Topics A67-71. Neoplasm 4: Epidemiology, Preneoplastic Disorders, Grading/Staging, Tumor Effects, Diagnosis Flashcards Preview

Y Pathology I (Dustin) > Topics A67-71. Neoplasm 4: Epidemiology, Preneoplastic Disorders, Grading/Staging, Tumor Effects, Diagnosis > Flashcards

Flashcards in Topics A67-71. Neoplasm 4: Epidemiology, Preneoplastic Disorders, Grading/Staging, Tumor Effects, Diagnosis Deck (52)
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1

How many people die every year from cancer around the world?

What are the top 3 causes of death worldwide vs in developed countries?

50 million deaths/year from cancer

Worldwide cause of death ranking:
1. Infectious disease
2. Cardiovascular disease
3. Cancer
Developed countries have infectious disease lower on the list, so cancer is #2.

2

What are the top 3 cancers in MEN as in total incidence (morbidity)? What are the top 3 cancers as cause of death (mortality)?

Morbidity:
1. Prostate (25% of total cancers)
2. Lung (15% total)
3. Colorectal (10% total)

Mortality:
1. Lung
2. Prostate
3. Colorectal

3

What are the top 3 cancers in WOMEN as in total incidence (morbidity)? What are the top 3 cancers as cause of death (mortality)?

Morbidity:
1. Breast (25% of total cancers)
2. Lung (15% total)
3. Colorectal (10% total)

Mortality:
1. Lung
2. Breast
3. Colorectal

4

What type of cancer (mentioned in lecture) has been declining in incidence since the early 20th century? Why?

Stomach cancer: mostly due to refrigeration and using less preservatives than were necessary previously (smoked meats etc). Continues to be common in Japan due to eating smoked fish.

Most of the other major cancers increased in incidence until the last 20 years or so, when better diet, screening, and treatment began to help

5

What are the 2 peak ages when cancers are most common?

-Around age 5: due to mutated inherited genes

-Age 60-70: accumulation of somatic mutations begins to form cancers

6

What are the 3 most common childhood cancers?

Leukemias, Neuroblastoma, Ewing sarcoma

(at least according to Matolcsy lecture... but looking it up, Ewing sarcoma is more rare. My histo class ranked them: 1. CNS tumors like medulloblastoma, 2. Solid tumors like in kidneys, 3. Neuroblastoma... but leukemia should still be the most common one. Annoying to not have a consistent answer)

7

Why do some countries have unusually high rates of certain cancers? Can you give any examples?

Not related to genes but environment and habits

India: chewing betel nut related to oral cancers

Africa: Burkitt lymphoma from malaria and EBV

Developing countries in general have higher rates of hepatocellular cancers from endemic Hepatitis B and C

8

What are some environmental factors related to cancer?
(5 are listed from lecture, but just remember some examples)

1. Alcohol: related to oral, liver, esophageal, breast, bowel
2. Smoking: lung, oral, kidney, urinary bladder, etc
3. Obesity: colorectal cancer
4. HPV: cervical cancer
5. Hepatitis B or C: liver

9

What is preneoplasia?

Precancerous states that may indicate a high likelihood for cancer, hopefully to stop it before it starts.

Essentially it is dysplasia (disordered growth with changes in chromatin, cell morphology, etc.)

10

What does "obligate precancerous state" mean? What are 3 examples of this? (all were mentioned in previous topics)

Person will for sure get cancer due to a hereditary disorder

1. XPA: Xerodema Pigmentosum -> skin cancer
2. Ataxia Teleangiectasia: p53 mutation -> many cancers
3. Familial Adenomatous Polyposis: APC mutation -> colon cancer

11

6 conditions that predispose for a cancerous state:
(this is the overview, will elaborate on them after)

1. Persistent Regeneration
2. Hyperplasia -> Dysplasia -> Neoplasia
3. Chronic Inflammation
4. Immune deficiency
5. Autoimmunity: mostly B cell proliferation
6. Benign Neoplasms transform into Malignant

12

What are 2 examples of persistent regeneration?
(conditions that predispose for a cancerous state)

1. Liver Cirrhosis: Necrosis of liver parenchyma, remaining cells proliferate too quickly and may make mistakes, prone to become cancerous

2. Paget's disease: Osteoclasts overactive, need to rebuild more. Risk for osteosarcoma.

13

What are 2 examples of how hyperplasia may develop into metaplasia, then dysplasia, then neoplasia?
(conditions that predispose for a cancerous state)

1. Bronchus: continuous smoke irritation causes ciliary epithelium hyperplasia

2. Ductal hyperplasia of the breast or endometrial hyperplasia: high estrogen content causes hyperplasia of both, may eventually transform to neoplasia

14

Why is chronic inflammation related to carcinogenesis? Some examples?
(conditions that predispose for a cancerous state)

Inflammatory cells release ROS that not only kill pathogens but can damage DNA. They also release cytokines that induce normal cells to proliferate

Examples: ulcerative colitis and colon cancer, gastritis and stomach cancer, viral hepatitis, etc.

15

What are 2 examples of immunosuppressed states and their cancer relations?
(conditions that predispose for a cancerous state)

1. AIDS: Kaposi sarcoma, glial cell tumors, lymphomas

2. Post-transplant patients are chronically immunosuppressed, often have lymphomas (PTLD = post-transplant-lymphoproliferative-disorders), also skin cancers

16

What are 2 examples of autoimmune diseases that have increased risk for cancer? What type of cancer?
(conditions that predispose for a cancerous state)

1. Hashimoto thyroidits
2. Sjogren syndrome

Both cause B cell proliferation, have risk for B cell lymphomas

17

Benign tumors can transform into malignant, but with variable incidence. Which ones have high, medium, and low incidence?
(conditions that predispose for a cancerous state)

1. High incidence: stomach and colon, up to 50% of cases

2. Medium incidence: Hepatocellular adenoma, about 20% incidence

Low incidence: leiomyoma (of uterus) and hypophysis: almost never

18

Intraepithelial neoplasms: What is the first one that developed a system to classify the likelihood of developing neoplasia based on morphology?

Cervical Intraepithelial Neoplasms: from Papanicolou of the pap smear for Cervical Intraepithelial Neoplasia (CIN)

Cervical cancers appear at squamo-columnar junction. Take sponge and collected desquamated cells ("exfoliative cytology") then smear and analyze under microscope.

19

What are the 5 classifications of pap smear?

P1: Inactive, normal
P2: Active, normal (P1 and P2 depend on menstrual stage)
P3: Suspicious, maybe normal or not. Should repeat exam.
P4: Dysplasia
P5: Neoplasia

20

What should be done if dysplasia is seen during a Cervical intraepithelial neoplasia (CIN) screening?

Perform a "co-resection" - cut off some of the dysplastic area and analyze it under a microscope. Then you can grade it CIN-I CIN-II or CIN-III depending on how much of the epithelium is replaced by dysplastic basal cells

21

What are the criteria for CIN-I, CIN-II, CIN-III

CIN-I: 1/3 of epithelium replaced by immature basal cells
CIN-II: 2/3 of epithelium replaced by basal cells
CIN-III: Whole epithelium replaced by basal cells

If it gets any deeper than CIN-III, it passes the basement membrane and becomes an invasive carcinoma

22

What are some examples of other neoplasm screening methods that follow similar patterns to the CIN scheme?
(not a detailed question, just be familiar)

Vagina: PIN
Prostate: PIN
Pancreas: PAN (because prostate used the P already)
Breast: DIN (ductal in situ neoplasm)
AML-MDS: acute myeloid leukemia-myelodysplastic syndrome

23

During a physical examination, what is a good sign of precancous states?

Leukoplakia: "white spot" - for example, on mucous membranes

Doesn't mean neoplastic for sure, just suspicious. Maybe hyperplasia, dysplasia.

24

What is the difference between "grading" and "staging" of tumor classifications?

Grading: based on morphology, degree of dysplasia, increasing order of anaplasia from Grade I to IV. Very subjective

Staging: Based on the size of the primary tumor and its spreading to lymph nodes and metastases.

25

What are the criteria for the T part of the TNM Staging system?

T for Tumor, based on depth/size of tumor. This example is with colon cancer, but it varies by region
T1: Just in mucosa
T2: Disrupts Muscularis Mucosae
T3: Makes it to Lamina Propria
T4: Invades peritoneum

26

What are the criteria for the N part of the TNM Staging system?

N for Nodes (testing lymph node metastases)
N0: No metastases
N1: Has 1 to 3 regional metastases
N2: Spread to more distant or more than 3 lymph nodes
Nx: unknown if there are metastases

27

What are the criteria for the M part of the TNM Staging system?

M for Metastasis
M0: No metastases
M1: Metastasis to a distant organ, beyond regional lymph nodes
Mx: unknown if there are metastases

28

What is Stage I? How long is the 5 year survival rate? What is the treatment?

T1-T2, N0, M0
High survival (93%)
Treatment is surgery

29

What is Stage II? How long is the 5 year survival rate? What is the treatment?

T3-T4, N0, M0
Still high survival (75%)
Treatment is surgery

30

What is Stage III? How long is the 5 year survival rate? What is the treatment?

T1-T4, N1, M0
Modest survival rate, 44%
Treatment is still only surgery

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