11. Neoplasia IV - Incidence, Prognosis and Treatment

Question 1

What cancers have the best prognosis?

Answer 1

Testicular
Melanoma
Breast

Question 2

What cancers have the poorest prognosis?

Answer 2

Pancreatic
Lung
Oesophageal

Question 3

Define tumour grading

Answer 3

Measure of how well or poorly differentiated the tumour is

Question 4

Define tumour staging

Answer 4

Measure of how much tumour there is and how far it has spread

Question 5

What categories does TNM staging analyse?

Answer 5

T - size - 1-4
N - nodes - 0-2
M - metastasis - 0-1

Question 6

What does a tumour have to have to be measured as a stage 4 cancer on the TNM scale?

Answer 6

It has to have metastasised

Question 7

What is the difference between a neoplasm measured as stage 1 and another as stage 2 on the TNM scale?

Answer 7

Size of the tumour

Question 8

What staging is used to stage a lymphoma?

Answer 8

Ann Arbor

Question 9

Describe the 4 stages in Ann Arbor scaling

Answer 9

Stage 1 - lymphoma in single node region
Stage 2 - lymphoma in 2 separate regions but on same side of diaphragm
Stage 3 - lymphoma has spread to both sides of the diaphragm
Stage 4 - disseminated involvement of one or more extra lymphatic organs

Question 10

What is Duke’s staging used for?

Answer 10

Colorectal carcinoma

Question 11

What are the 4 stages of Duke’s staging?

Answer 11

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

Question 12

How are tumours graded?

Answer 12

G1 - G4

G1 being well differentiated
G4 being poorly differentiated

Question 13

How are breast carcinomas graded?

Answer 13

Bloom Richardson

Question 14

What factors does bloom Richardson grading take into account?

Answer 14

Tubule formation
Nuclear variation
Rate of mitosis

Question 15

Name the 5 main treatments of cancer?

Answer 15

Surgery
Radiotherapy
Chemotherapy
Hormone therapy
Treatment targeted to specific molecular alteration

Question 16

What is adjuvant treatment?

Answer 16

Treatment given after surgical removal of a tumour to eliminate sub clinical disease

Question 17

What is neoadjuvant treatment?

Answer 17

Treatment given to reduce the size of a tumour prior to surgical excision

Question 18

Why is radiation given in fractionated doses in radiation therapy?

Answer 18

To minimise the damage done to the normal tissues while still killing the cancerous cells

Question 19

What are antimetabolites?

Answer 19

Chemotherapy form that acts as a mimic for substrates used in DNA replication to prevent it occurring

Question 20

What are alkylating and platinum based drugs such as cisplatin?

Answer 20

Chemotherapy drugs that cross link the strands of DNA

Question 21

Name 2 types of hormone therapy and what cancers they are used in

Answer 21

Tamoxifen - breast cancer

Androgen blockade - prostate cancer

Question 22

Name 2 oncogenes that can be targeted in therapy

Answer 22

Philadelphia chromosome

HER-2

Question 23

What can be tumour markers be useful for?

Answer 23

Monitoring tumour burden
Checking treatment efficacy
Follow up to check for recurrence

Question 24

Name some tumour markers

Answer 24

HCG
Oncofetal antigens
Specific proteins such as prostate specific antigen
Mucins such as CA125

Question 25

Name 3 types of bias that can occur due to screening

Answer 25

Lead time bias
Length bias
Over diagnosis

Question 26

Name four of the most common cancer locations

Answer 26

Breast
Lung
Prostate
Bowel