Pathology - Six Common Cancers

Front 1

Most common invasive carcinomas of the uterine cervix?

Back 1

1. Squamous cell carcinoma (75%)
2. Adenocarcinoma
3. Other epithelial tumors

Front 2

Mean age of cervical squamous cell carcinoma?

Back 2

1. 51
2. Uncommon before age 30
3. Most are aged 45-55 when diagnosed

Front 3

Clinical picture of squamous cell carcinoma of the cervix?

Back 3

1. White patches after application of acetic acid to cervix
2. Mosaic vascular patterns seen in colposcopy

Front 4

Prognostic factors of squamous cell carcinoma of cervix?

Back 4

1. Clinical stage
2. Angiolymphatic invasion;
3. HPV negative patients do worse

Front 5

When squamous cell carcinoma of the cervix is diagnosed, in which stage are most of the carcinomas?

Back 5

2/3s are stage I or II

Front 6

How does cervical cancer spread?

Back 6

1. Through cervical lymphatics in a sequential manner
2. Direct extension to vagina, uterus, parametrium, LUT, uterosacral ligaments
3. In rare cases distant metastases to lungs, bones, and ovaries (1%)

Front 7

Risk factors for squamous cell carcinoma of the cervix?

Back 7

1. HPV infection
2. Early sexual debut
3. Multiple sexual partners
4. Oral contraceptives
5. Smoking
6. High parity
7. Family history (HLA)
8. Immunosuppression

Front 8

Risk factors for breast carcinoma?

Back 8

1. Proliferative breast disease
2. Cancer of contralateral breast
3. Radiation
4. Length of reproductive life
5. Parity
6. Obesity
7. HRT
8. BRCA1, BRCA2, Li-Fraumeni, Cowden syndrome

Front 9

Most common place of breast carcinoma?

Back 9

Upper lateral quadrant (50%)
Central part (20%)

Front 10

Van Nuy's prognostic index (VNPI) is a score to determine treatment of ductal carcinoma in situ (DCIS) of breast cancer. What are the scorings?

Back 10

1. 3-4 points - only surgery
2. 5-7 points - surgery and radiation therapy
3. 8-9 points - mastectomy

Front 11

Which cancer is responsible for the most deaths?

Back 11

Lung cancer

Front 12

Risk factors (etiology) of lung cancer

Back 12

1. Tobacco smoke (9/10 cases caused by tobacco smoke)
2. Industrial hazards (asbestos, radiation)
3. Air pollution (indoor, radon)
4. Genetic factors (CYP1A1 polymorphism)

Front 13

Symptoms of lung cancer

Back 13

1. Appear late in the course of the disease
2. Cough
3. Chest pain
4. Dyspnea

Front 14

5yr survival rate of lung cancer?

Back 14

1. <9%
2. highest for squamous cell carcinoma (bronchoalveolar carcinoma 5yr is 50%?)
3. lowest for small cell carcinoma

Front 15

Systemic symptoms of lung cancer?

Back 15

1. Lambert-Eaton myasthenic syndrome
2. Peripheral sensory neuropathy
3. Acanthosis nigricans
4. Leukemoid reaction
5. Hypertrophic osteoarthropathy (finger clubbing)
6. Superior vena cava syndrome
7. Pancoast tumors (apical lung tumors)

Front 16

Prostate cancers have two major categories, what are they?

Back 16

1. Adenocarcinoma of peripheral ducts/acini (majority; most studies dealing with grading, staging, prognosis refer exclusively to them)
2. Carcinoma of large ducts

Front 17

Where do most adenocarcinomas of the prostate occur?

Back 17

70% occur in the peripheral zone (posterior, lateral, anterior)

Front 18

Prostate cancer can metastasize to

Back 18

1. Lymph nodes/nodal metastases
2. Lung/liver/pleura
3. Adrenals
4. Bones/bony metastases (multiple, usually osteoblastic)
5. Poorly differentiated carcinomas may metastasize to the left supraclavicular or mediastinal nodes

Front 19

Prognostic factors of prostate cancer

Back 19

1. Stage
2. Gleason score
3. Surgical margins
4. Preoperative PSA
5. Perineurial invasion, MIB-1, angiolymphatic invasion, size of nodal metastases

Front 20

All but the least differentiated prostatic tumors secrete increased amounts of PSA. At which point is there an indication for a biopsy? Which other conditions may lead to higher PSA levels?

Back 20

1. >4 g/L (ng/mL)
2. Higher PSA levels in prostatitis, prostatic infarct, and major trauma

Front 21

How is the Gleason score calculated?

Back 21

The pathologist assigns a grade to the most common tumor pattern, and the second most common tumor pattern, and adds them together;

Patterns are graded from 1 (well differentiated) to 5 (poorly differentiated)

Front 22

What is PIN?

Back 22

1. "Prostatic Intraepithelial Neoplasia"
2. It is the most likely precursor of prostatic adenocarcinoma
3. Does not cause elevated PSA levels

Front 23

If the biopsy reveals a high grade PIN, what does it mean for the patient?

Back 23

1. Indicates 33% risk of carcinoma in subsequent biopsies
2. If the two subsequent biopsies are negative for high grade PINs, there is a low risk for cancer (13%)

Front 24

The number of cores with a high grade PIN predicts the risk of cancer. By how much?

Back 24

1. One core - 30%
2. Three cores - 40%
3. 4+ cores - 75%

Predominantly cribriform/microcapillary patterns are associated with a higher risk

Front 25

Epidemiology of gastric cancer

Back 25

1. 4th most common cancer worldwide
2. 5yr survival - 20% or less, 95% for surgically treated early gastric carcinoma

Front 26

Most common sites of gastric cancer?

Back 26

In descending order:
1. Pylorus and antrum
2. Cardia
3. Lesser curvature
4. Greater curvature

Front 27

Where does gastric cancer normally metastasize?

Back 27

1. Supraclavicular nodes (Virchow's node)
2. Peritoneum/lung/liver/spleen
3. Adrenal glands
4. Krukenberg tumor (metastase to one or both ovaries)

Front 28

What is the single most important prognostic factor of gastric cancer?

Back 28

Depth of invasion

Front 29

Prognostic factors that suggest a poor outcome in gastric cancer?

Back 29

1. Younger age (diffuse histology, more advanced disease)
2. Proximal half of stomach
3. Deep invasion
4. Infiltrative margin
5. Diffuse histologic type
6. Positive surgical margins (predicts recurrence)
7. Lymph node metastases

Front 30

Surprisingly these factors are not risk factors for intestinal type adenocarcinoma of the stomach

Back 30

1. Alcohol
2. Antacids
3. Occupational exposure

Front 31

Risk factors for diffuse type adenocarcinoma of the stomach?

Back 31

No known risk factors

Front 32

Etiology of diffuse type adenocarcinoma of the stomach?

Back 32

1. Appears to arise without a dysplastic precursor
2. Possibly through primary involvement of genes affecting cell-cell and cell-matrix junctional proteins

Front 33

What is Linitis plastica?

Back 33

It is a morphological variant of diffuse (or infiltrating) gastric cancer. It is also known as Brinton's disease or leather bottle stomach. A broad region of the gastric wall, or entire stomach, is extensively infiltrated by malignancy, creating a thickened, rigid, leather bottle-like stomach. May cause pyloric obstruction.

Front 34

Early gastric cancer is limited to

Back 34

mucosa and submucosa, regardless of the presence or absence of lymph node metastases

Front 35

Prognosis in EGC (N0), EGC with N1, and advanced gastric cancer

Back 35

1. 90-95%
2. 75-85%
3. 15%

Front 36

Way to prevent colorectal cancer?

Back 36

Polypectomy (adenomectomy) prevents cancer

Front 37

Most common form of colorectal cancer?

Back 37

1. 98% are adenocarcinomas
2. Peaks at age 60-79
3. Less than 20% before age 50

Front 38

Risk factors for colorectal cancer?

Back 38

1. Increased age
2. Obesity
3. Physical inactivity
4. Ulcerative colitis
5. Crohn's disease
6. Schistosomiasis
7. Polyposis syndrome
8. FHx of colorectal neoplasia
9. Diet

Front 39

Polyposis syndromes

Back 39

1. FAP and variants (APC gene)
2. Juvenile polyposis (DPC4, PTEN genes)
3. Peutz-Jeghers syndrome (STK11 gene)
4. Lynch syndrome and variants (MSH2, MSH3, MSH6, MLH1, PMS1, PMS2 genes)

Front 40

Colorectal cancer may metastasize to?

Back 40

1. Regional lymph nodes and liver (most commonly)
2. Peritoneum
3. Lung
4. Ovaries

Front 41

Prognosis of colorectal cancer?

Back 41

5yr survival 40-60%; most recurrences occur within 2 years

Front 42

Colorectal cancer prognostic factors that indicate a poor outcome?

Back 42

1. Late stage
2. High grade/poorly differentiated tumors
3. Positive margins (particularly rectal carcinoma)
4. Small cell carcinoma
5. Mucinous, anaplastic, or signet ring subtypes

Front 43

The two main molecular pathways of colorectal carcinoma?

Back 43

1. Chromosome instability
2. Microsatellite instability

Front 44

Mutations in certain oncogenes and tumor suppressor genes may lead to colorectal cancer. Which genes?

Back 44

1. APC
2. ß-catenin
3. K-RAS
4. BRAF
5. SMAD4
6. PTEN
7. p53
8. BAX
9. FAP and variants, DPC4