Chapter 10: Cancers: Cells out of control Flashcards
(204 cards)
1
Q
What is an abnormal mass of cells caused by uncontrolled growth?
A
Neoplasm
2
Q
What is a malignant neoplasm with the ability to spread?
A
Cancer
3
Q
When cells of malignant neoplasm spread to another location that is called
A
metastasis
4
Q
When cell shrinks in size it is called
A
atrophy
5
Q
When cell enlargens in size it is called
A
hypertrophy
6
Q
When cells multiply it is called
A
hyperplasia
7
Q
Normal cell growth in wrong location
A
metaplasia
8
Q
Loss of cell to cell contact inhibition; cells crawling on top of each other
A
dysplasia
9
Q
Difference between benign and malignant
A
benign is usually well circumscribed, does not outgrow its capsule, does not outgrow its blood supply; does not metastasize; obeys physiology
Malignant is the opposite of the above.
10
Q
What do malignant cells secrete to increase blood supply to “feed the tumor”
A
angiostatin
11
Q
MC tumor of any organ (be careful, it doesn’t say “primary”)
A
metastasis
12
Q
Usually -oma on end means benign tumor. What are some exceptions?
A
seminoma, lymphoma, mesothelioma, retinoblastoma
13
Q
What ending do you give tumor if it has epithelial tissue origin?
A
carcinoma
14
Q
What ending do you give tumor if it has connective tissue origin?
A
sarcoma
15
Q
malignant gland tumor of epithelial origin
A
adenocarcinoma
16
Q
a tumor that has tissue from ectoderm, mesoderm and endoderm (hair, teeth, bone)
A
teratoma
17
Q
MC primary cancer overall in US?
A
basal cell carcinoma #2 squamous cell carcinoma of skin (but because of slow growth and early detection, usually not listed in MC cancers that cause death)
18
Q
MC primary cancer of liver
A
hepatocellular adenocarcinoma
19
Q
MC primary breast cancer
A
invasive ductal carcinoma
20
Q
MC primary lung cancer
A
adenocarcinoma
21
Q
MC intracranial tumor (brain)
A
meningioma
22
Q
MC primary brain tumor
A
astrocytoma
23
Q
MC astrocytoma in child
A
pilocytic astrocytoma (posterior fossa, “Rosenthal fibers”(worm-like, corkscrew fibers)
24
Q
4 neoplasms with Psammoma bodies
A
PSAMM
Papillary thyroid carcinoma
Serous-
Adenocarcinoma of ovary
Meningioma
Mesothelioma
25
brain tumor associated with NF1
optic glioma and neural crest derived tumors
26
brain tumor of oligodendrocytes that cause personality changes and movement disorders
oligodendroglioma
27
brain tumor of ependymal cells that line ventricles
ependymomas
28
What happens if an ependymoma obstructs CSF flow?
non-communicating hydroencephalus
29
What are signs and symptoms of non-communicating hydroencephalus?
papillary edema, blurring of disc, headache, seizures
30
Peripheral neuromas, axillary freckling, Lisch nodules, pheochromocytoma, and optic gliomas associate with
NF1
31
Which chromosome is affected in NF1?
Ch 17
32
Which chromosome is affected in NF2?
Ch22
33
Which tumor suppressor gene is inactivated in NF2?
MERLIN
34
What brain tumors are seen in NF2?
meningiomas, bilateral schwannomas (Ch22, 2 ears)
35
What skin anamoly is seen in NF2?
cafe au lait spots
36
What other disease can you see cafe au lait spots with precocious puberty?
McCune--Albright Syndrome
37
Which syndrome has noted port wine stain on forehead with angiomas of brain and retina accompanied by learning disabilities.
Sturge-Weber Syndrome
38
Which disease can you see ash leaf spots (hypopigmentation) and sebaceous adenomas?
tuberous sclerosis
39
What three organs are affected in Tuberous Sclerosis?
brain (tubors); heart (rhabdomyoma/rhabdomyosarcoma); kidney (renal cell carcinoma)
40
Which two tumor suppressor genes are responsible for TS and which chromosome are they found on?
TS1 (Ch 9-- hamartin); TS2 (Ch16--tuberin)
41
MC primary brain cancer
grade IV astrocytoma a.k.a. Gliobastoma Multiforme
42
What does GM look like histologically?
pseudopallisading pleiomorphic cells around central hemorrhage/necrosis; "garland-like"
43
most common brain cancer ("didn't say primary!!)
metastasis (usually at grey-white junction) and usually from lung, breast & skin
44
MC pituitary tumor?
pituitary adenoma
45
pituitary adenoma (acidophilic)
produce prolactin and growth hormone
46
pituitary adenoma of (basophilic)
produce ACTH, TSH, FSH, LH
47
most common functional tumor of pituitary
prolactinoma
48
Which medicine can shrink prolactinoma?
bromocriptine/cabergoline (dopa agonist)
49
What tumor could cause precocious puberty?
pinealloma
50
Englargement of pineal gland could cause..
noncommunicating hydroencephalus and Parinaud's syndrome (eyes fixed down ward, cannot look up)
51
Which eye problem is seen in Marfan's syndrome?
can't look down
52
Which eye problem is seen in homocystinuria?
can't look up
53
Which brain tumor develops from Rathke's pouch, may damage pituitary, is quite cystic and liquid inside has "motor-oil" appearance?
craniopharyngioma
54
MC childhood malignant primary brain tumor
medulloblastoma (cerebellar, papilledema, headaches, ataxia)
55
What "neuro" origin tumor grows medially in abdomen and is known to exhibit "dancing eyes, dancing feet"?
neuroblastoma
56
Rule of 10 for pheochromocytomas
10%in children; 10%bilateral; 10%metastatic; 10% familial; 10%malignant (don't forget to turn it around 90% in adults; 90% unilateral; 90% not metastatic; 90% idiopathic; 90% benign
57
Neural crest locations MOTEL PASS
melanoma
odentoblasts
tracheal cartilage
enterochromaffin (make serotonin)
laryngeal cartilage
pseudo unipolar cells (cover neurons)
adrenal medulla
schwann cells
spiral membrane (aorto-pulmonary membrane)
58
Which tests can detect neural crest cancers?
urinary or serum VMA, metanephrines, or HVA (dopamine)
59
Medicine for neural crest tumors (to control)
phenoxybenzamine
60
Definite treatment for neural crest tumors
surgical removal
61
The four T tumors of anterior mediastinum
thymus, thyroid, T-cell leukemia(hairy cell)/lymphoma, teratomas
62
What is the main T cell leukemia?
hairy cell leukemia
63
What test is positive in hairy cell leukemia?
TRAP (tartrate resistant acid phosphatase)
64
Two kinds of T cell lymphomas:
mycosis fungoides (cutaneous), and sezary syndrome (systemic)
65
What autoimmune disease is thymoma associated with?
Myasthenia gravis
66
Which organs are immunoprivileged (have barriers)
thymus, brain, eyes, testes, (remember if one eye loses immunoprivilege, the other loses it too)
67
What is the first thing to do if a thyroid mass is discovered?
ultrasound (to determine if cystic or solid)
68
If a thyroid mass is cystic, what is the next step in management?
FNA (fine needle aspiration)--diagnostic and therapeutic
69
If thyroid mass is solid, what is the next step in management?
If less than 1 cm, do thyroid scan: hot nodule, treat for hyperthyroidism; cold nodule and previous irradiation of the neck, lobectomy; no previous irradiation, fine needle biopsy.
If greater than 1 cm, fine needle biopsy.
70
PTH up, Ca up, PO4 down What is the meaning?
primary hyperpituitarism (moans, groans, stones and psychiatric overtones)
71
Tx for primary hyperparathyroidism
bisphosphanates (remember to sit up at least 30 minutes after taking them!); parathyroidectomy if severe
72
Most common cancer of parafollicular gland?
medullary carcinoma of thyroid (produces calcitonin)
73
3 Ps of MEN1 (Werner's syndrome)
pituitary, pancreatic, parathyroid tumors
74
MENII (Sipple Syndrome)
medullary carcinoma of thyroid (parafollicular secretes Calcitonin), pheochromocytoma, +/- parathyroid adenomas
mutation in RET
75
MEN IIb
Marfanoid habitus,pheochromocytoma, mucosal neuroma (like bumps on tongue) mutation in RET
76
MC tumor of heart?
myxoma (more common in females: pass out and recover a few seconds later--estrogen connection)
77
What are the two central primary lung cancers?
squamous cell carcinoma and small celll carcinoma
78
What hormone does squamous cell carcinoma often produce?
PTHrp
79
What hormones are small cell carcinomas able to produce?
ACTH, ADH, PTH, TSH
80
Which primary lung cancer is not related to smoking?
bronchoalveolar adenocarcinoma
81
Which syndrome of SCLC is when antibodies to presynaptic Ca channels produce muscle weakness that gets better with repetitive movement?
Lambert--Eaton
82
Which complication of SCLC present with low serum osmolarity and high urine osmolarity?
SIADH
83
If after high dose dexamethasone, the cortisol level is suppressed, where was the problem?
pituitary
84
If after high dose dexamethasone, the cortisol level is NOT suppressed, which two possible origins did problem originate? How can we distinguish one from the other?
could be a problem from adrenal gland or Lung cancer (SCLC) if ACTH is down from adrenal; if ACTH is up from lung cancer (or we can CT chest to find lesion)
85
What kind of pneumocosis comes from coal dust?
anthracosis
86
What kind of pneumocosis comes from shipyard work, construction, or plumbing?
asbestosis
87
What kind of pneumocosis comes from sandblasting?
silicosis
88
What kind of pneumocosis can you see eggshell calcifications in the hilum?
silicosis
89
What kind of pneumocosis could come from working in electronics or space industry?
berryliosis
90
All pneumocosis show restrictive lung pattern: what would lab values pAO2, RR, pCO2, pH look like?
pAO2 down, RR up, pCO2 down, pH up respiratory alkalosis
91
What three differentials for hilar calcifications?
silicosis, sarcoidosis, lymphoma
92
What is cancer of pleura?
mesothelioma
93
What is the histological finding of mesotheliomas?
psammoma bodies
94
most common primary cancer of nasopharynx
nasopharyngeal carcinoma MCC seen in Chinese men
95
Most common primary cancer of oral cavity
squamous cell carcinoma from smoking, chewing tobacco
96
Most common primary cancer of esophagus
squamous cell carcinoma
97
risk factors for esophageal SCC
Barrett's esophagus
98
How does Barrett's esophagus often present
odonyphagia (first cannot eat solids, then cannot drink liquids)
99
If a person has Barrett's, how often should they have an endoscopy?
If they have low dysplasia, give endoscopy once every 6-12 mo.
100
cancer associated with Virchow's nodes
stomach adenocarcinoma
101
What kind of cells can be seen in stomach adenocarcinoma biopsy?
signet ring (M cells making mucin)
102
What if stomach adenocarcinoma spreads to ovaries? What is it called?
Kruckenberg tumor
103
#1 risk factor for stomach MALToma (kind of B cell lymphoma)
H. pylori
104
Tx for H. Pylori
triple therapy: clarythromycin, amoxicillin, PPI; if resistant to amoxicillin: metronidazole; if no response chemotherapy
105
top risk factors for UGI cancers
#1 smoking, alcohol, nitrates, Japanese race
106
most common cancer of ileum
lymphoma
107
most common cancer of the appendix
carcinoid: usually originates from 1)pancreas 2) ileum; puts out large amount of serotonin; check urinary serotonin levels;
108
What other condition could develop with carcinoid syndrome?
Pellagra: dermatitis, diarrhea, dementia (death) because using up niacin to make serotonin
109
Tx for carcinoid syndrome
octreatide
110
top colon cancer risk factors
low fiber diet, high fat diet, polyps, UC
111
In familial polyposis, which gene is inactivated? Which gene is activated?
APC inactivated, KRAS activated
112
When should children in families with FAP get colonoscopy and how often?
yearly colonoscopy by age 12
113
Which disease presents with osteomas and sebaceous adenomas (bone tumors)
Gardner's
114
Which present with osteomas, sebaceous adenomas (polyps) and brain tumors?
Turcot's
115
Lynch syndrome (HNPCC) is associated with which gene mutations?
MSH1,2; MCH1
116
Which liver tumor is associated with estrogen use or injected steroids and could rupture and lead to life-threatening hemorrhage if ruptured?
hepatic adenoma
117
Which disease is associated with arteriovenous malformations in brain, GI and pulmonary?
Osler-Weber-Rendu
118
Which gene mutation is associated with Osler-Weber-Rendu?
ALK1, ALK2 on Ch12
119
Which disease leads to AVM or cysts in brain and abdomen?
VHL, from VHL gene on Ch3 (increase susceptibility to renal cell carcinoma)
120
Name 2 cancers where smoking is protective:
UC and endometriosis, all other cancers #1 risk factor
121
name risk factors for hepatocellular carcinoma
smoking, alcohol, Hep B, Hep C, schistosomiases, aniline dyes, aflatoxin, vinyl chloride (angiosarcoma); benzene
122
Most common primary cancer of biliary tract
cholangiosarcoma
123
Which autoimmune biliary disease is associated with anti-mitochondrial antibodies?
Primary Biliary cholangitis (PBC)
124
Which biliary disease is seen in men with UC and is associated with pANCA.
primary sclerosing cholangitis (PSC)
125
Adenocarcinoma of which organ is associated with Trousseau syndrome (migratory thrombophlebitis) and why?
pancreatic adenocarcinoma because mucin interacts with PLTs and makes them "sticky", so pts. develop clots in various veins
126
What is Libman Sachs endocarditis
a noninfectious endocarditis due to antigen-antibody (IgG-C3-IgM) immune complex deposition in heart valves
127
Which pancreatic adenoma can cause elevated glucose, lipids and ketones
glucagnoma (maybe treated as diabetes, but does not respond to insulin)
128
Which pancreatic adenoma can cause very low blood glucose?
insulinoma
129
Which pancreatic adenoma could cause severe constipation?
somatostatinoma
130
Which pancreatic adenoma could cause watery diarrhea?
VIPoma
131
Most common primary ovarian tumor?
serous adenocarcinoma (highly malignant and most mucinous cancer in women)
132
ovarian cancer with elevated estrogen
granulosa cell tumor
133
ovarian cancer with high AFP
yolk sac tumor
134
ovarian cancer with high hCG
choriocarcinoma
135
ovarian cancer with masculinization
Sertoli-Leydig (elevated testosterone)
136
ovarian cancer that could cause pseudomyxoma peritonei
mucinous cystadenocarcinoma
137
fibroma associated with pleural effusion or ascites
Meig's syndrome
138
germ cell tumor with elevated LDH
dysgerminoma/seminoma or embryonal cell carcinoma
139
most common tumor in uterus
leiomyoma
140
most common cancer
endometrial adenocarcinoma
141
irregularly enlarged uterus (nonsymmetrical)
fibroids
142
Tx for fibroids:
OCPs, leuprolide (GnRH analogue); surgery (uterine artery embolization)
143
bleeding between periods or after menoupause:
endometrial adenocarcinoma
144
risk factors for endometrial adenocarcinoma
early menarche, late menopause, PCOS, obesity
145
most common cancer of cervix
squamous cell carcinoma
146
most common cause of cervical cancer (preventable)
HPV
147
most common mass of vagina
warts, Bartholin cysts
148
tx of Bartholin cysts
1st time: antibiotics; reoccurrence: marsupialization (open gland); after age 50 BIOPSY
149
most common cancer of vagina (upper half)
squamous cell from cervix
150
most common cancer lower vagina
children--rhabdomyoma; adults rhabdomyosarcoma (sarcoma botryoides "bunch of grapes"
151
treatment for warts
trichloroacetic acid, podophyllum drops, cryosurgery
152
Most common primary kidney cancer
children--Wilm's tumor (WAGR Wilm's, Aniridia, GU abnormalities, retarded mentation)
Adults- renal cell carcinoma
153
What hormones could renal cell carcinoma produce and their effects?
If JG cell hyperplasia: up renin, up ALDO=HTN
If peritubular interstitial hyperplasia, up EPO, polycythemia vera
154
What is Conn's syndrome
hyperplasia of glomerula of adrenals, ALDO up=HTN
155
What is Cushing syndrome
adrenal adenoma of fasciculata makes more cortisol
156
What will an adenoma in adrenal medulla lead to?
pheochromocytoma; up in metanephrines
157
Most common primary cancer of bladder
transitional cell adenocarcinoma
158
risk factors for transitional cell adenocarcinoma of bladder
aniline dyes, benzene, aflatoxin, cyclophosphamide
159
What is the rescue drug for doxirubicin causing cardiomyopathy?
dextrazoxane
160
What is the rescue drug for methotrexate causing Bone marrow depletion?
leukovorin (folinic acid)
161
What is the rescue drug for cyclophosphamide causing bladder cancer?
Mesna (a scavenger drug)
162
What is the rescue drug for cysplatin causing nephrotoxicity?
Amifostine
163
Which parasite can cause squamous cell carcinoma of bladder?
schistosoma haematobium
164
What is the difference between prostatitis, prostatic hyperplasia, and prostate adenocarcinoma on digital rectal exam?
prostatitis the prostate will feel soft and boggy; prostatic hyperplasia prostate is big with no nodules, prostate adenocarcinoma prostate is hard and nodular
165
Rx for benign prostate hyperplasia:
terazosin/doxazocin (alpha 1 antagonists relax sphincter); finasteride/dutasteride 5 alpha reductase inhibitor (shrink prostate); TURP transurethral resection of prostate
166
Most common cancer of testes in first year of life
yolk sac cancer
167
most common cancer of testes in teens to adults
seminoma
168
most common skin cancer
basal cell
169
most common malignant skin cancer
squamous cell carcinoma
170
most malignant skin cancer
melanoma
171
What determines the prognosis of melanoma?
depth of invasion
172
most common bone cancer of epiphysis
chondrosarcoma
173
most common bone cancer of metaphysis
osteosarcoma: starburst effect on cortex; "Codman's triangle"
174
most common bone cancer of diaphysis (middle) for children
Ewing's osteosarcoma t(11,22); onion skinning
175
most common tumor of breast under 25 y/o
fibroadenoma (estrogen dependent)
176
most common tumor of breast above 25 y/o
fibrocystic disease (progesterone dependent)
177
most common cancer of breast
intraductal adenocarcinoma
178
presenting sign of intraductal adenocarcinoma
dimpling of breast
179
breast cancer with nipple bleeding
intraductal papilloma
180
breast cancer with cells lined up in single file
lobular adenocarcinoma
181
breast cancer with focal areas of necrosis
comedocarcinoma
182
breast cancer with peau d'orange
inflammatory adenocarcinoma (most malignant)
183
a sarcoma that explodes out of breast then stops growing; wide excision is curative
cystosarcoma phyllodes
184
ulcerative rash around nipple associated with intraductal adenocarcinoma
Paget's Disease
185
tx for cystic breast mass
FNA
186
tx for firm breast mass
lumpectomy and biopsy
187
benign firm breast mass
removal only
188
malignant firm breast mass
after lumpectomy, perform modified radical mastectomy, nodal dissection, check for estrogen/ progesterone +, Raloxifene for estrogen +, chemo for premenopausal and radiation for postmenopausal; HER2NEU Tran2zumab (SE cardiomyopathy rescue drug Dextrazoxane--same for doxirubicin)
189
PSA marker for
prostate cancer
190
CEA marker for
colon, pancreas, biliary cancers
191
S-100 marker for
melanoma (neural crest)
192
AFP
yolk sac tumor, choriocarcinoma
193
hCG
choriocarcinoma,
194
C-myc
Burkitt's lymphoma
195
L-myc
small cell lung cancer
196
N-myc and bombesin
neuroblastoma
197
desmin
rhabdosarcoma
198
vimentin
sarcoma
199
Ca-125
serous adenocarcinoma of ovaries
200
Ca-19
pancreatic cancer
201
BCL2
follicular lymphoma
202
RET
MEN II
203
RB
retinoblastoma, osteosarcoma
204
p53
everything!
