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What are the major CURABLE (7) disseminated malignancies? What are the percentages? (Curable) Testicular (80%) Hodgkins (70%) Non Hodgkins (50%) Acute Myelogenous Leukemia (20% - 30%) Acute Lymphocytic Leukemia KIDS (80% - 90%) Acute Lymphocytic Leukemia ADULTS (20%) Extensive Small Cell Carcinoma (5%) What are the major INCURABLE (9) disseminated malignancies? (Incurable) Lung Breast Colorectal Prostate Pancreas Gastric Multiple Myeloma Chronic Myelogenous Leukemia Sarcoma Explain apoptosis. What is the significance of apoptosis in the context of cancer? (Apoptosis) Programmed cell death that occurs when there is a problem with the replication machinery of the cell. Systems in the cell allow it to KNOW when to die. (Apoptosis & Cancer) Normally, there is a balance between cell proliferation and cell death (Apoptosis). When there is a defect in apoptosis, cells may grow relatively unchallenged leading to CANCER. What is the role of p53 in apoptosis & cancer? What may be the role in cancer? (Role of p53) p53 is involved in PAUSING the cell cycle between G1 & S to allow the cell to repair it's DNA damage. If there is DNA damage, p53 production INCREASES leading to the cell pausing and going into repair mode. If there is too much DNA damage the cell progresses to p53 mediated APOPTOSIS. (p53 and Cancer) p53 is implicated in more than 50% of all cancers. A mutation possibly leads to malfunctioning p53 which lead to a LACK of pause thus leading to continuous cell division with damaged DNA which is cancer. http://o.quizlet.com/i/TP5aGnNIAsa6GXf6tnEKoA.jpg What is Li-Fraumeni Syndrome & how may it be caused? How does the incidence of cancer in these patients compare with the general public? What kinds of cancers do these patients get? (Li-Fraumeni Syndrome) Loss or severe mutation in p53 that leads to unchecked cell division. (Li-Fraumeni vs General Public) For patients with Li-Fraumeni, 50% of patients developed a number of cancer by age 30 compared to 1% in the non affected public. (Tumor Types) Rhabdomyosarcoma Breast Soft Tissue Carcoma Brain Osteosarcoma Leukemia Adrenocortical Carcinoma What is the leading cause of cancer related death in men? What is a major cause attributed this type of cancer? What also increases the likelihood of developing any type of lung CA? (Leading Cause of Cancer Related Death in Men) Lung Cancer (Major Cause) ACTIVE & PASSIVE Smoking (Increase Risk) Asbestos Exposure Do you have to have smoked to develop lung cancer? If smoking is stopped, what happens to the risk for lung cancer? How do we screen for Lung CA? Are the screenings effective? (Smoking and Lung Cancer) Not all people with lung cancer were smokers. 15% of women with lung cancer were non smokers. (Cessation of smoking & cancer risk) Risk of lung cancer drops after cessation of smoking but does remain elevated. (Screening for Lung Cancer) Chest XRay Sputum Cytology (Effectiveness of Screenings) Early Detection is Improved Survival Rate (NOT IMPROVED) What are the lung cancer types? Which one is the most predominant and what are the percentages? What are the Non Small Cell Cell Lung Cancer Types? (Lung Cancer Types) Non Small Cell Lung Cancer (NSCLC) 75%-80% Small Cell 20%-25% (NSCLC Types) Squamous Adeno Large Cell What is a Paraneoplastic Symptom and where does it come from? (Paraneoplastic Symptom) Disease or symptom that is the result of the presence of cancer in the body. What is common Squamous Cell Cancer associated Paraneoplastic Symptom? Explain. What are some of the Paraneoplastic Symptoms/Syndromes? (Possible causes of Squamous Cell Cancers) Squamous cell cancers are associated with HYPERCALCEMIA resulting from the release of PTHRP (Parathyroid Hormone like product) from the carcinoma cells. (Paraneoplastic Symptoms/Syndromes) Cushing's Syndrome (Too much ACTH) SIADH (Too Much ADH) Hypercalcemia (Too Much PTHRP) Hypoglycemia (Insulin undersecretion) Carcinoid Syndrome (Serotonin/Bradykinin) Lambert Eaton Myasthenic Syndrome (Immunologic) What are some of the treatment options for the Non Small Cell Lung Cancer Types? What about treatment options for Small Cell Lung Cancer? What is Limited vs Extensive refer to in terms of Small Cell Lung Cancer? (Treatment Options for NSCLC) SURGERY Only (Treatment Options for SMALL CELL Lung Cancer) Limited Disease - CHEMO is 20% successful Extensive - CHEMO is <5% successful but most patients respond (Limited verses Extensive Small Cell Lung Cancer) LIMITED - Disease can be encompassed within 1 radiation field EXTENSIVE - Disease outside of 1 radiation field Do patients get Hypercalcemia as a Paraneoplastic Symptom with Small Cell Lung Cancer? NO but they do get other Paraneoplastic Symptoms but NOT HYPERCALCEMIA Typically What percentage of patients are getting Colorectal Cancer & what is the age group that is most commonly involved? What commonly held misbelief is no longer supported regarding colon cancer prevention? Which type of Colorectal Cancer is the most common? What protein marker provides prognostic information regarding colon cancer? What percentage of colon cancer cases have a genetic component to them? (Colorectal Cancer & Age Group) 90% are People OVER 50 (Not True ANymore) High Fiber Diet does not prevent colon cancer (What TYPE of Colorectal Cancer Predominates) Sporadic Colon Cancer accounts for 90% Cases (Protein marker involved in colon cancer) p53 (Genetics and Colorectal Cancer) 10% of cases have GENETIC DISPOSITION What is APC? What is the gene responsible for this cancer type? What percentage of colon carcinoma does APC account for? What age do people have this? (APC) Adenomatous Polyposis Coli (Gene responsible for APC) Tumor Suppressor Gene (5q) (% of All Colon CA's that are APC) 1% (Age) 42 (100 % have it by this age??) What is the most common type of HEREDITARY colon cancer in the western world? What characterizes this cancer type? What about family members for people with this type of cancer? (Most common hereditary colon cancer) Hereditary Non Polyposis Colon Cancers make up 5% of colon cancer in industrialized nations (Characteristics of HNPCC) Adenomatous Polyps in PROXIMAL Colon that OFTEN progress to MALIGNANT DEGENERATION (Family Members of HNPCC Pt's) Higher Risk for other types of cancer http://o.quizlet.com/i/jjVGTe7umxBAZgjcoacNRg.jpg Which screening test for Colorectal Cancer is the MOST effective? How does colon cancer START & Progress? (Most effective Screening Test for Colorectal CA) COLONOSCOPY detects 95% of advanced neoplasias (START & Progression of Colorectal Cancer) STARTS with ADENOMATOUS Polyp which then progresses to CARCINOMA over 10-12 Years. http://o.quizlet.com/i/xAgRb_ZLtYQNz7R3EB1kqg.jpg What is important to understand regarding prostate cancer and men aged 30 and up. What is good about PSA screening today? What are the chances of a 50 year old man getting and dying from Prostate Cancer? What are the stats for African American verses Caucasian Men? (Men over 30 and Prostate Cancer) Men will most likely have microscopic evidence of Prostate Cancer. (Increased incidence of Prostate Cancer Cause) More men surviving into old age (What's good about PSA Screening Today) Easy to obtain multiple samples (Chances of a man aged 50 Dx with & Dying From) 10% Chance of getting Dx'd with Prostate CA 2%-3% Chance of Dying from Prostate CA (African American Vs. Caucasian Men) African American Men = 50% Higher Incidence What role does heredity play in prostate cancer? What dietary factor influences the development of prostate CA? (Heredity) Significant Risk Factor if a Family Member has prostate CA (Dietary Factors Involved) High Fat Diets involved in the progression from Microscopic Prostate CA Evidence to Significant Disease What are the symptoms of prostate cancer? Is Hematuria a sign of prostate cancer? What are advanced signs of prostate CA? (Symptoms are SIMILAR to BPH) Urinary HESITANCY Urinary FREQUENCY Nocturia Impotence (Periprostatic Tissue Involvement) Less Firm Penile Erections (Same Tissue as Above) (Hematuria) NOT a SIGN for PROSTATE CA (Sign of Bladder/Kidney Pathology) (Advanced Signs of Prostate CA) Back Pain (Mets to Vertebrae) Supraclavicular Lymphadenopathy What is PSA? Is PSA always associated with prostate cancer? What is the normal range of PSA and what happens to it over time? Who could have elevated levels of PSA? Who could have normal levels of PSA? (PSA) Prostate Specific Antigen is a protease produced by prostatic epithelium. (PSA and Prostate Cancer) PSA is PROSTATE SPECIFIC but NOT always associated with Prostate Cancer (PSA Normal Range & What Happens Over Time) 0-4 ng/ml *Increases with age (People with elevated Levels PSA Normally) Men with BPH (20% - 45%) SLIGHTLY ELEVATED PSA (Normal PSA Levels) Men with Prostate CA (25% - 45%) NORMAL PSA http://o.quizlet.com/i/34uD8ffKrcnWJv2SfxGwgQ.jpg What happens to the PSA after radiation &/or prostatectomy? When might a PSA be a false positive (4)? Which of the 2 types of PSA found in the blood is produced by prostatic carcinoma? Which PSA is produced by normal cells? (PSA Following Prostatectomy) Drops to 0 *If not, there is still disease present (False Positive PSA) Prostatitis BPH Acute Urinary Retention Recent Ejaculation (Serum PSA from Prostatic Carcinoma) Bound to Plasma Proteins (Bound PSA) (Serum PSA From Normal Prostate Cells) Free PSA http://o.quizlet.com/i/34uD8ffKrcnWJv2SfxGwgQ.jpg What is the difference between Hodgkin's Disease and Non Hodgkin's Lymphoma? Who typically gets Hodgkin's Disease? What about Non Hodgkin's Lymphoma? WHat is the cure rate for HD and NHL? (Difference Between HD & NHL) HD - Systemic Symptoms (Spreads Contiguity) NHL - Non Systemic Symptoms (Disseminates Systemically) (Who Gets Hodgkin's Disease) Young Adults (Who Gets Non Hodgkin's Lymphoma) All AGES (Cure Rates) Hodgkin's (80%) Non Hodgkins Lymphoma (50%) What is the significance of the Reed-Sternberg Cell Pathognomonic? Presence of Reed-Sternberg Cells means POSITIVE HODGKIN's Disease http://o.quizlet.com/i/jcOdtxaSmz9JCmBzLg5tbw.jpg What are the 6 Tumor Markers? What cancer types are associated with each marker? What are the Tumor Markers primarily used for? WHat aren't they used for? (Tumor Markers) AFP (Non Seminomatous Testicular Cancer)(Hepatoma) HCG (Non Seminomatous Testicular Cancer) LDH (Non Seminomatous Testicular Cancer) (NHL) CA 125 (Ovarian Cancer) CEA (Colon Cancer) (Breast Cancer) PSA (Prostate Cancer) (Use of Tumor Markers) Markers used for FOLLOWING RESPONSE TO THERAPY (Not Used For) Screening