17. Oncology Flashcards
1
Q
What is a neoplasm?
A
A mass of tissue that grows faster than normal in an uncoordinated manner
2
Q
What is a tumour?
A
A mass or growth of tissue
Can be benign or malignant
3
Q
What are the most common causes of cancer death in the world?
A
Lung Liver Colorectal Stomach Breast
4
Q
Which types of countries have higher cancer rates?
A
Developed countries
5
Q
What type of cell division do cancer cells undergo?
A
Mitosis
6
Q
What architecture do normal cells have?
A
Start off differentiated and specialised
Organised in the tissue and fulfil a particular function
7
Q
What architecture do cancer cells have?
A
Not differentiated
Grow in an uncontrolled manner
Becoming irregular and disorganised
Specialised function is lost
8
Q
How does cancer come about?
A
Through genetic mutations
Result of an underlying cause
9
Q
What are tumour suppression genes?
A
They tell a cell when to stop dividing
10
Q
What happens to tumour suppression genes (TSG) during cancer cell growth?
A
TSG becomes deactivated
New genes called oncogenes are formed
11
Q
What do oncogenes do?
A
Cause the overproduction of growth factors and increase cell division at uncontrolled/rapid pace
12
Q
What is angiogenesis?
A
Growth of new blood vessels
13
Q
Why do malignant cells undergo angiogenesis?
A
As they can only grow 1-2mm without a blood supply
14
Q
What is the prime environment for cancer cells to thrive in?
A
Acidic
Anaerobic
Glucose rich
15
Q
What is contact inhibition?
A
Prevents cells dividing beyond the space available
16
Q
Do cancer cells have contact inhibition?
A
No
17
Q
What is mutation?
A
Change in genetic sequence
18
Q
What is a mutagen?
A
An agent that changes the genetic sequence
19
Q
Examples of mutagens
A
Chemicals Radiation Viruses Inflammation (chronic) Stress/emotional trauma Defective immunity Environmental hazards
20
Q
What is a carcinogen?
A
A cancer-causing agent
21
Q
What is carcinogenesis?
A
The transformation of normal, healthy cells into cancer cells
22
Q
Examples of carcinogens
A
Heavy metals
Asbestos
X-rays
UV rays
23
Q
What percentages of cancers are attributed to genetics vs environmental factors?
A
5-10% genetics
90-95% environment/lifestyle
24
Q
How long can tumours take to develop?
A
20-40 years
25
What are risk factors for cancer?
```
Genetics
Chronic inflammation
Chronic stress
Smoking
Radiation
Excess alcohol
Obesity
Excessive exposure to sunlight
Compromised immunity
Metal toxins
Medications
Vaccine ingredients
Drugs/cosmetics
GIT dysfunction
Sexual behaviour
Vit D deficiency/thyroid disease
```
26
What are dietary risk factors?
```
Red meats
Burnt food
Low fibre
Refined sugars
Dairy
Table salt
Pesticides
Aspartame
N-nitroso compounds (cured meats)
```
27
How can chronic immunodeficiency increase the risk of cancer?
Cytotoxic T-cells, NK cells, macrophages are needed to destroy abnormal cells. However..
HIV targets CD4 cells, compromising the immune system
28
How can chronic stress suppress the immune system?
By elevating cortisol levels
29
What is the architecture for benign tumours?
Differentiated cells
Appear similar to normal cells
May be functional
30
How do benign tumour cells reproduce?
At a higher rate than normal
31
How do benign tumour cells grow?
Very slowly
| Doesn't spread (encapsulated - no metastasis)
32
Are benign tumours life-threatening?
No but damage can result from compression of tissues
33
What is the architecture for malignant tumours?
Undifferentiated cells
Non functional
Varied shapes/sizes
Large nuclei
34
How do malignant tumour cells reproduce?
Much faster than normal
35
How do malignant tumour cells grow?
Rapidly
Not encapsulated so they metastasise
Can spread quickly to other organs
36
Are malignant tumours life-threatening?
Yes due to tissue destruction and spread
37
What is grading?
The measure of degree of cell differentiation/abnormality
38
What are grade 1 tumours?
Similar to original cells
| Differentiated and specialised
39
What are grade 4 tumours?
Undifferentiated
| Abnormal cells varying in size and shape
40
What is staging?
Classification of malignant tumours according to size and spread of the tumour
41
What are the benefits of staging?
Helps to identify treatment approaches, disease progression and prognosis
42
What is stage 0 cancer?
Pre-cancerous cells
43
What is stage 1 cancer?
Cancer limited to tissue of origin
44
What is stage 2 cancer?
Limited local spread of cancerous cells
45
What is stage 3 cancer?
Extensive local and regional spread
46
What is stage 4 cancer?
Distant metastasis
47
What is the TNM staging system?
Tumour
Node
Metastasis
48
What does T (1-4) staging stand for?
Size of primary tumour
49
What does N (0-3) staging stand for?
Degree of lymph node involvement
50
What does M (0-1) staging stand for?
Metastasis - 1 indicates metastasis
51
What are the local effects of a tumour?
Compresses blood vessels - leading to necrosis of surrounding tissue
Obstructs tubes or ducts
Tissue ulceration/necrosis may produce infection
52
What are the systemic effects of a tumour?
Cachexia (weight loss and muscle atrophy)
Anaemia
Infection
Para-neoplastic syndromes
53
What are neo-plastic syndromes?
Set of signs and symptoms as a result of a cancerous tumour
| eg lung cancers may produce ACTH leading to Cushing's syndrome (excess corticosteroids produced by lung tumour cells)
54
What is metastasis?
Spread of a malignant tumour
55
How do malignant tumours spread?
Via blood or lymph
| Produce secondary tumours
56
Are secondary tumour cells similar to parent tumour?
Yes
57
What are the common sites for metastasis?
Bone
Liver
Lungs
Brain
58
How can cancer present in signs and symptoms?
```
Solid lump
Swollen lymph nodes
Difficulty swallowing
Persistent cough
Change in bowel/bladder habits
Appearance of wart/mole
Unexplained weight loss
Anaemia/fatigue
```
59
What are the typical diagnostic tests for cancer?
Blood tests
Tumour markers
Imaging
Biospies
60
What do blood tests look for?
Haemoglobin
Erythrocytes
Leukocytes
Platelets
61
What are tumour markers?
Substances (usually proteins) produced by tumours
62
Where can tumour markers be found?
Blood
Urine
Stools
Tissues
63
Can tumour markers be used on their own to diagnose cancer?
No, must be used in context of patient presentation and other clinical findings
64
Examples of tumour markers
```
CA-125 (ovarian cancer)
CA 15-3 (breast cancer)
CEA (colorectal cancer)
PSA (prostate cancer)
hCG (testicular cancer)
Tumour M2-PK (colorectal cancer)
```
65
What is CEA?
Carcinoembryonic antigen
Glycoprotein present in normal mucosal cells
Blood-borne marker
66
How is CEA tested?
Blood test
67
What is CEA testing used for?
Monitoring
| due to low sensitivity and specificity
68
In which conditions may CEA be elevated?
Colorectal cancer
Ulcerative colitis
Pancreatitis
Liver cirrhosis
69
What is PSA?
Prostate specific antigen
| Protein produced by prostate glands
70
In which conditions may PSA be elevated?
Prostate cancer
| Prostatic hyperplasia
71
What is PSA testing used for?
Diagnosis of prostate cancer
Monitor tumour progression
Monitor metastasis
72
What is hCG?
Human chorionic gonadotrophin
73
What is hCG testing used for?
Testicular cancer
Pancreatic cancer
Pituitary gland cancer
Pregnancy
74
What is tumour M2-PK?
Not organ specific so may be elevated in many tumour types
75
How is tumour M2-PK tested?
Stool test
76
In which conditions may tumour M2-PK be elevated?
Colorectal cancer
77
What is CA-125 used to test for?
Ovarian cancer
78
How is CA-125 tested?
Blood test
79
What is CA-15-3 used to test for?
Breast cancer
80
How is CA-15-3 tested?
Blood test
81
Examples of imaging
X-rays
MRI
CT scan
Radioisotopes
82
Examples of biopsies
Fine needle
Core
Surgical
83
What happens during a biospy?
Small tissue sample is removed and examined
84
What are the risks of a biopsy?
Procedure may cause cancer cells to break off and spread
85
What are the basic allopathic treatments for cancer?
Surgery
Chemo
Radiation
86
What are the conventional treatment approaches?
Curative
| Palliative
87
What is curative care?
Treatment used to resolve the malignancy
88
What is palliative care?
Focuses on reducing symptom severity rather than 'curing'
| Quality of life
89
Examples of cancer surgery
Mastectomy
Prostatectomy
Orchiectomy
90
What is a mastectomy?
Removal of breast
91
What is a prostatectomy?
Removal of prostate gland
92
What is a orchiectomy?
Removal of the testes
93
What does radiotherapy do?
Affects cells which divide most rapidly - cancer and healthy cells
Causes loss of reproduction and induces apoptosis
94
Examples of radiotherapy
External beam
Internal beam
Systemic beam
95
What is external beam radiotherapy?
Beams generated from outside the patient
96
What is internal beam radiotherapy?
Higher dose of radiation released from within a body cavity
97
What is systemic beam radiotherapy?
Radioactive material enters the blood to reach cells all over the body
98
What are the adverse effects of radiotherapy?
Bone marrow depression = immunocompromised
Inflammation/ulceration of skin
Hair loss
Sterility
99
What kind of natural support can be given during radiotherapy?
Exercise
Rest/relaxation
Creams/gels for skin irritation
100
What is chemotherapy?
Chemical agents destructive to malignant cells
101
What does chemotherapy do?
Targets rapidly dividing cells - cancerous and healthy
102
What does chemotherapy interfere with?
Protein synthesis
| DNA replication
103
What are the adverse effects of chemotherapy?
```
Bone marrow depression
Diarrhoea
Vomiting
Nausea
Hair loss
Organ damage
```
104
Examples of drug treatments
Hormones
Biologic response modifier
Analgesics
105
Example of hormone drug treatment
Tamoxifen
106
What does tamoxifen do?
Blocks oestrogen receptors
107
What is an adverse effect of tamoxifen?
Induces menopause
108
Example of an analgesic
Opioid analgesic - morphine
109
What complementary therapies can be used to support cancer?
```
Nutrition - high antioxidant, high anti-inflammatory, high fibre, whole plant foods, omega-3, 7-9 portions fruit/veg
Medicinal mushrooms
Herbs
Acupuncture
Homeopathy
```
110
What is 'cured' from cancer?
5 years without reoccurrence
111
Why is cancer hard to diagnose?
Some cancers only present clinically once disease is very advanced
112
What are the different categories of cancer?
Carcinomas
Sarcomas
Leukaemias
113
What are carcinomas?
Cancers forming in epithelial tissue
114
Where can carcinomas be found?
```
Skin
Mouth
Nose
Throat
Respiratory tract
Lung
Breast
Prostate
Stomach
```
115
What are sarcomas?
Cancers forming in connective tissue
116
Where can sarcomas be found?
Bone
Cartilage
Muscle
Tendons
117
What are leukaemias?
Cancers found in blood and bone marrow
Abnormal leukocytes travel through bloodstream
NOT solid tumours
