11. Prognosis of Neoplasms

Question 1

What factors influence the prognosis of a neoplasm?

Answer 1

Grade
Stage
Size
Site
Type
Host response
Therapy
General health
Ability to metastasise

Question 2

What staging system is no longer used for colonic carcinomas?

Answer 2

Dukes staging system

Question 3

What is the stage of a tumour?

Answer 3

The extent to which the tumour has spread

TNM system

Question 4

What does the TNM system stand for?

Answer 4

Tumour: size or level of involvement in wall
Nodes no.
Metastasis no.

Question 5

What is the grade of a tumour?

Answer 5

Histological assessment of the degree of differentiation

well differentiated= looks like original tissue= good prognosis

Question 6

Which cytological features are used to determine tumour grade?

Answer 6

Hyperchromasia
Pleomorphism
N/C ratio
Mitotic activity

Question 7

Which architectural features are used to determine tumour grade?

Answer 7

Gland formation in adenocarcinoma

Degree of maturation of epithelium

Question 8

What is the sentinel node?

Answer 8

The first node a tumour spreads to

Question 9

How is the sentinel node detected?

Answer 9

Tumour is injected with blue dye

Drains to the sentinel node first and picked up on radiology

Question 10

Why is there a high rate of false negatives when using the sentinel node method?

Answer 10

No dye will get in if the node is completely taken over by tumour

Question 11

How does the site of the tumour influence the prognosis?

Answer 11

Visible tumours are reported quicker

Question 12

What immune response gives a good prognosis?

Answer 12

Lymphocytic infiltrate

Question 13

What are common sites of metastasis?

Answer 13

Lung
liver
bone
brain
lymph nodes

Question 14

How does a patient’s general health affect their prognosis?

Answer 14

Patient must be able to withstand treatment

GI cancer patients can be malnourished

Question 15

What are the ways a tumour can metastasise?

Answer 15

Directly to adjacent tissues
Lymph
Blood
Transcoelomic
Perineural

Question 16

What facilitates tumour cells in metastasis?

Answer 16

Collagenases
Low cell to cell adhesion amongst tumour cells
Increased adhesion with endothelial cells
Tumour embolisation
Angiogenesis

Question 17

How to collagenases help a tumour to spread?

Answer 17

Break basement membrane and connective tissue

Question 18

How might a metastasis present clinically?

Answer 18

Lymphadenopathy
Jaundice
Bone pain or fractures
Cerebral stroke
Cachexia and anorexia

Question 19

Name a growth receptor blocking agent

Answer 19

Tamoxifen

Question 20

Name a small molecule inhibitor

Answer 20

Imatinib

Question 21

What does tamoxifen do?

Answer 21

Prevents oestrogen binding on ER+ breast cancer cells

Question 22

What type of drug is herceptin?

Answer 22

Monoclonal antibody

Blocks Her2 receptors which are increased in breast cancer

Question 23

What do small molecule inhibitors do?

Answer 23

Inhibit intracellular tyrosine kinase receptor to prevent cell signalling

Question 24

What are the side effects of radiotherapy?

Answer 24

Necrosis
Fibrosis
2nd malignancy

Question 25

What are the side effects of chemotherapy?

Answer 25

Extreme immunosuppression

Carcinogenic

Question 26

Which neoplasms commonly metastasise to bone?

Answer 26

Breast
Prostate
Tyroid
Renal