diagnosis and treatment of neoplasia

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Questions and Answers

What is the primary purpose of fine needle aspiration biopsy in cytopathology?

To provide tissue architecture

To eliminate the need for surgery

To perform genetic analysis of tumors

To yield floating cells for analysis (correct)

Which aspect of cancer biology can be analyzed through molecular pathology?

Only individual genes

Physical characteristics of tumors

Epigenetic modifications and metabolism (correct)

Patient's clinical history

What does The Cancer Genome Atlas (TCGA) primarily focus on?

Developing new chemotherapy protocols

Studying side effects of radiation therapy

Determining patient eligibility for clinical trials

Classifying cancer types at a genomic level (correct)

Why are serum tumor markers significant in cancer management?

They assist in screening and monitoring treatment response Signup and view all the answers

What type of cells or DNA does a liquid biopsy detect?

Circulating tumor DNA or cancer cells Signup and view all the answers

What is an advantage of molecular tests in oncology?

They provide information about genetic aberrations for targeted therapy Signup and view all the answers

What percentage concordance is reported for margin status determination in head and neck squamous cell carcinoma (H&N SCC)?

98% Signup and view all the answers

Which technique allows for the comprehensive analysis of expressed RNA in cancer research?

Transcriptome analysis Signup and view all the answers

What is the primary purpose of tumor staging in cancer management?

To measure the extent and spread of cancer in the body Signup and view all the answers

Which imaging technique is best for evaluating the extent of disease for staging purposes?

CT scan Signup and view all the answers

Which of the following best describes the TNM system used in tumor staging?

A classification based on tumor size, lymph node involvement, and metastasis Signup and view all the answers

Which statement about the Warburg effect is true?

Cancer cells depend on aerobic glycolysis for energy, requiring large amounts of glucose. Signup and view all the answers

What factors are discussed during a tumor board meeting for a cancer patient?

Patient overall health and treatment algorithms Signup and view all the answers

In which oncology discipline is the management of cancer achieved through the use of surgical procedures?

Surgical oncology Signup and view all the answers

What is the significance of well-differentiated and poorly-differentiated squamous cell carcinoma (SCC)?

They indicate the degree of histological similarity to normal tissue. Signup and view all the answers

What is the key prognostic factor that is often considered more important than tumor grade?

Tumor size and lymph node involvement Signup and view all the answers

What is a common side effect of chemotherapy affecting rapidly dividing tissues?

Mucositis Signup and view all the answers

Which technique minimizes radiation exposure to normal tissues while delivering the required dose to cancer cells?

Intensity modulated radiation therapy (IMRT) Signup and view all the answers

What complication can arise from hematopoietic stem cell transplantation related to immune reaction?

Graft-versus-host disease (GVHD) Signup and view all the answers

Which of the following is a long-term side effect of radiation therapy for head and neck cancers?

Xerostomia Signup and view all the answers

How is chemotherapy most often administered for treatment?

As monotherapy or in combination Signup and view all the answers

What type of chemotherapy uses drug combinations to enhance treatment effectiveness?

Combination therapy Signup and view all the answers

What percentage reduction in salivary gland function is expected after the average radiation dose for head and neck cancer?

75% Signup and view all the answers

Which of the following classifications of chemotherapy is known for its potential to interfere with DNA replication?

Alkylating agents Signup and view all the answers

What is the mechanism by which radiation therapy primarily induces death in cancer cells?

Generating DNA-damaging free radicals Signup and view all the answers

What is a potential risk associated with the use of alkylating agents in chemotherapy?

Secondary malignancies Signup and view all the answers

Which term describes chemotherapy given before surgery to reduce tumor size?

Neoadjuvant chemotherapy Signup and view all the answers

Which treatment technique requires the surgical implantation of radioactive sources directly near the tumor?

Brachytherapy Signup and view all the answers

What common complication of chemotherapy may lead to a life-threatening situation due to rapid tumor cell death?

Tumor lysis syndrome Signup and view all the answers

Study Notes

Medical Specialists

Surgical oncologist, medical oncologist, and radiation oncologist manage different aspects of cancer care.
Radiologists interpret medical images, like CT scans, MRI, and PET/CT scans.
Pathologists examine tissue samples to confirm diagnosis and provide information about the type of cancer.

Cancer Management

Treatment combinations include surgery, chemotherapy, and radiation therapy.
Treatment decisions consider inherent cancer biology, stage, and patient health status.

Surgical Management

Surgery typically targets the primary tumor and may involve lymph node dissection.
Surgery is usually performed with curative intent and is generally not appropriate for stage IV cancers.
Surgery may involve chemotherapy before or after the procedure.
It can lead to loss of function and cosmetic changes.

Radiation Therapy

Sometimes used as the primary treatment, but often administered after surgery.
Typically delivered in numerous fractions over several weeks.
Given as an outpatient procedure.
Linear accelerators (LINACs) are commonly used to deliver radiation.

Radiation Therapy: Dosage and Side Effects

Average total radiation dosage: 45-60 Grays.
Exact dosage depends on the patient's characteristics and cancer type.
Delivered in smaller fractions to minimize side effects.
Side effects include fibrosis, skin atrophy, and organ dysfunction.
There is a rare risk of developing radiation-induced sarcoma.

Side Effects of Head and Neck Radiation Therapy

Most common long-term effect is salivary gland damage and xerostomia.
Even low doses can cause permanent damage to salivary glands.

Radiation Therapy Techniques

Intensity-modulated radiation therapy (IMRT) delivers radiation beams from multiple sources to minimize damage to surrounding tissues.
Brachytherapy delivers radiation internally using implanted sources, minimizing radiation exposure to healthy cells.

Chemotherapy

Uses cytotoxic drugs to treat cancer.
Chemotherapy is administered systemically and can be used for all stages of cancer.
Over 100 chemotherapy drugs exist, with different mechanisms of action, including alkylating agents, antimetabolites, anti-tumor antibiotics, topoisomerase inhibitors, and mitotic inhibitors.

Chemotherapy: Administration and Purpose

Can be used as monotherapy or in combination with surgery and/or radiation.
Neoadjuvant chemotherapy is given before surgery to reduce tumor size.
Adjuvant chemotherapy is given after surgery and/or radiation to eliminate any remaining cancer cells.

Chemotherapy and Hematologic Malignancies

Often used as the primary treatment for hematologic malignancies like acute lymphocytic leukemia.
Induction chemotherapy: intensive 1-month regimen to achieve remission.
Maintenance therapy: lower-dose chemotherapy for several years to prevent relapse.

Mechanism of Action and Side Effects of Chemotherapy

Cytotoxic effects are achieved by impairing cell division leading to apoptosis.
Rapidly dividing cells, like cancer cells, are particularly susceptible to cytotoxic effects.
Chemotherapy affects both cancer cells and normal cells.
Common side effects include mucositis, pancytopenia, and accelerated aging.
Side effects may occur at locations distant from the tumor.

Chemotherapy and Mucositis

An acute complication affecting the gastrointestinal tract.
May cause treatment interruption.
Oral mucositis can be debilitating.

Chemotherapy and Massive Tumor Cell Lysis

Massive tumor cell lysis can occur following successful chemotherapy.
Release of intracellular contents can lead to medical emergencies, like nausea, vomiting, diarrhea, heart failure, renal failure, and even sudden death.

Chemotherapy and Secondary Malignancies

Alkylating agents can cause secondary malignancies due to their mutagenic effects.
Acute myeloid leukemia is a common secondary malignancy.

Targeted Therapy

Targets specific cells, minimizing side effects compared to cytotoxic chemotherapy.
Not entirely without side effects, as normal tissues with targeted signaling pathways can be affected.

HER2 Amplification in Breast Cancer

Certain breast cancers exhibit HER2 amplification, increasing cell sensitivity to growth stimuli.

Trastuzumab (Herceptin)

A targeted therapy that binds to the HER2 receptor, blocking downstream signaling and leading to immune destruction of targeted cells.

Chronic Myelogenous Leukemia (CML)

Characterized by the Philadelphia chromosome (t(9;22) chromosomal translocation)
Produces BCR-ABL oncogene.

Imatinib (Gleevec)

A BCR-ABL tyrosine kinase inhibitor.
Induces sustained remission in CML patients.

BRAF Inhibitors

Dabrafenib is a BRAF inhibitor that has shown effectiveness in reducing tumor volume in patients with ameloblastoma.

Chemotherapy and Immunotherapy

Immunotherapy enhances the host's immune response to fight cancer.
Cancer cells can downregulate the immune system by activating immune checkpoints.
PD-L1 and PD-L2 interact with the PD-1 receptor on T cells, promoting apoptosis.

Checkpoint Inhibitors

Antagonize PD-1 or PDL-1 receptors.
Enhance the immune system's ability to recognize and destroy cancer cells.
Durable remission is uncommon.

Chimeric Antigen Receptor (CAR) T-cells

Genetically engineered CD8+ T-cells, specifically designed to target cancer cells.
Infused for the treatment of cancer.

Immunotherapy Side Effects

Inflammatory side effects can occur, like colitis, rashes, polyendocrinopathies, cytokine storms, and neurotoxicity.
Generally safer than chemotherapy.

Epigenetic Targets

Several FDA-approved therapies targeting epigenetic mechanisms are emerging.

Chemotherapy and Drug Resistance

Genomic instability and alterations can lead to chemotherapy and targeted therapy failure.
Acquisition of drug-resistant mutations may occur.

Hematopoietic Stem Cell Transplantation (HSCT)

HSCs are progenitor cells responsible for all blood cell types.
Potentially curative treatment for hematologic malignancies.
Involves replacing the recipient's HSCs with those from a donor.

HSC Transplantation: The Basics

HSCs harvested from donors can be derived from bone marrow, peripheral blood, or umbilical cord blood.
Before transplantation, the recipient's immune system is suppressed using chemotherapy and/or radiation therapy.

Complications of HSCT

Immunodeficiency: Frequent complication due to pre-transplant treatment, myeloablative preparation, and delayed immune system recovery.
Graft-versus-host disease: Occurs in 30-70% of transplants.
Prophylactic immunosuppression is crucial to manage these complications.

Clinical Management of Cancer Disease

Multiple specialties are involved in cancer management, including surgery, pathology, radiology, and oncology.

Immunohistochemistry

Uses specific antibodies to identify proteins within tissues.
This technique can help to classify difficult-to-diagnose tumors, which can be helpful in treatment planning.

Tumor Staging

A system for measuring the extent of cancer spread.
A significant prognostic factor, more important than tumor grade.
Based on the TNM system:
- T: Size of primary tumor
- N: Presence or absence of lymph node metastases
- M: Presence or absence of distant metastases

Radiographic Imaging for Tumor Staging

CT, MRI, and PET/CT scans are used to assess the extent of tumor spread for staging purposes.

PET/CT

Provides metabolic information by using a radioactive tracer (fluorodeoxyglucose, F18) which is taken up by cells with high metabolic activity.
Cancer cells are PET-avid due to their reliance on aerobic glycolysis.

Oncology

Deals with the management of cancer.
Surgical, radiation, and medical oncology treat cancer using different approaches.

Tumor Board

A multidisciplinary cancer conference to discuss diagnosis, treatment options, and prognosis for individual patients.
Decisions are reached regarding treatment intent, patient's ability to withstand therapy, and margin status of resected tumors.

Cytopathology

Fine needle aspiration biopsy and exfoliative cytology yield cell samples without tissue architecture.
Provides definitive diagnosis or sufficient information for patient management.

Molecular Pathology

Includes analysis of:
- Genome
- Transcriptome
- Epigenome
- Proteome
- Metabolome
Can facilitate diagnosis and identify targetable genetic aberrations.

The Cancer Genome Atlas (TCGA)

National Cancer Institute project aiming to classify cancer types at the genomic level.

Serum Tumor Markers and Liquid Biopsy

Serum tumor markers: Proteins released by tumors into the blood.
Useful for screening, monitoring treatment response, and detecting recurrence.
Liquid biopsy detects cancer cells or circulating tumor DNA (ctDNA) in the blood.

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Description

Explore the roles of various medical specialists involved in cancer care, including surgical, medical, and radiation oncologists. This quiz covers important treatment strategies, surgery protocols, and the significance of radiation therapy in managing cancer effectively. Test your knowledge of comprehensive cancer care management.