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Neoplasms-DD exam 2 > Presentation, Treatment, Pathology, Survival (CLINICAL STUFF) > Flashcards

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What are the four types of cancer I should be pretty knowledgeable about for this unit?

• The ones that kill the most americans
• Lung, pancreas, colon, prostate


What are Carcinomas in simple terms?

• Clonal expansions of stem cells in the epithelium that form abnormal growths


What does "invasion" of a carcinoma really mean?

• Small groups of the initial tumor cell have broken off and have broken through the basement membrane that separates the pithelium from the underyling sub mucosal, connective tissue stroma
• It is a group of cells invading a new tissue where it wasn't from originally


How does the workup of a carcinoma of any of the four tissues we care about here start?

• Get a tissue sample EARLY to see what's going on
• Examines cells sampled from lesion (core needle biopsy)
• Examine cells from sections of the removed lesion/tissue
• Use special IHC staines to determine certain common cancer variants


What are the two features of a carcinoma that need to be determined?

• Grade and stage
• Stage - extent of tumor spread at time of ddx (strongest predictor of prognosis)
• Grade - state of the differentiation of the cells that are being looked at (also mitotic activity)


What is the TNM classification of a tumor?

• T - size of tumor (Tis for in situ)
• N - lymph node involvement
• M - presence of metastasis (M0= no metastasis, M1=distant metastasis)


What is meant by High grade vs. Low grade in carcinomas?

• High grade is "that cell doesn't even look like epithelium"
• Low grade is "that cell is trying to be epithelial but it's still abnormal"


Where can signs and symptoms of neoplasia stem from?

• Both local effects and distant effects
• Cachexia is a result of systemic cytokine secretion (TNF-alpha)
• Can cause severe electrolyte imbalance and arrhythmias


What is the most common immediate cause of death in advanced stage carcinoma?

• Infection (60% of cases)
• Often acute bronchopneumonia


What are the classic signs and symptoms of lung carcinoma?

• Pateints present with coughing (persistant cough)
• Chest pain
• Persistent hoarseness because of involvement of the recurrent laryngeal nerve
• Facial swelling
• Weight loss
• B symptoms


How do you diagnose lung carcinoma?

• Imaging (CT, MRI, PET) - looking for masses and infiltrates
• Chest film (imaging)
• Transbronchial biopsy
• Open lung biopsy
• Video-assisted thoroscopic biopsy (VATS)
• Percutaneus biopsy
• Cytology of bronchial alveolar lavage
• Mediastionoscopy to assess mediastinal lymph nodes


What percentage of lung carcinoma patients are long term survivors?

• Only 16%. Lung carcinoma kills pretty easily


Seeing adenocarcinoma in the lungs of non-smoking patients has become "common". Why is it thought to be there?

• Radon gas exposure is the current idea


What are the four major variants of lung cancer that are seen clinically?

• Squamous cell carcinoma (25-40%)
• Adenocarcinoma (25-40%)
• Large cell carcinoma (10-15%)
• Small cell (oat cell) carcinoma (20-25%)


What is typical of squamous cell carcinomas?

• Strongly linked to cigarrette smoking
• Squamous metaplasia and dysplasia in the major branches of the bronchial tree (centrally)
• Often pretty large (3cm or more)
• Necrosis and hemorrhage at core of lesion is common
• More differentiated than not
• Some have keratin pearls
• P53, loss of Rb, p16 inactivation are common genetic signatures
• Metastasis through lymph nodes and blood


What are commonly mutated genes in squamous cell carcinomas?

• P53, loss of Rb, p16 inactivation are common genetic signatures


What are the common mechanisms of metastasis in squamous cell carcinomas?

Lymphatics and blood spread (hematogenously)


Small Cell Lung Carcinoma (SCLC) is different from other lung cancers in it's treatment....why?

You don't treat it with surgery, ONLY CHEMOTHERAPY


Paraneoplasic syndromes can be seen in Lung cancer, but what type in particular?

SCLC (small cell lung carcinoma). Even then, it's only 1-5% of cases


What hormones or hormone like substances do SCLC's produce that result in paraneoplasic syndromes?

antidiuretic hormone, ACTH, parathormone (hypercalcemia), gonadotropins (gynecomastia)


What are the classic symptoms of pancreatic cancer?

○ Back pain
○ Unexplained painless jaundice (tumor blocks common bile duct)
○ Cachexia
○ Migratory thrombophlebitis


• What are pancreatic intraepithelial neoplasias?

○ Early stages of pancreatic cancer
○ Focal areas of non-invasive foci of epithelial cell proliferations within pancreatic ducts and ductules


• Why does pancreatic cancer have such a terrible prognosis?

It grows without symptoms, and when it does cause symptoms (also causing the patient to go in) the diagnosis comes too late
* There is metastasis upon diagnosis a great majority of the time
* Liver and lung and lymph nodes


• What is the cause of pancreatic cancer?

○ Still unknown


• What are the risk factors for pancreatic cancer?

○ Age, smoking, chronic pancreatitits from alcoholism, diabetes mellitus, family history


• Where in the pancreas can the cancer originate/be?

○ Anywhere in the body, head or tail


• What is the diagnostic workup of pancreatic cancer?

○ Imaging (CT, MRI)
○ Percutaneous and ultrasound guided biopsy (via endoscopy)


• What can you do with small lesions that are discovered early

○ You can go all crazy and do a whipple, or you can get out the focal lesions and cure it surgically
* The cure rate the focal lesion resection is RARE
* The whipple takes out most of the pancreas, common bile duct, gall bladder, duodenum so that's not the first case scenario of what you want


• What does "desmoplasia" mean in the context of pancreatic cancer?

○ This cancer has a specific flavor of stimulating stromal cells
○ There is a distinctive connective tissue support network around pancreatic cancer cells


Where is pancreatic cancer wont to metastasize?

○ Liver, lung, lymph nodes
○ Peri-gastric, peri-aortic, omental lymph nodes are common sites