11. Prognosis of Neoplasms Flashcards
What factors influence the prognosis of a neoplasm?
Grade Stage Size Site Type Host response Therapy General health Ability to metastasise
What staging system is no longer used for colonic carcinomas?
Dukes staging system
What is the stage of a tumour?
The extent to which the tumour has spread
TNM system
What does the TNM system stand for?
Tumour: size or level of involvement in wall
Nodes no.
Metastasis no.
What is the grade of a tumour?
Histological assessment of the degree of differentiation
well differentiated= looks like original tissue= good prognosis
Which cytological features are used to determine tumour grade?
Hyperchromasia
Pleomorphism
N/C ratio
Mitotic activity
Which architectural features are used to determine tumour grade?
Gland formation in adenocarcinoma
Degree of maturation of epithelium
What is the sentinel node?
The first node a tumour spreads to
How is the sentinel node detected?
Tumour is injected with blue dye
Drains to the sentinel node first and picked up on radiology
Why is there a high rate of false negatives when using the sentinel node method?
No dye will get in if the node is completely taken over by tumour
How does the site of the tumour influence the prognosis?
Visible tumours are reported quicker
What immune response gives a good prognosis?
Lymphocytic infiltrate
What are common sites of metastasis?
Lung liver bone brain lymph nodes
How does a patient’s general health affect their prognosis?
Patient must be able to withstand treatment
GI cancer patients can be malnourished
What are the ways a tumour can metastasise?
Directly to adjacent tissues Lymph Blood Transcoelomic Perineural
What facilitates tumour cells in metastasis?
Collagenases
Low cell to cell adhesion amongst tumour cells
Increased adhesion with endothelial cells
Tumour embolisation
Angiogenesis
How to collagenases help a tumour to spread?
Break basement membrane and connective tissue
How might a metastasis present clinically?
Lymphadenopathy Jaundice Bone pain or fractures Cerebral stroke Cachexia and anorexia
Name a growth receptor blocking agent
Tamoxifen
Name a small molecule inhibitor
Imatinib
What does tamoxifen do?
Prevents oestrogen binding on ER+ breast cancer cells
What type of drug is herceptin?
Monoclonal antibody
Blocks Her2 receptors which are increased in breast cancer
What do small molecule inhibitors do?
Inhibit intracellular tyrosine kinase receptor to prevent cell signalling
What are the side effects of radiotherapy?
Necrosis
Fibrosis
2nd malignancy
What are the side effects of chemotherapy?
Extreme immunosuppression
Carcinogenic
Which neoplasms commonly metastasise to bone?
Breast
Prostate
Tyroid
Renal