families
-Sometimes involves BRCA1 and BRCA2 genes

Front 26

What cancer is increasing at the most rapid rate worldwide?

Back 26

Malignant melanoma

Front 27

What is the top cancer in China?

Back 27

Nasopharyngeal carcinoma secondary to EBV

Front 28

What is the top cancer in Japan?

Back 28

Stomach adenocarcinoma due to smoked foods

Front 29

What is the top cancer in SE Asia?

Back 29

Hepatocellular carcinoma due to Hep B virus plus aflatoxins (produced by Aspergillus) in food

Front 30

What is the top cancer in Africa?

Back 30

Burkitt’s lymphoma due to EBV and Kaposi’s sarcoma due to human herpes virus 8

Front 31

Describe lifestyle modifications in preventing modalities in cancer

Back 31

1. Stop smoking cigarettes – the most important factor
2. Increase fiber/decrease dietary saturated animal fat
-Decreases risk for colorectal cancer
3. Reduce alcohol intake
4. Reduce weight

Front 32

Describe the results if adipose tissue is increased

Back 32

Increases aromatase conversion of androgens to estrogen

Front 33

Describe the results if estrogen is increased

Back 33

Increases risk for endometrial and breast cancer

Front 34

What cancer results from the precursor lesion actinic (solar) keratosis?

Back 34

Squamous cell carcinoma

Front 35

What cancer results from the precursor lesion atypical hyperplasia of ductal epithelium of breast?

Back 35

Adenocarcinoma

Front 36

What cancer results from the precursor lesion chronic irritation at sinus orifice, third-degree burns scars?

Back 36

Squamous cell carcinoma

Front 37

What cancer results from the precursor lesion chronic ulcerative colitis?

Back 37

Adenocarcinoma

Front 38

What cancer results from the precursor lesion complete hydatidiform mole?

Back 38

Choriocarcinoma

Front 39

What cancer results from the precursor lesion dysplastic nevus?

Back 39

Malignant melanoma

Front 40

What cancer results from the precursor lesion endometrial hyperplasia?

Back 40

Adenocarcinoma

Front 41

What cancer results from the precursor lesion glandular metaplasia of esophagus (Barrett’s esophagus)?

Back 41

Adenocarcinoma

Front 42

What cancer results from the precursor lesion glandular metaplasia of stomach (H. pylori)?

Back 42

Adenocarcinoma

Front 43

What cancer results from the precursor lesion myelodysplastic syndrome?

Back 43

Acute Leukemia

Front 44

What cancer results from the precursor lesion regenerative nodules in cirrhosis?

Back 44

Adenocarcinoma

Front 45

What cancer results from the precursor lesion scar tissue in lung?

Back 45

Adenocarcinoma

Front 46

What cancer results from the precursor lesion squamous dysplasia of oropharynx, larynx, bronchus, cervix?

Back 46

Squamous cell carcinoma

Front 47

What cancer results from the precursor lesion tubular adenoma of colon?

Back 47

Adenocarcinoma

Front 48

What cancer results from the precursor lesion vaginal adenosis (diethylstilbestrol exposure)?

Back 48

Adenocarcinoma

Front 49

What cancer results from the precursor lesion villous adenoma of rectum?

Back 49

Adenocarcinoma

Front 50

Describe immunization against cancer

Back 50

1. Hepatitis B (HBV) vaccination
-Immunization decreases the risk for hepatocelliular carcinoma due to hepatitis B-induced postnecrotic cirrhosis
2. Human papillomavirus (HPV) immunization
-Decrease the risk for developing cervical squamous cancer

Front 51

List the screening procedures for cancer

Back 51

1. Cervical papanicolaou (Pap) smears
2. Colonoscopy
3. Mammography
4. Prostate-specific antigen (PSA)

Front 52

Describe Cervical papanicolaou (Pap) smears

Back 52

1. Decreases risk for cervical cancer
2. Pap smear detects cervical dysplasia, which can be surgically removed
a. Detection for low-grade dysplasia –sensitivity~70%, specificity 75%
b. Detection for high-grade dysplasia – sensitivity 75%, specificity 95%

Front 53

Describe colonoscopies

Back 53

Detects and removed polyps that are precancerous

Front 54

Describe mammographies

Back 54

Detects nonpalpable breast masses

Front 55

Describe Prostate-specific antigen (PSA)

Back 55

1. Detects prostate cancer
2. Lacks specificity (increased false positive results)
-PSA may be increased in prostate hyperplasia

Front 56

Describe treatment of conditions that predispose to cancer

Back 56

1. Treatment of H. pylori infections
-Decreases risk for developing malignant lymphoma and adenocarcinoma of the stomach
2. Treatment of gastroesophageal reflux disease (GERD)
-Decreases the risk for developing distal adenocarcinoma arising from Barrett’s esophagus