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Oncology > Aetiology, imaging and tumour markers > Flashcards

Aetiology, imaging and tumour markers Flashcards

1
Q

What is the guardian of the genome

A

p53 - tumour suppressor gene

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2
Q

What does cigarette smoke act as a carcinogen

A

Carcinogens in cigarette smoke cause specific mutations in p53 tumour suppressor gene

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3
Q

What cancer are aromatic amine associated with?

A

Bladder cancer

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4
Q

What cancer are benzenes associated with

A

leukaemia

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5
Q

what cancer is wood dust associated with

A

nasal adenocarcinoma

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6
Q

what cancer is vinyl chloride associated with?

A

Angiosarcomas

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7
Q

What does radiation increase the risk of cancer?

A

Increases DNA damage leading to the accimulation of mutations in tumour-suppressor genes and oncogenes.

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8
Q

In terms of radiation what 2 factors is tumour development associated with?

A

Radiation source

Level of exposure

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9
Q

What sort of cancer are low fibre western diets associated with

A

colorectal carcinomas

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10
Q

what sort of cancer is the smoked food eaten in Japan associated with

A

Gastric carcinomas

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11
Q

How do low fibre diets cause cancer

A

decreased transit time through the bowel therefore increasing the exposure to carcinogenic substances

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12
Q

what type of drugs are associated with increase in malignancy

A

Cytotoxic drugs - induce DNA damage

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13
Q

How does HPV cause cancer

A

the E6 protein produced by HPV16 binds to and inactivated p53 protein, this causes dysregulation of the cell cycle and apoptotic pathways and subsequent malignant transformation of epithelial cells infected.

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14
Q

what cancers are associated with the sexual transmission of HPV

A

cervical and anal carcinoma

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15
Q

what type of cancer is EBV associated with

A

Non-Hodgkins lymphoma and other lymphomas

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16
Q

how does EBV cause cancer

A

Most common genetic abnormality caused by EBNA, a 14:8 translocation in which the proto-oncogene c-myc on Ch8 becomes transcriptionally controlled by the control elements of immunoglobulin genes on Ch14

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17
Q

What cancer is Hep B virus associated with

A

hepatocellular carcinoma (100 x risk)

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18
Q

How can retroviruses cause cancer

A

through integration into the cellular genome retroviruses can cause abnormal overexpression of oncogenes

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19
Q

what cancer is H. pylori associated with?

A

mucosal associated lymphoid tissue (MALT) tumours

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20
Q

what immunodeficiency is associated with increased risk of tumours

A

T cell deficiencies

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21
Q

what is the key element for diagnosis of cancer

A

Biospy

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22
Q

What does TNM stand for

A

Tumour, node, metastasis

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23
Q

In staging, what does TX mean

A

Primary tumour cannot be assessed

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24
Q

In staging what does T0 mean

A

No evidence of primary tumour

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25
Q

in staging, what does Tis mean

A

Carcinoma in situ

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26
Q

In staging what does T1, T2, T3, T4 mean

A

Increasing side and /or local extent of the primary tumour

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27
Q

in staging what does NX mean

A

regional lymph nodes could not be assessed

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28
Q

In staging, what does N0 mean

A

No regional lymph node metastasis

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29
Q

In staging, what does N1, N2, N3 mean

A

increasing involvement of regional lymph nodes

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30
Q

in staging, what does MX mean

A

Presence of distant metastasis cannot be assessed

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31
Q

in staging what does M0 mean

A

No distant metastasis

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32
Q

in staging what does M1 mean

A

distant metastasis

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33
Q

In colorectal cancer what does Tis mean

A

Carcinoma in situ: intraepithelial or invasion of lamina propria

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34
Q

in colorectal cancer, what does TI mean

A

Tumour invades submucosa

35
Q

in colorectal cancer, what does T2 mean

A

tumour invades muscularis propria

36
Q

in colorectal cancer, what does T3 mean

A

tumour invades through muscularis propria into subserosa or into non-peritonealised pericolic or perirectal tissues

37
Q

in colorectal cancer, what does T4 mean

A

tumour directly invades other organs or structures and/or perforates visceral peritoneum

38
Q

in colorectal cancer, what does NI mean

A

metastasis in 1 to 3 pericolic or perirectal lymph nodes

39
Q

in colorectal cancer, what does N2 mean

A

metastasis in 4 or more pericolic or perirectal lymph nodes

40
Q

what does grade mean in cancer

A

this is histologically, to what extent the tumour resembles normal tissue or has a bizarre appearance

41
Q

In grading what does GX mean

A

grade of differentiation cannot be assessed

42
Q

in grading, what does G1 mean

A

well differentiated: similarities remain to normal tissue of the organ of origin

43
Q

In grading what does G2 mean

A

moderately differentiated

44
Q

In grading, what does G3 mean

A

poorly differentiated, bizarre cells

45
Q

What do higher grades mean in terms of recurrence

A

Higher grades have a higher risk of recurrence locally and of being of higher stage including development of secondaries

46
Q

What is the purpose of staging and grading

A

to indicate prognosis and give the appropriate treatment

47
Q

what do lymph node metastasis indicate?

A

they are a powerful indicator of probable systemic blood borne metastases

48
Q

what is the standard imaging tool for the evaluation of chest and abdominal malignancies

A

CT scan

49
Q

When is MRI useful in cancer imaging

A

In bone and soft tissue lesions, and regions where bone causes artifact in the CT appearance eg pelvis or post. fossa of the brain

50
Q

What is the RECIST system

A

objective tool used to measure response to treatment

51
Q

in the RECIST system, what defines complete response

A

no disease detectable radiologically

52
Q

in the RECIST system, what defines partial response

A

all lesions have shrunk by at least 30%, but disease is still present

53
Q

in the RECIST system, what defines stable disease

A

less than 20% increase in size or less than 30% decrease in size

54
Q

in the RECIST system, what defines progressive disease

A

new lesions or lesions that have increased in size by more than 20%

55
Q

is routine follow up imaging routine practice

A

no - there is no proven benefit

56
Q

what are the qualities of a tumour marker

A

highly sensitive so that few people are missed AND highly specific so that few people are falsely labeled as having the disease

57
Q

what is sensitivity of a marker

A

the ability to detect those with a certain disease. if 100 people have the disease and the marker is elevated in only 95 = sensitivity 0.95

58
Q

what is specificity of a marker

A

its ability to accurately define those who are disease free. If in 100 disease free people the marker is negative in only 90 the specificity of the test is 0.90

59
Q

which tumours is MRI scanning the gold standard for

A

neurospinal, rectal, prostate and MSK tumours

60
Q

what is real time MR

A

uses the changes in MR appearances over time or after contrast agents and are of increasing use in diagnostic work such as assessment of breast masses

61
Q

under what circumstances can you not have an MRI

A

pacemaker, implantable cardiac defibulators, metal foreign bodies. Metallic foreign bodies in the brain or eye are an absolute contraindication eg vascular clips, surgical staples and metallic shards following trauma

62
Q

in terms of tumours what can doppler ultrasound be used to assess

A

tumour blood flow

63
Q

what can USS be used for in cancer diagnostics

A

ultrasounded guided biopsy (real-time guidance)

64
Q

what is bone scintography (bone scan) used for

A

skeletal masses

65
Q

what scan are PET scans usually merged with

A

CT scans, to map functional images with detailed anatomy

66
Q

what does PET scan stand for

A

Positron emission tomography

67
Q

how does a PET scan work

A

detects high energy photons emitted by short-lived radioisotopes which can be chemically tethered to molecules such as glucose or somoatostain to form a tracer.

68
Q

how does PDG-18 work in PET -CT scans

A

it is rapidly taken up in very metabolically active cells such as malignant cells or neurons.

69
Q

when is PDG-18 often used

A

where radical treatment appears possible but has high mortality and/or morbidity

70
Q

what are tumour markers

A

substances produced either by, or in response to a tumour and are present in blood or other tissue and can be quantified

71
Q

what benign conditions can CA125 be elevated in

A

endometriosis, menstruation and pregnancy

72
Q

what does marked elevated in PSA in a man with disseminated bone mets diagnostic of

A

prostate cancer

73
Q

what tests should young males with metastasis have

A

serum LDH, alphaFP, beta-hCG - to diagnose chemo sensitive and potentially curable germ cell tumours.

74
Q

what is one of the most clinically useful features of tumour markers?

A

indicate response to treatment, reduction suggestive of response

75
Q

what is the most common use of CEA tumour marker

A

colorectal cancer

76
Q

what is CEA

A

a cell surface antigen also expressed in a variety of normal tissues

77
Q

what other things can cause elevated CEA

A

smoking, IBD, hepatitis, pancreatitis or gastritis

78
Q

what s the level of CEA in a normal person who is a non-smoker

A

<5ng/ml

79
Q

what is the tumour marker CA125 used for

A

ovarian cancer

80
Q

what is CA125

A

antigen expressed on the surface of ovarian cells

81
Q

what CA125 level is suggestive of cancer

A

> 200 U/ml

82
Q

what other cancers can CA125 be raised in

A 
pancreatic (59%)
lung (32%)
colorectal (21%)
breast cancer (12%)
usually when these are disseminated in to the abdo cavity
83
Q

what cancers is alpha fetoprotein (alphaFP) raised in

A

hepatocellular carcinoma

cancers containing yolk sac elements

84
Q

what is the level of alpha FP in normal individuals

A

undetectable

Oncology (3 decks)

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