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Pathological Processes > 10. Neoplasia 4 > Flashcards

10. Neoplasia 4 Flashcards

1
Q

What are the most common types of cancer in adults?

A

breast, lung, prostate and bowel carcinomas

all epithelium - labile tissues

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2
Q

What are the most common types of cancer in children (<14)?

A

Leukaemias, CNS tumours and lymphomas

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3
Q

Which cancer is the biggest cause of cancer-related deaths?

A

Lung cancer

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4
Q

Which cancers have the lowest 5-year survival rates?

A

Pancreatic, lung and oesophageal cancers

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5
Q

Which cancers have the highest 5-year survival rates?

A

Testicular, melanoma, breast cancer and prostate

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6
Q

What factors should you consider when predicting cancer outcome?

A

Age, general health and comorbidities, tumour site, tumour type, grade, stage and availability of treatments

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7
Q

What does tumour stage measure?

A

Tumour burden

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8
Q

What staging system is the commonest?

A

TMN

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9
Q

What is the advantage of using TMN over other staging methods?

A

Its standardised across the world

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10
Q

What things do T, M and N measure?

A 
T = size of primary tumour (T1-T4)
N = regional node metastasis 
M = metastatic spread
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11
Q

Which cancers are staged using the Ann-arbor staging system?

A

Lymphomas

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12
Q

What are the principles of the Ann-arbor staging system?

A 
I = lymphoma in single node region
II = 2 separate regions on same side of diaphragm
III = spread to both sides of diaphragm
IIII= diffuse involvement of one or more extra-lymphatic organs - bone marrow or lung
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13
Q

Which cancers are assessed using Dukes staging?

A

Colorectal carcinoma

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14
Q

Outline the principles of Dukes staging.

A

A -invasion into but not through bowel
B - invasion through bowel wall
C- involves lymph nodes
D- distant metastasis

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15
Q

What does tumour grade describe?

A

Degree of differentiation

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16
Q

What grading system is used for breast carcinoma?

A

Bloom Richardson

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17
Q

How is the Bloom Richardson system used?

A

G1 - well differentiated to G4 - anaplastic

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18
Q

What 3 things does the bloom richardson system assess?

A
  1. Mitosis number
  2. Tubule formation
  3. Nuclear variation
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19
Q

When is adjuvant therapy given?

A

Given after surgical removal to eliminate subclinical micromets

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20
Q

When is neoadjuvant therapy given?

A

Given prior to surgery to reduce the size of a primary tumour.

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21
Q

What is usually the curative treatment of cancer?

A

Surgical removal

22
Q

How is radiation therapy given, what is the significance of this?

A

Fractionated doses - minimise damage to normal tissues

23
Q

How does radiation therapy work?

A

X-rays or other ionising radiation are used to kill rapidly dividing cells either by direct or free-radical induced DNA damage that is detected by cell cycle checkpoints, triggering apoptosis.

24
Q

What are the 4 types of chemotherapy drugs?

A

Alkylating agents and platinum-based drugs
Antibiotics
Antimetabolites
Plant-derived drugs

25
Q

Why are there significant side effects associated with chemotherapy drugs?

A

They are non-specific, target other proliferating cells such as hair cells, GI tract cells, haematopoietic cells.

26
Q

What is tamoxifen?

A

SERM - selective oestrogen receptor modulator, prevents oestrogen binding to ER.

27
Q

Why is targeting oncogenes?

A

Relatively non-toxic and specifically targets cancer cells.

28
Q

What are the 3 main UK cancer screening programs?

A

Breast
Bowel
Cervical cancer

29
Q

What are the problems associated with screening?

A
  • lead-time bias
  • length-time bias
  • over-diagnosis
30
Q

What is the aim of screening?

A

Attempts to detect dysplasia and cancer while it is asymptomatic and there is a higher chance of cure and survival.

31
Q

What is Herceptins mechanism of action?

A

Inhibits HER-2 receptor
Encourages immune attack as it’s an antibody
Triggers HER2 internalisation and degradation

32
Q

What is Gleevec/Imatinib used to treat ?

A

CML

33
Q

How does gleevec work?

A

Inhibits the fusion protein bcr-able created by the abnormal philadelphia chromosome formed in CML.

34
Q

What are tumour markers?

A

Substances released by cancer cells into the circulation

35
Q

What are tumour markers useful for?

A

Monitoring progress of treatment and follow up, not accurate for diagnosis as may be raised in other situations.

36
Q

What tumour marker is used in testicular cancer?

A

Human chorionic gonadotropin (HCG)

37
Q

What tumour marker is used in hepatocellular carcinoma?

A

alpha fetoprotein (AFP)

38
Q

What tumour marker is used in prostate carcinoma?

A

Prostate specific antigen (PSA)

39
Q

What glycoprotein is used to monitor ovarian cancer?

A

CA-125

40
Q

What tumour markers are used for germ cell tumours?

A

carcinoembryonic antigen (CEA) and AFP

41
Q

What microscopic features are classical of Hodgkin’s lymphoma?

A

Eosinophils - dark pink cytoplasms and sunglasses

Reed sternberg cells - mirror nuclei ‘owl eyes’

42
Q

What major side effects does tamoxifen have?

A

Increased risk of DVT and PE

Endometrial hyperplasia and cancer

43
Q

Which women are part of the UK breast screening program, how often are they screened?

A

47-73, every 3 years a mammogram is carried out

44
Q

Which tumour marker is used when monitoring tumours of the large intestine?

A

CEA - carcinoembryonic antigen

45
Q

How are people screened for bowel cancer?

A

Stool sample assessed for presence of blood.

46
Q

Why is back pain a common symptom of prostate cancer?

A

Bone metastasis

47
Q

Who is screened for bowel cancer, at what intervals?

A

Men and women 60-74 years, every 2 years

48
Q

Who is screened for cervical cancer, at what intervals?

A

Women 25-49 years – every three years

50-64 years – every five years

49
Q

What is a tumour that can secrete 5-HT

A

Carcinoid tumour - well differentiated neuroendocrine tumour

50
Q

Other than HPV, what are other predisposing factors for cervical cancer?

A
  • Early age at first intercourse.
  • Multiple sexual partners.
  • A male partner with multiple previous sexual partners.
  • Oral contraceptives and nicotine.

Pathological Processes (12 decks)

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