17. Oncology Flashcards
Define ‘oncology’
The study and treatment of cancer / malignant tumours
Define oncologist
A physician who practices oncology
Define neoplasm
A mass of tissue that grows faster than normal in an uncoordinated manner
Define a tumour
Translates to “swelling”
Primarily used to describe a mass/growth of tissue. This growth can be either malignant or benign.
What 5 types of cancer are currently the most common cause of death in the world?
Lung
Colon and rectum
Liver
Stomach
Breast
Where are the highest rates of cancer and why might this be?
In developed countries which emphasises the link to environment, lifestyle, diet, medication and drugs.
How do cancerous cells appear under the microscope?
Disorganised
Growing in an uncontrolled manner.
Cell architecture is lost.
Explain what is meant by ‘angiogenesis’.
The creation of more blood vessels
Describe the genetic mutation that occurs to cause cancerous growth.
Tumour suppression genes become inactivated and new genes called oncogenes are formed that cause the over production of growth factor and increase cell division.
What environment will cancer most thrive in?
Acidic environment
Anaerobic environment
Glucose rich
What external factors can produce acidity in the body?
Red meats
Processed foods
Dairy
Sugar
Salt
Smoked foods
How might the body develop an anaerobic environment?
Stress
Shallow breathing
Diet
Lack of exercise
Why is a glucose-rich environment preferable for cancer cells?
Malignant cells are dependent on glucose for their own metabolism.These cells have many more glucose receptors on their membrane.
What is contact inhibition?
Contact inhibition prevents cells from dividing beyond the space available.
Cancerous cells lose contact inhibition resulting in uncontrolled growth.
Define mutation.
The change in the genetic information (change in DNA sequence / number)
What is a mutagen and list 4 examples?
It’s an agent that changes the genetic information causing a mutation.
- Environmental hazards
- Chemicals
- Radiation
- Viruses
- Chronic inflammation
- Defective immunity
- Stress / emotional trauma
Define carcinogen
Any cancer-causing agent
E.g. heavy metals, asbestos, x-rays, UV rays
Define carcinogenesis
The process by which normal cells are transformed into cancer cells.
What percentage of cancer is attributed to inherited genetic defects?
Only 5-10%
The remaining 90-95% are attributed to environment and lifestyle.
List 5 risk factors (excluding genetics) for cancel
Chronic inflammation
Radiation
Smoking
Drugs and cosmetics
GIT dysfunction
Vit D deficiency
Chronic stress
Sexual behaviour
Compromised immunity
Excess alcohol
Obesity
Excessive exposure to sunlight
Metal toxins
Medications
Vaccine ingredients
Describe how chronic inflammation could increase the risk of cancer
It promotes the proliferation of cancer cells.
Inflammatory bowel disease
Gastro-oesophageal reflux disease
Gastritis
Describe how smoking could increase the risk of cancer
Causes 1 mutation every 15 cigarettes
Describe how GIT dysfunction could increase the risk of cancer
The liver detoxifies substances and the intestines excrete body waste, absorb nutrients and is vital in the body’s immune function. If these aren’t working effectively, toxins can accumulate in the body causing damage.
Describe how chronic stress could increase the risk of cancer
Suppresses the immune system
Describe how alcohol could increase the risk of cancer
It puts extra strain on the liver which is needed to detoxify and eliminate toxins.
Describe how Obesity could increase the risk of cancer
Excess body fat changes hormone metabolosm
This causes higher oestrogen in the body.
This drives oestrogen-positive tumours.
Describe how a low fibre diet could increase the risk of cancer
Fibre is important to help pull waste, toxins, and hormones out of the body. Without these can end up being reabsorbed into the body rather than being eliminated.
Describe how refined sugar could increase the risk of cancer
Feeds cancer cells and promotes growth.
Also increases acidity.
Describe how dairy could increase the risk of cancer
Proinflammatory
Contains insulin-like growth factor (IGF) that promote tumour growth
Describe how chronic immunodeficiency could increase the risk of cancer
A healthy, functioning immune system is essential to providing support against malignant cell development.
Cytotoxic T-lymphocytes, natural killer cells, and macrophages are needed to destroy abnormal cells.
Describe THREE key differences between ‘benign’ and ‘malignant’ tumours.
Benign:
Consist of differentiated cells
Very often encapsulated (cant break off)
Grows very slow in comparison to malignant.
Malignant:
Undifferentiated cells
Not encapsulated so can spread
Cells reproduce much faster
Using definitions explain the difference between ‘grading’ and ‘staging’ of cancer.
Grading is the measure of the degree of cell differentiation / abnormality.
Grade ranges from 1 - 4
Staging is the classification of malignant tumours according to the extent of the disease at the time of diagnosis.
Stage 0 = precancerous
Stage 5 = Distant metastisis
Explain the TNM staging system
Tumour, node, metastasis (TNM)
T is for the size of the primary tumour
scored 1-4
N is the degree of lymph node involvement
Scored 0-3
M is whether there is metastasis
Scored 0 or 1
An X for any of these means it couldn’t or wasn’t assessed.
List TWO local effects of a tumour.
- Compression ofblood vessels leading to necrosis of surrounding tissues.
- Pain caused by pressure or inflammation
- Obstruction may occur in tubes/ducts
- Infection from ulceration or necrosis
Describe the following systemic effects in cancer:
Cachexia
Cachexia is weight loss and muscle atrophy
Normally a later symptom.
Patients may still have a strong appetite.
Describe the following systemic effects in cancer:
Para-neoplastic syndrome
Symptoms that occur at site distant from a tumour or metastases
E.g. lung cancers may produce ACTH leading to Cushing’s syndrome
List TWO ways by which malignant tumours spread in the body.
Blood or lymph
List FOUR common sites of metastasis in the body.
Bone, liver, lungs and brain
Because of their routes to lymph and arteries.
List 4 early signs that may present in cancer patients.
Unexplained weight loss
Anaemia and fatigue
Night sweats
Unusual bleeding
Persistent indigestion / heartburn
Difficulty swallowing
Change in bowel or bladder habits
A solid lump
Swollen lymph nodes
Discuss the following statement:
‘Tumour markers can provide an absolute diagnosis of cancer’.
This is not true - false positives and false negatives are possible.
Tumour markers are 1 possible diagnostic tool
List ONE blood born tumour marker that may be elevated in:
a. Colorectal cancer
b. Prostate cancer
Colorectal cancer =
Carcinoembryonic antigen (CEA)
Low sensitivity and specificity.
Used more for monitoring
Prostate cancer =
Prostate Specific Antigen (PSA)
Normally present in small quantities in the blood.
PSA used to assist in diagnosis or monitor metastasis post-treatment
Name ONE tumour marker used to diagnose testicular cancer.
Human chorionic gonadotrophin (hCG)
Men do not naturally produce this hormone.
Name a tumour marker elevated in:
a. Ovarian cancer
b. Breast cancer
Ovarian cancer = CA-125 protein
Normal blood range less than 35U/ml
Breast cancer = CA-15-3
Normal blood range less than 30U/ml
Name ONE stool tumour marker which can be used as a screening method for colorectal cancer.
M2-PK
Not organ specific so may be raised in many tumour types.
List 4 diagnositc tests that can be used to detect cancer
Blood tests
Tumour markers
Imaging (x-rays etc)
Biopsies
What are the 3 basic conventional treatments for cancer?
Surgery
Chemotherapy
Radiotherapy
Describe the difference between ‘curative’ and ‘palliative’ treatment approaches in cancer.
Curative = treatment used in an attempt to resolve the malignancy.
Palliative = focuses on quality of life and reducing symptoms
What is the term used for the surgical procedure to remove the testes?
Orchiectomy
What is the term used for the surgical procedure to remove the prostate?
Prostatectomy
What is the term used for the surgical procedure to remove the breast?
Mastectomy
Explain why radiotherapy can cause immunosuppression.
Radiotherapy affects any cell that divides rapidly - both cancerous and healthy cells.
RBCs are rapidly dividing cells so the bone marrow depression can occur leading to immunocompromised
What 3 types of radiotherapy are there?
External beam radiation - beams are generated outside the body
Internal beam radiations - beams are generated inside the body
Systemic beam radiation - radioactive material enters the blood to reach cells all over the body.
List TWO adverse effects of chemotherapy.
- Bone marrow suppression
- Diarrhoea
- Vomiting
- Nausea
- Hair loss
- Organ damage
- Cancer
What is the term used for Cancer which forms in the epithelial tissue
Carcinomas
What is the term used for Cancer which forms in the connective tissue
Sarcomas
What is the term used for Cancer which forms in the blood and/or bone marrow
Leukaemias
List 4 nutritional elements that could be used to prevent cancer or alongside conventional treatment.
- Phytonutrients
- High levels of antioxidants
- High fibre
- Whole plant food
- Adequate protein and omega-3
- Anti-inflammatory foods
- Diet rich in fruit and veg (7-9+ portions)
Breifly describe the prevalence of lung cancer
Peaks between 60-70 years of age.
Mostly in men (3:1)
2nd most common malignancy in men.
Poor prognosis (15% 5 year survival rate)
90% due to smoking
List THREE characteristics signs and/or symptoms (not weight loss) of lung cancer.
Dry & persistent cough
Dyspnoea
Chest pain
Voice horseness
Blood in sputum
Wasting in muscles in hands
‘Clubbing’ in nails
Briefly describe the prevalence of colorectal cancer
Common in over 50 years of age.
More common in developed countries
Name THREE risk factors for the development of colorectal cancer.
Diet high in meat
Low fibre intake
Lack of vit D
Polyps
Family history
List TWO characteristic signs and / or symptoms of colorectal cancer.
(Initially few symptoms)
Rectal bleeding, blood/mucus in stools
Obstruction causing abdominal pain
Consistent change in bowel habits.
Describe TWO differences between a ‘benign breast mass’ and a ‘malignant breast mass’.
Benign (most breast lumps)
- Painful / tender lumps
- Mobile
- Smooth and have regular borders
Malignant:
- Painless
- Static
- irregular
List TWO overlying skin changes and TWO nipple / breast changes observed in breast cancer.
Overlying Skin:
-Dimpling
-‘Orange peel’ appearance
Nipple/breast:
- Inverted nipple
- Discharge from nipple
Describe the role of oestrogen in breast cancer.
Breast cancer cells contact receptors that hormones or proteins can bind to and promote tumour growth.
80% have oestrogen receptors.
High oestrogen exposure increases risk.
Describe what is meant by ‘triple negative’ breast cancer.
Tumours normally have one of 3 receptors types: oestrogen, progesterone, or epidermal growth factor.
When a tumour doesn’t have the 3 receptor types, it’s called a triple negative.
Accounts for 15% of cases
Explain how a longer reproductive life can increase the risk of breast cancer.
It’s a longer period of endogenous oestrogen and progesterone exposure.
Name TWO genetic mutations which may increase the risk of breast cancer.
BRCA 1
BRCA 2
Explain why aluminum and parabens may increase the risk of breast cancer.
Both mimic oestrogen or have oestrogen-like hormone effects. And both found in deodorant/antiperspirant.
Why is dairy a risk factor for breast cancer?
Contains IGF-1
Describe the main difference between ‘mammography’ and ‘thermography’.
Mammography is an x-ray and only detects tumours when they reach a particular size.
Thermography measures increased temperature in the body and can detect earlier pathological cancerous changes.
Name ONE hormone strongly associated with ovarian cancer.
Oestrogen
List FOUR risk factors for ovarian cancer.
Family history
BRCA 1 and BRCA 2 genes
Long reproductive lifescan
Infertility or never given birth
HRT
Poor lifestyle (exercise, smoker, obesity)
Diet rich in animal fats
List TWO characteristic signs and/or symptoms of ovarian cancer.
Vague abdominal discomfort and bloating.
Abdominal mass and pelvic pain.
Name TWO risk factors for cervical cancer.
Persistent HPV infection
Sexual behaviour
Smoking
COCP
HIV
Name TWO characteristic signs and / or symptoms of cervical cancer.
Abnormal vaginal bleeding
Vaginal discharge
White/red patches on the cervix
List TWO characteristic signs and / or symptoms of liver cancer.
Jaundice
Ascites
Hepatomegaly (enlarged liver)
Pruritis (itchy skin)
Weight loss
- Describe the pathophysiology of liver cancer due to:
a. Liver cirrhosis
b. Hepatitis B / C
Liver cirrhosis:
Alcohol/toxins cause necrosis in the liver.
Causes chronic inflammation and cell proliferation
Hep B/C -
Viral integration into host genome.
DNA deletions and oncogenes activated
List TWO dietary risk factors for gastric cancer.
High intake of:
Salt
Pickled foods
Smoked foods
Low fruit and veg diet
Name ONE diagnostic tumour marker for gastric cancer.
CEA
CA19-9
Describe TWO differences in the signs and / or symptoms associated with ‘early stage’ and ‘advanced stage’ of gastric cancer.
Early:
Persistent indigestion
Frequent burping
Heartburn
Feeling full quickly when eating
Late:
Black blood in stools
Loss of appetite
Weightloss
Tiredness
List ONE red flag symptom associated with oesophageal cancer.
Dysphagia (difficulty swallowing)
List TWO lifestyle risk factors for the development of oesophageal cancer.
Obesity
Low fruit and veg
Alcohol
Smoking
List TWO causes of pancreatic cancer
Smoking
Family history
Chronic pancreatitis
Diabetes
H. pylori
List TWO characteristic signs and / or symptoms of pancreatic cancer.
Epigastric pain
Unexplained weight loss
Jaundice
List TWO characteristic signs and / or symptoms of prostate cancer.
Nocturia
Haematuria
Explain the relevance of ‘back pain’ in prostate cancer.
Common metastasis in the spine
List FOUR risk factors (not age) which increases the risk of prostate cancer.
Ethnicity (black men at higher risk)
Family history
Genetics
Obesity
Diet high in meat, dairy and refined sugar
Mr X displays the followings signs and / or symptoms, what pathology could this patient be experiencing?
‘Painless haematuria, increases urine frequency, urgency, dysuria, bone metastases’
Bladder cancer
Explain how smoking can contribute to bladder cancer.
Carcinogens inhaled enter the blood stream.
Filtered out by kidneys
Pool in the bladder and induce mutations
Describe TWO characteristic signs and/or symptoms of testicular cancer.
Hard, painless unilateral mass
Dragging sensation
Dull ache
List TWO risk factors which increase the risk of skin cancer.
UV light exposure
Chemicals on the skin (including sunscreen)
Name TWO body locations commonly affected by skin cancer.
Head
Neck
Back
- Describe the lesions associated with:
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Melanoma
a. Basal cell carcinoma
Raised, smooth, pearly bump
b. Squamous cell carcinoma
Red, scaling, thickened nodule
c. Melanoma
Brown/black lesions that changes in size, shape, colour
Describe FIVE warning signs that may indicate a melanoma.
Lesion changes in:
Size
Shape
Colour
Elevation
Or a new mole appears
Explain what is meant by ‘osteosarcoma’.
Malignant bone tumour
Describe ONE feature of ‘pain’ associated with osteosarcoma.
Worsening pain that becomes unremitting.
Pain wakes the patient at night
Describe the main difference between ‘high-grade’ and ‘low-grade’ brain tumours.
High-grade - grows rapidly and aggressively
Low-grade grows slower
Describe the headache associated with a brain tumour.
Unexplained headache that’s worse in the morning.
List ONE sign (not headache) of a brain tumour.
Papilloedema (bulging optic disc)
Using definitions compare ‘lymphoma’ with ‘leukaemia’.
Lymphoma = malignancy of lymphatic cells
Leukaemia = group of bone marrow cancers
Name the ‘lymphocyte’ commonly involved with lymphoma.
B-lymphocyte
List ONE viral risk factor found in 50% of patients with Hodgkin’s lymphoma.
Epstein-Barr virus (EBV)
HIV
List TWO characteristic signs and / or symptoms of lymphoma.
Enlarged and asymptomatic lymph nodes in neck
Chest discomfort
Drenching night sweats
Fever
Weightloss
Describe two differences between acute and chronic leukaemia/
Acute:
Sudden onset
All ages
Immature leukaemic cells
Chronic:
Insidious onset
Usually adults
Mature leukaemic cells
