laboratory diagnosis

Question 1

example of a mass screening

Answer 1

Pap smears for cervical cancer

Question 2

example of a screening for asymptomatic patietns

Answer 2

PSA in men for prostate cancer

Question 3

example of a screening for symptomatic patients

Answer 3

CA-125 for ovarian cancer

Question 4

gold standars for tumor tissue biopsy

Answer 4

histology

Question 5

biomarkers are used for

Answer 5

prognostic and predictive use

Question 6

three identifiers preferred

Answer 6

yep

Question 7

normal overlying mucosa makes primary adenocarcinoma very unlikely

Answer 7

yep

Question 8

Tumor type?

Cytokeratins (CK), Epithelial Membrane Antigen (EMA)

Answer 8

carcinoma

Question 9

tumor type?

ER, PR, GCDFP-15, GATA-3

Answer 9

breast

Question 10

tumor type?

PSA, PSAP

Answer 10

prostate

Question 11

tumor type?

TTF-1, Napsin A, CK7

Answer 11

lung adenocarcinoma

Question 12

tumor type?

CDX2, CK20, CEA

Answer 12

colon

Question 13

tumor type?

CD10, vimentin, RCC, PAX2, PAX8

Answer 13

kidney (renal cell carcinoma)

Question 14

tumor type?

Leukocyte common antigen (CD45)

Answer 14

lymphoma

Question 15

tumor type?

S-100, Melan-A, HMB-45, SOX-10

Answer 15

melanoma

Question 16

tumor type?

CK, chromogranin, synaptophysin, CD56

Answer 16

neuroendocrine tumor

Question 17

tumor type?

CK, ß-HCG, AFP, PLAP

Answer 17

Germ cell tumor

Question 18

tumor type?

Variable and tumor-type specific
vimentin, desmin, smooth muscle actin, CD31, CD34

Answer 18

soft-tissue/sarcoma

Question 19

Clinicopathologic correlation is essential in addition to immunohistochemistry

Answer 19

yep

Question 20

small cell lung carcinoma:

1. type of tumor
2. tumor analysis needed?
3. surgery?
4. chemo?

Answer 20

1. neuroendocrine carcinoma
2. no further tumor analysis needed
3. surgery a no go
4. platinum-based chemo

Question 21

tumor treatment depends on (4)

Answer 21

1. tumor subtype
2. tumor stage
3. molecular testing for NSCLC
4. multidisciplinary tumor conference

Question 22

CK5 - , p56 - , TTF +, CK7 +, napsin A+

Answer 22

adenocarcinoma

Question 23

CK5 + , p56 + , TTF -, CK7 -, napsin A-

Answer 23

squamous cell carcinoma

Question 24

predictive molecular studies (4)

Answer 24

1. DNA sequence analysis
2. FiSH
3. RNA-based gene expression studies
4. immune checkpoint inhibition therapy

Question 25

Examples in lung cancer 1. DNA sequence analysis 2. FiSH 3. RNA-based gene expression studies 4. immune checkpoint inhibition therapy

Answer 25

1. DNA sequence analysis- EGFR mutation to predict response to tyrosine kinase inhibitors 2. FiSH- EML4-ALK fusion for ALK inhibitor therapy 3. RNA-based gene expression studies- potential drug targets 4. immune checkpoint inhibition therapy- nivolumab: PD-L1 expression by IHC

Question 26

______ is essential for further testing

Answer 26

tissue conservation

Question 27

Tumors with specific therapies; represent _____ of CUP

Answer 27

10 -15%

Question 28

initial IHC goal is to

Answer 28

broadly categorize tumor

Question 29

Ck 7 -/CK 20+

Answer 29

colorectal and merkel cell carcinoma

Question 30

Ck 7 +/CK 20+

Answer 30

urothelial, ovarian, and pancreatic cancer and cholangiocarcinoma

Question 31

Ck 7 -/CK 20-

Answer 31

hepatocellular, renal cell, prostate, squamous cell

Question 32

Ck 7 +/CK 20-

Answer 32

lung, breatm thryoid, endometrial, cervical and pancreatic carcinoma and cholangiocarcinoma

Question 33

A characteristic that is objectively measured as an indicator of normal biological processes, pathogenic processes, or a pharmacological response to a therapeutic intervention.

Answer 33

biomarker

Question 34

A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.

Answer 34

biomarker

Question 35

cancer biomarker prognostic

Answer 35

assess survival probabilities- tumor size

Question 36

cancer biomarker : | predictive

Answer 36

effective drug therapy-- ER, HER2 and KRAS

Question 37

cancer biomarker : | therapeutic monitor

Answer 37

detect tumor recurrence-- CEA

Question 38

cancer biomarker: risk stratification

Answer 38

chance of getting cancer- BRCA1

Question 39

pT3

Answer 39

tumor extends into subserosal fat

Question 40

Lymph nodes positive for metastatic tumor (histology)

Answer 40

Higher tumor stage is prognostic of poorer survival

Question 41

Presence of K-ras mutation in tumor (DNA analysis)

Answer 41

Predicts lack of therapeutic response to a specific drug

Question 42

Monitor postoperative serum CEA levels (tumor marker)

Answer 42

Increasing values signal tumor recurrence

Question 43

Immunohistochemistry: 1. Loss of expression in tumor 2. May prompt DNA analysis Microsatellite DNA Analysis 1. Additional peaks in tumor 2. Confirms microsatellite instability Conclusion?

Answer 43

1. Consider genetics consultation | 2. Possible Lynch syndrome (HNPCC)

Question 44

if the tumor has this mutation it will not respond to cetuximab

Answer 44

Kras

Question 45

A substance produced by a tumor or by a host in response to the tumor’s presence.

Answer 45

tumor markers

Question 46

clinical uses of serum tumor markers: (4)

Answer 46

1. Screening select populations (sensitivity and specificity are variable) 2. An aid in diagnosis in correlation with clinical/imaging/pathology 3. Primary use: Monitor response to therapy or recurrence 4. Not used for primary diagnosis

Question 47

- Absence ctDNA after surgery associated with better prognosis, less chance of relapse - Prognosis aids in selecting treatment and need for adjuvant therapy - Patients at high risk may need targeted treatment --Low risk patients can be spared unnecessary chemotherapy

Answer 47

prognosis determination

Question 48

- ctDNA analyzed by blood test (liquid biopsy) - Can be repeated for consistent monitoring of response to treatment - Elevated ctDNA or increased number of mutations indicate treatment failure/relapse earlier than clinical relapse

Answer 48

monitoring treatment efficacy/relapse

Question 49

- Sequencing ctDNA informs choice of therapy to target specific mutations - Monitors intratumoral heterogeneity to refine targeted treatment

Answer 49

selection of treatment

Question 50

- Increased ctDNA correlates with advanced tumor stage/tumor burden - Can be repeated more often than imaging or traditional biopsies

Answer 50

tumor size/disease burden

Question 51

- Poor sensitivity for early stage tumors - Insufficient ctDNA to allow for an accurate test result - ctDNA for early diagnosis and early intervention and higher cure rates

Answer 51

defection in asymptomatic individuals (screening)