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Cancer, Diabetes, Obesity > Cancer > Flashcards

Cancer Flashcards

1
Q

What are breast cancer risk factors?

A

Oestrogen
Obesity
Alcohol
Breast feeding - reduces chance by 5%

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2
Q

What are lung cancer risk factors?

A

Smoking
Air pollution
Work place exposure

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3
Q

What are bowel cancer risk factors?

A 
Processed meats 
Not enough fibre 
Obesity 
Alcohol 
Smoking
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4
Q

What is cancer?

A

Highly invasive and destructive neoplasms

Neoplasms - cells formed from irreversible deviant cell division

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5
Q

What is a tumour?

A

A collection of cells that have lost genetic control of proliferation & differentiation

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6
Q

What is a benign tumour?

A

Localised & closely resembling cells of origin, but lost control of proliferation
Oma to tissue type that the growth originated from
Differentiated cells similar to normal cells
Mitosis is fairly normal
Relatively slow growth
Expanding mass
Frequently encapsulated
Remains localised
Systemic effects - rare
Only life threatening in certain locations (e.g. brain)

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7
Q

What is a malignant tumour?

A

Invasive and destructive cells that do not resemble cells of origin
Carcinoma (epithelial) or sarcoma (connective tissue)
Lymphoma, melanoma, leukaemia, hepatoma are all malignant
Cells vary in size and shape - large nuclei
Many undifferentiated cells
Mitosis increased & atypical
Rapid growth
Cells not adhesive, infiltrate tissue
No capsule
Invades nearby tissue or metastasises & lymph vessels
Systemic effects - open present
Life threatening by tissue destruction & spread of tumours

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8
Q

What happens in a normal cell vs a cancer cell?

A 
Normal cell :
- cellular proliferation 
- cell differentiation 
Cancer cell:
- cellular over-proliferation 
- undifferentiated cells
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9
Q

Why does cancer occur?

A

Occurs because of unrepaired gene mutation
Caused by altering genes that control cell:
- reproduction (mitosis, meiosis)
- growth
- differentiation
- death
The cell is allowed to grow uncontrollably (altered proliferation) and loses its ability to carry out its specified function (altered differentiation) & doesn’t die when expected

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10
Q

What are the characteristics of cancer cells?

A

Angiogenesis causes increased blood supply to neoplastic cells
New antigens present on cell surface trigger immune response
Lack of cell contact inhibition causes an increase in cell proliferation
Changes in surface enzymes degrade the extracellular matrix
Enlarged/altered nucleus provides increased energy to rapidly dividing cells
Secretion of substances alters metabolic processes of unaffected cells and increases growth of neoplastic cells
Increased motility causes increased movement to other locations in the body
Lack of adhesion and cohesion makes cells “slippery” and able to move easily throughout adjacent structures

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11
Q

What is the impact of cancer on tissues, organs & organ systems

A

Loss of cell-to-cell communication which allows further unrestricted growth of tumour cells
Increased energy expenditure which deprives unaffected cells of nutrients
Increased motility & loss of cohesion & adhesion, which promotes movement to other locations
Rapid angiogenesis which provides extensive blood flow to the tumour cells
Substance secretion which alters the metabolism & degrades neighbouring unaffected cells
Present foreign antigens on the cancer cell surface, which can trigger the immune response

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12
Q

What are the major categories of cancer genes?

A

Mutator genes
- genes that repair mutated DNA & protect the genome
Protooncogenes
- genes that regulate cell function
Tumour suppressor genes
- genes that prohibit overproliferation of cells & regulate apoptosis (regulated cell death)

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13
Q

What are carcinogens?

A

High energy ionising radiation
Hormones
Chemicals
Viruses & bacteria

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14
Q

What’s the spread of cancer?

A

Local spread - proliferation of the neoplasm within the tissue of origin
Direct extension - process of tumour cells moving into adjacent tissues & organs
Seeding - malignant tumours move along membranes of peritoneal & pleural cavities, gaining easy access to organs within
Metastasises - neoplasms spread to distant sites by way of lymphatics or blood vessels

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15
Q

What’s organ tropism?

A

Affinity of a primary tumour to a specific distant site

  • colon -> liver
  • breast -> bone
  • lung -> brain
  • prostate -> bone
  • malignant melanoma -> lung, liver, brain, lymph nodes
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16
Q

What are cancer classifications?

A

Tumour staging - size, extent, spread, nodes
TNM classification of tumour staging
Level of anaplasia
- grades I & II
- well differentiated
- resemble tissue of origin in size, shape, structure & mitotic activity
- grades III & IV
- highly undifferentiated
- demonstrate little or no resemblance to tissue of origin

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17
Q

What are warning signs of cancer?

A

Unusual bleeding or discharge anywhere in body
Changes in bowel or bladder habits
Change in wart or mole
Sore that doesn’t heal (on skin or in mouth)
Unexplained weight loss
Anaemia or low HB & persistent fatigue
Persistent cough or hoarseness without reason
A solid lump, often painless, in breast or testes or anywhere on body

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18
Q

What are the general manifestations of cancer?

A

Systemic inflammatory & immune responses
- fever
- anorexia
- weight loss
Increased metabolic rate
Paraneoplastic symptoms
- indirect changes in body functions
Local effects of tumour on neighbouring tissues
- occupies space - palpable mass, pain
- loss of function - constipation, diarrhoea, SOB
- changes in blood

19
Q

What is cancer treatments goals?

A

Completely eradicate the neuroplasms
Control continued growth and spread
Reduce symptoms without curing the cancer

20
Q

What are the types of treatment?

A 
Surgery 
Chemotherapy 
Radiotherapy 
Hormones 
Immunotherapy 
Bone marrow transplantation 
Stem cell transplantation 
Adjuvant therapy: additional prophylactic treatment used in cancers known to metastasise early e.g breast (surgery with radiotherapy & chemotherapy) 
Each of these can be used in combination or alone
21
Q

What’s the prognosis?

A

Many factors affect the course and outcome:

  • type
  • location
  • stage of disease
  • age
  • overall health
  • response to treatment
22
Q

What’s the prevention?

A 
Screening 
- breast, bowel, cervical 
Exercise 
Balanced healthy diet 
Maintain healthy weight 
Vaccinations 
Skin protection 
Avoid tobacco 
Avoid heavy alcohol consumption 
Protect against exposure to industrial carcinogens
23
Q

What’s the initiation, promotion, progression theory?

A

Normal cell - carcinogenic agent
DNA damage and cell mutation
Activation of oncogenes by promoter agent
Malignant tumour

24
Q

What are the initiation agents?

A 
Oestrogen 
Red & processed meat 
Smoking 
Alcohol 
Obesity 
UV rays
25
Q

What’s the risk factors of oestrogen?

A 
Early menarche 
Late menopause 
No/limited breast feeding 
Contraceptive pill
HRT 
Obesity
26
Q

What’s the potential initiation process from oestrogen?

A

Oestrogen linked to increase of activation-induced deaminase (AID) in B-cells of immune system
AID causes hypermutation in B-cells as part of antibody production
AID also causes cancer-causing mutations in B-cells
Oestrogen also found to activate AID in breast tissue
??causes cancer-mutations in breast tissue

27
Q

What are the risk factors of red & processed meat?

A

1/4 male & 1/6 female bowel cancer linked to eating red/processed meat
Each 120g/day red meat increases risk by 28%
Each 30g processed meats increases risk by 9%

28
Q

What are the initiating factors of red & processed meat?

A

Haem stimulates gut bacteria to produce N-nitroso compounds
Nitrates & nitrites involved in presenting processed meats also converted to N-nitroso compounds
N-nitroso compounds irritate & damage bowel epithelial cells causing increased division & increased risk of mutation
Cooking red meat at high temperature produces cancer inducing chemicals (amines)

29
Q

What are the risk factors of smoking?

A

5000 chemicals
- many poisons
- 70+ can cause cancer
15 cigarettes produces DNA damage in lung cells
Risk factors increase with length of time smoked rather than amount
- 1 pack day x 40 years worse than 2 packs day x 20 years

30
Q

What’s the initiation process of smoking?

A

Direct action on lung tissue
- chromium & aromatic hydrocarbons damage cellular DNA
- arsenic & nickel prevent DNA repair
Systemic effects
- reduces immune system response to damaged cells

31
Q

What are the risk factors of alcohol?

A

Linked to breast, bowel and lung cancers
Alcohol is a group 1 (highest risk) carcogenic agent
Causes - 4% cancer cases in UK
1 drink (1.5 units)/day increase risk by 5%
Each increase of 1.25 units increases risk by 7.12%

32
Q

What are the initiation factors of alcohol?

A

Breast cancer
- increases oestrogen levels
Lung cancer
- increases the absorption of carcinogenic agents from smoking
- alcohol and smoking together gives a higher risk than each alone
Bowel cancer
- 4,800 cancer linked to alcohol (11%)
- 4+ drinks/day (6+ units) increases risk by over 50%
- alcohol converted to acetaldehyde which damages DNA & stops repair processes
- alcohol causes reactive oxygen species (ROS) in cells which can damage DNA

33
Q

What are the risk factors of obesity?

A

Linked to breast and bowel - ‘belly fat’ or ‘apple shape’
1:5 children overweight before primary school
1:3 overweight after primary school
Obese children often become obese adults
Obesity in childhood may increase cancer risk regardless of the adult weight

34
Q

What are the initiation factors of obesity?

A 
Immune system 
- attracts immune cells, chronic inflammation 
Hormones 
- oestrogen, insulin 
Obesity 
- fat cells
35
Q

What are the risk factors of UV rays?

A

Fair skin
Blonde/red hair
Freckles & moles
Holidays

36
Q

What are initiating factors of UV rays?

A

UVA rays - ageing of skin
UVB rays - cause sunburn
Sunburn - DNA damage to skin cells

37
Q

What are promotion factors?

A

Continued presence of initiation factors
- oestrogen
- smoking
Chronic inflammation

38
Q

What are the symptoms of breast cancer?

A

Change in size or shape
Redness or rash on the skin and/or around the nipple
Discharge from the nipple without squeezing
Swelling in armpit or around collarbone
Lump or thickening that feels different to the rest of the breast tissue
Change in skin texture
Nipple becoming inverted
Constant pain in breast or armpit

39
Q

What’s the symptoms of prostate cancer?

A 
Passing urine more frequently 
Getting up in the night 
Difficulties passing urine 
Urgency 
Leaking 
Blood in urine 
Raised PSA
40
Q

What are the symptoms of lung cancer?

A 
Persistent cough for longer than 3 weeks 
A change in long-term cough 
SOB 
Blood in sputum 
Pain in chest/shoulder 
Loss of appetite 
Fatigue 
Loss of weight
41
Q

What are the types of lung cancer?

A 
Smell cell (oat cell cancer)
-12% lung cancer 
- caused by smoking 
- spreads early 
Non-small cell 
- 87% lung cancer 
- adenocarcoma 
- squamous cell 
- large cell 
- undifferentiated non-small cell 
Pancoast&mesothelioma
42
Q

What are symptoms of bowel cancer?

A 
Bleeding from rectum 
Blood in faeces 
Change in bowel habits 
Pain in abdomen or rectum 
Losing weight 
Fatigue 
SOB 
Bowel obstruction
43
Q

What are the symptoms of skin cancer?

A 
Melanoma 
- A- asymmetry 
- B- border 
- C- colour 
- D - diameter 
- E - elevation 
Basal cell carcinoma 
- a small, slow growing lump (shiny & pink/red)
- spot or sore which doesn’t heal within 4 weeks, itchy, crusty, scabs over bleeds
44
Q

What treatments are there?

A 
Surgery 
- wide local incision or mastectomy 
- lobectomy 
- pneumonectomy 
- prostatectomy 
- colectomy 
Chemotherapy 
- many different regimes - breast cancer - FEC-T
Radiotherapy 
- different regimes - curative lung cancer - daily treatment for 4-7 weeks, breast cancer - daily treatment for 3 weeks 
Hormone/targeted therapy 
- tamoxifen/herceptin

Cancer, Diabetes, Obesity (3 decks)

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