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Cancer Flashcards

1
Q

How does basal cell carcinoma spread?

A

It only spreads locally - never spreads to other parts of the body

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2
Q

What is the cure for basal cell carcinoma?

A

complete local excision
= cure

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3
Q

How are white blood cells involved in cancer?

A

white blood cells circulate round the body
and so will any tumour of white blood cells

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4
Q

How are lymph nodes involved in carcinoma?

A

carcinomas spread to the lymph nodes that drain the site of the carcinoma

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5
Q

How else can carcinomas spread?

A

Carcinomas can spread through the blood bone

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6
Q

What are the cancers that spread commonly through the bone?

A

Breast, prostate, lung, thyroid and kidney

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7
Q

What is the treatment plan for breast cancer?

A

Confirm diagnosis of breast cancer > Has it spread to the axilla? > Yes : Axillary clearance is needed No: Has it spread to the rest of the body? > Yes: Systemic Chemo is needed No: Surgery with or without axillary lymph node clearance

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8
Q

What could still be present if a tumour is completely excised?

A

Micro metastases could still be present

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9
Q

What is adjuvant therapy?

A

Extra treatment given after surgical excision e.g. radiotherapy to breast after lumpectomy

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10
Q

What is carcinogenesis?

A

The transformation of normal cells to neoplastic cells though permanent genetic alterations or mutations. A multistep process.

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11
Q

What does carcinogenesis apply to?

A

Malignant neoplasms

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12
Q

What is oncogenesis?

A

Applies to malignant and benign tumours

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13
Q

What is a carcinogen?

A

Agents known or suspected to cause tumours
Carcinogenic = cancer causing
Oncogenic = tumour causing
Act on DNA i.e. are mutagenic

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14
Q

What are the classes of carcinogens?

A

Chemical
Viral
Ionising and non-ionising radiation
Hormones, parasites and mycotoxins
Miscellaneous

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15
Q

What are the features of chemical carcinogens?

A

No common structural features
Some act directly
Most require metabolic conversion from pro-carcinogens to ultimate carcinogens
Enzyme required may be present or confined to certain organs

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16
Q

What are the features of viral carcinogens?

A

Viruses cause approx. 10-15% of all cancers
Most oncogenic viral infections don’t result in cancer

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17
Q

What are some DNA viral carcinogens?

A

Virus: Associated cancers:
Human Herpes Virus | Kaposi Sarcoma
Epstein Barr virus | Burkitt lymphoma

Hepatitis B virus | Hepatocellular carcinoma
Human papillomavirus | Squamous cell carcinomas of head, neck, penis, cervix, anus
Merkle cell polyomavirus | Merkle cell carcinoma

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18
Q

What are some RNA viral carcinogens?

A

Virus: Associated Cancers:
Human T-lymphotrophic virus | Adult T- Cell leukaemia
Hepatitis C Virus | Hepatocellular carcinoma

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19
Q

Radiant energy and cancer

A

UV Light:
Exposure to UVA or UVB increases risk of BCC, melanoma, Squamous cell carcinoma (SCC)
↑↑ Risk in xeroderma pigmentosum

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20
Q

What are some biological carcinogens?

A

Hormones
↑Oestrogen → ↑breast or mammary/endometrial cancer - reduce oestrogen by having kids
Anabolic steroids → hepatocellular carcinoma

Mycotoxins
Aflatoxin B1 → hepatocellular carcinoma

Parasites
Chlonorchis sinensis → cholangiocarcinoma
Shistosoma → bladder cancer

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21
Q

What are other miscellaneous carcinogens?

A

Asbestos, metals

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22
Q

What are some factors of the host that can affect cancer and carcinogens? RISK FACTORS

A

Ethnicity
Diet / Lifestyle
Constitutional factors - age, gender etc.
Premalignant lesions
Transplacental exposure

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23
Q

How can ethnicity affect carcinogens and cancer?

A

Increased oral cancer in South East Asia, due to reverse smoking and betal chewing (Paan)
Decreased risk of skin cancer for those with darker skin

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24
Q

How do constitutional factors affect cancer?

A

Inherited predisposition
familial polyposis coli (chr 5)
retinoblastoma (chr 13)

Age
incidence increases with age

Gender
breast cancer F:M = 200:1

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25
How can lifestyle affect cancer?
Diet / Exercise Excess alcohol use increases risk of cancers of the mouth, oesophagus, liver, colon and breast Obesity increases risk of breast, oesophagus, colon and kidney cancer Exercise reduces risk of colon and breast cancer Sexual behaviour Unprotected sex increases risk of HPV-related cancer (cervix, penis, oropharyngeal)
26
How can premalignant conditions affect your chance of getting cancer?
Identifiable local abnormality associated with increased risk of malignancy at that site e.g.: Colonic polyps Cervical dysplasia (CIN) Ulcerative colitis Undescended testis
27
What is leukaemia?
Cancer of the white blood cells
28
Leukaemia need what treatment?
Systemic chemotherapy - need chemotherapy in the whole body
29
Why do carcinomas spread to local lymph nodes?
Lymphatic vessels are very thin walled - easier for cancer cells to get in there and will drain into local lymph nodes
30
Nearest lymph nodes to breast?
Axillary lymph nodes
31
How do we confirm breast cancer diagnosis?
Needle core biopsy and send it to pathology - needs to be disorganised invasive carcinoma
32
CT can pick up things ....
that are 10mm or more in diameter - size limit though Some tumours you cant see
33
To stop breast cancer after surgery you can give...
adjuvant anti-oestrogen therapy
34
What is cancer at its fundamental level?
genetic
35
Where does most of our cancer risk come from?
Environment
36
What is a neoplasm?
A lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after the initiating stimulus has been removed - a new growth
37
What is asbestos linked to?
Mesothelioma
38
What is basement membrane made from?
Thick collagen
39
What does in situ in cancer mean?
The cancer is still within the duct - there is a big band of collagen around the duct
40
How do we treat in situ cancer?
Excise the cancer
41
What is an invasive cancer/ carcinoma?
The cells have invaded the basement membrane
42
What is microinvasive carcinoma?
It has invaded the basement membrane but not very far
43
How do you treat microinvasive cancer in the cervix?
Treat it with excision
44
What is metastasis?
The process whereby malignant tumours spread from their site of origin to form other tumours at distant sites
45
What is proliferation?
Fast mitosis, when cell reproduces rapidly.
46
Process of metastasis?
1.Detachment of tumour cells from their neighbours 2.Invasion of the surrounding connective tissue to reach conduits of metastasis 3.Intravasation into the lumen of vessels 4.Evasion of host defence mechanisms, such as NK cells 5.Adherence to endothelium at a remote location 6.Extravasation of the cells from the vessel lumen into the surrounding tissue 7.Tumour cells proliferate in the new environment Also look at Invasion and metastasis lecture for a decent explanation
47
What type of spread do carcinomas prefer?
Lymphatic spread
48
What type of spread do sarcomas prefer?
Hematogenous spread
49
Name of malignant tumour in striated muscle?
rhabdo myosarcoma
50
Which cancer does not commonly metastasise to bone?
Liposarcoma
51
What term describes a cancer that has not invaded the basement membrane?
Carcinoma in situ
52
Name of benign tumours in glandular epithelium?
Adenoma
53
What is colorectal screening?
Testing for blood in faeces - if positive then colonoscopy done - lots of polyps most of the time not cancer
54
What is breast cancer screening?
Mammography
55
What is cervical cancer screening?
Direct swab from cervix
56
What do aromatic amines cause?
Bladder cancer
57
What does aflatoxin cause?
Hepatocellular cancer
58
What is a tumour?
Any abnormal swelling e.g Neoplasm Inflammation Hypertrophy Hyperplasia
59
What is the structure of neoplastic cells?
-Derive from nucleated cells -Usually monoclonal -Growth pattern related to parent cell Synthetic activity related to parent cell: collagen, mucin, keratin, hormones etc
60
What is the neoplasm stroma?
connective tissue framework mechanical support nutrition
61
Why classify neoplasms?
To determine appropriate treatment To provide prognostic information
62
Methods of classification?
Behavioural: benign/malignant Histogenetic: cell of origin
63
Neoplasm may be classified as...?
benign borderline malignant
64
Describe a benign neoplasm?
Localised, non-invasive Slow growth rate Low mitotic activity Close resemblance to normal tissue Circumscribed or encapsulated e.g. fibroid
65
What are features of a benign neoplasm?
Nuclear morphometry often normal Necrosis rare Ulceration rare Growth on mucosal surfaces often exophytic
66
Why should we worry about benign neoplasms?
Because they cause morbidity and mortality: Pressure on adjacent structures Obstruct flow Production of hormones Transformation to malignant neoplasm Anxiety
67
What is a description for malignant neoplasms?
Invasive Metastases Rapid growth rate Variable resemblance to normal tissue Poorly defined or irregular border
68
What does a high grade neoplasm mean?
It doesnt look like normal tissue - is a bad prognosis
69
What does a low grade neoplasm mean?
It doesnt look like normal tissue - good prognosis
70
What does a low grade neoplasm mean?
It doesnt look like normal tissue - good prognosis
71
What are the features of a malignant neoplasm?
Hyperchromatic nuclei – darker than normal Pleomorphic nuclei – vary in size Increased mitotic activity Necrosis common – because It outgrows blood supply Ulceration common Growth on mucosal surfaces and skin often endophytic
72
How do malignant neoplasms attack and cause cancer
Encroach upon and destroy surrounding tissue Are poorly circumscribed – tongues of them to surrounding tissue Have a ‘crab-like’ cut surface (Latin: cancer) Metastasise
73
Why should we worry about malignant neoplams?
They cause morbidity and mortality Destruction of adjacent tissue Metastases Blood loss from ulcers Obstruction of flow Hormone production Paraneoplastic effects – finger clubbing due to lung cancer Anxiety and pain
74
What does it mean if a neoplasm is subclinical?
Patient doesnt know we have it
75
What is the structure of neoplastic cells?
Derive from nucleated cells Usually monoclonal Growth pattern related to parent cell Synthetic activity related to parent cell: collagen, mucin, keratin, hormones etc
76
What is the general structure of a neoplasm?
Neoplastic cells + Stroma
77
neoplastic cells derive from what?
Nucleated cells
78
What is the function of the stroma in a neoplastic cell?
connective tissue framework mechanical support nutrition Stroma supports neoplastic cell Rich in fibroblast
79
What is histogenesis?
the specific cell of origin of a tumour
80
Neoplasms can arise from what?
Epithelial cells Connective tissues Lymphoid/haematopoietic organs
81
What suffix do all neoplasms have?
"oma" at the end
82
What is the prefix dependent on?
behavioural classification and cell type
83
What is the nomenclature for a benign epithelial neoplasm of non-glandular, non-secretory epithelium
Papilloma - benign tumour of non-glandular, non-secretory epithelium Prefix with cell type of origin e.g. squamous cell papilloma – almost always this
84
What is the nomenclature of a benign tumour of glandular or secretory epithelium?
Adenoma - benign tumour of glandular or secretory epithelium Prefix with cell type of origin e.g. colonic adenoma, thyroid adenoma.
85
What is the nomenclature for malignant epithelial neoplasms?
Carcinoma - malignant tumour of epithelial cells Prefixed by name of epithelial cell type e.g. urothelial Ca.
86
What is a carcinoma of glandular epithelium called?
Adenocarcinoma
87
What are some bening connective tissue neoplasms?
Named according to cell of origin, suffixed by ‘-oma’ Lipoma: adipocytes Chondroma: cartilage Osteoma: bone Angioma: vascular – blood vessels Rhabdomyoma: striated muscle Leiomyoma: smooth muscle Neuroma: nerves
88
What are some malignant connective tissue neoplasms?
Liposarcoma adipose tissue Rhabdomyosarcoma striated muscle Leiomyosarcoma smooth muscle Chondrosarcoma cartilage Osteosarcoma bone Angiosarcoma blood vessels
89
What is the tumour called if the cell type is said to be unknown?
Anaplastic
90
What are some '-omas' that are not neoplasms?
e.g. granuloma, mycetoma- growth of fungus in lung, tuberculoma – mass of inflamed infected tissue due to TB
91
Which malignant tumours arent carcinomas or sarcomas?
melanoma: malignant neoplasm of melanocytes Mesothelioma: malignant neoplasm of mesothelial cells lymphoma: malignant neoplasm of lymphoid cells
92
Which tumours were named after the person that first discovered them?
Burkitt’s lymphoma Ewing’s sarcoma – bone cancer Grawitz tumour – kidney cancer Kaposi’s sarcoma - herpes
93
What is the behavioural classification of a benign tumour?
Does not invade the basement membrane Exophytic (grows outwards) Low mitotic activity Circumscribed Necrosis and ulceration rare
94
What is the behavioural classification of a malignant tumour?
Invade the basement membrane Endophytic (grows inwards) High mitotic activity Poorly Circumscribed Necrosis and ulceration common
95
What is histogenesis classification?
Based on the specific cell or origin of the tumour Epithelial cells form carcinomas Connective tissues form sarcomas Lymphoid forms lymphomas or leukaemia
96
What is histological grading?
Grade is based on the extent to which the tumour resembles its original histology Grade 1 – Well differentiated (most closely resembles parent tissue) Grade 2 – Moderately differentiated Grade 3 – Poorly differentiated
97
What are the routes of metastasis?
Bone metastasises from lung, breast, kidney, thyroid, prostate Lymphatic metastasis is common (secondary tumours in lymph nodes) Carcinomas prefer lymphatic spread Sarcomas prefer haematogenous spread
98
What is tumour staging?
Staging is the extent of a tumours spread Determined by histopathological examination and clinical examination

Pathology (7 decks)

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