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Y1 TP2 Pathological Processes (topic 3 Onwards) > 11. Neoplasia 4 > Flashcards

11. Neoplasia 4 Flashcards

1
Q

—> Determining which individuals will have a favourable outcome for malignant neoplasms

A 
Factors to consider include age and general health status, the tumour site, the tumour type, the grade (i.e. differentiation), the tumour stage (see below) and the availability of effective treatments. 
	• Grade 
	• Stage 
	• Treatment – for that specific tumour 
	• Age 
	• Health 
	• Status 
	• Site 
	• Type
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2
Q

TNM system staging

A
  • Tumor-node-metastasis (TNM) system used for most cancers
    • Size, in cm, of the tumor (T)
    • Involvement of lymph nodes (N)
    • Presence or absence of distant metastasis (M)
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3
Q

—-> For any Given Cancer TNM Staging System Converts into Stage from I to IV

A

The details vary for each cancer but very broadly speaking:
• stage I is early local disease
• stage II is advanced local disease (i.e. N0, M0),
• stage III is regional metastasis (i.e. any T, N1 or more, M0)
• stage IV is advanced disease with distant metastasis (i.e. any T, any N and M1). ..

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4
Q

Ann Arbor staging for lymphoma

A
  1. Localised
    1. Involvement of 2 or more lymph nodes on same side of diaphragm
    2. Nodes on both sides of diaphragm
    3. Diffused extralymphatic disease, in liver, bone marrow, lung
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5
Q

Dukes staging for colorectal carcinoma

A 
A = least problematic – tumour growing on inner lining
B = Tumour growing through inner lining into muscle 
C =  same as B but local lymph nodes involved
D = distant lymph nodes involved
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6
Q

Grading for Breast Carcinoma

A
  • Tubele formation
    • Nuclear pleomorphism
    • Mitosis count

Scharf bloom richarson grading

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7
Q

Stage and grade of tumours

A
  • Stage and grade of tumors indicates prognosis

* Treatment plans based upon stage and grade, among other factors

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8
Q

4 Cancer Treatments

A
  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Molecular Targeted Therapies – more modern
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9
Q

Cure Rate Comparisons - cancer treatment

A

• Surgery – 49%
○ Good cure for an early detected tumour that is not very developed

* Chemotherapy – 11%
* Radiotherapy – 40%

Most patients are treated using a combination of all 3

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10
Q

Surgery

A
  • Removal of body tissue
  • One of main treatments for cancer
  • 49% of those ‘cured’ of cancer are treated by surgery (Royal College of Radiologists 2003)
  • The best treatment for cancers that have not spread, leading to better prognosis.
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11
Q

Adjuvant treatment

A

Adjuvant treatment is given after surgical removal of a primary tumour to eliminate subclinical disease
• Diagnosis
• Curative treatment
• Adjuvant treatment

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12
Q

Neoadjuvant treatment

A

Neoadjuvant treatment is given to reduce the size of a primary tumour prior to surgical excision.
• Diagnosis
• Neoadjuvant treatment
• Curative treatment

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13
Q

Chemotherapy

A
  • Use of drugs for treatment
  • Cytotoxic chemotherapy
  • 11% of those ‘cured’ of cancer are treated by chemotherapy
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14
Q

Classes of Chemotherapy drugs

A
  • Antimetabolites mimic normal substrates involved in DNA replication, e.g. Fluorouracil.
  • Alkylating and platinum-based drugs, e.g. cyclophosphamide and cisplatin, cross-link the two strands of the DNA helix.
  • Antibiotics act in several different ways, e.g. doxorubicin inhibits DNA topoisomerase, which is needed for DNA synthesis, while bleomycin causes double-stranded DNA breaks.
  • Plant-derived drugs include vincristine, which blocks microtubule assembly and interferes with mitotic spindle formation. - target machinery of cell division instead of DNA
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15
Q

Chemotherapy cocktail

A

Chemotherapy cocktail – combination of different drugs, multiple diffferent drugs for different tumours
• Disadvantaged = therapy attacks normal cells as well

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16
Q

Different ways of delivering cytotoxics:

A
  • single agent – tends to cause side-effects
  • combination – lower doses less side-effects
  • continuous infusion
  • Intermittent – enables cell recovery
  • high dose – used to destroy bone marrow
17
Q

Medium-term side effects:

Of cytotoxic drugs

A
  • hair loss
  • low blood count
  • nausea, vomiting
  • loss of appetite
  • sore mouth
  • flu-like symptoms
  • tiredness, weakness
  • diarrhoea, constipation
  • blood in urine
  • discoloured urine.
18
Q

Immediate side effects:

Of cytotoxic drugs

A
  • pain at the injection site
  • sensation of cold during administration
  • itching – along or near path of vein
  • hypersensitivity reaction
  • allergic reaction
  • leakage of drug into the tissues.
19
Q

Radiotherapy

A
  • Radiotherapy is the use of high energy X-rays and similar rays (such as electrons) to cause damage to cells, which then makes it difficult for them to replicate.
  • Single Dose or Daily Dose
  • Daily treatments where total dose is split into fractions to preserve normal tissue and reduce side effects of treatment. Affects both normal and cancer cells
  • Aim to preserve normal cells and damage only cancer cells
  • Normal tissue repairs more effectively
  • An area treated with radiotherapy usually receives a lifetime dose
20
Q

Radiotherapy side effects

A
  • fatigue
  • malnutrition
  • weight loss
  • skin: redness/sunburn-like symptoms
  • head and neck: irritation of mucosal lining, dryness, ulceration
  • chest: heartburn-like symptoms if oesophagus is affected
  • upper abdomen: nausea and vomiting
  • lower abdomen: cramps, diarrhoea and urinary problems
21
Q

Treatment of glioblastoma

A
  • Surgery – but it is very difficult due to position of tumour In the brain
    • glioblastoma multiforme is very infiltrative and can travel to neurons
22
Q

Radiotherapy – action

A

• Causes DNA breaks which kills cells
○ DNA double strand break
○ One irreparable break = cell death

23
Q

Radiotherapy - problems

A
  • DNA breaks are repaired in “repair factories” using protein factors
    • And we can’t give more radiation as this can harm patient
    • Sensitivity of tissue limits how much radiation can be used to cause more breaks
24
Q

Gold np

A

When gold NP is close to DNA it amplifies the effects of radiation and causes more damage

25
Q

Gold or platinum

A 
Gold or platinum can act as an amplifier for radiation when we coat tumour cells with gold 
	• Potential to increase the dose by 
		○ Photoactivation
		○  Stable Scaffolds 
		○ Size easy to control 
		○ Water soluble 
		○ Stable to radiation 
		○ Versatile surface chemistry
		○ Inert and non-toxic 
		○ Approved for clinical applications (colloidal gold)
26
Q

peptide-coated-gold designer nanoparticle

A

NPs are stable and biocompatible
Get the gold close to DNA
Maximize the DNA damage inflicted in tumour cells after irradiation
Can be used to target GBM cells preferentially

27
Q

Precision Medicine

A
  • Cancers classified by molecular abnormalities and site of origin
  • Exceptional success when treatment is matched to a driver mutation
28
Q

Rise of new immunotherpay - process

A
  • Incubate patient’s own T cells
    • Gentically reporgramme patient T cells to find and attack cancer cells
    • Grow larger number sof them in a lab
    • Reprogrammed t cells are infused into patient
29
Q

Tumour Markers Monitoring

A

• Various substances are released by cancer cells into the circulation. Although some have a role in diagnosis, in general they are most useful for monitoring tumour burden during treatment and follow up. Tumour markers include hormones

Use things that tumours release like hormones to monitior the presence of the tumour or tumour regrowth

Y1 TP2 Pathological Processes (topic 3 Onwards) (9 decks)

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