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From Flashcardlet > Patho 4 > Flashcards

Patho 4 Flashcards

1
Q

When is pancreatic cancer usually detected?

A

Usually found in late stages

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2
Q

What is the most common form of cancers?

A

Adenocarcinoma

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3
Q

Where is adenocarcinoma of the pancreas?

A

Pancreatic head

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4
Q

What are the red flags of pancreatic cancer?

A
  • Painless jaundice
  • Back pain
  • Unintentional weight loss
  • DVT, PE (migratory phlebitis)
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5
Q

What are some common metastases of pancreatic cancer?

A

Liver, lung, peritoneum

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6
Q

Why does back pain present with pancreatic cancer?

A

Pancreas is retroperitoneal

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7
Q

What are the risk factors for pancreatic cancer?

A

-Smoking
-Family history
-Diabetes
-Chronic pancreatitis
-Alcohol abuse (relates to above)
-Obesity
-Age greater than 60
Male dominant

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8
Q

Why does pancreatic cancer present with jaundice?

A

Back up of bile in the biliary tree

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9
Q

What other symptom presents with pancreatic cancer due to the blockage of the biliary tree?

A

Tea colored urine

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10
Q

What does tea colored urine result from?

A

Increased bilirubin levels, due to back up of biliary tree

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11
Q

What is the common treatment of pancreatic cancer?

A

Chemotherapy

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12
Q

What does treatment of pancreatic cancer focus on?

A

Quality versus quantity of life - chemotherapy is usually palliative to shrink mass and make end of life more comfortable

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13
Q

How can pancreatic cancer be described in terms of severity?

A

Very aggressive and invasive

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14
Q

Where do 95% of pancreatic cancers arise from?

A

95% are solid, malignant tumors arising from the ductal network of the exocrine pancreas

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15
Q

What is the difference between exocrine/endocrine pancreas?

A

Exocrine pancreas is ductal
Endocrine is islets of Langerhans of hormonal pancreas
- Most pancreatic cancer occurs in exocrine pancreas

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16
Q

Which cancer is one of the most lethal cancers?

A

Pancreatic because it is so aggressive and invasive, and usually found in late stages

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17
Q

How does pancreatic cancer begin?

A

Dysplasia of the ductal epithelium

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18
Q

Why is pancreatic cancer usually not caught until late stages?

A

It is asymptomatic mostly, patients start to show signs and symptoms when it is already too late

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19
Q

What is migratory thrombophlebitis?

A

Formation of intravenous thrombi at various points without apparent cause

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20
Q

What tumor marker helps to confirm diagnosis of pancreatic cancer?

A

CA 19

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21
Q

What is the most common neoplasm of the lung?

A

Metastasis from a cancer somewhere else in the body

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22
Q

What is the most common tumor of the lung?

A

Bronchogenic carcinoma - arise from epithelium lining the bronchi

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23
Q

What is the most common type of cancer?

A

Lung cancer - bronchogenic carcinoma

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24
Q

What is the number one cause of death from cancer?

A

Lung cancer - bronchogenic carcinoma

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25
Q

What is the cause of 85-90% of all lung cancers?

A

Smoking!

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26
Q

What are some causes of lung cancer?

A
  • Smoking
  • Second hand smoke
  • Asbestos - inhalants
  • Industrial exposures
  • Genetic predispositions
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27
Q

What are the two types of lung cancer?

A

Small cell and non small cell carcinoma

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28
Q

What is small cell carcinoma?

A

Most lethal and resistant to therapy, derived from neuroendocrine cells for he bronchial mucosa

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29
Q

What are non small cell carcinomas?

A

Other types of cancer that look nothing like small cell carcinoma microscopically

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30
Q

What type of carcinoma only occurs in smokers?

A

Small cell carcinoma

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31
Q

What are the types of non small cell carcinoma?

A
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell carcinoma
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32
Q

What is the most common type of lung cancer in nonsmokers?

A

Non small cell adenocarcinoma

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33
Q

What are the signs and symptoms of lung cancer?

A

-SOB, wheezing, dyspnea
-Vague chest pain
-Unintentional weight loss
-Coughing
Fatigue
-Hyponutremia
-Hemotysis
-Effusion

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34
Q

How are 25% of lung cancers detected?

A

Accidentally on a chest X-ray

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35
Q

What are the common metastases of lung cancer?

A

Brain, liver, bone

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36
Q

What are the treatments of lung cancer?

A

Surgery, radiation, chemotherapy

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37
Q

What lung cancer patients would be eligible for surgery?

A

Nonsmall cell carcinoma, stage I or II, contained

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38
Q

Why would we use surgery in small cell carcinoma or late stage cancers?

A

Pallative

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39
Q

What is the treatment for small cell carcinoma or late stage cancers?

A

Radiation and chemotherapy - initial response, but soon relapse
(Surgery rarely plays a role)

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40
Q

What is can be removed in surgery for lung cancer?

A

Lobe, lobes, or even whole lung, leaving patient with only one lung

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41
Q

What is ictirus?

A

Jaundice of the eye

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42
Q

What is the second most common cause of cancer death?

A

Colon cancer

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43
Q

What type of growth outnumbers malignant colon growths?

A

Benign colon growths, but they can be precancerous

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44
Q

Why is early detection and screening so important in colon cancer?

A

Because benign, precancerous growths are so common

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45
Q

What do most carcinomas of the colon arise from?

A

Colon adenomatous polyps

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46
Q

How long are polyps usually present before turning malignant?

A

Usually 10 - 15 years

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47
Q

What symptom in a patient over 50 is assumed to be colon cancer unless proven otherwise?

A

Iron deficiency anemia

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48
Q

Are nonneoplastic and hyperplastic polyps premalignant?

A

No

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49
Q

What type of polyps are premalignant?

A

Tubular adenoma and villous adenoma

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50
Q

What are some risks of colon cancer?

A
  • Diet* - low fiber, high fat
  • Genetic predisposition
  • Smoking
  • Age over 50
  • Mutated oncogenes and tumor suppressor genes
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51
Q

What causes a production of an overgrowth of epithelium that forms a benign neoplastic polyp?

A

Activation of oncogenes
Deletion of TSG
Failed apoptosis

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52
Q

What is a polyp?

A

Projection of tissue above mucosa

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53
Q

What are the two types of polyps?

A

Pedunculated or sessile

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54
Q

Which type of polyp has a stalk?

A

Pedunculated

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55
Q

What is the difference between neoplastic and nonneoplastic polyps?

A

Their nature

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56
Q

What is the difference between hyper plastic and adenomatous polyps?

A

Microscopic appearance

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57
Q

What symptoms arise with polyps?

A

Usually asymptomatic, possibly minor bleeding

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58
Q

What are hyper plastic polyps?

A

Nonneoplastic accumulations of epithelial cells - not premalignant!

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59
Q

What are adenomatous polyps?

A

Premalignant neoplasms of colon epithelium

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60
Q

Where are adenomatous polyps most commonly found?

A

Half are found in rectosigmoid colon (other half found scattered throughout colon)

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61
Q

What are the two types of adenomatous polyps?

A

Tubular and villous adenomas

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62
Q

What is the most common type of adenomatous polyp?

A

Tubular adenoma

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63
Q

Are tubular/villous adenomas usually pedunculated/sessile?

A

Tubular - pedunculated

Villous - sessile

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64
Q

What is FAP syndrome?

A

Familial adenomatous polyposis - uncommon autosomal dominant disorder that develops in teens with a defected APC gene

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65
Q

What is required for diagnosis of FAP?

A

Minimum of 100 polyps (1000s may be present)

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66
Q

By what age will someone with untreated FAP develop cancer?

A

30 (100% of cases)

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67
Q

How do they treat FAP?

A

Total colectomy

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68
Q

What are some early signs of FAP?

A
  • Darkly pigmented retina
  • Osteomas of mandible and long bones
  • Extra teeth, dental abnormalities
  • Benign` skin tumors and cysts
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69
Q

What organ is host to the most number of neoplasms?

A

(behind the skin,) colon

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70
Q

What are the different symptoms of colon cancer due to?

A

Location of the cancer

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71
Q

What would a tumor in the right colon present with?

A

Protrusion into the lumen - Watery stool

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72
Q

What would a tumor in the left colon present with?

A

Constriction of the lumen (napkin ring) - Pencil thin stool

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73
Q

Why might a tumor in the right colon be less symptomatic?

A

Because there is a higher water content in the stool in that region - less likely to be hard and become obstructed

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74
Q

What are some symptoms of colon cancer?

A
  • Early cancer is asymptomatic
  • Iron deficiency
  • Blood in stool
  • Change in stool caliber
  • Change in bowel habits
  • Left lower quadrant discomfort and cramping
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75
Q

What describes a change in stool caliber?

A

Pencil thin versus diarrhea

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76
Q

What is a change in bowel habits?

A

From being regular to only pooping three times a week

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77
Q

What is a FOBT?

A

Fecal occult blood test

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78
Q

How often should someone get a colonoscopy?

A

Every ten years

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79
Q

What are treatments of colon cancer?

A

Surgery with hope of cure is possible in 70% of cases. Chemotherapy increases survival in patients with lymph node metastases

80
Q

What are the most common sites of colon cancer metastasis?

A

Lung, liver, bone

81
Q

What kind of tumors of the urinary tract are common?

A

Benign

82
Q

What kind of tumors of the kidney are common?

A

Malignant

83
Q

What is the most common renal malignancy?

A

90% is renal cell carcinoma

84
Q

What renal malignancy makes up 10% of cases?

A

Carcinoma of the renal pelvis (urothelial carcinoma)

85
Q

Where do urothelial carcinomas occur?

A

Collecting system

86
Q

What does renal cell carcinoma typically invade?

A

Renal veins, sometimes extending into inferior vena cava

87
Q

What is the preferred treatment for urothelial carcinoma?

A

Radial nephrectomy, including ureters and uretervasicular junction

88
Q

What does the carcinoma of the renal pelvis arise from?

A

Lining urothelium (transitional epithelium) of the renal pelvis

89
Q

At what points do urothelial carcinomas occur in the urinary tract?

A

At multiple points

90
Q

What do urothelial carcinomas often present along with?

A

Carcinoma of the bladder

91
Q

What is the presenting symptoms of urothelial carcinoma?

A
  • Hematuria* most common and often only symptom
  • Painful urination
  • Urinary obstruction - back flow to kidney resulting in nephritis, urgency, frequency
  • Flank pain
  • Unintentional weight loss
  • Hypertension
92
Q

How many times does smoking increase your risk of developing bladder cancer?

A

5 times more likely

93
Q

What are the risk factors for urothelial carcinomas?

A
  • Age over 65
  • Smoking
  • Men
  • Chemical exposure
  • Hematuria
94
Q

What clinical test should smokers have yearly, in reference to urothelial cancer?

A

Urinalysis

95
Q

Why is hypertension a sign and symptom of urothelial carcinoma?

A

Increased renin and increased blood pressure (from compression of blood flow by a mass) - leads to hypertension

96
Q

What are some paraneoplastic processes associated with urothelial carcinoma?

A

Polycythemia

Hypercalcemia

97
Q

What is a paraneoplastic process?

A

Set of signs and symptoms that is the consequence of cancer in the body that is not due to the local presence of cancer cells - mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor.

98
Q

Why is renal cell carcinoma aggressive?

A

Due to the direct supply of blood

99
Q

What is another name for urothelial carcinoma?

A

Transitional cell carcinoma

100
Q

What structures does transitional cell carcinoma affect?

A

Kidneys, ureters, bladder

101
Q

What are the common metastases of renal and transitional cell carcinoma?

A

Lung and bone (from the invasion of the renal artery and IVC)

102
Q

What happens to a person that continues to smoke after removal of a urothelial lesion?

A

Continuation to smoke causes carcinoma to return

103
Q

(What is the progression of urothelial carcinoma?)

?? Slide 48

A
  • Urothelial neoplasm of low malignant potential
  • Papillary carcinoma, low grade, noninvasive
  • Papillary carcinoma, high grade, noninvasive
  • Carcinoma in situ
  • Invasive papillary or flat carcinoma
104
Q

What are two types of urothelial tumors?

A

Papillary and flat

105
Q

What are the four types of papillary lesions?

A
  • Urothelial papilloma
  • Papillary urothelial neoplasm of low malignant potential
  • Low grade papillary urothelial carcinoma
  • High grade papillary urothelial carcinoma
106
Q

What is urothelial papilloma?

A

Benign tumor - not precancerous

107
Q

What is a papillary urothelial neoplasm of low malignant potential?

A

Similar to urothelial papilloma that shows a limited degree of atypia

108
Q

What is a low grade papillary urothelial carcinoma?

A

Low grade nuclear atypism, do not regularly progress to invasive carcinoma

109
Q

What is a high grade papillary urothelial carcinoma?

A

Clearly malignant, high grade atypical cells, frequently progressing to invasive carcinoma

110
Q

What does urotheilal carcinoma in situ look like?

A

Flat malignant lesions

111
Q

Are low grade papillary carcinomas invasive?

A

Usually not invasive at time of discovery

112
Q

Are high grade papillary carcinomas invasive?

A

Almost always invasive

113
Q

Are carcinoma in situ urothelial lesions invasive?

A

About 30% proceed to invasive carcinoma

114
Q

What symptom do we assume is urothelial carcinoma until proven otherwise?

A

Gross hematuria

115
Q

What are invasive urothelial carcinomas treated with?

A

Complete cystectomy with urine diversion into abdominal wall or ileal pouch connected to urethra

116
Q

What is benign prostatic hyperplasia (BPH)?

A

Enlargement caused by nodular hyperplasia of the prostate gland - very common and all men will get it if they live long enough

117
Q

Is benign prostatic hyperplasia precancerous?

A

Not precancerous

118
Q

What may contribute to the cause of benign prostatic hyperplasia?

A

Cause is not clear - may be abnormal testosterone metabolism plays a role

119
Q

What is the most common malignancy?

A

Prostate cancer

120
Q

Is prostate cancer more or less lethal than breast cancer?

A

Less - breast cancer is far more lethal

121
Q

In what groups of people is prostate cancer more and less likely?

A

Asians are less likely to have it

African americans are more likely than Caucasians

122
Q

What factor plays an important role in prostate cancer?

A

Androgens

123
Q

What treatment is successful with prostate cancer?

A

Castration or anti androgen therapy produces significant regression of metastatic or locally invasive disease

124
Q

Where does prostate cancer usually develop?

A

Periphery of the gland, away from urethra

125
Q

How does the location of prostate cancer contribute to symptoms?

A

Due to location away from urethra it usually does not cause obstructive symptoms

126
Q

How does asymptomatic prostate cancer get discovered?

A

Elevated PSA levels in blood labs

127
Q

What symptoms present with prostate cancer tumors that have spread?

A
  • Obstructive problems
  • Hematuria
  • Urgency, frequency, incomplete urination
  • Dribbling, decreased stream
128
Q

What are some common metastases of prostate cancer?

A

Bone, especially spine, pelvis, and ribs

129
Q

What is the most important diagnostic test for prostate cancer?

A

PSA

130
Q

What is the grading scale used for prostate cancer?

A

Gleason score

131
Q

What is the best and worst score of the Gleason score?

A

1 indicates well differentiated mass (best), 5 indicates poorly differentiated mass (worst)
Dominant and second patterns are each scored 1-5 and summed - Best score is 2 and worst score is 10

132
Q

What is the most significant factor in the development of cervical cancer?

A

HPV - human papilloma virus

133
Q

What does HPV do to cause cancer?

A

DNA damage and causes cells to proliferate - changes become more pronounced if infection persists until entire thickness is occupied by atypical cells - equivalent of carcinoma in situ

134
Q

What does persistent HPV infection cause?

A

infections convert normal
epithelium into increasingly severe dysplasia until malignant epithelium breaks through the basement membrane to become invasive cancer

135
Q

What other factors contribute to the development of cervical cancer?

A
  • first intercourse at young age
  • multiple sexual partners
  • male partner with multiple female partners
  • persistent infection with high risk HPV
  • immunodeficient state
  • certain HLA genotypes
  • oral contraceptive use
  • smoking
136
Q

What is characteristic of most HPV infections?

A

Transient and eliminated by the immune system

137
Q

How is infected cervical epithelium constantly changing?

A

Low grade lesions usually regress to normal, high grade lesions often progress to more severe dysplasia and invasive cancer

138
Q

What is cervical intraepithelial neoplasia?

A

New term for classification of cervical dysplasia

139
Q

Why don’t we use carcinoma in situ with cervical cancer?

A

New terms created to bring greater precision of diagnosis and better correlation between tissue biopsy findings and Pap smear reports

140
Q

Are Pap smears diagnostic?

A

No - they reliably predict biopsy findings but only serve as a guide to post smear steps in diagnosis

141
Q

What is the name of the Pap smear system?

A

Bethesda system

142
Q

What are the two determinations of dysplasia in the Bethesda system?

A

LSIL - low grade squamous intraepithelial lesion

HSIL - high grade squamous intraepithelial lesion

143
Q

What are the different possible results of the Bethesda system?

A
  • Negative for intraepithelial lesion or malignancy
  • ASCUS
  • LSIL
  • HSIL
  • Carcinoma
144
Q

What is ASCUC?

A

Atypical squamous cells of undetermined significance

145
Q

What is performed during a Pap smear?

A

Spatula used to scrape cells from ectocervix and narrow brush used to collect cells from endocervix - cells then smeared onto glass slide

146
Q

What are the symptoms of cervical cancer?

A

Mostly asymptomatic

  • Vaginal bleeding after intercourse, between periods, or during menopause
  • Watery, bloody vaginal discharge, may be heavy or foul odor
  • Low pelvic pain or pain during intercourse
147
Q

What is the treatment of LSIL?

A

90% of Pap smear findings of SIL are LSIL and are not treated as if the lesion is precancerous, as most regress without treatment and none proceed directly to invasive cancer without first progressing to HSIL (watch and wait)

148
Q

Where does invasive carcinoma of the cervix travel to?

A

Vagina, pelvis, bladder

149
Q

What is the treatment for invasive carcinoma of the cervix?

A

Radical hysterectomy - removal of uterus, tubes, and ovaries

- Radiation, chemotherapy

150
Q

What vaccine protects against HPV?

A

Gardasil

151
Q

Do only women get Gardasil?

A

No, men get it too so that they don’t transmit to women

152
Q

When should a patient get the Gardasil vaccine?

A

Ages 9 - 26 (before every encountering HPV)

Series vaccine - 3X 2 mo, 6 mo,

153
Q

What other condition does HPV cause?

A

Genital warts

154
Q

Does Gardasil only protect against one kind of HPV?

A

No, it protects against many strains (maybe not the genital warts strains)

155
Q

If a person has been infected with HPV, should they still receive Gardasil?

A

Yes, because there are many different strains

156
Q

What is the most common malignancy in women?

A

Breast cancer

157
Q

What is the second leading cause of cancer death?

A

Breast cancer

158
Q

What kind of prognosis does carcinoma in situ have?

A

Favorable prognosis

159
Q

What do all breast carcinomas rise from?

A

Cells in the terminal duct lobular unit (TDLU)

160
Q

What where the two distinctions of breast cancer before TDLU was discovered?

A

Lobular and ductal carcinoma - due to differing microscopic appearance

161
Q

What are the major risk factors for breast cancer?

A 
Hormonal*
Genetic 
Smoking
- Early menses
- Childlessness or first child bearing over the age of 30
- Late menopause
- Increased breast density
162
Q

What hormone affects breast cancer and how?

A

Estrogen promotes cancer

Progesterone limits the effect of estrogen

163
Q

How does having cancer in one breast affect the risk of cancer in the other?

A

Having cancer in one breast is 10 times more likely to develop cancer in opposite breast

164
Q

Does carcinoma in situ usually produce a palpable mass?

A

No

165
Q

Where does carcinoma in situ arise and travel to?

A

Arises in TDLU and extends through nearby ducts, filing them with intraluminal cancer

166
Q

Why are mastectomies performed instead of lumpectomies?

A

With carcinoma in situ, you cannot be sure that all the cancer cells were removed

167
Q

What percentage of breast cancers are carcinoma in situ?

A

25% carcinoma in situ, 75% invasive

168
Q

What are the two types of carcinoma in situ?

A

Lobular and ductal

169
Q

Which carcinoma in situ is more common?

A

Ductal

170
Q

Which carcinoma in situ is associated with mammography calcifications or densities?

A

Ductal - lobular is found incidentally

171
Q

What is the treatment for carcinoma in situ?

A

Mastectomy followed by chemotherapy and radiation

172
Q

What is the most important step in the development of breast cancer?

A

Progression from carcinoma in situ to invasion

173
Q

What does the tumor gain when it turns invasive?

A

Gains access to lymphatics and blood vessels and can metastasize

174
Q

If a palpable mass is an invasive breast cancer, half of patients will have what in addition?

A

Axillary lymph node metastases

175
Q

What is Paget disease?

A

Special kind of carcinoma in situ that occurs in the skin of the nipple in women who have a brest carcinoma immediately beneath the nipple

176
Q

What are the symptoms of Paget disease?

A

Nipple and areola are:

  • red
  • tender
  • inflamed
  • cracked
  • oozing
  • crusted
177
Q

What is the most common type of invasive breast cancer?

A

Invasive ductal carcinoma - no special type (IDC-NST)

178
Q

What are the characteristics of IDC-NST?

A

Stimulate growth of dense fibrous stromal tissue and calcification, makes them gritty and hard and accounts for density and calcium deposits, send fingers of invasive tumor into nearby tissue

179
Q

What type of cancer increases your risk of also having breast cancer?

A

Endometrial cancer

180
Q

What are the gravest clinical prognostic signs of breast cancer?

A

Women who present with distant metastasis or with inflammatory carcinoma

181
Q

Which lymph nodes are usually biopsied? What does a negative result mean?

A

If sentinel lymph nodes biopsy is negative, it is unlikely other nodes are involved and further axillary exploration is not necessary

182
Q

What are the major prognostic factors in breast cancer?

A
  • Carcinoma in situ or invasive
  • Distant metastasis
  • Lymph node metastasis
  • Tumor size
  • Locally advanced disease
183
Q

What is a general rule for diagnosis and treatment (saying)?

A

Diagnosis is standardized, treatment is individualized

184
Q

How is breast cancer diagnosed?

A
  • Mammography screening
  • Physical exam
  • Biopsy
  • Molecular profiling of tumor
185
Q

What does the treatment of breast cancer depend on?

A

Pathologic classification, staging, and molecular profliling

186
Q

What are treatments aimed at local control of breast cancer?

A

Lumpectomy, mastectomy, and axillary lymph node dissection

187
Q

What are treatments aimed at local and systemic control of breast cancer?

A

Radiation and chemotherapy

188
Q

What are symptoms of breast cancer?

A
  • Usually asymptomatic
  • Lump
  • Asymmetric breasts
  • Inverted nipple
  • Nipple retraction
  • Dimpling
  • Breast pain
  • Nipple discharge, and/or with blood
189
Q

What do mammograms look for?

A

Calcifications of breast tissue

190
Q

Where are the local metastases of breast cancer?

A
  • Internal mammary lymph nodes
  • Axillary lymph nodes
  • Sentinal nodes
191
Q

Where are the distant metastases of breast cancer?

A
  • Brain
  • Supraclavicular nodes
  • Lung
  • Adrenal
  • Liver
  • Bone
192
Q

What is the grading of cancers based upon?

A

Pathologic exercise that classifies tumors according to their microscopic characteristics

193
Q

What is the staging of cancers based upon?

A

Clinical exercise that classifies tumors according to their size, invasiveness, and spread

194
Q

What is the common staging system?

A

TNM

195
Q

What are TNM for in the staging system?

A

T - tumor size
N - lymph node involvement
M - metastasis

From Flashcardlet (133 decks)

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