10. Neoplasia 4 Flashcards
What are the most common types of cancer in adults?
breast, lung, prostate and bowel carcinomas
all epithelium - labile tissues
What are the most common types of cancer in children (<14)?
Leukaemias, CNS tumours and lymphomas
Which cancer is the biggest cause of cancer-related deaths?
Lung cancer
Which cancers have the lowest 5-year survival rates?
Pancreatic, lung and oesophageal cancers
Which cancers have the highest 5-year survival rates?
Testicular, melanoma, breast cancer and prostate
What factors should you consider when predicting cancer outcome?
Age, general health and comorbidities, tumour site, tumour type, grade, stage and availability of treatments
What does tumour stage measure?
Tumour burden
What staging system is the commonest?
TMN
What is the advantage of using TMN over other staging methods?
Its standardised across the world
What things do T, M and N measure?
T = size of primary tumour (T1-T4) N = regional node metastasis M = metastatic spread
Which cancers are staged using the Ann-arbor staging system?
Lymphomas
What are the principles of the Ann-arbor staging system?
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
Which cancers are assessed using Dukes staging?
Colorectal carcinoma
Outline the principles of Dukes staging.
A -invasion into but not through bowel
B - invasion through bowel wall
C- involves lymph nodes
D- distant metastasis
What does tumour grade describe?
Degree of differentiation
What grading system is used for breast carcinoma?
Bloom Richardson
How is the Bloom Richardson system used?
G1 - well differentiated to G4 - anaplastic
What 3 things does the bloom richardson system assess?
- Mitosis number
- Tubule formation
- Nuclear variation
When is adjuvant therapy given?
Given after surgical removal to eliminate subclinical micromets
When is neoadjuvant therapy given?
Given prior to surgery to reduce the size of a primary tumour.
What is usually the curative treatment of cancer?
Surgical removal
How is radiation therapy given, what is the significance of this?
Fractionated doses - minimise damage to normal tissues
How does radiation therapy work?
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.
What are the 4 types of chemotherapy drugs?
Alkylating agents and platinum-based drugs
Antibiotics
Antimetabolites
Plant-derived drugs
Why are there significant side effects associated with chemotherapy drugs?
They are non-specific, target other proliferating cells such as hair cells, GI tract cells, haematopoietic cells.
What is tamoxifen?
SERM - selective oestrogen receptor modulator, prevents oestrogen binding to ER.
Why is targeting oncogenes?
Relatively non-toxic and specifically targets cancer cells.
What are the 3 main UK cancer screening programs?
Breast
Bowel
Cervical cancer
What are the problems associated with screening?
- lead-time bias
- length-time bias
- over-diagnosis
What is the aim of screening?
Attempts to detect dysplasia and cancer while it is asymptomatic and there is a higher chance of cure and survival.
What is Herceptins mechanism of action?
Inhibits HER-2 receptor
Encourages immune attack as it’s an antibody
Triggers HER2 internalisation and degradation
What is Gleevec/Imatinib used to treat ?
CML
How does gleevec work?
Inhibits the fusion protein bcr-able created by the abnormal philadelphia chromosome formed in CML.
What are tumour markers?
Substances released by cancer cells into the circulation
What are tumour markers useful for?
Monitoring progress of treatment and follow up, not accurate for diagnosis as may be raised in other situations.
What tumour marker is used in testicular cancer?
Human chorionic gonadotropin (HCG)
What tumour marker is used in hepatocellular carcinoma?
alpha fetoprotein (AFP)
What tumour marker is used in prostate carcinoma?
Prostate specific antigen (PSA)
What glycoprotein is used to monitor ovarian cancer?
CA-125
What tumour markers are used for germ cell tumours?
carcinoembryonic antigen (CEA) and AFP
What microscopic features are classical of Hodgkin’s lymphoma?
Eosinophils - dark pink cytoplasms and sunglasses
Reed sternberg cells - mirror nuclei ‘owl eyes’
What major side effects does tamoxifen have?
Increased risk of DVT and PE
Endometrial hyperplasia and cancer
Which women are part of the UK breast screening program, how often are they screened?
47-73, every 3 years a mammogram is carried out
Which tumour marker is used when monitoring tumours of the large intestine?
CEA - carcinoembryonic antigen
How are people screened for bowel cancer?
Stool sample assessed for presence of blood.
Why is back pain a common symptom of prostate cancer?
Bone metastasis
Who is screened for bowel cancer, at what intervals?
Men and women 60-74 years, every 2 years
Who is screened for cervical cancer, at what intervals?
Women 25-49 years – every three years
50-64 years – every five years
What is a tumour that can secrete 5-HT
Carcinoid tumour - well differentiated neuroendocrine tumour
Other than HPV, what are other predisposing factors for cervical cancer?
- Early age at first intercourse.
- Multiple sexual partners.
- A male partner with multiple previous sexual partners.
- Oral contraceptives and nicotine.
