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Year 2 Medicine @ Lancaster Uni > 2.10 - Breast and Colorectal Cancer > Flashcards

2.10 - Breast and Colorectal Cancer Flashcards

1
Q

What are the different types of cancerous growth?

A
  • Benign
  • Malignant
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2
Q

What is the defintion of benign neoplasia?

A
  • Non cancerous growths
  • DO NOT invade nearby tissue
  • NO mets
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3
Q

What are the cell characteristics of benign neoplasia?

A
  • Resemble normal cells in structure and function
  • Slower growth rates of division
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4
Q

What is the growth pattern of benign neoplasia?

A
  • Grow locally and form a cohesive mass
  • Growth confined to a specific area
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5
Q
  • What are the clinical features associated benign neoplasia?
A
  • Usually asymptomatic
  • Present as well-defined encapsulated masses that can be resected surgically
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6
Q

What is the prognosis surrounding benign neoplasia?

A
  • Generally non-life threatening and have a good prognostic outlook
  • Usually resected surgically and have rare rates of recurrence
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7
Q

What is the definition of malignant neoplasia?

A
  • Cancerous growths that display uncontrolled cell growth, invasion and mets
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8
Q

What are the cell characteristics seen in malignant neoplasia?

A
  • Show abnormal morphology with pleomorphism
  • Increased nucleus size and loss of differentiation
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9
Q

What is the growth pattern seen in malignant neoplasia?

A
  • Malignant tumours infiltrate other tissues and spread distantly
  • May form irregular margins and invade adjacent structures
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10
Q

What are the clinical features associated with malignant neoplasia?

A
  • Symptoms relate to local tissue invasion, compression or metastatic spread
  • Symptoms include: Pain, weight loss, fatigue
  • Systemic symptoms such as fever also present
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11
Q

What is the prognosis around malignant neoplasia?

A
  • Carry a significant risk of mortality and morbidity depending on many factors
  • Treatments include surgery, chemo, radiation and other adjuvent therapies
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12
Q

What is the definition of colorectal cancer (CRC)?

A
  • Refers to malignancy that arises from any part of the colon
  • Most common sites are the rectum and sigmoid colon
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13
Q

What is the epidemiology around colorectal cancer (CRC)?

A
  • 4th most common malignancy in the UK
  • 42,000 cases a year
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14
Q

What proportion of people have metatastic spread of colorectal cancer (CRC) at diagnosis?

A
  • Around a 1/4
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15
Q

What are the symptoms associated with colorectal cancer (CRC)?

A
  • Change in bowel habit
  • Weight loss
  • Malaise
  • Tenesmus
  • Rectal bleeding
  • Abdominal pain
  • Palpable mass
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16
Q

What are the usual clinical signs seen in colorectal cancer (CRC)?

A
  • Pallor
  • Abnormal PR exam
  • Abdominal mass
  • Anorexia
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17
Q

What signs are seen in metastatic colorectal cancer (CRC

A
  • Hepatomegaly
  • Jaundice
  • Lymphadenopathy
  • APC gene mutations
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18
Q

What is the most common site of metastasis in colorectal cancer (CRC)?

A
  • The liver
  • Also seen in lungs if rectal involvement
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19
Q

What are the risk factors associated with colorectal cancer (CRC)?

A
  • Family history
  • Hereditary
  • IBD
  • White ethnicity
  • Radiotherapy
  • Obesity
  • DM
  • Smoking
  • Poor diet
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20
Q

What are the features of right sided colorectal cancer (CRC)?

A
  • Tend to develop masses from dysplastic polyps
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21
Q

What are the features of left sided colorectal cancer (CRC)?

A
  • Tend to grow circumferentially, giving an apple core appearance
  • More likely to cause obstruction and stricture
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22
Q

What would a narrowing of the lumen manifest as in colorectal cancer (CRC)?

A
  • Habit change
  • Obstruction
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23
Q

What is left-sided colorectal cancer (CRC) classicallly accompanied with?

A
  • Iron deficiency anaemia
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24
Q

What are the most common sites of colorectal cancer (CRC)?

A
  • Sigmoid colon
  • Rectum
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25
Q

What hereditary conditions can contribute to the development of colorectal cancer (CRC)?

A
  • Lynch syndrome
  • FAP
  • MYH-associated polyposis
  • Serrated polyposis
  • Juevenile polyposis syndrome
  • Peutz-Jeghers
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26
Q

What is Lynch syndrome?

A
  • Hereditary nonpolyposis CRC (HNPCC)
  • Autosomal dom. responsible for 3% of CRC
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27
Q

What are common mutations that are seen in Lynch syndrome?

A
  • MCH1, MCH2, MSH6, PMS2
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28
Q

What is FAP in relation to colorectal cancer (CRC)?

A
  • Familial adenmatous polyposis
  • Development of numerous polyps in the colon and rectum
  • 90% -> CRC if not treated
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29
Q

Which gene is affected in FAP?

A
  • Mutations to the APC gene which plays role in tumour suppression
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30
Q

What is the treatment of FAP?

A
  • Prophylatic surgical resection to prevent progression of colorectal cancer (CRC)?
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31
Q

What is MYH-associated polyposis?

A
  • Characterised by colorectal adenomas and cancers caused by mutation in MYH gene
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32
Q

What is the MYH gene and how does it increase risk of colorectal cancer (CRC)?

A
  • Acts as a base excison gene
  • Failure of this increase risk of polyposis and there CRC
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33
Q

What is serrated polyposis?

A
  • Characterised by multiple serrated polyps
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34
Q

What is jeuvenile polyposis syndrome?

A
  • Characterised by hemiartotous polyps throughout the GI tract
  • Increases risk
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35
Q

What is Peutz-Jeghers syndrome?

A
  • Characterised by hamartotous polyps in the GI tract, pigmented mucocutaneous lesions and increased risk of malignancy
  • 40% lifetime risk of colorectal cancer (CRC)?
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36
Q

What are the different management options available for colorectal cancer (CRC)?

A
  • Surgical resection
  • Endoscopic techniques
  • Radiotherapy
  • Chemo
  • Palliative care
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37
Q

What is neoadjuvant therapy?

A
  • Therapy given prior to surgery to help with containment and reduction of any tumours
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38
Q

What is adjuvant therapy?

A
  • Refers to therapies given post-surgical resection
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39
Q

What are examples of adjuvant chemotherapy regimes?

A
  • FOLFOX
  • CAPOX
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40
Q

What is given in the FOLFOX chemotherapy regimen?

A
  • FOLinic acid
  • Fluororacil
  • OXaliplatin
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41
Q

What is give in the CAPOX chemotherapy regimen?

A
  • CAPecitabine
  • OXaliplatin
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42
Q

What are the preventative measures that can be taken in colorectal cancer (CRC)?

A
  • Optimisation of modifiable risk factors
  • Medication
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43
Q

What are the genetic pathways from which colorectal cancer (CRC) can develop?

A
  • Sporadic (70%)
  • Inherited (10%)
  • Familial (20%)
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44
Q

What is the most common pathway for the development of colorectal cancer (CRC)?

A
  • Adenoma-Carcinoma sequence
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45
Q

What is involved in the Adenoma-Carcinoma sequence?

A
  • Mutations occur over time
  • These become adenomas and become more dysplastic over time
  • These then become carcinomas
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46
Q

What is one of the earliest mutations seen in the Adenoma-Carcinoma sequence?

A
  • APC gene
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47
Q

What is the function of the APC gene and what does a mutation in this gene cause?

A
  • Functions as a tumour suppressor gene
  • Leads to a hyperproliferative epithelium
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48
Q

Other the APC, which other gene mutations may be seen in colorectal cancer (CRC)?

A
  • KRAS - Proto-oncogene
  • p53
  • SMAD4
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49
Q

What is the NHS screening program related to colorectal cancer (CRC)?

A
  • Open to ages 56-74, every two years
  • Uses faecal immunochemical test (FIT)
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50
Q

What happens if abnormalities are detected in the FIT test?

A
  • Invited for colonoscopy
  • TWW pathway
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51
Q

When should a 40 year old be referred on a TWW?

A
  • 40+
  • Weight loss
  • Abdominal pain
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52
Q

When should a 50 year old be referred on a TWW?

A
  • 50+
  • PR bleeding
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53
Q

When should a 60 year old be referred on a TWW?

A
  • Iron deficiency anaemia
  • Habit changes
  • PR bleeding
54
Q

What is the gold standard investigation for colorectal cancer (CRC)?

A
  • Colonoscopy
  • Allows for visualisation of colon
55
Q

Which tumour marker is indicative of colorectal cancer (CRC)?

A
  • CEA (Carcinoembryonic antigen)
56
Q

Which blood tests are performed in colorectal cancer (CRC)?

A
  • FBC
  • Serum Iron
  • Renal function
  • LFT
  • Clotting screen
57
Q

What imaging tests are done in suspected cases of colorectal cancer (CRC)?

A
  • CT chest/abdo/pelvis
  • MRI liver
  • MRI rectum
  • PET/CT
58
Q

What is Dukes classification and what are the different stages?

A
  • Used for colorectal cancer (CRC)?
  • A = inner bowel lining
  • B = Through muscular layer
  • C = At least 1 node near bowel
  • D = Mets
59
Q

What is the usual classification system used for colorectal cancer (CRC)?

A
  • TNM classification
60
Q

What are the different tumour stages in the TNM classification system?

A
  • Tx - Can’t be assessed
  • T0 - No evidence
  • T1 - Carcinoma in-situ
  • T2 - Invades muscularis propria
  • T3 - Into peri-CRC tissues
  • T4a - Through visceral peritoneum
  • T4b - Adherance to adjacent structures
61
Q

What are the different lymphatic stages in the TNM classification system?

A
  • Nx - Can’t be assessed
  • N0 - No node mets
  • N1a - 1 node
  • N1b - 2-3 nodes
  • N1c - Tumor deposits
  • N2a - 4-6 nodes
  • N2b - 7+ nodes
61
Q

What are the different metastsis stages in the TNM classification system?

A
  • M0 - No distant mets
  • M1 - Distant mets
  • M1a - 1 organ, no peritoneal
  • M1b - 2+ organs, no peritoneal
  • M1c - Peritoneal involvement +/- organs
62
Q

What is the estimated 1 year prognostic outcome?

A
  • Around 78%
63
Q

What is the estimated 5 year prognostic outcome?

A
  • Around 58%
64
Q

What are some possible complication associated with tumor resection?

A
  • Structural damage
  • Anastomotic leak
  • Sexual dysfunction
65
Q

How can the risk of death be calculated prior to surgery?

A
  • SORT score
66
Q

What is the definition of breast cancer?

A
  • Any malignancy that effects the breast tissue and/or associated structures surrounding breast
67
Q

Who can breast cancer (BC) affect?

A
  • Male
  • Female
  • Trans-men
  • Trans-women
  • Non-binary
68
Q

What is the epidemiology behind breast cancer (BC)?

A
  • Around 55,000 in UK each year
  • Most common in women
69
Q

What is the 1 year survival rate of breast cancer (BC)?

A
  • Around 96%
70
Q

What clinical signs are seen in breast cancer (BC)?

A
  • Breast +/- axillary lump which are often irregular and can be fixed to skin or muscle
71
Q

What breast skin may be seen in breast cancer (BC)?

A
  • Tethering
  • Oedema
  • ‘Peau d’orange’
72
Q

What nipple changes may be seen in breast cancer (BC)?

A
  • Inversion
  • Discharge
  • Vein dilation
  • Cracking
73
Q

What gene mutations are the most common in breast cancer (BC)?

A
  • BRCA
74
Q

What symptoms are associated with breast cancer (BC)?

A
  • Pain
  • Tenderness
  • Swelling
75
Q

What are the risk factors associated with the development of breast cancer (BC)?

A
  • Female gender
  • Age
  • FHx
  • Personal Hx
  • Genetic predispositions
  • Early period/Menopausal delay
  • Nulliparity
  • Increased 1st pregnancy age
  • Mulitparity
  • Combined oral contraceptive
  • HRT
  • White ethnicity
  • Radiation exposure
76
Q

What happens in a BRCA 1 mutation?

A
  • Mutation on chromosome 17 that predisposes patients to breast cancer (BC) amongst other malignancies
  • Risk increases to 65%-80%
  • Risk of ovarian cancer increases also
77
Q

What happens in a BRCA 2 mutation?

A
  • Mutation on chromosome 13 that increase genetic predisposition
  • Risk increased to 45%-70%
  • Risk of ovarian cancer also increased
78
Q

What are the two types of surgical mangement for breast cancer (BC)?

A
  • Breast conservation
  • Mastectomy
79
Q

What is involved in a breast conservation surgery for breast cancer (BC)?

A
  • Involves excision of tumor with maximum tissue left
  • Aesthetic wishes should be followed
80
Q

What is indicated post-op in breast conservation surgery?

A
  • Radiotherapy of excision site
  • Margins must be checked
81
Q

What is involved in a mastectomy surgery in breast cancer (BC)?

A
  • Preferred if there is an unfavourable ratio of tumor:breast tissue
  • Used when radiotherapy is contraindicated
82
Q

How can a mastectomy be used prophylactically?

A
  • Pre-emptive removal of breast tissue when there is significant genetic predisposition
83
Q

When and why is breast recontruction performed in breast cancer (BC)?

A
  • After removal of tumor/tissue
  • Helps to restore some QOL to the patient
84
Q

How is radiotherapy used in the treatment of breast cancer (BC)?

A
  • Role of a key adjunct to reduce incidences of recurrence following conservative surgery
85
Q

What are the associated risks seen with radiotherapy in breast cancer (BC)?

A
  • Risks for surrounding structures such as heart and lungs
86
Q

How can chemotherapy and biologics used in breast cancer (BC)?

A
  • Neoadjuvant
  • Adjuvant
87
Q

When is neoadjuvant therapy given in breast cancer (BC)?

A
  • Used to reduce tumour size prior to surgical removal
88
Q

What drugs are used in adjuvant chemotherapy?

A
  • Regimes tend to include a taxane and an anthracycline:
  • F - Fluorouracil
  • E - Epirubicin
  • C - Cyclophosphamide
89
Q

What drug is offered to people who are HER2 positive?

A
  • Trastuzumab - Monoclonal antibody that targets HER2 receptors
  • Can cause cardiac based adverse effects
90
Q

When is endocrine therapy used in the treatment of breast cancer (BC)?

A
  • Typically used as an adjunct to other treatments to reduce risk or recurrence
  • Dependant on ovarian function
91
Q

What are examples of endorcrine therapy given in breast cancer (BC)?

A
  • Tamoxifen
  • Aromatase inhibitors (Eg. Anastrozole)
92
Q

How long is the standard course of endocrine therapy in breast cancer (BC)?

A
  • 5 years
93
Q

What are the five major stages of breast cancer (BC)?

A

Stage 0 = non invasive DCIS
Stage I-IV = Invasive BC

94
Q

What classification system is used for the grading of breast cancer (BC)?

A
  • TNM classification system
95
Q

What are the tumour stages in the TNM classification for breast cancer (BC)?

A
  • Tx - No evaluation
  • T0 - No evidence
  • Tis - Carcinoma in-situ
  • T1mi - 1mm or smaller
  • T1a - 1mm-5mm
  • T1b - 5mm-10mm
  • T1c - 10mm-20mm
  • T2 - 20mm-50mm
  • T3 - >50mm
  • T4a - Into chest wall
  • T4b - Into skin
  • T4c - Inflammatory breast cancer
96
Q

What are the nodal stages in the TNM classification for breast cancer (BC)?

A
  • Nx - No evaluation
  • N0 - No cancer or smaller than 0.2mm
  • N1 - Axillary lymph nodes 1-3
  • N2 - Axillary lymph nodes 4-9
  • N3 - Axillary lymph nodes +10
97
Q

What are the metastatic stages in the TNM classification of breast cancer (BC)?

A

Mx - No evaluation
M0 - No evidence
M0(i+) - No radiological evidence but cells in blood and bone
M1 - Distant mets in other part of body

98
Q

What are the majority of breast cancer (BC) cases classed as?

A
  • Carcinomas
99
Q

What can breast carcinomas be subdivided into?

A
  • Lobular
  • Ductal
100
Q

How are breast cancers (BC) classified based on their invasive properties?

A
  • In-situ
  • Invasive
101
Q

How are breast cancer (BC) grouped molecularly?

A
  • Based on gene expression
  • Luminal A
  • Luminal B
  • Basal
  • HER-2
102
Q

What are the two types of ductal carcinoma?

A
  • Ductal carcinoma in situ (DCIS)
  • Invasive ductal carcinoma (IDC)
103
Q

What is ductal carcinoma in-situ?

A
  • Heterogenous group of non-invasive legions that progressive to be invasive
  • Lesions either low, intermediate, high risk
  • Comedo DCIS is a high-grade example
104
Q

What is invasive ductal carcinoma?

A
  • Composes 70%-80% of invasive breast cancer (Most common)
  • Graded on level of differentiation of tumor cells
105
Q

What are the two types of lobular breast cancer (BC)?

A
  • Lobular carcinoma in-situ (LCIS)
  • Invasive lobular carcinoma (ILC)
106
Q

What is lobular carcinoma in-situ (LCIS)?

A
  • Lobular neoplasia
  • Relatively uncommon
  • Presents a greater risk of ILC
107
Q

What is invasive lobular carcinoma (ILC)?

A
  • Second most common (5%-10%)
  • Potential link with post-menopausal hormone therapy
  • Vast majority are oestrogen receptor positive
108
Q

Broadly, what is the development of breast cancer (BC) due to?

A
  • DNA damage and genetic mutations
109
Q

Overexposure to what hormone can increase breast cancer (BC) risk?

A
  • Oestrogen
110
Q

What screening program is used for breast cancer (BC)?

A
  • NHS program for 50-71 year olds
  • Involves a mammogram
  • Approximately 96% will return normal result
111
Q

What happens to patients who return abnormal results on a mammogram?

A
  • Should be referred on a TWW pathway
112
Q

When should a 30 year old be referred on a TWW for breast cancer (BC)?

A
  • 30+
  • Unexplained lump +/- pain
113
Q

When should a 50 year old be referred on a TWW for breast cancer (BC)?

A
  • 50+
  • Unilateral nipple discharge, retraction or concerning changes
114
Q

What is performed at a one-stop breast clinic?

A
  • Triple assessment
  • History
  • Examination
  • Histopathology
115
Q

Which element of a patient history is most important for a breast cancer (BC) diagnosis?

A
  • Family history
116
Q

What imaging modalities are commonly used in the diagnosis of breast cancer (BC)?

A
  • Mammogram
  • USS
117
Q

How is histopathology used in the diagnosis of breast cancer (BC)?

A
  • Sample taken by a fine-needle aspiration
  • Core biopsy can also be taken
118
Q

In advanced disease which imaging modalities can be used?

A
  • CXR
  • Breast tomosynthesis
  • CT chest/abdo/pelvis
  • Contrast liver USS
  • DXA scan
  • PET/CT
119
Q

How is receptor testing used in the diagnosis of breast cancer (BC)?

A
  • Oestrogen and Progesterone receptor status should be measured as they influence growth of breast cancer (BC)
  • HER2 also measured
120
Q

What is triple positive breast cancer (BC)?

A
  • Postive oestrogen receptor
  • Positive progesterone receptor
  • Positive HER2 receptor
121
Q

Which genes are most common in inherited breast cancer (BC)?

A
  • BRCA 1
  • BRCA 2
  • Normally help to repair damaged to DNA but this doesn’t happen once mutated
122
Q

Which chromosome is BRCA 1 found on?

A
  • Chromosome 17
123
Q

Which chromosome is BRCA 2 found on?

A
  • Chromosome 13
124
Q

What are the different types of molecular biology techniques used in the detection of breast cancer (BC)?

A
  • Karyotype testing
  • FISH
  • PCR
  • Sanger sequencing
  • Next-gen sequencing
  • Comparitive genomic hybridisation
125
Q

How does karyotype testing work in breast cancer (BC)?

A
  • Helps to identify numerical and large structural abnormalities
  • Large deletions/duplications
126
Q

How does FISH work in breast cancer (BC) investigation?

A
  • Flurorescent in-situ hybridisation
  • For anueploidies and known microdeletions/duplications
  • Commonly used to look for HER2 gene amplifications in breast cancer (BC)
127
Q

How does PCR testing work in breast cancer (BC)?

A
  • Allows for amplification of DNA sequences which all identification of genetic abnormalities
  • Mutations in oncogenes and tumor-suppressor genes
128
Q

How is Sanger sequencing used in breast cancer (BC)?

A
  • Helps to sequence DNA allowing single nucleotide variations to be indentified
  • Useful for detecting specific genes
129
Q

How is next-generation sequencing used in breast cancer (BC)?

A
  • NGS help to enable sequencing on large genomic regions or even full genomes
  • Allow for analysis of coding regions of cancer-related genes
  • Detection of abnormalities
130
Q

How does comparative genetic hybridisation work in breast cancer (BC)?

A
  • CGH is that compares tumor DNA to normal DNA
  • Microarray platforms detect genomic imbalances that may be linked to cancer
131
Q
A

Year 2 Medicine @ Lancaster Uni (15 decks)

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