What are the 6 hallmarks of a cancer cell?
Self-sufficiency in growth signals
Insensititvity to anti-growth signals
Tissue invasion and metastasis
Limitless replicative potential
What are a few causes of cancer?
Genes- DNA mutation
Diet- high fat, low fiber diets
Exposure to carcinogens and mutagens
Age/alterations in immune system
What are the phases of multistep carcinogenesis? Which is rapid and which is slow? At what point do the changes stop being reversible?
Initiation- rapid, DNA damage but not enough to induce neoplastic trasformation
Promotion- reversible changes
Progression- slow and irreversible
What are 3 important aspects of obtaining a comprehensive history of a patient with a tumor?
1. Doubling time (rapid vs slow growth)
2. Extent of involvement (local vs systemic)
3. Co-morbidities (continuum of disease)
How do you definitively establish a tissue diagnosis?
From what 3 distinct cell types do most cancers come from?
What are the types of round cell tumors?
(Please Help Me Learn This, Meow?)
Under a microscope, which tumor hass spindle-shaped, stellate or oval cells arranged in individually or in non-cohensive aggregates? What are some examples of these types of tumors?
Sarcomas: OSA, Chondrosarcoma, Fibrosarcoma, HSA
Which tumor has the best diagnostic yield (i.e. exfoliates the best), which has the lowest yield?
Best: Round cell
How do carcinomas look microscopically? What type of cell tumor are these?
Round, cuboidal, columnar or olygonal cells arranged in cohesive sheets or clusters
Epithelial cell tumors
What does anisokaryosis mean?
Variation in nuclear size (characterstic of malignancy)
What does it mean that cytopatholgy has low sensitivity but high specificity?
Low sensitivity = false negatives likely
High specificity = false positives unlikely
With which neoplasm has needle tract implantation been reported?
What are the 2 clinical techniques for FNA? Which is better?
Needle off- coring: better- less blood contamination and better needle control
What is the preferred technique for cytology slide preparation? When should you use the other technique?
Use vertical pull-apart with fragile cells (e.g. LNs)
What question does staging answer? What system is it based on? What does staging require?
Is the tumor localized, spread regionally or diffusely?
WHO TNM (tumor, node, metastasis) system (0-IV)
Staging requires a series of generally non-invasive testing
What is required to grade a tissue? What does it establish/determine?
A block of tissue (e.g. biopsy, FNA)
It establishes inherent aggressiveness and allows definitive prognostication
Also inflences therapeutic recommendations
What do the stages T1-T4 indicate? What does the N stand for (in staging)? What does the M stand for?
The size and/or extent of the primary tumor
N= regional LNs
M= distant metastasis
T/F: If lymph nodes are normally sized (i.e. not enlaged), they are most likely not metastatic.
False, never assume!
How large does a nodule have to be in order for it to be visible on an x-ray?
What do you call tumor associated alternations in bodily structure or function occuring distant to the tumor?
What tumors commonly cause the PNS hypercalcemia?
Anal sac ACA
What type of tumor commonly causes the PNS hypoglycemia?
What tumor causes neurologic PNS?
What is the cutaneous PNS that occurs with renal cyadenocarcinoma?
What is the bone PNS caused by many primary lung tumors, esophageal tumors and metastatic tumors?
T/F: Conventional chemoterapy drugs target all rapidly dividing cells.
What is adjuvant chemotherapy?
Chemo given as adjunct to local therapy (i.e. after sx)
Why is neoadjuvant chemo given?
To try to shrink the tumor prior to definitive treatment (i.e. sx)
What is it called when you are using chemo as the sole treatment for measurable disease?