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. 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.
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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
10. CANCER MEDICINE (ONCOLOGY) 835 osteosarcoma flUgh Mo o Popb o, 7 5. mixed-tissue tumor IUimly [',m‘:_gj 4 dtumt fupes a3 . neoplasm W _{J/mafitn o - . neurofibromatosis Zumps [/ 2rvs Suppor” t Jlye TIB5Y% . benign _/lincencirpus = e 1 [ /l differentiation *\_‘;}}__Lg;”/[/fl Yl (I is g e S - Name the terms that describe tumor growth as seen through a microscope. Definitions and word parts are given. 1. 2 3. 4. 5. 6. 10. small nipple-like projections: pap 14j0vy abnormal formation of cells: dys r}kiLL, s o o localized growth of cells: carcin ga (N ..5_J1 / densely packed; containing fibrous tissue: &«'.H(’bk i ous pattern resembling small, microscopic sacs: alv thf,\/ small, round, gland-type clusters: foll _1 U Qv/ . variety of cell types: pleo Wi;’f} A‘—T,, \ 3. lacking structures typical of mature cells: un . L{H/eon »{'ZA\ . spreading evenly throughout the tissue: di }J}L resembling epithelial cells: epiderm f\¢ o Match the gross descriptions of tumors with the descriptions/definitions that follow. cystic - medullary -ulcerating fungating™ “necrotic “verrucous inflammatory —polypoid 1. Containing dead tissue: \"\b\\)\fi;\‘ 2 -~ W . Characterized by redness, swelling, and heat: r\\’ Ny M ; Mushn(oming pattern of growth: tumor cells pile on top of each other: LTI . Characterized by larlge, open, exposed surfaces: '\J‘LQ)((,' VXA ( . Growths are projections from a base; sessile and pedunculated tumors are examples: 0Oy gy \ . Tumors form large, open spaces filled with fluid; serous and mucinous tumors are examples: N T\~ . Tumors resemble wart-like growths: Xt s \ . Tumors are large, soft, and fleshy: WV \A\ \ \Sln 1 |
836 o Circle or supply the appropriate medical terms. 1. o Match the surgical procedure in Column | with its meaning in Column Il Write the letter of the meaning in the space provided. COLUMN | COLUMN Il 1. fulguration J}_ /A. Removal of tumor and a margin of normal tissue 4y P 17 diagnosis and possible cure of small tumors 2. enbloc resection _L . Burning a lesion to destroy tumor cells 3. incisional biopsy (,\ L7 Wide resection involving removal of tumor, its org of origin, and surrounding tissue in the body spa 4. excisional biopsy L /D. Destruction of tissue by electric sparks generated " " { a high-frequency current SeilpRIeER _\; S . Removal of entire tumor and regional lymph nod 6. cauterization 0 . Freezing a lesion to kill tumor cells 7 . (/ G. Cutting into a tumor and removing a piece to . exenteration Q Supply medical terms to complete the following sentences. 1, w such a cancerous tumor is a/an __ X\\r0\ 2, OOUAKON TN 0 taG_ SUMONO WAL WY Mg N . " sample of . A (carcinoma/sarcoma) is a cancerous tumor composed of connective tissue An example ¢ a cancerous tumor is a/an [/ Qsyriuma, VY4 A (D na 1€49 % . Retinoblastoma and adenomatous polyposis coli syndrome are examples of (chemical 6. In the TNM staging system, T stands for (tissue/tumor), N stands for (node/necrotic), and . Loss of differentiation of cells is called (hyperplasia/anaplasia). . Programmed call death is known as (apoptosis/carcinogenesis). . If tumor tissue survives large doses of radiation, it is a/an __ (o s 1S5 e _tu . If radiation can cause loss of tumor cells without serious damage to surrounding regions, the . A tumor that is completely destroyed by RT is a/an 3&;‘kw XA tumoe . The method of giving radiation in small, repeated doses is _ QYL anue - i . Drugs that increase the sensitivity of tumors to x-rays are [Tt N4 . Treatment of cancerous tumors with drugs is hor 019 CANCER MEDICINE (ONCOLOGY) A (carcinoma/sarcoma) is a cancerous tumoy composed of cells of epithelial tissue An example carcinogens/inherited cancers). The assessment of a tumor’s degree of maturity or microscopic differentiation 1s (grading/ staging) of the tumor. The assessment of a tumor’s extent of spread within the body is known as (grading/staging). M stands for (mitotic/metastasis). establish a diagnosis The method of treating cancer using high-energy radiation is XL\‘ TSI LT ¥4 tumor is (G NFN YA
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CANCER MEDICINE (ONCOLOGY) 837 8. A condition of tumors of fibrous supportive nerve cells is Y\ o \soeNan g L . The use of two or more drugs to kill tumor cells is _( A\ P S " RN AT s, - A large electronic device that Dm\hlt‘t.\ high-energy x-ray or photon beams for treatment of LU TV V.81 717 . Alkylating agents, antimetabolites, hormones, antibiotics, and antimitotics all are types of LT deep-seated tumors is a/an ___ __ agents, \ 12. Implantation of seeds of radioactive material directly into a tumor is (W YhivnD ] 13. The unit of absorbed radiation dose is N e 14. Radiation applied to a tumor from a distant Yource is 2X0ML\ Druen - Technique in which subatomic positively charged particles produced by a cyclotron deposit a dose of radiation at a tightly focused point is Qe X\ W\ 16. The dimension of the area of the body that receives radiation is aan __ Ajel\\ 17. Study performed using CT or MRI to map the area to receive treatment before radiotherapy is given is EANAN RN 18. Technique in which a single large dose of radiation is delivered under precise 3D guidance to destroy vascular abnormalities and small brain tumors is UM L A NSUTRI M. - —— Match the side effects of radiotherapy and chemothera py with the descriptions/ | o treatments that follow. “alopecia “myelosuppression “pneumonitis cystitis and proctitis Nausea _secondary tumors “Tibrosis < oral mucositis xerostomia infertility 1. Inflammation and ulceration of lining cells in the mouth caused by (WA radiation to the jaw: \ s MUASR 9 VO ETREYY 2. Radiation to the lungs causes inflammation of the lungs: “M XS Chemotherapy for ovarian cancer causes loss of hair on the head: \?kUL\ . Bone marrow depression with leukopenia, anemia, and thrombocytopenia: AN q;} Wlfiw\m 5. Radiation to the lungs causes increase in connective tissue: _; W5\S 6. Radiation of salivary glands causes dryness of the mouth: 2O W . Chemotherapy may cause this sensation leading to vomiting: A & 8. New type of growths in separate sites frum the primary tumor: S JW\1a) ;.. M 9. Loss of reproductive function: _\\\{ 5 \ \ 10. Radiation effects on the urinary bladder and rectum: (S} A9 VLY S el R
@ 838 CANCER MEDICINE (ONCOLOGY) o Give the meanings of the following medical terms. 1. modality bl o nstjpent - & 2. adjuvant chemotherapy 4555111y primavy fytrwes?” W/ th (Deygs 3. protocol Jlport o plin of SHp7s 'J“”A“_‘.“ gt o JiSChre (AT 4. remission _475¢hw. o /.// ”9“) af distase 5. relapse __ D Ympz/ 6. morbidity _(vac)fyens of f(m'f;; 1 povmal < son DN S 7. neoadjuvant chemotherapy U5¢ Ay‘, A s Lv ,w g I Side (F. W 8. genetic sc:ccning/!‘wu‘r are Z /<;_/__ v femn, R 9. external beam irradiation jl«n{’l\!m‘ agrl'c | £ 4 funw fn ¢ sewi it 10. immunotherapy ‘«mwk‘t wing imnut alls awnd Crbibodes K|\ b s 11. apoptosis _(yUh/np ! ol LH B —— 12. cachexia Y‘/\‘xfm/j'*" n Miartee by yapfatge Gn) gmgre Y 13. palliative _ Yl 1¢i/4n \’U Mo (ufping, : 14. molecularly targeted(therapy USe of J,_/'Jb “'u atbiedy SPUIN 4' 4 1) 15. nucleotide \J\\\ (J\ ?\\H’ uwm‘ll of \Aw‘«’JA‘)[’/A“ , 44 EAPS G Match the test or procedure with its description/definition. ‘beta-hCG test core needle biopsy . laparoscopy bone marrow biopsy”, estrogen receptor assay—— PSA test CA-125~— exfoliative cytology -~ stem cell transplant CEA test 1. test for the presence of a portion of human chorionic gonadotropin hormone (a marker for testicular cancer) \/\Q}V\A \’\L.,(1 fi% 2. protein marker for ovarian cancer detected in the blood h- 3. visual examination of the abdominal cavity; peritoneoscopy 4. test for the presence of a hormone receptor on breast cancer cells ¢S5/ Yt {uoph bl 5. removal of bone marrow tissue for microscopic examination \\"‘C 18 (' 6. obtaining a plug of tissue for microscopic examination (e Vawde, ooepry 7. blood test for the presence of an antigen related to prostate cancer VOMX QX 8. blood test for carcinoembryonic antigen (marker for GI cancer) __L’j;;¥ N o 9. cells are scraped off tissue and microscopically examined __OAn\ o (o 10. an intravenous infusion of blood-forming cells S N s o \
¢ CANCER MEDICINE (ONCOLOGY) 839 Circle the correct boldface terms to complete the sentences. 1. Pauline was diagnosed with a meningioma, which usually is a/an (benign, anaplastic, necrotic) tumor, The doctor told her that it was not malignant, but that it should be removed because of the pressure it was causing on the surrounding tissues. 2. Marlene underwent surgical resection of her breast mass. After surgery, Dr. Mendez recommended (dedifferentiated, modality, adjuvant) chemotherapy because her tumor was large and she had one positive lymph node. 3. Unfortunately, at the time of diagnosis, the tumor had spread to distant sites because it was (pleomorphic, metastatic, mutagenic). The oncologist recommended beginning chemotherapy as soon as possible. 4. The polyp in Lisa’s colon was not pedunculated, and Dr. Sidney described it as flat and (fungating, scirrhous, sessile). 5. Mr. Elder had difficulty urinating and had an elevated PSA blood level. Dr. Jones examined him and found a hard prostate gland. (Laparoscopy, Electrocauterization, Biopsy) demonstrated adenocarcinoma. 6. During the days following her chemotherapy for breast cancer, Mrs. Yang experienced loss of appetite and (fibrosis, nausea, xerostomia). Blood tests revealed low levels of blood cells, indicating (hematopoiesis, myeloma, myelosuppression). One year after Mr. Smith’s diagnosis and treatment for lung cancer, he underwent follow-up (bone marrow biopsy, PET-CT scan, exfoliative cytology), which enabled his doctors to (restage, regrade) his disease using the (ABCD, 1234, TNM) system. =~ 8. Mrs. Broom’s doctor told her she needed (CA-125, RT, PSA) because her tumor was nonoperable and could not be (resected, irradiated, electrocauterized).
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