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Block 7 - Week 8/9
cancer and nutrition
75
Chemistry
Graduate
12/03/2009

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Cards

Term
Breats cancer increases with age, family history. From age 20-40 they should inspect 2-3 years. What imaging modality?
Definition
Mammography, then ultrasound, then mri
Term
What is diff btw benign and malign breast cancer on ultrasound?
Definition
Beingn ovla, clear borders, parallel to skin; malign is irreg shape, taller, bad margins
Term
T or f, Swelling of breasts with tenderness may not be equal and varies with cycles and does not require treatment.
Definition
True
Term
Nodularity in boobs is general pattern of lumpiness.
Definition
What is treat/
Term
Mastalgia is usually unilateral, frequent before menopause, what is treat for mild and severe?
Definition
NSAID, estrogen blockade with danazol
Term
Bilateral nipple discharge is almost always benign, if unilateral and bloody what are two causes?
Definition
Intraductal papilloma(can turn malign) or ductal ectasia
Term
The most common cause of unliateratal bloody nipple discharge is intradutal papilloma, rarely palpable in age 40 to 50, what is treat?
Definition
Excision
Term
Mastitis is uncommon in non-lac women and rarely becomes abcess. What is treatment for abcess?
Definition
Surgical or aspiration with preop antibiotics
Term
A benign dominant mass in breast is unchanging lesion thru 2-3 cycles. What is diff btw 3 types - gross cyst, galactocele, fibroadenoma.
Definition
GROSS CYST si fluid filled epithelial lined, well circumscribed, non classic symptoms; milk filled cyst caused by duct blockage; small, mobile, solid mass, mildly hormone sensitive, painless. None can be differentiated from gross cyst on palap, and treat is usually aspiration or excision
Term
Which of the following have an increase in cancer risk - CYST, DUCTAL ECTASIA, FIRBOADENOMA, MILD EPITHELIAL HYPERPLASIA, FIBROSIS, MASTITIS, MILD SCLEROSING ADENOSIS, METAPLASIA (SQUAMOUS OR APOCRINE).
Definition
None. Anythings else increases risk
Term
What is more common type of breast cancer - sporadic, fmaillial, hereditary.
Definition
Sporadic
Term
Which ehtnicty has highest prob of breast cancer and what are secondary risk factors other than BRCA1/2?
Definition
Whites, early menacrh, nullparous, HRT, late menopause, late preggers,
Term
Which is a true pre-malignant lesion ductal (comedo or non-comedo) of lobular breast carcinoma in situ?
Definition
Ductal
Term
What are the treat for ductal carcinoma in situ?
Definition
Local surgery, rads, node biopsy if large
Term
HER2/neu is a growth factor receptor causing breast cancer, when does it become oncogene?
Definition
When it loses its extracellular ligand binding domain; treated with herceptin aka transtuzamab
Term
SERMs is for treatment and prophylazis of breast cancer and anastrazole is only for treatment in postmenpasual women, what is mech?
Definition
Competitive estrogen receptor inhib, aromatase inhi8hnb
Term
T or f, Cronic inflammation can lead to cancer such as UC, Crohns, h. pylori gastris, viral hep, chronic panc.
Definition
true
Term
Barrets esophagus puts you at higher risk for what type of cancer?
Definition
Adenocarcin
Term
ID which type of gastric carcinoma in the groups. 1. gland forming that resmbles colon, precursor lesions. 2. sheets of cells have mucin vacuole, no precursor.
Definition
1 is intestinal 2 is diffuse or signet type
Term
The stomach normally has no MALT. But H. pylori can cause B-cell lymphoma of MALT because it is most common site for extranodal lymphoma. Can you treat the H. pylori?
Definition
Yes 50% respond to antibiotics
Term
Endocrine tumors microscopically have sheets of monotonous cells in islands and trabeculae, round nucles with salt and pepper chromatin, and scant eosinophilic cytoplasm. Name a well and poor differentiated tumor.
Definition
Well is carcinoid, poor is small cell
Term
Most common site of carcinoid tumors are in small intestine. What is the carcinoid syndrome?
Definition
Tumors secrete 5-HT. if in bowel no prob cause of liver. If mets, then right heart fibrosis, flushing, palpitations, asthma, HTN
Term
GI stromal tumors are difficult to predict malign behavior but are known mesenchymal sarcomas. What gene is positive in this disease?
Definition
cKit
Term
Which is a risk for CRC, high fat diet or low fiber?
Definition
Both
Term
Prevention of CRC involves calcium, cox-s inhibs, hormonal therapy. When should detection begin for regular and high risk fuckers?
Definition
50 yrs, 40 repeat every ten
Term
This gene is in 85% of polyps, 5q21, adhesion molecule, interacts with beta catenin, seen in familial adenomatous polyposis.
Definition
APC
Term
This genetic syndrome has APC muatation, thousand sof polyps, 100% chance of cancer, auto dom, pancolonic.
Definition
FAP
Term
Which of the following gene mutations are involve in the pathway for CRC that starts with normal tissue>adenoma>cancer - 5q deletion, Kras, 18q deletion (DCC, SMAD2/4), p53, MMR mutator pathway causing microsatellite instability.
Definition
All
Term
Most colonic adenomas are asymptomatic, but can have bleeding, anemia-microcytic, obstruction, and changes in bowel movements. What are poor prognostic indicatiors?
Definition
Obstruction or perforation; microsatellite instable is good prog
Term
Stage 1-3 CRC treatment is surgery with 5-FU/LV or rads for rectal cancer. What about stage 4?
Definition
Chemo and biologics, sugery only if symptomatic
Term
What are the two types of bioligcs used in CRC?
Definition
Angiogenesis inhibs and VEGF/EGFR antags like rhumab VEGF and cetuximab
Term
What is the first biomarker in colon cancer?
Definition
K-ras
Term
Esophageal squamous cell carcinoma is greater in men, blacks, tobacco, alcohol, celiac, HPV. Another etiology involves failure of LES via loss of myentreric plexus and a syndrome with dysphagia, glossitis, and Fe def anemia. What are they?
Definition
Achlasia, Plummer-Vinson Syndrome
Term
For early gastric and esophageal cancer what is treatment?
Definition
Endoscopic
Term
Gastric cancer occurs highly in san marino, costa rica, and japan. What dietary risks?
Definition
Carbs, nitrates liks veges and preserve, high salt intake
Term
T or f, Fecal occult blood and hepatomegaly are signs for both esophageal and gatrisc cancer.
Definition
True
Term
Which of the hereditary factors can cause pancreatic cancer? familial atypical multiple mole melanoma syndrome, familial breast cancer (BRCA2), Peutz-Jeghers syndrome, and hereditary pancreatitis.
Definition
All
Term
Esopho/GI/Colon cancers are predominatly male.
Definition
True; COX2 is overexpressed in maligs and can confer resistance to apop, stim cell prolifer and invasion, and angiogenesis
Term
When doing helical ct for pancreatic cancer why is contrast timed to arterial phase?
Definition
Because the cancer is poorly perfused with blood and this helps to image it
Term
A pancreatic cancer patient can have surgery if the disease is local. What is the procedure called and what eventually kills people?
Definition
Whipple, recurrent systemic disease
Term
Chemo for pancreatic cancer is 5-FU and leucovroin and dipyridamole, but what performed better than 5-FU?
Definition
Gemcitabine
Term
The non-endocrine mechanisms of H. pylori in clued enzymes, bacterial adherence, urease/ammonium choloride release. What are its endocrine pathogenicities?
Definition
Increased gastrin release associated with cytokines, ammonia production downs somato by D cells
Term
In addition to somato inhibiting gastrin, CCK, and enzyme secretion it also does what to help with variceal, fistula, neuroendocrine tumors of GI?
Definition
Decreases bloodflow to GI and thus activity; so drugs that mimic it like octreotide are used cause of longer half life
Term
What is the function of glucagons from alpha cells?
Definition
Secretion is stimulated by low blood glucose, downs peristalsis, ups hepatic glucose release, ketogenesis, glycogenolysis
Term
What gut hormone inhibits motility and promotes satiety?
Definition
PYY
Term
What g-protein coupled receptors does gastrin activate versus CCK?
Definition
Gastrin CCK2>>CCK1, CCK does CCK1=CCK2
Term
What is the effect of secretin stimulation ttest on gastrinomas?
Definition
Causes increase, which opposite of expected in normal tissue; however, they do express somato receptors allowing them to be imaged
Term
Describe this syndrome - pancreatic or duodenal neuroendocrine tumor, 50% malign, some MEN-1 inheritance.
Definition
Gatrinoma, Zollinger-Ellsion (peptic ulcer, hyperacid, pancreatic tumore)
Term
What is the treat for gastrinoma when found via secretin stim test, fasting gastrin, and octreotide scan?
Definition
Ppi, h2, octreotide, and sugery
Term
Name this - symp of watery diarrhea, hypokalemia, acholridia, tumor of panc that is 60-80%malig, mostly in the tail.
Definition
Pancreatic VIPoma, non-a non-b cell tumor that releases VIP and thus water and electrolytes.
Term
Carcinoid tumors of neuroendocrine origin. What type of cells and where in GI?
Definition
EC or kulchinsky cells, all GI but mostly small intest and lung
Term
Biochemical diagnosis of carcinoids in chromogranin A. what is treat?
Definition
Chemo, octreotide, surgery
Term
Adenomas and carcinomas can be functioning and non-func and clonal, what is diff tbw?
Definition
Adenoma does not spread outside the margin of gland event hough it can grow and impinge structre, whil carcinoma is defined by spread outside of glands
Term
Since detecting test and synthetic test is difficult what test is used?
Definition
carbon isotope. Syn hormones made from yams with low C13
Term
What is the testosterone to estrogen ratio reported in comps?
Definition
>4:1; note detecting hGH no test yet
Term
What foods causes gas?
Definition
Fiber, carbs
Term
What is a natural cholesterol fighter in foods and why?
Definition
Stanols block cholesterol absorption in micelles but are not absorpbed
Term
Soy is limiting but not lacking in sulfur amino acids.
Definition
True
Term
What is malnutrition defined as?
Definition
Greater than 10% weight loss and depressed albumin
Term
What is the biff btw marasmus and kwashiorkor in food intake and time to progression?
Definition
Decreased energy intake vs protein intake in stress state; months or years versus weeks
Term
What is the BMI for over weight vesus obese?
Definition
>25, >30
Term
Low birth weight has a correlation to obesity due to ______ gene activation.
Definition
Thrift
Term
What is metabolic syndrome?
Definition
Metabolic risk factors including - waist size, dyslipidemia, glucose intolerance, HTN
Term
T or f, Abdominal and omental visceral fat correlates better with with co morbidities of obesity.
Definition
True
Term
Adipose tissue is seen as an endocrine organ, why?
Definition
Secretion of adipokines regulate metab, immune response, blood press, reproduction such as - leptin, tissue factor, LPL as well as many endocrine receptors
Term
Adipocytes have a correlation between what immuno cell and how?
Definition
Macros are based on inflammatory respone while adipos have metabolic functions and have similar hormone receptors, so it modifies inflammatory response and might be unlerying affector causing metabolic syndrome
Term
What is the abdominal waist size that is high risk in men and women?
Definition
>40, >35
Term
Adipocytes have adverse effects related to these up hormones, list what the effects are - tnf-a, angiotensinogen, insulin, leptin, plasminogen actiator inhibitor, down adiponectin.
Definition
Inflammation, HTN, dyslipids, t2dm, thrombosis, atherosclerosis
Term
Leptin is secreted by adipocytes and directly correlates to what physio response?
Definition
Leptin inhibits NPY/AgRP and stimulates POMC in hypothalamus which inhibs food intake. However, obese are leptin resistant
Term
Adiponectin is only excerted by fat cells, what is relationship to obesity, inflammation and insuln resistance?
Definition
Inverse, as weight goes up adiponectin goes down, inflammation and insulin resistance go up.
Term
Orlistat is a gastic and pancreatic lipase inhib that prevents dietary fat absorption via what mech?
Definition
It binds intestinal lipase
Term
Sibutramine increases satiety in fat people. How?
Definition
Norepi and serotonin reup inhib; that is also why serotenergic ags and CB antags work
Term
Gastric bypass, sleeve gastrectomy, and biliopancreatic diversion all cause an increase in PYY and drop in grehlin. But what nutrional deficiencies result?
Definition
B vitamins, folte, iron, zinc, VIt A/D
Term
Post-surgical dumping syndrome is where body increases satiety and causes GI and hypoglycemia probs. What is instigator?
Definition
Dumping of undigested food into small bowel; can also nesidioblastosis which is hyperinsulinemia
Term
Of the lap band, gastic bypass, and biliary bypass which losses most weight.
Definition
Biliary, but major malabsoprtion. Lap band least weight, safest.
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