CANCER MEDICINE (ONCOLOGY) Chapter 19 HW Done

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/ { // CANCER-MEDICINE (ONCOLOGY) 831 Answers to questions are on page 841 vFYI: OTHER MALIGNANT TUMORS Pk Soecy, TN S A number of malignant tumors do not contain the combining form carcin/o or sarc/o in their names. MALIGNANT TUMOR DESCRIPTION glioma primary brain tumor ;4 hepatoma liver tumor (hepatocellular carcinoma) 3? hypernephroma kidney tumor lymphoma lymph node tumor ‘ melanoma tumor of pigmented skin cells ‘ mesothelioma tumor of cells within the pleura | multiple myeloma bone marrow cell tumor ; . thymoma thymus gland tumor | .Questlons about FYI: Other Malignant Tumors 1. Which tumor develops from a dysplastic nevus? '!T-Q/‘J; NOYW (A \ 2. Which tumor arises from an organ located within the mediastinum? VWO G . 3. Which tumor arises from an organ in the RUQ of the abdomen? ___ NP AL A 4. Which tumor has types called astrocytoma, ependymoma, glioblastoma multiforme? B ___ﬂ}h&a_ \ 5. Which tumor is also known as a renal cell carcinoma? g* =3 . Which tumor is characterized by large numbers of plasma cells (bone marrow antibody-producing o cells)? Ybegle Wuthoenie 7. Which tumor arises from membrane cells surrounding the lungs? \\‘3‘g 35‘\ oy 8. Which tumor has a type known as Hodgkin disease? Mﬂ__ CASE STUDY: SUSPECTED BREAST CANCER A 52-year-old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o’clock position, 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted.

— e e v 832 CANCER MEDICINE (ONCOLOGY) »scribed a gross specimer An excisional biopsy of the mass was performed. The pathology report described a gross Sp¢ : fatty breast tissue. Microscopic evaluation of the nodule revealed an invasive JH_AU‘ carcinoma margins of the lumpectomy specimen were free of tumor. Sentinel node [first lymph node where car cells are likely to spread] biopsy revealed no tumor involvement . A portion of the specimen was sent for estrogen receptor assay and proved to be positive The patient was informed of the diagnosis and underwent additional studies, including chest x-ray liver ¢ CBC, and bone scan; all results were negative. The patient’s tumor was staged as a TINOMO0, stage | carcinoma of the left breast She was referred a radiation oncologist for primary radiation therapy. After completion of radiotherapy she was treated w tamoxifen. Prognosis is excellent for cure. hemistrie Questions about the Case Study 1. Where was the primary breast lesion located? a. Under the pigmented area of the breast b-"About an inch and a half above and to the left of the nipple and pigmented area c. Near the axilla and under the shoulder blade 2. Other associated findings were a. Redness and swelling b. Enlarged lymph nodes under the armpit ¢.'None of the above 3. The tumor was composed of a. Dense connective tissue surrounding the tumor cells, giving it a hard structure b. Glandular tumor with invasion of surrounding tissue c. Cells that had extended into the skin overlying the tumor 4. What procedure gave evidence that the tumor had not yet metastasized? a. Estrogen receptor assay b. Excisional biopsy of the mass ¢. Sentinel node biopsy 5. What additional therapy was undertaken? a. Bone scan, liver chemistries, CBC, and chest x-ray b. Radiation to the breast ¢. Radiation to the breast and then treatment with an estrogen blocker 6. Tamoxifen was prescribed because a. The tumor was found to be nonresponsive to estrogen b. The tumor had an estrogen receptor, and tamoxifen is an antiestrogen ¢. The tumor was at an advanced stage CHART ROUNDS REVIEW: CENTER FOR RADIATION ONCOLOGY Patient A has metastatic melanoma, with severe chest pain on deep breathing (with one metastasis involving a rib). He is being treated palliatively with 3000 cGy to the painful area. Patient B is being treated for esophageal carcinoma. Because of previous treatment for breast cancer, the radiation dose to the recurrent field is limited to 3000 cGy. Patient C is being treated for a pathologic stage I Hodgkin lymphoma with a radiation field to the mediastinum and adjacent lymph nodes. Patient D is being treated for a GBM [glioblastoma multiforme]. The plan for appropriate fields of irradiation needs to be signed.

————————— CANCER MEDICINE (ONCOLOGY) 833 (@m'uestions about the Chart Rounds Review 1. Which patient is being treated for a brain tumor? ANLE ) 2. Which patient is being treated for lesions in the ribs? QN 3 3. Which patient has disease in cervical and thoracic lymph nodes? _\x 4¢ — 4. Which patient is being treated for gastrointestinal cancer? ____ \(fa*%onX T ) PATHOLOGY REPORT: RESECTED SPLEEN, GROSS DES?RIPTION The spleen weighs 127 grams and measures 13.0 x 9.2 cm. External surface is smooth, leathery, homogeneous, and dark purplish brown. There are no defects in the capsule. The blood vessels of the hilum of the spleen are patent [open], with no thrombi or other abnormalities. On section of the spleen at 2- to 3-mm intervals, there are three well-defined, pale gray nodules on the cut surface, ranging from 3.0 to 4.0 cm in greatest dimension. The remainder of the cut surface is homogeneous and dark purple, and the tissue consistency is firm. Possible diagnosis: Hodgkin lymphoma. Question about the Pathology Report 1. Which information leads the pathologist to the diagnosis of possible Hodgkin lymphoma? | a. Blood clots in patent blood vessels | b. Capsular defects ¢. Uniform, smooth surface = d. Large, pale nodules in spleen SHORT HISTORIES \s you read these actual patient histories, congratulate yourself on your understanding of medical terms! 1A ear-old man feels a hard, nontender mass in his right testicle. He goes to his doctor, who checks his serum human chorionic gonadotropin and alpha-fetoprotein levels and finds both to be quite elevated. The tentative diagnosis is a germ cell tumor of the testis. A CT scan of the abdomen reveals extensive lymphadenopathy. A chest CT shows nodes in both lungs suggestive of tumor. An orchiectomy confirms the diagnosis of testicular cancer. He is given four cycles of chemotherapy with vinblastine, cisplatin, and bleomycin, and his serum AFP and HCG markers return to normal. His CT scans reveal no evidence of residual tumor. [ A 42-year-old woman notices repeated episodes of red blood in her stool with each bowel movement. A colonoscopy reveals a 4-cm mass arising from the epithelium of the rectum. A biopsy demonstrates a rectal adenocarcinoma. An abdominal CT shows two large metastases in the liver and enlarged lymph nodes. She first receives four cycles of chemotherapy, which cause the liver lesions to shrink significantly and the lymph nodes to regress. The remaining liver lesions are surgically resected. Radiation therapy with chemotherapy (5-fluorouracil) is then administered to shrink the rectal tumor and lymph nodes, after which the rectal mass shrinks to a small 1-cm nodule. This is resected surgically. The lymph nodes are removed and contain no tumor. 3. A 62-year-old man has a routine PSA blood sample drawn. PSA is elevated at 5.8 (normal is less than 4.0). A transrectal biopsy of the prostate reveals a Gleason grade 6 adenocarcinoma in 4 of 12 biopsy pieces. He chooses to be treated with brachytherapy. Treatment causes dysuria, cystitis, and proctitis, but these symptoms disappear 3 weeks after therapy ends, and his PSA is now undetectable.

834 CANCER MEDICINE (ONCOLOGY) Remember to check your answers carefully with those given in the Ar o . i y tions as Identify the following characteristics of malignant tumors based on their defini ! given below. Word parts are given as clues l 1. loss of differentiation of cells and reversion to a more primitive cell type | ana \"““» = ] L'\m 2. extending beyond the normal tissue boundaries: n Y [ YAV L 1 3. having the ability to enter and destroy surrounding tissue: it VD5\W& L B y 4. spreading to a secondary site: meta € 725~ 0 Match the terms or abbreviations with the definitions/descriptions that follow | chemical carcinogen mitosis RNA | DNA mutation _ virus radiation - oncogene 1. replication of cells; two identical cells are produced from a parent cell . change in the genetic material of a cell __ "\N\UXOX\0eN [ S+ 3. genetic material within the nucleus that controls replication and protein synthesis _ONEy 4 4. cellular substance (ribonucleic acid) that is important in protein synthesis ‘ i b ; _WNW f 5. energy carried by a stream of particles _ {00.a %100 6. infectious agent that reproduces by entering a host cell and using the host’s genetic materi make copies of itself __ VI{ys ] region of genetic material found in tumor cells and in viruses that causes cancer — O0ohaNg. J 8. an agent (hydrocarbon, insecticide, hormone) that causes cancer _ W\ U M ONOeA G Give the mea\i:ms of the following terms. L. solid tumor, TN (AR gl G (WNRSS O (N ___ = 2. ade : 3 s A\ s &. adenoma __ YN O MMM SO - . ) - i - s fNeanl o f 4 X\ A { 3. adenocarcinoma _\ N\ 05 AL Nl - - Y] 3 S L S . \ - — 4. osteoma ____ A ypy A e NN

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