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BioMed S2 > 17. Oncology > Flashcards

17. Oncology Flashcards

1
Q

What is a neoplasm?

A

A mass of tissue that grows faster than normal in an uncoordinated manner

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2
Q

What is a tumour?

A

A mass or growth of tissue
Can be benign or malignant

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3
Q

What are the most common causes of cancer death in the world?

A 
Lung
Liver
Colorectal
Stomach
Breast
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4
Q

Which types of countries have higher cancer rates?

A

Developed countries

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5
Q

What type of cell division do cancer cells undergo?

A

Mitosis

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6
Q

What architecture do normal cells have?

A

Differentiated and specialised
Organised in the tissue and fulfil a particular function

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7
Q

What architecture do cancer cells have?

A

Not differentiated
Grow in an uncontrolled manner
Becoming irregular and disorganised
Specialised function is lost

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8
Q

How does cancer come about?

A

Through genetic mutations
Result of an underlying cause/environmental interaction
Promoting mutations of multiple genes

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9
Q

What are tumour suppression genes (TSG)?

A

They tell a cell when to stop dividing
Like an off switch

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10
Q

What happens to tumour suppression genes (TSG) during cancer cell growth?

A

TSG becomes deactivated
New genes called oncogenes* are formed

*mutated from normal proto-oncogenes

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11
Q

What do oncogenes do?

A

Cause the overproduction of growth factors and increase cell division at uncontrolled/rapid pace

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12
Q

What is angiogenesis?

A

Growth of new blood vessels

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13
Q

Why do malignant cells undergo angiogenesis?

A

As they can only grow to 12 mm³ without a blood supply

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14
Q

What is the prime environment for cancer cells to thrive in?

A

Acidic
Anaerobic
Glucose rich

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15
Q

What is contact inhibition?

A

Proteins produced by cells preventing cells dividing beyond the space available

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16
Q

Do cancer cells have contact inhibition?

A

No

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17
Q

What is mutation?

A

Change in genetic sequence

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18
Q

What is a mutagen?

A

An agent that changes the genetic sequence

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19
Q

Examples of mutagens

A 
Chemicals
Radiation
Viruses
Inflammation (chronic)
Stress/emotional trauma
Defective immunity
Environmental hazards
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20
Q

What is a carcinogen?

A

A cancer-causing agent

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21
Q

What is carcinogenesis?

A

The transformation of normal, healthy cells into cancer cells

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22
Q

Examples of carcinogens

A 
Heavy metals
Asbestos
X-rays
UV rays
Parabens
Formaldehyde
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23
Q

What percentages of cancers are attributed to genetics vs environmental factors?

A

5-10% genetics
90-95% environment/lifestyle

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24
Q

How long can tumours take to develop?

A

20-40 years

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25
Q

What are risk factors for cancer?

A 
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 (poor liver function)
Sexual behaviour
Vit D deficiency/thyroid disease
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26
Q

What are dietary risk factors for cancer?

A 
Red meats
Burnt food
Low fibre
Refined sugars
Dairy
Table salt
Pesticides
Aspartame
N-nitroso compounds (cured meats)
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27
Q

How can chronic immunodeficiency increase the risk of cancer?

A

Cytotoxic T-cells, NK cells, macrophages are needed to destroy abnormal cells. However..
HIV targets CD4 cells, compromising the immune system

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28
Q

How can chronic stress suppress the immune system?

A

By elevating cortisol levels

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29
Q

What is the architecture for benign tumours?

A

Differentiated cells
Appear similar to normal cells
May be functional

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30
Q

How do benign tumour cells reproduce?

A

At a higher rate than normal

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31
Q

How do benign tumour cells grow?

A

Very slowly
Doesn’t spread (encapsulated - no metastasis)

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32
Q

Are benign tumours life-threatening?

A

No but damage can result from compression of tissues*

eg brain tumour increasing intra-cranial pressure

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33
Q

What is the architecture for malignant tumours?

A

Undifferentiated cells
Non functional
Varied shapes/sizes
Large nuclei

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34
Q

How do malignant tumour cells reproduce?

A

Much faster than normal

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35
Q

How do malignant tumour cells grow?

A

Rapidly
Not encapsulated so they metastasise
Can spread quickly to other organs

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36
Q

Are malignant tumours life-threatening?

A

Yes due to tissue destruction and spread

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37
Q

What is grading?

A

The measure of degree of cell differentiation/abnormality

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38
Q

What are grade 1 tumours?

A

Benign
Similar to original cells
Differentiated and specialised

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39
Q

What are grade 4 tumours?

A

Undifferentiated
Abnormal cells varying in size and shape

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40
Q

What is staging?

A

Classification of malignant tumours according to size and spread of the tumour

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41
Q

What are the benefits of staging?

A

Helps to identify treatment approaches, disease progression and prognosis

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42
Q

What is stage 0 cancer?

A

Pre-cancerous cells

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43
Q

What is stage 1 cancer?

A

Cancer limited to tissue of origin

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44
Q

What is stage 2 cancer?

A

Limited local spread of cancerous cells

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45
Q

What is stage 3 cancer?

A

Extensive local and regional spread

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46
Q

What is stage 4 cancer?

A

Distant metastasis

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47
Q

What is the TNM staging system?

A

Tumour
Node
Metastasis

48
Q

What does T (1-4) staging stand for?

A

Size of primary tumour

49
Q

What does N (0-3) staging stand for?

A

Degree of lymph node involvement

50
Q

What does M (0-1) staging stand for?

A

Metastasis - 1 indicates metastasis

51
Q

What are the local effects of a tumour?

A

Compresses blood vessels - leading to necrosis of surrounding tissue or tumour itself (calcification*)
Obstruction of tubes or ducts
Tissue ulceration/necrosis may produce infection (increased risk with chemo)

*calcification can be seen on x-ray

52
Q

What are the systemic effects of a tumour?

A

Weight loss
Cachexia*
Anaemia
Infection
Para-neoplastic syndromes

*Weight loss and muscle atrophy, later symptom

53
Q

What are neo-plastic syndromes?

A

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
Q

What is metastasis?

A

Spread of a malignant tumour
Malignant cells do not adhere to each other
Cells break off (non-encapsulated tumour) into the blood or lymphatic system

55
Q

How do malignant tumours spread?

A

Via blood or lymph
Produce secondary tumours

56
Q

Are secondary tumour cells similar to parent tumour?

A

Yes

57
Q

What are the common sites for metastasis?

A

Bone
Liver
Lungs
Brain

58
Q

How can cancer present in signs and symptoms?

A 
Solid lump
Swollen lymph nodes
Difficulty swallowing
Persistent cough
Change in bowel/bladder habits
Appearance of wart/mole
Unexplained weight loss (red flag)
Anaemia/fatigue
Drenching night sweats

Initially few vague symptoms

59
Q

What are the typical diagnostic tests for cancer?

A

Blood tests
Tumour markers
Imaging
Biospies

None 100% reliable, also more effective in later stages

60
Q

What do blood tests look for?

A

Haemoglobin
Erythrocytes
Leukocytes
Platelets

61
Q

What are tumour markers?

A

Substances (usually proteins) produced by tumours

62
Q

Where can tumour markers be found?

A

Blood
Urine
Stools
Tissues

Depends on the specific marker

63
Q

Can tumour markers be used on their own to diagnose cancer?

A

No, must be used in context of patient presentation and other clinical findings
Tumour markers can be present in non-cancerous conditions

64
Q

Examples of tumour markers

A 
CA-125 (ovarian cancer)
CA 15-3 (breast cancer)
CEA (colorectal cancer)
PSA (prostate cancer)
hCG (testicular cancer)
Tumour M2-PK (colorectal cancer)
65
Q

What is CEA?

A

Carcinoembryonic antigen
Glycoprotein present in normal mucosal cells
Normally undetectable after birth
Blood-borne marker

66
Q

How is CEA tested?

A

Blood test

67
Q

What is CEA testing used for?

A

Monitoring
Due to low sensitivity and specificity

Small raises could be due to smoking

68
Q

In which conditions may CEA be elevated?

A

Colorectal cancer
Ulcerative colitis
Pancreatitis
Liver cirrhosis

69
Q

What is PSA?

A

Prostate specific antigen
Protein produced by prostate glands

70
Q

In which conditions may PSA be elevated?

A

Prostate cancer
Benign Prostatic hyperplasia

71
Q

What is PSA testing used for?

A

Diagnosis of prostate cancer
Monitor tumour progression
Monitor metastasis

72
Q

What is hCG?

A

Human chorionic gonadotrophin

73
Q

What is hCG testing used for?

A

Testicular cancer
Pancreatic cancer
Pituitary gland cancer
Pregnancy

Should only be present in pregnant women

74
Q

What is tumour M2-PK?

A

Not organ specific so may be elevated in many tumour types

75
Q

How is tumour M2-PK tested?

A

Stool test

76
Q

In which conditions may tumour M2-PK be elevated?

A

Colorectal cancer
Gastric cancer

77
Q

What is CA-125 used to test for?

A

Ovarian cancer

78
Q

How is CA-125 tested?

A

Blood test
Normal range <35 U/ml

79
Q

What is CA-15-3 used to test for?

A

Breast cancer

80
Q

How is CA-15-3 tested?

A

Blood test
Normal range <30 U/ml

81
Q

Examples of imaging

A

X-rays
MRI
CT scan
Radioisotopes

82
Q

Examples of biopsies

A

Fine needle
Core
Surgical

83
Q

What happens during a biospy?

A

Small tissue sample is removed and examined

84
Q

What are the risks of a biopsy?

A

Procedure may cause cancer cells to break off and spread

85
Q

What are the basic allopathic treatments for cancer?

A

Surgery
Chemo
Radiation

86
Q

What are the conventional treatment approaches?

A

Curative
Palliative

87
Q

What is curative care?

A

Treatment used to resolve the malignancy

88
Q

What is palliative care?

A

Focuses on reducing symptom severity rather than ‘curing’
Quality of life

89
Q

Examples of cancer surgery

A

Mastectomy
Prostatectomy
Orchiectomy

90
Q

What is a mastectomy?

A

Removal of breast

91
Q

What is a prostatectomy?

A

Removal of prostate gland

92
Q

What is a orchiectomy?

A

Removal of the testes

93
Q

What does radiotherapy do?

A

Affects cells which divide most rapidly - cancer and healthy cells
Causes loss of reproduction
Induces apoptosis

94
Q

Examples of radiotherapy

A

External beam
Internal beam
Systemic beam

95
Q

What is external beam radiotherapy?

A

Beams generated from outside the patient

96
Q

What is internal beam radiotherapy?

A

Higher dose of radiation released from within a body cavity
Probe used (cervical, colorectal)

Also known as Brachytherapy

97
Q

What is systemic beam radiotherapy?

A

Radioactive material enters the blood to reach cells all over the body

98
Q

What are the adverse effects of radiotherapy?

A

Bone marrow depression* => immunocompromised
Burns => inflammation/ulceration of skin
Hair loss
Gut ulceration (diarrhoea, bleeding)
Sterility
Fatigue
Fibrosis

*leads to aplastic anaemia with pancytopenia

99
Q

What kind of natural support can be given during radiotherapy?

A

Exercise*
Rest/relaxation (good sleep and stress management)
Creams/gels for skin irritation

*reduces fatigue

100
Q

What is chemotherapy?

A

Chemical agents destructive to malignant cells

101
Q

What does chemotherapy do?

A

Targets rapidly dividing cells - cancerous and healthy

102
Q

What does chemotherapy interfere with?

A

Protein synthesis
DNA replication

103
Q

What are the adverse effects of chemotherapy?

A 
Bone marrow depression
Diarrhoea
Vomiting
Nausea
Hair loss
Organ damage
Cancer
104
Q

Examples of drug treatments in cancer

A

Hormones
Biologic response modifier
Analgesics

105
Q

Example of hormone drug treatment in cancer

A

Tamoxifen

106
Q

What does tamoxifen do?

A

Blocks oestrogen receptors

107
Q

What is an adverse effect of tamoxifen?

A

Induces menopause

108
Q

Example of an analgesic

A

Opioid analgesic - morphine

109
Q

What complementary therapies can be used to support cancer?

A 
Nutrition - high antioxidant, high anti-inflammatory, high fibre, whole plant foods, omega-3, 7-9 portions fruit/veg
Medicinal mushrooms*
Amygdalin (B17) => cyanide in cancer cells
Herbs
Acupuncture
Homeopathy

*beta glucans immune modulating, anti-cancer properties

110
Q

What is ‘cured’ from cancer?

A

5 years without reoccurrence

111
Q

Why is cancer hard to diagnose?

A

Some cancers only present clinically once disease is very advanced

112
Q

What are the different categories of cancer?

A

Carcinomas
Sarcomas
Leukaemias

Over 200 types of cancer

113
Q

What are carcinomas?

A

Cancers forming in epithelial tissue

114
Q

Where can carcinomas be found?

A 
Skin
Mouth
Nose
Throat
Respiratory tract
Lung
Breast
Prostate
Stomach
115
Q

What are sarcomas?

A

Cancers forming in connective tissue

116
Q

Where can sarcomas be found?

A

Bone
Cartilage
Muscle
Tendons

117
Q

What are leukaemias?

A

Cancers found in blood and bone marrow
Abnormal leukocytes travel through bloodstream
NOT solid tumours

BioMed S2 (34 decks)

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