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

90% solid tumors need surgery, biopsy, for complications B. all patients of cancer, should be evaluated in multidisciplinary medicine between medical, surgical and radiation oncologists 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 stabilized C. page 3: prostate had peak in 92, then decreased, prostate cancer found with PSA which has increased number of reported cases page 4: probability developoing cancer throughout life A. in men its 1 in 2 B. in women its 1 in 3 C. breast varies with age, from 1 in 235 to 1 in 8 throughout life D. colon and rectum: birth to death 1 in 18 for both women and female E. lung and bronchus: men its 1 in 12, women its 1 in 18 F. prostate: 1 in 6 page 5 A. recommendations for early detection B. 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 year C. colorectal D. prostate: controversial page 6: Cell has mechanism so that when detects DNA defect, can protect body from proliferating these abnormal cells Page 7 A. G0: resting state, regular cell functions B. G1: when begin to produce proteins for nucleic acid synthesis C. S: when begins DNA synthesis D. G2: discontinues DNA synthesis, continues developing proteins and RNA E. M phase: mitosis F. Cyclones: activate phases of cell cycle G. Tyrosine kinases: cyclones activate and direct actions of specific tyorisine kinases called cyclin dependent kinases H. Checkpoints: before mitosis, before DNA synthesis I. Apoptosis page 8 A. P53: deals with checkpoint at synthesis B. Germ cells: meiosis, reproduce themselves indefinitely C. 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

VIII.

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D. Partially differentiated cells E. Fully mature specialized cells F. Differentiation inversely related to immortality: only 50 replications/fibroblast, for example G. Clonal origin: originate from single abnormal cells H. Field defect: cancers arise from multiple cells and multiple malignant clones I. Immortality: telomeres, the ends of chromosomes, are shortened as cells differenteiate, but cancer cells teleomeres are replenished by telomerase page 9 A. 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 and nutrients noted in cancer cell cultures: reproduce so many that use up their nutrient supply C. Metastasis: detachment of cells from primary tumor, infiltrate the blood vessels (intravasation), loss of or abnormalities of cellular proteins responsible for adhesion to the extracellular matrix D. Causes of overproduction of cancer cells E. Failure of abnormal cells to undergo apoptosis page 10 A. tumor suppressor gene abnormality: suppresses proliferation of cells, BRCA1,2 is hereditary tumor B. p53: see page 21, if one tumor suppressor gene damaged, not enough, need both genes damaged C. li fraumeni syndrome: mutant p53, brain, leukemia, breast, etc, hereditary autosomal dominant syndrome of both soft tissue and epithelial cancers at multiple sites D. tumor angiogenesis: vascular endothelial growth factor (VEGF), can be difficult to locate primary tumor if tumor elaborate angiogenesis inhibitors to stop growth at primary site Carcinogenic viruses: page 14 and 15 A. HTLV-1: lymphoblastic leukemia in south japan, only virus that is proven to cause cancer B. htlv 2 causes hairy cell leukemia C. Htlv 3 associated with HIV and kaposis sarcoma D. 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 colon cancer F. Hepatitis B: HCC

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

G. Malignant transformation: steps of signal transduction not important, use as reference only (page 16-18) XI. other A. Page 19: oncogenes B. Page 20: virus related cancers, table format C. 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, shortcomings XIII. Page 25: tumor markers A. Brca1 B. Tumor markers in blood or other body fluids C. Medullary thyroid carcinoma: calcitonin D. Ca 15-3: breast E. Ca 125: ovary, not for screening, but for follow up F. CEA: breast, lung, colorectal, not screening, good for follow up G. HCG H. LDH: seminoma, high grade lympohoma I. Neuron specific enolase (NSE): neuroendocrine tumors, neuroblastoma J. Ca 19-9: pancreas cancer XIV. page 28: grading and staging A. first treatment should be definitive, if not, then the patient cure may not be achieved B. 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 aggressivity B. useful with pulmonary metastasis, can see with xray and measure doubling time C. TDT varies from 8-600 days, but majority are from 20-100 days D. 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 after resection XVI. terminology A. complete remission B. partial remission C. minimla remission D. progression XVII. indications for RTX: page 31 A. before B. number of days, dosis C. emergeneyc palliative radiation: spinal cord compression, superior vena caval syndrome, airway obstruction, cranial nerve compression D. obstruction, bleeding are indications for surgery emergency