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Flashcards in GI Neoplasia Deck (69):
1

what is interchangeable with carcinoma in situ?

intraepithelial neoplasia

2

malignancy is defined by?

invasion/metastasis

3

aneuploidy?

more than 2 chromosomes, inappropriate numbers: chromosomal instability

4

proto-oncogenes need one or two hits?

one hit

5

how many hits for TSGs?

two hit

6

P53 active between which cell phases?

G1 and S
G2 and M

7

RBactive between which cell phases?

G1 and S

8

carcinoma is cancer of?

epithelium

9

sarcoma is cancer of?

mesenchymal

10

dysplasia signs? 3

disordered
premalignant lesion
mutations

11

cancer is defined by?

invasion and breach of basement membrane to stroma

12

bone is a common site for breast and prostate possibly due to?

similar micro environment

13

example of physiological metaplasia?

cervical transformation zone during menstrual cycle

14

pathological metaplasia in oesophagus?

barrett's oesophagus due to chronic GORD

15

HPV is only on cervix?

ubiquitous: >150 serotypes

16

What are the high risk cancer HPVs?

16 and 18

17

What are the low risk cancer HPVs?

6 and 11

18

what part of HPV genes leads to cervical cancer?

E2 gene disruption during viral genome integration leads to too much E6, E7 then loss of p53 and Rb tumour suppressors

19

What does HPV E6 and E7 oncoproteins do?

inhibits tumour suppressor protein

20

cervix intraepithelial neoplasia increased risk are which 2 categories?

ClN2 and ClN3

21

diagnostic criteria for Barrett's oesophagus?

endoscopic evidence of columnar
histo: metaplasia (goblet cells)

22

what gives you an increased 10% lifetime risk of oseophageal adenocarcinoma?

Barrett's oesophagus

23

What is the most common familial colorectal cancer syndrome?

Lynch Syndrome

24

gland fusion or fusion with lamina propria is a feature of?

malignancy

25

what happens to nucleus of dysplastic cells?

loss of polarity
nuclear atypia

26

dysplastic changes to basement membrane?

separation of basal cell layer

27

fused glands in mucosa indicates what?

lamina propria invasion

28

what is a pre-invasive term for severe dysplasia?

carcinoma in situ

29

is there metaplastic precursor in breast ductal carcinoma in situ?

Nope.

30

breach in what = invasive carcinoma for cervix?

basement membrane

31

breach in what = invasive carcinoma for prostate?

basal cell layer loss

32

breach in what = invasive carcinoma for breast?

myoepithelial cell layer loss

33

breach in what = invasive carcinoma for oesophagus?

basement membrane

34

breach in what = invasive carcinoma for colon?

muscularis mucosae

35

4 ways of carcinoma spread?

direct
lymphatic
vascular
perineural

36

what are adenomatous dysplastic polyps?

precursor lesions

37

Are Tubular adenoma/villous adenoma invasive? what are their features

nope. precursor, no invasion
Tubular: sessile/pedunculated
Villous: large/sessile

38

if the polyp is >1cm and high grade dysplasia then what?

increased risk of malignancy

39

cancer risk if you have Familial adenomatous polyposis?

100%

40

cancer risk if you have lynch syndrome?

70-80%

41

Familial adenomatous polyposis recessive or dominant?

dominant

42

where are the lymphatics in the colon?

not in the lamina propria

43

how to treat adenomatous polyps?

complete excision

44

are adenomatous polyps invasive?

no invasion beyond muscularis mucosae

45

are hyperplastic polyps benign? or malignant?

benign

46

at what point do you get colorectal adenocarcinoma?

invasion beyond muscularis mucosae

47

what happens to stroma witth colorectal adenocarcinoma?

desmoplastic stromal reaction

48

3 colorectal cancer pathways

Chromosomal instability
microsatellite instability (MSI)
CpG island methylator phenotype (CIMP)

49

which TSGs are lost in carcinoma?

p53
SMAD4/SMAD2

50

which proto-oncogenes are lost in carcinoma?

K-RAS

51

what is the most common familial colorectal cancer syndrome?

Lynch Syndrome

52

Lynch Syndrome dominant or recessive? onset of cancer?

dominant
mean age 45

53

extracolonic cancers in Lynch Syndrome?

yes
endometrium
renal pelvis

54

2 things in micro satellite instability pathway?

defective DNA mismatch repair
widespread mutations in DNA micro satellites

55

where do sessile serrated adenoma/polyps usually arise?

proximal colon

56

sessile serrated adenoma/polyps easy or heard to detect?

hard to detect at colonoscopy

57

what is serrated in sessile serrated adenoma/polyps ?

elongation and serration of crypts

58

How do colorectal cancers grow in:
1. proximal colon
2. distal colon
why?

1. bulky, polypoid: due to more liquid stool
2. annular, stenosing, ulcerated: due to more solid stool

59

invasion assessment of colon cancer. 4 things

muscularis muscosae
lymph nodes
infiltration of adjacent organs
perforation into peritoneal cavity

60

Australian staging for colorectal cancer:
ACPS A
ACPS B
ACPS C
ACPS D

ACPS A: beyond muscularis mucosae
ACPS B: beyond muscularis propria
ACPS C: lymph node metastasis
ACPS D: distant metastase

61

TMN staging is?

Tumour invasion Tis, T1,2,3,4
Node metastases: N0,1,2
M etastases: Mx, M0,1

62

what organ is common site of metastases for colorectal cancer?

liver cause of portal system

63

neoadjuvant therapy is? Grade 1 is best or worse?

pre-operative chemoradiotherapy
grade 1 is complete tumour destruction

64

early onset cancer should raise suspicion of?

underlying syndrome

65

2 things that dysplasia has histologically:

nuclear atypia
disordered growth

66

complete excision of dysplasia will cure?

yes

67

Cetuximab and panitumumab block what?

EGFR signalling

68

K-RAS and B-RAF mutation predicts what?

poor response to EGFR-targeted therapy so need to screen before targeted therapy

69

Colorectal sequence:

normal, then get first hit (APC)
dysplastic
early adenoma (K-RAS)
intermediate adenoma (SMAD4)
late adenoma (p53)
carcinoma
metastasis