cancer

Question 1

what is a tumour?

Answer 1

a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant

Question 2

Benign

Answer 2

Benign

Localized growths of tissue

Question 3

malignant

Answer 3

Malignant
Abnormal cells growth
Structural and functional alterations
Invasion of nearby tissues
Migrate and colonize other organs via blood and lymph
Success of therapy and survival depend on extent and control of metastases

Question 4

Cells require six characteristics to become fully malignant

Answer 4

Production of growth signals
Lack of sensitivity to antigrowth signals
Resistance towards apoptosis
Immortalization
Stimulation of blood vessel production
Ability to invade and metastasize

Question 5

cancer approaches

Answer 5

Approaches
Epidemiological approach
Study designs
Exposures vs outcomes
Distribution

Experimental approach
Identification of carcinogens via lab testing
Experimental animals, mostly rodents-long term
No universal criteria to translate this data to cancer risk in humans
Effects of chemical agents on end-points belonging to DNA damage, mutagenicity, chromosome testing- short term
Mechanical tests
Identification of intermediate steps in compound-specific carcinogenic process
Limitations
Non-genotoxic carcinogens such as hormones and obesity with no bio-markers

Question 6

Classification of carcinogenic chemicals by the IARC (International Agency for Research on Cancer

Answer 6

Group: 1
Evidence of carcinogenicity in humans:
-Derived from epidemiological studies; sufficient
GROUP 2A
Evidence of carcinogenicity in humans :Limited; agent is experimental carcinogen

GROUP 2B
Evidence of carcinogenicity in humans: Experimental agent; inadequate or non-existent evidence

GROUP 3
Evidence of carcinogenicity in humans
:Non-classifiable as to its carcinogenicity in humans

Group 4
Evidence of carcinogenicity in humans:
Probably non-carcinogenic to humans

Question 7

Risk factors leading to cancer

Answer 7

1. Genetic predisposition (small percentage)
   - Family

2.Tobacco smoking
Single major cause of human cancer globally- 30% of all cancers in HICs; less in LMICs because later start of tobacco epidemic

3.Behavioural
Diet and obesity
Exposure to aflatoxin( produced by fungi in tropical areas)
liver cancer
High intake of red meat and processed meat colorectal cancer
Alcohol

4.Viruses

5.Bacteria
6.Parasites
7.Occupation and pollution
8.Ionizing and non-ionizing radiation
-Acute lymphocytic leukemia
Acute and chronic myeloid leukemia
Cancers of breast, lung, bone, brain, thyroid

Question 8

lung cancer histology

Answer 8

Histology
Small cell carcinoma
Non-small cell
Squamous cell
decreasing
Adenocarcinoma
increasing
Large cell

Question 9

Staging System?

Answer 9

way cancer is thought to

spread

Question 10

Non-Small Cell Lung Cancer:

Staging

Answer 10

T = Main Tumor
N = Regional Nodes
M = Distant Metastasis

Question 11

TNM Staging: Regional Lymph Nodes

Answer 11

NO
No tumor spread to regional lymph
nodes

N1
Spread detected in nodes close to
the tumor

N2
Spread found in nodes in middle of
chest

Question 12

TNM Staging: Primary Tumor (T)

Answer 12

Based on Size of Tumor - bigger more chance
of breaking off and spreading

T1 < or equal 3 cm diameter
T2 >3 m diameter

Question 13

TNM Staging: Distant Metastasis

Answer 13

MO No spread or metastasis outside
of chest

M1 Spread or metastasis present
outside of chest, for example in brain
or bone or liver

Question 14

A etiology and risk factors of lung cancer

Answer 14

Tobacco smoke
Increases risk by 20-40 fold, even for moderate smokers
Cumulative risk of lung cancer is 16%
Excess risk levels off in ex-smokers
Exposure to involuntary smoking increases risk among non-smokers-20% excess risk compared to unexposed non-smokers
Contribution of all aspects of smoking
Average consumption
Duration of smoking
Time since quitting
Age at start
Type of tobacco product
Inhalation pattern

Question 15

Protective factor of lung cancer

Answer 15

Intake of cruciferous vegetables

High content of isothiocyanates

Question 16

Ionizing radiation of lung cancer

Answer 16

Underground miners
Atomic bomb survivors
Radiotherapy for breast cancer or ankylosing spondylitis
Annual low dose CT scan among smokers

Question 17

Lung cancer prevention

Answer 17

Prevention
Control tobacco smoking, including involuntary
Reduction in exposure to occupational an environmental carcinogens-indoor pollution and radon
Increase consumption of fruits and vegetables

Question 18

Liver cancer risk factors

Answer 18

Risk factors and causes
Hep B and C
Main causes of hepatocellular carcinoma (HCC)-75% of liver cancers
Risk increases with early age at infection
Presence of liver cirrhosis is a pathogenic step

Risk factors and causes
Contamination of foodstuffs with aflatoxins especially B1( mycotoxins produced by fungi Aspergillus Flavus and parasiticus)

From improper storage of cereals, peanut’s, other vegetables

Alcoholic cirrhosis-VIP
In populations with low prevalence of HBV and HCV, and low exposure to aflatoxins

Tobacco smoking
Use of oral contraceptives
Diabetes/overweight/obesity
Development of non-alcoholic fatty liver disease (NAFLD)
Excess fat accumulation in liver
Ranges from isolated hepatic steatosis to non-alcoholic steatohepatitis (NASH)
NASH is aggressive and progresses to cirrhosis and HCC

Question 19

Liver cancer prevention

Answer 19

Prevention
HBV vaccination in perinatal period
Aflatoxin reduction in foods
Limited by logistic and economic factors
Control of transmission for HCV
Medical treatment for carriers of HCV and HBV (interferons and newer antiviral drugs)
Control of tobacco smoking and alcohol drinking

Question 20

Liver cancer screening

Answer 20

Fetal antigen α-fetoprotein secreted by HCC and not normal liver
No evidence of impact of screening such as decreased mortality at a population level

Question 21

Stomach cancer risk factors

Answer 21

Risk factors
Helicobacter pylori
High prevalence in developing countries
Precancerous stages
Chronic and atrophic gastritis
Not sufficient cause
Interaction between virulence factors and immune subversion and manipulation mechanisms
5% of all cases
Tobacco smoking
10% of all cases
Salt and salted foods
Strong environmental influence on disease
More varied affluent diet
Better food conservation-refrigeration
Control of H.pylori

Question 22

Protective factors for stomach cancer

Answer 22

Protective factors

Supplements with beta-carotene, vitamin E and selenium

Question 23

Prevention of stomach cancer

Answer 23

Prevention
Decreased consumption of cured meats and salt preserved foods
Eradication of H.pylori
Childhood
Adolescence
Mother-to-child transmission

Question 24

Screening of Stomach cancer

Answer 24

Early detection in Japan by X-ray photofluorography to identify early lesions followed by gastroscopy

Question 25

Histology of Colorectal cancer

Answer 25

Histology Adenocarcinoma Preceded by adenomatous polyp

Question 26

General risk factors of Colorectal cancer

Answer 26

Risk factors Carriers of one adenoma larger than 1 cm Risk increases if multiple adenomas present Prevalence of adenomas detected during colonoscopy parallels incidence of colon cancer Alcohol consumption Tobacco smoking Ulcerative colitis and Crohn’s disease Higher for young age at diagnosis and presence of dysplasia Diabetes Cholecystectomy Women: cancers of endometrium, ovary, breast-due to shared hormonal or dietary factors Cancer of the colon Hereditary rare conditions First degree relative of colon cancer patients high intake of meat and smoked, salted, or processed foods

Question 27

Colorectal cancer prevention

Answer 27

``` Primary prevention Increased physical activity Avoidance of overweight and obesity Reduce alcohol intake Quitting smoking No routine recommendation of aspirin ``` Secondary prevention Removal of adenomas via flexible colonoscopy

Question 28

Protective factor of Colorectal cancer

Answer 28

Vitamin D Aspirin NSAIDS Hormone therapy in menopause and other female hormones (OC)

Question 29

Surveillance of colorectal cancer

Answer 29

``` Surveillance Flexible colonoscopy for adenomas Faecal occult blood Detection of adenoma Low specificity To a lesser extent-low sensitivity Sigmoidoscopy for distal colon Current recommendations Individuals over 50 Annual faecal occult blood testing OR one colonoscopic examination ( not need to be repeated for 10 years if results are normal) ```

Question 30

genetic factors of breast cancer

Answer 30

Genetic factors Carriers of mutations of several high-penetrance and low frequency genes BRCA1, BRCA2, PTEN, TP53 High risk breast cancer Defined as inherited breast cancer syndrome Cumulative lifetime risk in carriers >50%, but rare in most populations except the AshKenazi Jews Moderate risk Group of low penetrance and low frequency DNA repair genes Similarities and differences in risk profiles between TNBC and ER+ breast cancer Similar risk factors BMI Lack of physical activity Breast density

Question 31

risk factors of Breast cancer

Answer 31

Causes and risk factors Endogenous hormones Oestradiol concentrations in post-menopausal women; not so distinct in pre-menopausal Gender Less than 1% occur in men Risk factors: conditions involving high oestrogen levels Gonadal dysfunction Alcohol abuse Obesity Genetics: BRCA2 mutations more common than BRCA1 in male familial breast cancers Little evidence for geographic and interracial variations Fibrocystic disease and fibroadenoma Not pre-neoplastic Share with breast cancer epithelial proliferation, linked to hormonal alterations History of breast cancer in a first degree relative Role of family history related to low penetrance genes associated with hormonal metabolism and regulation, and DNA damage and repair

Question 32

Nulliparity

Answer 32

TNBC triple negative: Decreased risk | ER+: Increased risk

Question 33

Number of deaths

Answer 33

TNBC triple negative: Positively associated | ER+: Inversely associated

Question 34

Age at mernache and menopause

Answer 34

TNBC triple negative: No association | ER+: Modestely association

Question 35

Tobacco

Answer 35

TNBC triple negative: No association | ER+: Risk factor

Question 36

Alcohol

Answer 36

TNBC triple negative: Protective | ER+ : Risk factor

Question 37

Breast cancer prevention

Answer 37

Primary Control of weight gain especially in post menopausal women ``` Secondary Mammography Effective in patients >50 years. Not well demonstrated for <50 Breast self examination No proven reduction in mortality ```

Question 38

Protective factors of breast cancer

Answer 38

Protective factors | Physical exercise

Question 39

Esophageal cancer histology

Answer 39

high risk areas Squamous cell carcinoma (SqCC) Decreasing incidence Adenocarcinoma of lower oesophagus On the rise

Question 40

Esophageal cancer prevention

Answer 40

``` Prevention SqCC Avoidance of smoking Reduction in alcohol drinking Improved diet Increased consumption of fresh fruits and vegetables Adenocarcinoma Avoidance of smoking Control of obesity Increased physical activity Treatment of reflux ```

Question 41

Adenocarcinoma of esophageal cancer

Answer 41

Adenocarcinoma Lower third of oesophagus Increasing incidence among white people and high social classes Preneoplastic Barret’s oesophagus-columnar metaplasia of epithelium Main risk factor: persistent reflux oesophagitis Overwight Lack of physical activity Tobacco smoking Salty foods Protective factor: high intake of fruits and vegetables

Question 42

Esophageal risks and causes

Answer 42

``` Risk factors and causes 90% SqCC from tobacco smoking and alcohol drinking in HICs Smoking Quitting smoking reduces the risk Smoking black tobacco, high-tar, hand-rolled cigarettes, pipes, chewing tobacco Snuff use Genetic factors Genes responsible for keratosis palmaris and plantaris(tylosis) Mycotoxins and N-nitroso compounds Eating Bracken fern Ionizing radiation Radiotherapy for breast cancer ```

Question 43

Other Risk factors and causes of esophageal cancer

Answer 43

Risk factors and causes Diet rich in foods from animal origin and poor in vitamins and fibre Low intake of fresh fruits and vegetables Low intake of fish High intake of red meat and processed meat Plummer-Vinson syndrome Sideropenic dysphagia Deficit of iron, riboflavin, and other vitamins Coeliac disease Nutritional deficiencies Family history of oesophageal cancer

Question 44

Normal characteristics of benign

Answer 44

``` Normal characteristics Amenable to surgery Minor symptoms Fatal Compression Difficult area for surgery Production of hormones ```