Exam 5: Common Cancers

Question 1

Breast Cancer

Answer 1

Etiology: Prolonged reproductive life , Over the age of 50 years, Obesity (Increased levels of estrogen in adipose tissue), Family history of breast cancer, Nulliparous or Late childbirth (after age 30 yrs), Genetic predisposition (BRCA1 and BRCA2 - defective tumor suppressor genes)

1 out of 8 women will have breast cancer

Disease Process: either “over-expression” of estrogen and progesterone receptors (ER-Positive) or human epidermal growth factor receptor-2 (HER2-Positive)

Non-tender to palpation, Firm, Irregular borders, Adherence to the skin or chest wall, Upper, outer quadrant of breast, Nipple discharge/retraction, Swelling in one breast, Peau d’orange

Question 2

Luminal A:

Answer 2

Slow-growing breast cancers, 90% cure rate, often found on screening mammograms.

Question 3

Luminal B:

Answer 3

Aggressive cancers that invade blood vessels and lymph nodes. Often difficult to surgically remove the tumor from surrounding tissue with clear margins.

Question 4

Basal:

Answer 4

Very aggressive, rapidly growing cancer that lacks estrogen, progesterone and HER2 receptors.

Question 5

HER2 Positive:

Answer 5

Overproduction of HER2 -> Signals breast cancer to grow and spread.

Question 6

Most common sites of breast cancer mets:

Answer 6

bones, lung, liver, brain

Question 7

Colorectal cancer

Answer 7

Etiology: Age, Genetics, Obesity, Physical inactivity, Tobacco use, Insulin resistance, IBS, Diet (Low fiber, high amount of animal fat, low in vitamin A, C and E)

Most commonly begins as a “polyp” - > “Adenomatous Polyps” - Polyps with cancerous potential

Change in BM, rectal bleeding, rectal/abdominal mass

Colonoscopy with a biopsy, FOBT (Fecal Occult Blood Test), Sigmoidoscopy

Overall survival is increasing due to increased detection early, but still not great

Question 8

Most common sites of colorectal cancer mets:

Answer 8

liver

Question 9

Non-Small Cell Lung Cancer (NSCLC) -

Answer 9

NSCLC is more common (80%) lung CA, slow growing and spreading

Question 10

Adenocarcinoma -

Answer 10

In the alveoli. Most common (more in women).Periphery -> bronchoalveolar. Usually large at time of diagnosis -> mets early. May not be associated with smoking or exposure*

Question 11

Squamous cell carcinoma -

Answer 11

Found in the center of the lung next to an air tube (bronchus), detected in sputum. Grows slowly -> spreads to major bronchi. Paraneoplastic syndrome: hypercalcemia

Question 12

Large cell carcinoma -

Answer 12

Can occur in any part of the lung. Highly anaplastic (poorly differentiated). Difficult to categorize as squamous or adenocarcinoma. Tends to grow and spread faster. Poor prognosis spread to distant sites early.

Question 13

Small Cell Lung Cancer (SCLC) -

Answer 13

Almost always associated with cigarette smoke, treated with chemotherapy. Small oval cells that grow in clusters, rapid growth and most malignant -> mets early. Poorest prognosis (only 10% over 2yrs). Arises out of bronchus. Paraneoplastic complications common. Small cell carcinoma & Combined small cell carcinoma

Question 14

Most frequent sites of lung cancer metastasis:

Answer 14

liver, adrenal glands, bone, brain

Question 15

Ovarian cancer

Answer 15

Etiology: Older age (median age is 63yrs), Early Menarche <12yrs, Late menopause >52 yrs, Genetics -> BRCA, 1st degree relative with CA, Lynch syndrome, Nulligravity (not pregnant), Endometriosis, Asbestos

CM: Subacute - Adnexal mass, Pelvic or abdominal pain, Bloating, GI symptoms, N/V, constipation, Urinary frequency/urgency. Acute - Pleural effusion (SOB), Bowel obstruction (N/V), Venous thrombosis. Rarely have paraneoplastic syndromes.

Diagnosis: CT pelvic scan, Surgical evaluation: to determine malignancy removal of ovary or biopsy, Cancer Antigen-125 (CA-125), Assess for metastasis.

Prognosis/general statistics: 90% survival rate with early diagnosis

Question 16

Most common sites of ovarian cancer mets:

Answer 16

adjacent organs and lungs

Question 17

Pancreatic cancer

Answer 17

Etiology: age, alcohol, obesity, diabetes mellitus, male gender, and genetics, smoking

Disease Process: Most (85%) are adenocarcinomas of the pancreatic ducts in head, body or tail -> Can spread quickly anywhere

Clinical Manifestations/Signs & Symptoms:
Most pancreatic cancer discovered due to symptoms at a metastasis site rather than disruption of pancreatic function. Pain, jaundice, and weight loss. DVT less common.

Diagnosis: Ultrasonography / CT

Prognosis/general statistics: Lowest 5 year survival rate (10%) of all major cancers. Very poor.

Question 18

Most frequent sites of pancreatic cancer metastasis:

Answer 18

liver, peritoneum, and lungs.

Question 19

Prostate cancer

Answer 19

Etiology: Age, Genetics/family history, Diet high in fat, red meat, fried food and dairy, Smoking, Alcohol intake *mixed results, High intake ETOH increased risk

Epidemiology: African ancestry higher risk

CM: Asymptomatic in early stages, Enlarged prostate found on digital rectal exam (DRE), Decreased force of urinary stream, Incomplete emptying of the bladder, Palpates as hard and unmovable, large inguinal lymph nodes, pain in back - vertebrae mets

Diagnosis: PSA*, Digital rectal exam, Confirmed through biopsy

Prognosis/general statistics: 5-year survival is about 98%

Question 20

Common sites of prostate mets

Answer 20

vertebrae

Question 21

Bladder cancer

Answer 21

Etiology: Cause is not fully understood but thought to be carcinogens that are excreted in the urine and stored in the bladder. Products/chemicals used in the manufacture of rubber, textiles, paint, chemicals, and petroleum. Smoking & age.

Disease Process: Urothelial carcinoma of cells that line bladder
Can be low-grade noninvasive tumors or high-grade tumors that invade bladder wall and metastasize

CM: Increased frequency, Urgency, Dysuria, Hematuria**

Diagnosis:Ultrasonography, CT, MRI

Prognosis/general statistics: 5 year survival rate near 80%; Good if low grade type or caught before metastasis