TCP Week 9 Breast, Colon, Prostate, and Lung Cancers

[GENERAL] What is a neoplasm?

A broad term for abnormal tissue growth characterized by proliferation of anaplastic cells; a neoplasm may invade surrounding tissues and metastasize and does not necessarily form a solid mass.

[GENERAL] What is a tumor?

A benign or malignant mass/lump formed by abnormal growth of cells.

[GENERAL] Why are neoplasm and tumor not exactly synonymous?

Neoplasm is broader and includes abnormal growths that may not form a mass; a tumor specifically refers to a mass. Leukemia is an example of a neoplasm that typically does not form a solid tumor.

[GENERAL] How does the presentation define cancer?

A disease of failed regulation of cell growth.

[GENERAL] What do oncogenes do?

Promote cell growth and reproduction; mutated oncogenes can cause uncontrolled cell growth.

[GENERAL] What do tumor suppressor genes normally do?

Inhibit cell division and survival; loss or inactivation removes negative regulation of cell proliferation.

[GENERAL] What is apoptosis?

Programmed cellular self-destruction that can occur when major mutations or replication errors are detected; this capacity is often lost in cancer cells.

[GENERAL] What is a carcinoma?

A cancer derived from epithelial cells that line inner or outer body surfaces, such as skin or the gastrointestinal tract.

[GENERAL] What are examples of carcinoma histologies?

Adenocarcinoma, squamous cell carcinoma, anaplastic carcinoma, large cell carcinoma, and small cell carcinoma.

[GENERAL] What is a sarcoma?

A cancer derived from connective/mesenchymal tissue such as muscle, bone, cartilage, or fibrous tissue.

[GENERAL] What is leukemia?

A hematopoietic cancer arising from bone-marrow-derived cells that mature in the bloodstream.

[GENERAL] What is lymphoma?

A hematopoietic cancer arising from bone-marrow-derived cells in the lymphatic system.

[GENERAL] Which cancers are often considered solid cancers?

Carcinomas and sarcomas.

[GENERAL] Which cancers are often considered liquid cancers?

Hematopoietic cancers such as leukemia and lymphoma.

[GENERAL] Approximately what proportion of human cancers are carcinomas according to the lecture notes?

About 90%, in part because epithelial tissues are repeatedly exposed to environmental injury over time.

[GENERAL] What is carcinoma in situ (CIS)?

Cancer that has not penetrated through the epithelial basement membrane.

[GENERAL] What is carcinoma of unknown primary (CUP)?

A carcinoma with epithelial characteristics in which the original primary tumor site cannot be found or is unknown.

[GENERAL] What approaches can help determine the origin of a carcinoma biopsy?

Histologic examination, immunohistochemistry (IHC), molecular testing, and clinical correlation.

[GENERAL] What does histologic examination assess when determining tumor origin?

Tissue architecture and cell type.

[GENERAL] What can immunohistochemistry help assess?

Hormone receptor status, gastrointestinal markers, and other tumor-specific markers.

[GENERAL] What can molecular testing contribute to tumor classification?

Identification of gene mutations and gene-expression profiles.

[GENERAL] Why are carcinomas often considered diseases of older age?

They are commonly related to environmental exposure and cumulative epithelial injury over time; children develop cancers but rarely carcinomas.

[GENERAL] How can cancer kill by local organ effects?

Cancer can damage an organ essential for life, such as the lung or bone marrow.

[GENERAL] How can cancer kill through metastasis?

Metastatic spread to essential organs such as the brain or liver can be fatal.

[GENERAL] How can cancer kill by altering body chemistry?

Tumors can disrupt calcium, clotting, fluid balance, and other systemic processes.

[GENERAL] What is cancer cachexia?

Weight loss, fatigue, muscle atrophy, and weakness occurring in end-stage cancer and some other chronic diseases.

[GENERAL] Why is cancer cachexia clinically important?

It increases the risk of death.

[GENERAL] What mediators are suggested to contribute to cancer cachexia?

Cytokines such as TNF and interferons.

[GENERAL] What treatments are mentioned in the presentation as potentially helpful for cachexia?

Prednisone and medical marijuana; cachexia is generally difficult to treat.

[BREAST] What are the three major tissue components of the breast?

Lobules, ducts, and stroma.

[BREAST] What are breast lobules?

Glandular components of breast tissue.

[BREAST] What does breast stroma contain?

Connective tissue, fat, lymph channels, and blood vessels.

[BREAST] What is the epidemiologic rank of breast cancer in women?

The most common cancer in women.

[BREAST] What is the mortality rank of breast cancer in women according to the presentation?

The second most common cause of cancer death in women.

[BREAST] What is the lifetime risk of breast cancer in women given in the presentation?

About 1 in 8 women.

[BREAST] At what ages is breast cancer predominantly diagnosed according to the presentation?

Approximately 45 to 65 years.

[BREAST] Can men develop breast cancer?

Yes; male breast cancer accounts for less than 1% of breast cancer cases.

[BREAST] What reproductive factor increases breast cancer risk by increasing lifetime hormone exposure?

Nulliparity.

[BREAST] Why may nulliparity increase breast cancer risk?

Pregnancy interrupts ovulatory/hormonal cycles and lowers estrogen exposure for much of pregnancy; nulliparity may therefore result in greater lifetime estrogen exposure and more ovulatory cycles.

[BREAST] How may pregnancy protect breast tissue beyond lowering estrogen exposure?

Pregnancy may induce structural and molecular breast changes, including mammary differentiation, that increase resistance to carcinogenesis.

[BREAST] How does early menarche affect breast cancer risk?

It increases risk.

[BREAST] How does late menopause affect breast cancer risk?

It increases risk.

[BREAST] How does a first pregnancy after age 30 affect breast cancer risk?

It increases risk.

[BREAST] What therapeutic/exposure factors are listed as breast cancer risks?

Estrogen therapy and radiation therapy/exposure.

[BREAST] How does a first-degree relative with breast cancer affect risk?

It increases breast cancer risk.

[BREAST] How does advanced age affect breast cancer risk?

Risk increases with age.

[BREAST] What proportion of breast cancer patients have a significant family history according to the presentation?

About 20%.

[BREAST] Is hereditary breast cancer transmitted only maternally?

No. The presentation says the association may be stronger in the maternal lineage but can also occur paternally.

[BREAST] What family-history pattern suggests a possible BRCA defect?

Multiple first-degree relatives with early breast cancer or ovarian cancer.

[BREAST] What percentage of breast cancers are BRCA-gene-related according to the presentation?

About 5% to 10%.

[BREAST] What type of genes are BRCA1 and BRCA2?

Tumor suppressor genes.

[BREAST] Which cancers in women are strongly associated with BRCA mutations?

Breast and ovarian cancer.

[BREAST] Which male cancer is specifically associated with BRCA mutations in the presentation?

Male breast cancer; prostate cancer is also listed among associated malignancies.

[BREAST] What additional cancers are listed as associated with BRCA mutations?

Prostate, colon, pancreatic cancer, and melanoma.

[BREAST] What breast cancer risk is given for women who inherit a BRCA defect?

The presentation estimates about 80% will develop breast cancer.

[BREAST] Which population is described as having frequent BRCA carriers?

Ashkenazi Jewish individuals.

[BREAST] What is the classic breast cancer presentation?

A single, firm, non-tender breast mass.

[BREAST] Where do approximately 60% of breast cancers occur?

The upper outer quadrant of the breast.

[BREAST] Can breast cancer occur outside the upper outer quadrant?

Yes; it can occur in any part of the breast.

[BREAST] What nipple symptom can occur with breast cancer?

Nipple discharge, which may range from clear to bloody.

[BREAST] What skin changes can occur with breast cancer?

Dimpling, skin thickening, color change, and eczematous changes.

[BREAST] What is peau d'orange?

Breast-skin lymphedema producing an orange-peel appearance.

[BREAST] What nipple position change can suggest breast cancer?

Nipple retraction.

[BREAST] What lymph-node finding may occur with breast cancer?

An axillary mass.

[BREAST] Can breast cancer be asymptomatic?

Yes; some patients are first detected by an abnormal mammogram.

[BREAST] What mammographic finding is suggestive of breast cancer in the presentation?

Calcification.

[BREAST] What ultrasound finding is suggestive of breast cancer?

A solid mass.

[BREAST] What is the role of breast ultrasound in the workup?

To distinguish solid from cystic masses.

[BREAST] What imaging studies are listed for breast cancer evaluation?

Bilateral mammography, ultrasound, MRI, chest X-ray, and sometimes PET-CT for distant metastases.

[BREAST] What initial laboratory tests are listed in the breast cancer workup?

CBC, BMP, and liver function tests.

[BREAST] Are blood tests used to diagnose breast cancer directly?

No; they help assess overall health in the setting of possible cancer.

[BREAST] What is FNA?

Fine-needle aspiration.

[BREAST] What is the preferred breast biopsy method in the presentation?

Large-needle core biopsy.

[BREAST] What other tissue-sampling methods are listed for breast cancer?

FNA, open biopsy/lumpectomy, and cytology of nipple fluid.

[BREAST] What proportion of breast cancers does bilateral mammography typically detect according to the lecture?

About 80%; it is especially useful for small lesions.

[BREAST] Which three biomarkers are routinely assessed on breast tumor tissue?

Estrogen receptor (ER), progesterone receptor (PR), and HER2 status.

[BREAST] What is a false-negative mammogram?

A mammogram that appears normal even though breast cancer is present.

[BREAST] Approximately how many breast cancers may screening mammography miss according to the lecture notes?

About 1 in 8.

[BREAST] Who is more likely to have a false-negative mammogram?

Women with dense breasts.

[BREAST] What should be done if a patient has new breast symptoms despite a recent normal screening mammogram?

Further evaluation is still needed, such as a diagnostic mammogram and/or breast ultrasound.

[BREAST] What is a false-positive mammogram?

An abnormal-appearing mammogram when no breast cancer is actually present.

[BREAST] What factors are associated with more false-positive mammograms?

Younger age, dense breasts, prior breast biopsy, family history of breast cancer, and estrogen use.

[BREAST] What is the major histologic category of breast cancer?

Adenocarcinoma.

[BREAST] What is the most common breast cancer subtype?

Ductal carcinoma.

[BREAST] What is the second most common breast cancer subtype?

Lobular carcinoma.

[BREAST] What other breast cancer subtypes are listed?

Medullary, tubular, inflammatory breast cancer, Paget disease, DCIS, and LCIS.

[BREAST] What does DCIS stand for?

Ductal carcinoma in situ.

[BREAST] What does LCIS stand for?

Lobular carcinoma in situ.

[BREAST] How common is inflammatory breast cancer according to the presentation?

About 1% to 5% of breast cancers.

[BREAST] What is the basic pathophysiology of inflammatory breast cancer described in the notes?

It is a rare, aggressive invasive ductal carcinoma in which cancer cells block lymph vessels in the skin of the breast.

[BREAST] How common is Paget disease of the breast according to the presentation?

About 1% to 4% of breast cancers.

[BREAST] Where does Paget disease of the breast begin?

At the nipple, extending to the areola.

[BREAST] What underlying breast cancer is often present with Paget disease?

Underlying ductal breast cancer, either in situ or invasive.

[BREAST] Is Paget disease of the breast the same as Paget disease of bone?

No.

[BREAST] What defines breast cancer Stage 0 in the simplified lecture staging?

No invasion.

[BREAST] What defines breast cancer Stage I in the simplified lecture staging?

A mass less than 2 cm without spread.

[BREAST] What defines breast cancer Stage II in the simplified lecture staging?

A mass greater than 2 cm or spread to the axilla.

[BREAST] What findings can define breast cancer Stage III in the simplified staging?

A tumor greater than 5 cm, fixed nodes, skin involvement, inflammatory changes, chest-wall involvement, or supraclavicular nodes.

[BREAST] What defines breast cancer Stage IV?

Any tumor size with distant metastases.

[BREAST] In breast TNM staging, what is T0?

Carcinoma in situ, as shown in the lecture's TNM table.