11-Surgical Oncology

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Questions and Answers

What is a key role of the adenomatous polyposis coli tumor-suppressor gene (APC)?

Cell adhesion

Regulation of β-catenin (correct)

Inhibition of apoptosis

Promotion of cell migration

Which of the following alterations does the dysregulation of APC NOT affect?

Migration

Differentiation

Cell-cycle progression

Nutrient uptake (correct)

Which cancer syndrome is typically associated with hereditary nonpolyposis colorectal cancer (HNPCC)?

Li-Fraumeni syndrome

Cowden syndrome

Lynch syndrome (correct)

Tubular adenoma syndrome

At what age is early onset of colorectal cancer typically observed in Lynch syndrome?

44 years old Signup and view all the answers

What is required for the formation of a malignant tumor compared to a benign tumor?

At least four or five mutations Signup and view all the answers

Which of the following is NOT included in the high-risk profiles associated with Lynch syndrome?

Chronic lymphocytic leukemia Signup and view all the answers

Which phase of the cell cycle allows preparation for DNA replication?

G2 phase Signup and view all the answers

What is the Amsterdam criteria used for?

Identifying hereditary nonpolyposis colorectal cancer (HNPCC) Signup and view all the answers

What denotes the normal counterpart of an oncogene?

Proto-oncogene Signup and view all the answers

How can oncogenes be activated or overexpressed?

Translocation, promoter insertion, mutation, or amplification Signup and view all the answers

Which gene was the first tumor suppressor to be cloned?

RB1 Signup and view all the answers

What is the function of growth factors in relation to oncogenes?

They can be mutated or altered leading to cancer Signup and view all the answers

Which of the following is a physiological process regulated by alterations in APC?

Apoptosis Signup and view all the answers

Which aspect of tumor cells allows them to bypass the quiescent state?

Enhanced proliferation capabilities Signup and view all the answers

What is indicated by the prefix 'v-' in oncogene nomenclature?

Viral origin Signup and view all the answers

In which phase do cells exit to enter a quiescent state?

G0 phase Signup and view all the answers

Which of the following is NOT a role of the Rb protein in normal development?

Migration of neural crest cells Signup and view all the answers

What characteristic is associated with the diagnosis of HNPCC-related cancers?

Three or more family members diagnosed with verified cancers Signup and view all the answers

What is the consequence of the RET gene being associated with multiple endocrine neoplasia type 2?

It promotes uncontrolled cell proliferation. Signup and view all the answers

Which statement accurately describes the inheritance pattern of retinoblastoma in children?

Some children with an affected parent develop bilateral retinoblastoma. Signup and view all the answers

What is a significant indicator for diagnosis related to familial cancer syndromes?

Two generations must be involved in the diagnosis Signup and view all the answers

Which of the following is a definitive requirement for confirming HNPCC criteria?

At least one affected member before age 50 Signup and view all the answers

How does the Rb protein contribute to cellular processes?

By regulating apoptosis and influencing cell differentiation Signup and view all the answers

Which factor is NOT relevant to the specification of HNPCC-associated cancers?

Individuals exhibiting symptoms related to cancer of over 50 years Signup and view all the answers

What is the primary goal of surgical therapy in cancer treatment?

To ensure oncologic cure Signup and view all the answers

What must surgeons understand in addition to performing cancer operations?

Alternative treatments to surgery Signup and view all the answers

What does a negative surgical margin indicate?

Absence of cancerous cells at the surgical edge Signup and view all the answers

What are second-echelon nodes in the context of cancer metastasis?

Nodes that receive lymphatic drainage directly from sentinel nodes Signup and view all the answers

Which factor is crucial in determining the operability of a tumor?

Imaging studies defining local-regional disease extent Signup and view all the answers

What might cause false negative biopsy results?

Misidentification of wrong lymph nodes Signup and view all the answers

Which therapy can decrease local recurrence rates in cases with positive margins?

Radiation therapy and systemic therapy Signup and view all the answers

What is a significant complication of preoperative chemotherapy and radiation therapy?

Higher risk of operative infections Signup and view all the answers

Which model is used for estimating the likelihood of a BRCA mutation being present?

Tyrer-Cuzick Model Signup and view all the answers

What is the primary purpose of prognostic markers in cancer assessment?

Predict disease-specific survival Signup and view all the answers

Which of the following is NOT a risk factor used in the Gail Model for breast cancer risk assessment?

Body mass index Signup and view all the answers

MammaPrint is used in the context of what aspect of breast cancer treatment?

Assessing a 70-gene transcriptional signature Signup and view all the answers

What distinguishes predictive tissue markers from prognostic markers?

Predicts patient responses to specific therapies Signup and view all the answers

Which assay is specifically highlighted for predicting recurrence in node-negative, ER-positive breast cancer?

Oncotype DX assay Signup and view all the answers

What is a critical benefit of early cancer screening as stated?

Allows for less invasive surgical options Signup and view all the answers

What is the main goal of targeted therapies in molecular therapeutics?

To exploit differences between normal and cancer cells Signup and view all the answers

Which tumor marker is specifically associated with identifying patients who may benefit from anti-HER2 therapies?

HER2 Signup and view all the answers

Which of the following is not classified as a major group of targeted therapy agents?

Non-specific immune modulators Signup and view all the answers

What is a primary characteristic of protein kinase inhibitors in cancer treatment?

They have shown success in specific cancer types like CML. Signup and view all the answers

What is the function of the BOADICEA model in breast cancer assessment?

Estimating risk based on genetics and family history Signup and view all the answers

Which of the following statements regarding tumor markers is false?

Only produced by cancer cells. Signup and view all the answers

Which of the following statements about Trastuzumab (Herceptin) is correct?

It targets HER2 positive breast cancer. Signup and view all the answers

What mechanism does non-specific immunotherapy primarily utilize?

Administration of bacterial agents or their products Signup and view all the answers

Which option highlights a common misconception about cancer screening?

Screening guarantees cancer will be detected early. Signup and view all the answers

What major factor influences cancer screening guidelines?

The prevalence of cancer within the population Signup and view all the answers

What role do tumor-associated antigens play in cancer treatment?

They help the immune system recognize and attack cancer cells. Signup and view all the answers

Which of the following markers is primarily involved in predicting outcomes related to anti-estrogen therapies?

Estrogen Receptor (ER) Signup and view all the answers

Which of the following describes a potential application of gene therapy in cancer treatment?

To modify the genetic program of cancer cells Signup and view all the answers

Which compound is associated with the treatment of Melanoma?

Vemurafanib Signup and view all the answers

What is the significance of the Tyrer-Cuzick model in breast cancer risk assessment?

It incorporates complex family histories to assess risk. Signup and view all the answers

Study Notes

Surgical Oncology

Surgical oncology is a crucial part of surgical practice, responsible for initial diagnosis and management of solid tumors.
Surgeons need knowledge of cancer epidemiology, etiology, staging, and natural history to assess patients and select optimal surgical therapy.
The primary surgical therapy involves definitive en bloc resection of tumors with adequate margins of healthy tissue and regional lymph nodes.
Adjuvant therapy follows, involving radiation therapy, chemotherapy, immunotherapy, or hormonal therapy.
Modern cancer therapy is multidisciplinary, including surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, pathologists, radiologists, and primary care physicians.
Personalized care incorporates patient tumor characteristics, genome, host immune response, and tumor microenvironment, requiring understanding of molecular oncology.

Epidemiology of Cancer

Cancer incidence varies geographically due to genetic differences and environmental/dietary exposures.
Incidence represents new cases per 100,000 persons per year.
Mortality represents deaths per 100,000 persons per year.
Cohort studies follow a disease-free group over time to measure disease development.
Case-control studies compare patients with and without a disease to identify risk factor relationships.
Relative risk below 1 indicates a protective effect, while above 1 indicates an increased risk.

Cancer Biology

Over 100 cancer types share these six essential alterations for malignant growth:
- Self-sufficiency of growth signals
- Insensitivity to growth-inhibitory signals
- Evasion of apoptosis (programmed cell death)
- Potential for limitless replication
- Angiogenesis
- Invasion and metastasis

Cell Proliferation and Transformation

Normal cells have strict growth control, unlike cancer cells which lack this control.
Cancer cell transformation requires multiple genetic changes.
Transformed cells often display abnormal characteristics: loss of contact inhibition, altered appearance/adherence, loss of anchorage dependence, immortalization, and tumorigenicity.

Cell Cycle Dysregulation in Cancer

Mutations affecting cell cycle proteins, growth factors, growth factor receptors, intracellular signal transduction proteins, and nuclear transcription factors cause unregulated cell growth.
The cell cycle phases (G1, S, G2, and M) are disrupted.

Oncogenes

Oncogenes are abnormal genes linked to cancer formation.
Their normal counterparts are proto-oncogenes.
Oncogenes are often triggered by translocation, promoter insertion, mutation, or amplification.

Apoptosis and Autophagy

Apoptosis is a genetically controlled cell-death process.
Cancer cells often evade apoptosis for tumor growth.
Caspases, intrinsic/extrinsic pathways, and Bcl-2 family proteins are key components.
Autophagy also contributes to cancer cell elimination.

Cancer Invasion

A hallmark is the ability to invade surrounding normal tissue.
In situ cancer cells remain within the basement membrane.
Invasive cancer cells breach the basement membrane and enter the surrounding stroma.
Cadherins and cell-surface proteins affect adhesion and migration.
Extracellular matrix components (ECM) regulate migration through integrin interactions
Angiogenesis, the formation of new blood vessels, is crucial for tumor growth and metastasis

Cancer Etiology and Genomics

Cancer is a genetic disease stemming from genomic alterations.
Alterations involve gain-of-function in oncogenes and loss-of-function in tumor suppressor genes.
Somatic mutations occur within the tumor only, germinal mutations are inherited.

Genes Associated with Hereditary Cancer Risk

Genes like BRCA1/2, APC, and others are involved in hereditary risk.
Factors indicating hereditary cancer risk include :early-onset, bilateral, multiple cancers in a family, cancer in the less affected sex and cancer cluster in relatives.
Hereditary cancers frequently affect multiple tissues.

Viral Carcinogens

Certain viruses contribute to cancer development through various mechanisms (including direct transformation and cytokine secretion), including: Epstein-Barr, Hepatitis B, C, HIV, Human herpes virus 8, human papillomaviruses, Human T-cell Lymphotropic viruses.

Cancer Diagnosis

Physical examination, imaging, and tissue biopsies (fine needle aspiration, core needle, incisional and excisional) are used to diagnose cancer.
Serum markers and tissue pathology assessment are used to evaluate cancer type.
Staging is essential for treatment planning. Different diagnostic methods will vary depending on type of tissue involved.

Radiation Therapy

Ionizing radiation removes orbital electrons from atoms via electromagnetic or particulate radiation (e.g., X-rays, gamma rays).
This damages DNA through single- and double- strand breaks.
Varying radiation types penetrate tissue to varying depths and are used based on particular types of tumors.

Chemotherapy

Chemotherapy targets cancer cells via first-order kinetics.
This eliminates a fixed percentage of cells rather than a constant number of cells.

Hormone Therapy

Some tumors develop under hormonal control.
This is targeted by hormone therapies.
Hormonal manipulation (e.g., drugs stopping production or affecting hormone receptors) are used.

Immunotherapy

Immune responses to cancer cells are manipulated.
This approach can involve non-specific immunostimulation or more targeted treatments.

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Description

Test your knowledge on the role of key genes in colorectal cancer, including the adenomatous polyposis coli (APC) tumor-suppressor gene and Lynch syndrome. This quiz covers the genetic factors, cancer syndromes, and critical criteria associated with these conditions. Challenge your understanding of tumor formation and cellular processes involved in cancer development.