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USLME Step 1 > Neoplasms - First Aid 2014 > Flashcards

Neoplasms - First Aid 2014 Flashcards

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1
Q

What is P-glycoprotein?

A

Also known as Multidrug resistance protein 1 (MDR1). Expressed by some other cancer cells (e.g. colon, liver) to pump out toxins, including chemotherapeutic agents (one mechanism of decreased responsiveness or resistance to chemotherapy over time).

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2
Q

What is desmoplasia?

A

Fibrous tissue formation in response to neoplasm (e.g. linitis plastica in diffuse stomach cancer).

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3
Q

How do carcinomas and sarcomas spread? and what are notable exceptions?

A

Carcinomas generally spread by lymphatics.
Sarcomas generally spread by blood.

Exceptions with carcinomas include: renal cell carcinoma (invades renal vein), hepatocellular carcinoma (hepatic vein), follicular carcinoma of the thyroid, and choriocarcinoma. All of these are by blood.

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4
Q

What’s the difference between a hemangioma and an angiosarcoma?

A

Both neoplasms of blood vessels.

Hemangioma is benign while angiosarcoma is malignant.

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5
Q

What causes decreased apoptosis in malignant cells?

A

upregulation of telomerase prevents chromosome shortening and cell death so less apoptosis.

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6
Q

What is cachexia mediated by?

A

TNF-alpha (cachectin), IFN-gamma, IL-6.

remember: this is weight loss, muscle atrophy, and fatigue in chronic disease (AIDS, cancer, heart failure, TB etc). `

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7
Q

What disease is associated with visceral malignancy (esp. stomach)?

A

Aconthosis nigricans (hyperpigmentation and epidermal thickening)

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8
Q

What disease is associated with Squamous cell carcinoma of the skin?

A

Actinic keratosis

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9
Q

What disease is associated with aggressive malignant lymphomas (non-Hodgkin) and Kaposi sarcoma?

A

AIDS

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10
Q

What disease is associated with Lymphoma?

A

Autoimmune diseases (e.g. Hashimoto thyroiditis, SLE).

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11
Q

What disease is associated with espohageal adenocarcinoma?

A

Barrett esophagus (chronic GI reflux)

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12
Q

What disease is associated with gastric adenocarcinoma?

A

Chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants.

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13
Q

What disease is associated with hepatocellular carcinoma?

A

cirrhosis

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14
Q

What disease is associated with small cell lung cancer?

A

Cushing syndrome, SIADH, Lambert Eaton myasthenic syndrome

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15
Q

What disease is associated with lung cancer?

A

dermatomyositis

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16
Q

What disease is associated with ALL, AML?

A

Down syndrome (ALL: age > 5 years, AML age < 5 years).

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17
Q

What disease is associated with malignant melanoma?

A

dysplastic nevus

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18
Q

What disease is associated with squamous cell lung cancer?

A

hypercalcemia (from PTHrp)

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19
Q

What disease is associated with malignant lymphomas?

A

immunodeficiency states

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20
Q

What disease is associated with thymoma?

A

myasthenia gravis, pure RBC aplasia

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21
Q

What disease is associated with secondary osteosarcoma, fibrosarcoma?

A

Paget disease of the bone

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22
Q

What disease is associated with squamous cell carcinoma of esophagus?

A

Plummer-venson syndrome (decreased iron)

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23
Q

What disease is associated with renal cell carcinoma, hepatocellular carcinoma?

A

polycthemia. Both malignancies can produce EPO.

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24
Q

What disease is associated with leukemia, sarcoma, papillary thyroid cancer, and breast cancer?

A

Radiation exposure.

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25
What disease is associated with giant cell astrocytomas, renal angiomyolipoma, and cardiac rhabdomyoma?
tuberous sclerosis (facial angiofibroma, seizures, intellectual disability).
26
What disease is associated with colonic adenocarcinoma?
ulcerative colitis
27
What disease is associated with melanoma, basal cell carcinoma, and especially squamos cell carcinoma of the skin?
xeroderma pigmentosum, albinism
28
What oncogene is dysregulated in CML, ALL?
BCR-ABL, tyrosine kinase
29
What oncogene is dysregulated in follicular and undifferentiated lymphomas?
Bcl-2, anti-apoptotic molecule (inhibits apoptosis)
30
What onocgene is dysregulated in melanoma?
BRAF, serine/threonine kinase.
31
What onocgene is dysregulated in gastrointestinal stromal tumor (GIST)?
c-kit, cytokine receptor (for stem cell factor)
32
What oncogene is dysregulated in burkitt lymphoma?
c-myc, transcription factor
33
What oncogene is dysregulated in breast, ovarian, and gastric carcinomas?
HER2/neu (c-erbB2), tyrosine kinase
34
What oncogene is dysregulated in lung tumors?
L-myc, transcription factor. L for lung
35
What oncogene is dysregulated in neuroblastoma?
N-myc, transcription factor. N for neuro
36
What oncogene is dysregulated in colon cancer, lung cancer, pancreatic cancer?
Ras, GTPase.
37
What oncogene is dysregulated in MEN2A,2B?
ret, tyrosine kinase
38
What tumor suppressor is dysregulated in colorectal cancer (associated with FAP)?
APC
39
What tumor suppressors are dysregulated in breast and ovarian cancer?
BRCA1, BRCA2 | DNA repair proteins
40
What tumor suppressor is dysregulated in pancreatic cancer?
CPD4/SMAD4. | DPC - deleted in pancreatic cancer.
41
What tumor suppressor is dysregulated in colon cancer?
DCC - deleted in colon cancer
42
What tumor suppressor is dysregulated in MEN type 1?
MEN1
43
What tumor suppressor is dysregulated in neurofibromatosis type 1?
NF1 - RAS GTPase activating protein (neurofibromin)
44
What tumor suppressor is dysregulated in neurofibromatosis type 2?
NF2 - merlin (schwannomin) protein
45
What tumor suppressor is dysregulated in melanoma?
p16, cyclin-dependent kinase inhibitor 2A.
46
What tumor suppressor is dysregulated in most human cancer/Li-Fraumeni syndrome?
p53, transcription factor for p21, blocks G1->S phase.
47
What tumor suppressor is dysregulated in breast cancer, prostate cancer, endometrial cancer?
PTEN
48
What tumor suppressor is dysregulated in retinoblastoma, osteosarcoma?
Rb, inhibits E2F; blocks G1 -> S phase
49
What tumor suppressor is dysregulated in Tuberous sclerosis?
TSC1 (hamartin protein), TSC2 (tuberin protein).
50
What tumor suppressor is dysregulated in von Hippel-Lindau disease?
VHL - inhibits hypoxia inducible factor 1a
51
What tumor suppressor is dysregulated in Wilms Tumor (nephroblastoma)?
WT1, WT2.
52
What is the tumor marker for mets to bone, liver, Paget disease of the bone, seminoma?
``` alkaline phosphatase (ALP) for seminoma, we're talkign about placental ALP ```
53
What is the tumor marker for hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, testicular cancer, mixed germ cell tumor?
alpha-fetoprotein. Normally made by fetus. In the case of mixed germ cell tumor, it is co-secreted with B-hCG.
54
What is the tumor marker for hyaditiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer?
B-hCG. | Commonly associated with pregnancy.
55
What is the tumor marker for breast cancer?
CA-15-3/CA-27-29
56
What is the tumor marker for pancreatic adenocarcinoma?
CA-19-9
57
What is the tumor marker for ovarian cancer?
CA-125
58
What is the tumor marker for medullary thyroid carcinoma?
calcitonin
59
What is the tumor marker for colorectal cancer and pancreatic cancers?
CEA, carcinoembryonic antigen. Very nonspecific but produced by 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.
60
What is the tumor marker for prostate adenocarcinoma?
PSA, prostate specific antigen. Used to follow prostate cancer. Can also be elevated in BPH and prostatitis. Questionable risk/benefit for screening.
61
What is the tumor marker for melanomas, neural tumors, schwannomas, Langerhans cell histiocytosis?
S-100. Neural crest origins.
62
What is the tumor marker for hairy cell leukemia?
TRAP, tartrate-resistant acid phosphatase | TRAP the hairy animal. Largely replaced by flow cyt.
63
What is the microbe associated with burkitt lymphoma, hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma (in immunocompromised?
EBV
64
What is the microbe associated with hepatocellular carcinoma?
HBV, HCV
65
What is the microbe associated with Kaposi Sarcoma, body cavity fluid B-cell lymphoma?
HHV-8
66
What is the microbe associated with cervical and penile/anal carcinoma, head/neck or throat cancer?
HPV. | 16/18 with the penile/anal carcinoma form
67
What is the microbe associated with Gastric adenocarcinoma and MALT lymphoma?
H. pylori
68
What is the microbe associated with Adult T-cell leukemia/lymphoma?
HTLV-1
69
What is the microbe associated with cholangiocarcinoma?
liver fluke (Clonorchis sinensis)
70
What is the microbe associated with bladder cancer squamos?
schistosoma haematobium
71
What is the cancer associated with aflatoxins (aspergillus)?
Liver and hepatocellular carcinoma.
72
What is the cancer associated with alkylating agents?
Blood and leukemia/lymphoma
73
What is the cancer associated with aromatic amines (e.g. benzidine, 2-naphthylamine)?
Bladder and transitional cell carcinoma.
74
What is the cancer associated with arsenic?
Liver - Angiosarcoma lung - lung cancer skin - squamous cell carcinoma.
75
What is the cancer associated with asbestos?
Lung and bronchogenic carcinoma > mesothelioma
76
What is the cancer associated with carbon tetrachloride?
Liver and centrilobular necrosis, fatty change
77
What is the cancer associated with cigarette smoke?
Bladder - transitional cell carcinoma Esophagus - squamous cell carcinoma/adenocarcinoma Kidney - renal cell carcinoma Larynx - squamous cell carcinoma Lung - Squamous cell and small cell carcioma Pancreas - pancreatic adenocarcinoma.
78
What is the cancer associated with ethanol?
liver and hepatocellular carcinoma
79
What is the cancer associated with ionizing radiation?
thyroid and papillary thyroid carcinoma
80
What is the cancer associated with nitrosamines (smoked food)?
stomach and gastric cancer
81
What is the cancer associated with radon?
lung and lung cancer (2nd leading cause after cigarette smoke)
82
What is the cancer associated with vinyl chloride?
liver and angiosarcoma.
83
What is the paraneoplastic syndrome associated with hodgkin lymphoma, some non-Hodgkin lymphomas?
1,25-(OH)2D3 (calcitriol) | Hypercalcemia
84
What is the paraneoplastic syndrome associatd with small cell lung carcinoma?
ACTH, ADH Cushing syndrome, SIADH Also Lambert Eat myasthenic syndrome (muscle weakness) from antibodies against presynaptic Ca+2 channels at NMJ.
85
What is the paraneoplastic syndrome associated with small cell lung carcinoma and intracranial neoplasms?
ADH | SIADH
86
What is the paraneoplastic syndrome associated with renal cell carcinomas, thymoma, hemangioblastoma, hepatocellular carcinoma, leiomyoma, pheochromocytoma?
EPO, polycythemia.
87
What is the paraneoplastic syndrome associated with squamous cell lung carcinoma, renal cell carcinoma, breast cancer?
PTHrP, hypercalcemia.
88
What is associated with psammoma bodies?
laminated, concentric, calcific spherules. PSaMMoma bodies seen in: Papillary carcinoma of thyroid Serous papillary cystadenocarcinoma of ovary Meningioma Malignant mesothelioma
89
What's the cancer incidence for males and females?
Male: prostate (32%), lung (16%), colon/rectum (12%) Female: Breast (32%), lung (13%), colon/rectum (13%) Lung cancer incidence dropping in men but not women
90
What's the cancer mortality for men and females?
Male: Lung (33%), prostate (13%) Female: Lung (23%), Breast (18%). Cancer is second leading cause of death, heart disease is 1st.
91
What commonly metastasizes to brain and where?
Lung > breast > genitourinary > osteosarcoma > melanoma > GI. 50% of brain tumors are from mets. Commonly seen at multiple well circumscribed tumors at grey/white junction.
92
What commonly metastasizes to liver?
Colon >>> stomach > pancreas Liver and lung are the most common sites of metastasis after the regional lymph nodes.
93
What commonly metastasizes to bone?
Prostate, breast > lung > thyroid Bone mets>> primary bone tumors (e.g. multiple myeloma, lytic). WHole body bone scan shows tumor predilection for axial skeleton. Prostate = blastic. Breast = lytic and blastic.
94
What is a strawberry hemangioma?
Benign capillary hemangioma of infancy. Appears in first few weeks of life (1/200 births); grows rapidly and regresses spontaneously at 5-8 years old. Strawberries are sweet and cherries are sour
95
What is a cherry hemangioma?
Benign capillary hemangioma of the elderly. Does not regress. Frequency increases with age. Strawberries are sweet and cherries are sour
96
What is a pyogenic granuloma?
Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.
97
What is a cystic hygroma?
cavernous lymphangioma of the neck. Associated with Turner syndrome?
98
What is a glomus tumor?
Benign, painful, red-blue tumor under fingernails. Arises from modified smooth muscle cells of glomus body (in dermis layer of skin involved in temperature regulation...AV shunt)
99
What is bacillary angiomatosis?
Benign capillary skin papules found in AIDS patients. Caused by Bartonella henselae infections. Frequently mistaken for Kaposi's sarcoma.
100
What is angiosarcoma?
Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. Usually in elderly, on sun-exposed areas. Associated with radiation therapy and arsenic exposure. Very aggressive and difficult to resect due to delay in diagnosis.
101
What is lymphangiosarcoma?
Lymphatic malignancy associated with persistent lymphedema (e.g. post radical mastectomy).
102
What is Kaposi sarcoma?
Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and respiratory tract. Associated with HHV-8 and HIV. Frequently mistaken for bacillary angiomatosis. notes: purple patches, plaques, nodules on skin/visceral organs.

USLME Step 1 (7 decks)

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