Neoplasia 2 - Lecture 2

Virchow's node

- gastric cancer and other abdominal cancers may metastasize to the left supraclavicular lymph nodes via the thoracic duct. - In females, the virchow's node can indicate ovarian cancer.

Renal cell carcinoma

- has the propensity to invade veins.

other cancers that are increasing in incidence?

-Lung in women population -Multiple myeloma -Malignant lymphoma -Pancreatic carcinoma -Malignant melanoma (cancer that is increasing at the fastest rate worldwide)

Seeding of Body Cavities

-Most often peritoneal cavity (Douglas pouch, pseudomyxoma peritonei - this is appendiceal carcinoma) -other locations: Plueral Pericardial Subarachnoid Joint space

RB

-Retinoblastoma -malignancy of eye in children, 40% are inherited. -point mutation inactivates RB suppressor gene on chromosome 13; one gene inactivated in germ cells. -remaining gene inactivated after birth (one-hit-theory) -predisposition for osteogenic sarcoma in adolescence.

Why lymphatic nodes are enlarged in patients with cancer?

-Spread and growth of cancer cells. -Reactive hyperplasia (immune response on the tumor antigens and debris)

Metastases

-are tumor implants discontinuous with primary tumor. -only malignant tumors have metastases

Hematogenous spread

-can be seen in sarcomas and carcinomas. -venous spread (tumor cells more easily enter veins) - most metastatic cells will end in the lungs and liver. -if cancer site closed to vertebral column - paravertebral plexus - vertebral metastases (thyroid and prostate) -arterial spread (pulmonary tumors)

cancers in Hispanic

-cancer in general is less common in Hispanic than caucasians -higher incidence of stomach, liver, uterine, gallbladder cancer and child leukemias.

cancers in African-Americans

-cancer in general is more common in African-Americans than caucasians. -exceptions are malignant melanoma and testicular cancer which are less common in African-americans than whites.

precancerous condiitons

-chronic atrophic gastritis in B12 deficient, pernicious anemia. -solar keratosis of skin leukoplakia (oral, vulvular, penile) -benign tumors sometimes may transform into malignant (leiomyosarcoma)

Familial inherited cancers

-early age of onset -tumors arising in 2 or more relatives -presence multiple or bilateral tumors - not associated with specific tumor phenotypes -MC for breast cancer; ovarian cancer and pancreatic cancer -When a parent has inherited predisposition to cancer, each child has a 50/50 (one in two) chance of inheriting the predisposition.

gastric ulcer and gastritis - H. pylori - adenocarcinoma ulcerative colitis - colon cancer mechanism?

-increased proliferation of stem cells -release of various growth promoting factors by immune cells at the site of inflammation. -increased level of ROS - increased rate of DNA mutation

Pseudomyxoma Peritonei

-rare complication of mucinous tumors of appendiceal or ovarian origin, results in peritoneal and omental implants. - morbidity and mortality due to copious amounts of extracellular and peritoneal mucin results in distortion and loss of function of visceral organs.

neoplasms arise from

90% of the time from epithelium 10% of the time from mesenchymal cells

A 67-year-old retired man experiences increasing difficulty in urinating. His symptoms consist of urinary retention and discomfort with urination. He finally sees his family doctor. On physical examination, his rectal exam is positive for a palpable, nodular prostate. A needle biopsy is done and the diagnosis of prostate cancer is confirmed. Further work-up is done and it is determined that he has clinical stage C. Question: Which of the following would be a risk factor for this patient's diagnosis? A. African-American race B. Shorter stature C. Low BMI D. Lifestyle with high level of vigorous physical activity E. Diet rich in tomato sauce

A.

A 60-year-old white woman develops an annoying discomfort in her abdomen. She notices that meals seem to make her discomfort worse. She has lost her previously vigorous appetite. Over several weeks, she has unexplained weight loss. She sees her doctor because of these complaints, and he orders an upper GI series. The results of the upper GI series are suggestive of a malignancy. Subsequently, an endoscopy with biopsy is done. After the endoscopy, her doctor tells her that she has adenocarcinoma of the stomach.Question: She is understandably upset and asks for clarification as to why this happened to her. Which of the following is associated with an increased risk of this diagnosis?A. Pernicious (B12 deficient) anemiaB. Blood type BC. Inflammatory bowel diseaseD. Female genderE. Younger age

A. Pernicious (B12 deficient) anemia

Chromosomal instability syndrome

AR chromosomes susceptible to damage by ionizing radiation and drugs; predisposition to cancers (e.g. leukemia, lymphoma); disorders include Fanconi anemia, ataxia telangiectasia, bloom syndrome

Xeroderma pigmentosum

AR increased risk for developing skin cancers due to UV light (cross-links adjacent pyrimidine producing pyrimidine dimers); mutation in the genes which repair crosslinks (XPA, RAD2) clinically: examples include basal cell carcinoma, squamous cell carcinoma

cancer caused by Vinyl chloride

Angiosarcoma and liver

Pseudomyxoma peritonei is a complication of which tumor? A.Serous cystadenoma of the ovary B.Mucinous cystadenoma of the ovary C.Ovarian fibroma D.Myxoma of the heart E.Myxosarcoma of the lower extremity

B. Myxosarcoma of the lower extremity

blocking or reducing chronic inflammation prevent development of colon cancer via

COX2 inhibition - aspirin prevents colon cancer

PTEN

Cowden syndrome (epithelial cancers)

APC

Familial adenomatous polyposis/colon cancer

MSH2, MLH1, MSH6

Hereditary nonpolyposis colon cancer. Lynch syndrome

cancer caused by Benzene

Leukemia, Hodkin lymphoma

P53 mutation

Li- Fraumeni syndrome: increased risk for sarcomas, leukemia, carcinoma (e.g breast) before age 50; inactivation of TP53 suppressor gene

cancer caused by Beryllium

Lung

cancer caused by Chromium

Lung

cancer caused by Radon

Lung

cancer caused by Arsenic

Lung, Skin, Hemangiosarcoma

cancer caused by Asbestos

Lung, mesothelioma, gastrointestinal tract (esophagus, stomach, and large intestine)

Carcinomas mostly disseminate through

Lymphatic vessels

endometrial carcinoma

MC gynecologic cancer and has the best prognosis

NF1, NF2

Neurofibromatosis 1 and 2

PTCH

Nevoid basal cell carcinoma sundrome

cancer caused by Nickel

Nose, lung

LKB1

Peutz-Jegher syndrome (epithelial cancers)

cancer caused by Cadmium

Prostate

VHL

Renal cell cacinomas

Leukocoria. aka leukokoria or white pupillary reflex

abnormal white reflection from the retina of the eye in RB gene mutation

Bronchogenic carcinoma (venous drainage) spread to

adrenal gland

Sarcomas disseminate through

blood and lymphatic vessels

breast carcinoma (venous drainage) spread to

bones

cancers in decreasing order in incidence n women

breast lung colorectal

cancer incidence in women

breast - 29 lung and bronchus - 13 colon and rectum - 8

BRCA1, BRCA2

breast and ovarian tumors

what is the most common malignant lymphoma in Africa?

burkitt's lymphoma. why? due to EBV infection

viral infections leads to

cervical cancer

age brackets for gynecologic cancers

cervical: 45 and older endometrial: 55 and older ovarian: 65 and older

poor diet leads to

colon cancer

what is the second MC cancer and cancer killer in men and women?

colorectal

reason for increasing incidence of prostate cancer?

due to detection by PSA and digital rectal exam

reason for increasing incidence of breast cancer?

due to early detection by mammography

reason for decrease incidence of cervix cancer?

due to pap screens detecting cervical dysplasia and carcinoma in-situ

Decreasing incidence of gynecologic cancers-particularly

endometrial ovarian cervical

cancer rates among Korean

for both men and women highest incidence and mortality from stomach cancer

What is the most common cancer in Southeast Asia?

hepatocellular carcinoma. why? due to HBV infection + aflatoxins (molds) in food

cancer rates among Japanese?

highest incidence and death rates from colorectal cancer. highest death rates from breast and prostate cancer

cancer rate among Vietnamese?

highest incidence and death rates from liver, lung, and cervical cancer

cancer rate among Filipinos?

highest incidence and death rates from prostate cancer. highest death rate for females is breast cancer.

cancer rate among Chinese Americans

lowest incidence and death rate from all cancer combined

cancer mortalities in decreasing order in women

lung breast colorectal

cancer mortalities in decreasing order in men

lung prostate colorectal

cancer deaths in women

lung - 26 breast - 15 colon - 9

Chinese women had the highest death rate from?

lung cancer

smoking lead to

lung cancer

what is the MC cancer?

lung cancer

cancer deaths in men

lungs - 28 prostate - 9 colon - 8

p16/INK4A

melanoma

MEN1, RET

multiple endocrine neoplasia 1 and 2

decreasing mortality of gynecologic cancers

ovarian cervical endometrial

reason for decrease incidence of endometrial cancer?

parity, lactation, use of combined oral contraceptives, a diet low in fat and high in plant foods, physical activity.

cancer in decreasing order of incidence in men

prostate lung colorectal

Cancer incidence in men

prostate - 26 lung and bronchus - 14 colon and rectum - 8

which ones are rare sites of tumor metastases?

spleen and muscles

Breast cancer spreads through

upper outer quadrant - axillary nodes

reason for decrease incidence of stomach cancers?

wide usage of antibacterial therapy of gastric ulcers of those with intestinal metaplasia and Helicobacier pylori