surgery paperchase 110502

7/31/2019 Surgery Paperchase 110502

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Surgery Paper Chase

11/05/02 4-5PMSurgical Oncology

Dr. Bracers

I. IntroductionA. 90% solid tumors need surgery, biopsy, for complicationsB. all patients of cancer, should be evaluated in multidisciplinary medicine

between medical, surgical and radiation oncologistsII. most commons

A. most common cases: men (prostate > lung > colon) women (breast > lung> colon) page 1

B.page 2: breast increased, lung has increased then stabilizedC.page 3: prostate had peak in 92, then decreased, prostate cancer found with

PSA which has increased number of reported casesIII. page 4: probability developoing cancer throughout life

A. in men its 1 in 2B. in women its 1 in 3C.breast varies with age, from 1 in 235 to 1 in 8 throughout lifeD. colon and rectum: birth to death 1 in 18 for both women and femaleE. lung and bronchus: men its 1 in 12, women its 1 in 18F. prostate: 1 in 6

IV. page 5A. recommendations for early detectionB.breast: annual mammogram starting at age 40 (before it was 50), in Puerto

rico, if its negative at 40, then they repeat every 2 years until 50 years

when begin every yearC. colorectalD.prostate: controversialV. page 6: Cell has mechanism so that when detects DNA defect, can protectbody from proliferating these abnormal cells

VI. Page 7A. G0: resting state, regular cell functionsB. G1: when begin to produce proteins for nucleic acid synthesisC. S: when begins DNA synthesisD. G2: discontinues DNA synthesis, continues developing proteins and RNAE. M phase: mitosisF. Cyclones: activate phases of cell cycleG. Tyrosine kinases: cyclones activate and direct actions of specific tyorisine

kinases called cyclin dependent kinasesH. Checkpoints: before mitosis, before DNA synthesisI. Apoptosis

VII. page 8A. P53: deals with checkpoint at synthesisB. Germ cells: meiosis, reproduce themselves indefinitelyC. Stem cells: reproduce and produce cells destined to differentiate and

perform specialized functions of the breast


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Surgery Paper Chase 11/05/02 4-5PM Surgical Oncology Dr. Bracers 2

D. Partially differentiated cellsE. Fully mature specialized cellsF. Differentiation inversely related to immortality: only 50

replications/fibroblast, for example

G. Clonal origin: originate from single abnormal cellsH.

Field defect: cancers arise from multiple cells and multiple malignantclones

I. Immortality: telomeres, the ends of chromosomes, are shortened as cellsdifferenteiate, but cancer cells teleomeres are replenished by telomerase

VIII. page 9A. Loss of contact inhibition and anchorage dependent growth: normal cells

dont continue growing when no longer anchored to solid substratum

B. Progressive independence of proliferation from growth factors andnutrients noted in cancer cell cultures: reproduce so many that use up

their nutrient supplyC. Metastasis: detachment of cells from primary tumor, infiltrate the blood

vessels (intravasation), loss of or abnormalities of cellular proteinsresponsible for adhesion to the extracellular matrix

D. Causes of overproduction of cancer cellsE. Failure of abnormal cells to undergo apoptosis

IX. page 10A. tumor suppressor gene abnormality: suppresses proliferation of cells,

BRCA1,2 is hereditary tumorB.p53: see page 21, if one tumor suppressor gene damaged, not enough,

need both genes damagedC. li fraumeni syndrome: mutant p53, brain, leukemia, breast, etc, hereditary

autosomal dominant syndrome of both soft tissue and epithelial cancers at

multiple sitesD. tumor angiogenesis: vascular endothelial growth factor (VEGF), can bedifficult to locate primary tumor if tumor elaborate angiogenesis inhibitors

to stop growth at primary siteX. Carcinogenic viruses: page 14 and 15

A. HTLV-1: lymphoblastic leukemia in south japan, only virus that is provento cause cancer

B. htlv 2 causes hairy cell leukemiaC. Htlv 3 associated with HIV and kaposis sarcomaD. DNA viruses: HPV 80% uterine cervical cancer cells have it, but not

causes uterine cancer only

E. EBV: infects B lymphocytes, when exposed to other proliferative stimuli,such as malaria, malignancy results, medical missionary dr. burkitt had

neck tumor in Africa, saw children with this, he was visiting another dr.what do you do with this child, related with incidence of malaria, found

chemo worked on them, found relationship between diet in fiber and coloncancer

F. Hepatitis B: HCC


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Surgery Paper Chase 11/05/02 4-5PM Surgical Oncology Dr. Bracers 3

G. Malignant transformation: steps of signal transduction not important, useas reference only (page 16-18)

XI. otherA. Page 19: oncogenesB. Page 20: virus related cancers, table formatC.

Page 22: tobacco, alcohol,D. Page 23: Ionizing radiation, asbestos (peritonem, pleura), UV (basal,squamous, melanoma), electromagnetic field (glioma)

XII. Page 24: diagnosis, Biopsy: routelinly placed in formalin, shortcomingsXIII. Page 25: tumor markers

A. Brca1B. Tumor markers in blood or other body fluidsC. Medullary thyroid carcinoma: calcitoninD. Ca 15-3: breastE. Ca 125: ovary, not for screening, but for follow upF. CEA: breast, lung, colorectal, not screening, good for follow upG.

HCGH. LDH: seminoma, high grade lympohoma

I. Neuron specific enolase (NSE): neuroendocrine tumors, neuroblastomaJ. Ca 19-9: pancreas cancer

XIV. page 28: grading and stagingA. first treatment should be definitive, if not, then the patient cure may not be

achievedB. histologic grading determines degree of anaplasia grade I (very well

differentiated, not aggressive) to grade IV (less differentiated, aggressive)XV. page 29: tumor doubling time (TDT)

A. growth rate, measure aggressivityB.

useful with pulmonary metastasis, can see with xray and measure doublingtime

C. TDT varies from 8-600 days, but majority are from 20-100 daysD. Peripheral tumor in lung, measure doubling time, if its less than 20, then

dont recommend surgery, if its between 20-40, dont need to be ineligible

for surgery, if its more than 40, then have better tchance survival afterresection

XVI. terminologyA. complete remissionB.partial remissionC. minimla remissionD.progression

XVII. indications for RTX: page 31A.beforeB. number of days, dosisC. emergeneyc palliative radiation: spinal cord compression, superior vena

caval syndrome, airway obstruction, cranial nerve compression

D. obstruction, bleeding are indications for surgery emergency

surgery paperchase 110502

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