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Flashcards in GI Cancer Deck (61)
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where do sessile serrated adenomas typically arise

proximal colon

1

what is the pre-invasive term for severe dysplasia in the breast

ductal carcinoma in situ lobular carcinoma in situ

1

What staging does M1 represent in the Dukes and AJCC staging

Stage 4/Dukes D

2

what layer breach has to happen for metastasis of the prostate

basal cell layer

3

what is the pre-invasive term for severe dysplasia in the glans penis

Erythroplasia of Queyrat

4

high risk types of HPV

16 and 18

4

what is the pre-invasive term for severe dysplasia in the skin

Bowen's disease

4

what layer breach has to happen for metastasis of the colon

muscularis mucosae

5

what are the differences in macroscopic growth patterns between colorectal cancer in the proximal and distal colon

proximal - bulky, polypoid, exophytic distal - annular, stenosing, ulcerated

6

what are the serology hallmarks of HPV infection

koliocytosis p16 upregulation

7

main two causes of familial colorectal cancer

- lynch syndrome - familial adenomatous polyposis

8

what is interchangeable with carcinoma in situ

intraepithelial neoplasia dysplasia

10

What staging does T1 represent in the Dukes and AJCC staging

T1

11

what is the pre-invasive term for severe dysplasia in the bladder

carcinoma in situ

13

what is the metaplastic result of chronic atrophic gastritis

intestinal metaplasia

14

what are the main histological features of sessile serrated adenoma

- complex branching - boot-leg angulation and dilatation at base of crypts - elongated, vesicular nuclei, prominent nucleoli - increased atypia

15

what is attenuated variation of FAP

when you have

15

Explain the stages of Dukes' classification system of colorectal cancer

A - invades into, but not through bowel wall B - invades through bowel wall, but not involving lymph nodes C - lymph node metastases D - distant metastasis

16

how does APC mutation lead to FAP

decreased cell adhesion and increased cellular proliferation

17

what layer breach has to happen for metastasis of the oesophagus

basement membrane

17

which two oncogenes are the most common oncogene mutations in colorectal cancer

K-RAS, B-RAF

18

what are the precursor lesions for colorectal carcinoma

adenomatous polyps

19

what does lynch syndrome cause other than higher chance of getting colorectal cancer

- extracolonic cancers

20

morphology of the types of adenomatous polyps

- tubular adenoma - sessile or pedunculated - villous adenoma - often large and sessile - tubulovillous adenoma - mixed features

20

what kind of genetic pathway does Lynch syndrome fall in to cause colorectal cancer

microsatellite instability

21

which two TSG are most often associated with colorectal cancer

SMAD4, SMAD2 and p53

21

What are the 2 staging systems of colorectal cancer

Dukes' classification Australian ClinicoPathological Staging system

23

what layer breach has to happen for metastasis of the breast

myoepithelial cell layer loss

24

what are the 3 types of genetic pathways that can lead to colorectal cancer

- chromosomal instability - microsatellite instability - CpG island methylator phenotype

25

what is the gene mutation that causes Familial adenomatous polyposis

APC mutation

27

what gene does HPV integrate into and effect

E2 gene

28

what is the metaplastic result of chronic reflux oesophagitis

Barrets oesophagus

29

difference between mild/low grade dysplasia and moderate dysplasia

moderate - abnormal cells go to full thickness

30

what layer breach has to happen for metastasis of the cervix

basement membrane

31

what types of cells are in the cervical transformation zone

squamous epithelium and glandular epithelium

32

what are the dysplastic features of adenomatous polyps

- crowded cells --> push up to become pseudostratified - enlarged, hyperchromatic, pseudostratified nuclei - abnormal complexity to glandular architecture - goblet cell depletion - increased mitotic count

34

what is aneuploidy

distorted number of chromosomes with lots of switching between chromosomes

35

Which TSG is implicated in breast cancer

Her 2

36

which mutation is commonly associated with sessile serrated adenoma

BRAF mutation

37

What staging does T3 represent in the Dukes and AJCC staging

Stage 2/Dukes B

38

what are the main mutations of DNA mismatch repair genes in colorectal cancer

- MSH2 or MLH1 - sporadic MLH1 hypermutation

40

what defines epithelial cancer

invasion of cells across the BM

41

what is the most common familial colorectal cancer syndrome

lynch syndrome

42

criteria for identifying dysplasia of the oesophagus

- surface maturation of glandular mucosa - architecture of glands --> crowding, change in shape and complexity. Glad fusion (feature of malignancy) - cytology of proliferating cells --> nuclear atypia, loss of polarity - response to inflammation and erosions/ulcers

42

how many polyps do you have to have to be classed as having familial adenomatous polyposis

100

43

where does dysplasia normally start in the epithelia

at the lower levels (near the stem cells)

44

Barretts oesophagus is a key precursor for what

oesophageal adenocarcinoma

46

diagnostic criteria for Barretts oesophagus

- endoscopic evidence of columnar lining in oesophagus above gastroesophageal junction AND - histological evidence of intestinal metaplasia (goblet cell) in biopsies from the columnar epithelium

47

what does the overexpression of genes E6 and E7 do (from HPV)

E6 binds p53 --> apoptotic resistant, loss of G1/S and G2/M phase cell cycle check points, genomic instability E7 binds Rb --> disrupts G1/S phase cell cycle checkpoint, compensatory upregulation of P16

48

what could be the reasons for early onset colorectal cancer

- familial syndromes - chronic inflammatory bowel disease

49

what is the pre-invasive term for severe dysplasia in the endocervix

adenocarcinoma in situ

51

predictors of increased malignant risk of adenomatous polyps

- polyp size (>1cm) - villous morphology - high grade dysplasia (severe crowding, loss of nuclear polarity, pleomorphism, gland fusion)

52

how is lynch syndrome inherited

autosomal dominant - inherited mutation in a DNA mismatch repair gene

53

What staging does N1 represent in the Dukes and AJCC staging

Stage 3/Dukes C

54

what does disruption of the E2 gene do on the viral plasmid

- overexpression of E6 and E7 oncoproteins - loss of p53 and Rb tumour suppressor function - cell cycle can proceed despite DNA damage - loss of p53 apoptosis function

56

what is the main genetic pathway that leads to sporadic colorectal cancer

chromosomal instability

57

Colorectal cancer high risk features

- high grade - T3 with localised perforation or T4 - close, indeterminate or positive margins - lymphovascular invasion -

58

what is the difference between diagnosis of barrett's oesophagus from American college of gastroenterology and from the UK/Japan

presence of goblet cells no required for diagnosis for Japan/UK

59

where does HPV like to live

tropism for basal keratinocytes such as the cells of the transformation zone

60

what histology do the cells within adenomatous polyps show

- abnormal crypt architecture - dysplasia - no invasion beyond muscularis mucosae

61

explain the stages of the Australian clinciopathological staging system

A - invades beyond muscularis mucosa B - invades beyond muscularis propria C - lymph node metastases D - Distant metastasis