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C. Year 3: Clinical Pharmacology, Therapeutics and SBOM > Cancer > Flashcards

Cancer Flashcards

1
Q

There were around 10 millions deaths due to cancer in 2020. What fraction of these deaths were attributed to modifiable risk factors, such as tobacco, alcohol, BMI etc..?

1 - 1/3
2 - 2/3
3 - 1/2

A

1 - 1/3

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2
Q

What is the most common cancer worldwide?

1 - breast
2 - lung
3 - colon
4 - prostate

A

1 - breast
- prostate us most common in UK
- lung cancer kills more though

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3
Q

Genes are inherited from parents and are essentially the instructions to produce proteins. What is the exon parts of a gene?

1 - coding part of gene
2 - non-coding part of gene
3 - nucleotide backbone of DNA
4 - contains start sequence for transcription

A

1 - coding part of gene

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4
Q

Genes are inherited from parents and are essentially the instructions to produce proteins. What is an intron part of a gene?

1 - coding part of gene
2 - non-coding part of gene
3 - nucleotide backbone of DNA
4 - contains start sequence for transcription

A

2 - non-coding part of gene

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5
Q

Typically we see higher cancer incidence in older patients. Why is this?

1 - immunocompromised
2 - increased genetic variability
3 - increased genetic mutations
4 - all of the above

A

3 - increased genetic mutations
- we accumulate mutations as we age, so by the time we are older there are lots of mutations

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6
Q

Are all cancers acquired through mutations as we age?

A
  • no
  • can be inherited, with mutations in gametes and their precursors
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7
Q

What is a mutation in the DNA?

1 - altered instructions for a protein
2 - altered protein function
3 - altered protein structure
4 - all of the above

A

4 - all of the above
- change in instructions will affect the structure and function of the protein being made

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8
Q

What is an allele?

1 - variations in chromosome shape and number
2 - variations of a specific gene
3 - variations in genes susceptible to cancer
4 - variations in the number of SNPs

A

2 - variations of a specific gene
- we get a gene from each parent for the same traits
- different versions of the same gene

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9
Q

What is a germline mutation?

1 - mutation in a single nucleotide
2 - a chromosome is missing
3 - mutations present in gametes that is passed on to offspring
4 - mutations passed on in somatic cells

A

3 - mutations present in gametes that is passed on to offspring
- gametes are eggs in women and sperm in men
- these are inherited

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10
Q

What is a proto-oncogene?

1 - mutated gene causing abnormal cell growth and division in cell cycle
2 - gene responsible for negative regulation of cell growth and division in cell cycle
3 - gene responsible for positive regulation of cell growth and division in cell cycle
4 - mutated gene unable to control cell growth and division in cell cycle

A

3 - gene responsible for positive regulation of cell growth and division in cell cycle

  • these genes produce proteins that accelerate normal cell growth and division in the cell cycle
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11
Q

What is a tumour suppressor gene?

1 - mutated gene causing abnormal cell growth and division in cell cycle
2 - gene responsible for negative regulation of cell growth and division in cell cycle
3 - gene responsible for positive regulation of cell growth and division in cell cycle
4 - mutated gene unable to control cell growth and division in cell cycle

A

2 - gene responsible for negative regulation of cell growth and division in cell cycle

  • these genes produce proteins involved in DNA repair and inhibit transcription factors
  • they are able to induce apoptosis if a cell is abnormal or growing too fast
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12
Q

What is a oncogene?

1 - mutated gene causing abnormal cell growth and division in cell cycle
2 - gene responsible for negative regulation of cell growth and division in cell cycle
3 - gene responsible for positive regulation of cell growth and division in cell cycle
4 - mutated gene unable to control cell growth and division in cell cycle

A

1 - mutated gene causing abnormal cell growth and division in cell cycle

  • caused by mutation to proto-oncogene
  • leads to uncontrollable cell growth and division
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13
Q

What is the most common cause for genetic variation?

1 - single nucleotide polymorphisms (SNP)
2 - DNA mismatching
3 - mutations in whole gene sequence
4 - mutations in mitochondrial DNA

A

1 - single nucleotide polymorphisms (SNP
- one nucleotide: A, cytosine, or C, thymine, or T and guanine, or G is changed
- this can affect the structure and function of the protein encoded by the gene

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14
Q

What is a Cancer Predisposition Genes?

1 - mutations in proto-oncogenes
2 - mutations in tumour suppressor genes
3 - genes susceptible to single nucleotide polymorphism’s
4 - genes in which germline mutations lead to increased risks of cancer

A

4 - genes in which germline mutations lead to increased risks of cancer

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15
Q

Although inherited oncogenes are rare, as in most cases they would be lethal, there are some that we are aware of. Which of the following is an example of an inherited oncogene that causes cancer?

1 - Multiple Endocrine Neoplasia type 2
2 - T1DM
3 - Hyperparathyroidism
4 - Hirschsprung disease

A

1 - Multiple Endocrine Neoplasia type 2
- patients present with medullary thyroid cancer, phaeochromocytomas, parathyroid adenomas, hyperparathyroidism​

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16
Q

Which of the following is an example of an mutated tumour suppressor gene that causes cancer?

1 - Multiple Endocrine Neoplasia type 2
2 - Retinoblastoma
3 - Hyperparathyroidism
4 - Hirschsprung disease

A

2 - Retinoblastoma
- most common eye cancer in children
- typically diagnosed <5 y/o

17
Q

Retinoblastoma is an example of an mutated tumour suppressor gene that causes cancer, and is the most common eye cancer in children. How can this present clinically?

1 - nystagmus (involuntary eye movement)
2 - white reflex replaces red light reflex
3 - lack of convergence reflex
4 - inability to blink

A

2 - white reflex replaces red light reflex
- if identified early it has a 99% cure rate
- BUT are at increased of cancers in adulthood

18
Q

Which of the following has the highest occurrence in solid cancer tumours (up to 85%) and is due to a tumour suppressor gene mutation?

1 - BRCA1
2 - MLH1
3 - TP53
4 - PTEN

A

3 - TP53
- commonly due to somatic mutations
- very rare in germline mutations

19
Q

BRCA1 is a tumour suppressor gene mainly linked with which cancer?

1 - thyroid
2 - colon
3 - ovarian
4 - breast

A

4 - breast
- BRCA1 and BRCA2 genes produce proteins that suppress abnormal cell division and growth

  • can also increase risk of ovarian cancer (BRCA1) and men increases prostate cancer (BRCA2)
20
Q

What is the most common cancer in the UK?

1 - thyroid
2 - colon
3 - ovarian
4 - breast

A

4 - breast
- affects 1 in 8 women
- 5-10% inherited

21
Q

Breast cancer is the most common cancer in the UK, and 5-10% of this is accounted for by inherited genes, specifically BRCA1 and BRCA2. What type of inheritance are BRCA1 and BRCA2?

1 - autosomal dominant
2 - X linked recessive
3 - autosomal recessive
4 - X linked dominant

A

1 - autosomal dominant
- one copy of the mutated gene needed

22
Q

What is the risk factor in % that a patient can be genetically tested according to the NICE guidelines using an algorithm to assess the risk of inheritance?

1 - >50%
2 - >35%
3 - >10%
4 - >1%

A

3 - >10%

23
Q

Which of the following syndromes is caused by a mutation in the TP53 mutation that can increase the risk of cancer?

1 - Li Fraumeni Syndrome
2 - Metabolic Syndrome
3 - Down Syndrome
4 - Turner Syndrome

A

1 - Li Fraumeni Syndrome
- autosomal dominant inheritance (only 1 mutated gene needed)

  • high rates of osteosarcoma, soft tissue sarcoma, acute leukaemia, breast cancer, brain cancer, and adrenal cortical tumours
24
Q

Genetic testing is often offered in those patients with a high risk of cancer. Which of the following are reasons why this is the case?

1 - family support
2 - diagnose earlier
3 - personalised cancer treatment
4 - all of the above

A

4 - all of the above
- tumour may also be genetically tested ad they may be more responsive to specific medications

25
Q

What is epigenetics?

1 - process of up regulating transcription
2 - process of gene regulation
3 - process of down regulating transcription
4 - process of inducing apoptosis

A

2 - process of gene regulation
- can up or down regulate genes
- DNA is NOT modified

26
Q

DNA is wrapped around histones, which essentially come in groups of 8. When the DNA wraps around the histone twice it becomes nucleosomes and lots of these is called chromatin. If an acetyl group is added to a histone this causes acetylation. What then happens to the DNA?

1 - DNA tightness around histone increases, genes are exposed causing increased transcription
2 - DNA tightness around histone decreases, genes are exposed causing reduced transcription
3 - DNA tightness around histone decreases, genes are exposed causing increased transcription
3 - DNA tightness around histone increases, genes are exposed causing decreased transcription

A

3 - DNA tightness around histone decreases, genes are exposed causing increased transcription

  • removal of the acetyl group, called deacytelation has the opposite effect
27
Q

DNA is wrapped around histones, which essentially come in groups of 8. When the DNA wraps around the histone twice it becomes nucleosomes and lots of these is called chromatin. If histone undergoes methylation, which is when a methyl group is added to the DNA building blocks, this can cause what to happens to the DNA?

1 - DNA tightness around histone increases, genes are exposed causing increased transcription
2 - DNA tightness around histone decreases, genes are exposed causing reduced transcription
3 - DNA tightness around histone decreases, genes are exposed causing increased transcription
4 - DNA tightness around histone increases, genes are hidden causing decreased transcription

A

4 - DNA tightness around histone increases, genes are hidden causing decreased transcription
- essentially gene is turned off

28
Q

Reactive oxygen species are unstable molecule that contains oxygen and can react with other molecules in a cell. Lots of ROS can damage cells and all the contents. How have ROS been linked with cancer?

1 - result in DNA mismatch repair
2 - result in increased SNP
3 - induces acetylation and up regulates transcription in oncogenes
4 - removes methyl groups, increasing DNA transcription

A

1 - result in DNA mismatch repair
- ROS cause oxidative damage to DNA bases that result in DNA mismatching and mutations

29
Q

Which of the following are methods mechanisms of how metastasis are caused?

1 - direct infiltration of surrounding tissue
2 - cancer spreads through blood stream
3 - cancer spreads through lymphatics
4 - all of the above

A

4 - all of the above

30
Q

All of the following are steps in metastasis. What is typically the 1st step?

1 -Survival in the circulation and attachment to the endothelium
2 - Angiogenesis and Intravasation
3 - Invasion and Migration
4 - Extravasation and Colonisation

A

3 - Invasion and Migration
- tumour grows, invading local tissues, blood and lymphatic vessels
- tumour migrates elsewhere in the body

31
Q

All of the following are steps in metastasis. What is typically the 2nd step?

1 -Survival in the circulation and attachment to the endothelium
2 - Angiogenesis and Intravasation
3 - Invasion and Migration
4 - Extravasation and Colonisation

A

2 - Angiogenesis and Intravasation
- angiogenesis = new blood vessels made
- intravastation = tumour moves through blood or lymph vessel wall

32
Q

All of the following are steps in metastasis. What is typically the 3rd step?

1 -Survival in the circulation and attachment to the endothelium
2 - Angiogenesis and Intravasation
3 - Invasion and Migration
4 - Extravasation and Colonisation

A

1 -Survival in the circulation and attachment to the endothelium
- attach to endothelium at locations through the body

33
Q

All of the following are steps in metastasis. What is typically the 4th step?

1 -Survival in the circulation and attachment to the endothelium
2 - Angiogenesis and Intravasation
3 - Invasion and Migration
4 - Extravasation and Colonisation

A

4 - Extravasation and Colonisation
- extravasation = tumour can leave blood and lymphatics and enter tissues
- colonisation = divide, growth and develop into secondary tumour

34
Q

What % of cancer cells that metastasise become secondary tumours?

1 - 35%
2 - 20%
3 - 10%
4 - <0.1%

A

4 - <0.1%
- BUT if 1000s are released, this still means 10 can become secondary cancers

35
Q

CRP can be used to remember what is used clinically to help stage and diagnose cancer:

C = clinical diagnosis following surgery for example
R = radiological findings
P = pathological findings based on biopsy

Once a staging is given using TNM, is this a fixed staging?

A
  • no
  • can changed based on using CRP

C. Year 3: Clinical Pharmacology, Therapeutics and SBOM (25 decks)

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