Cancer Flashcards by Ailish Kemble

What are Tumours?

An abnormal mass of tissue that forms when cells divide more than they should

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What is Neoplasia?

An abnormal (clonal) growth of cells that may develop into a tumour

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What is Malignant?

Cells grow in an uncontrolled way and can have the ability to invade local tissues and/ or spread to distant sites via the blood and lymph system i.e. invasion and metastasis

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What is Benign?

A tumour that is not malignant

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What is Cancer?

A malignant growth or tumour resulting from an uncontrolled division of cells
Umbrella term used for myriad of diseases

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What is an Oncovirus?

A virus with the ability to cause cancer
e.g. HPV and cervical cancer

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What is the Grade?

The grade of a tumour describes how abnormal the tumour cells are.
Low grade= cells that look similar to their cells of origin
High grade= made of cells so big & wild that they are unrecognisable

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What is Stage?

Size and Extent of cancer

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What is the TNM stage?

Tumour
Nodes
Metastases
The higher the number for each one the worse
e.g. T1N0M0 is the best

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What is the case of Henrietta Lacks

“knot in tummy, something came out of me”
Dr Otto Gey
Cells just keep proliferating= termed these HELA cells

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What are the 6 special features of HELA cells?

Self- sufficiency in growth signals
Insensitivity to anti- growth signals
Tissue invasion & metastasis
Limitless replicative potential (increased telomerase, don’t shorten- continued replication)
Sustained angiogenesis
Evading apoptosis

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Hela- evading apoptosis?

Increase in anti- apoptotic genes and decrease in pro apoptotic genes
Insensitivity in anti growth signals (p53, RB)

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What are the 2 emerging Hallmarks?

Deregulating cellular energetics
Avoiding immune destruction

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What are the 2 enabling characteristics?

Genome instability and mutation
Tumor- promoting inflammation

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What are the 6 molecules involved in avoiding immune destruction?

M1 macrophages
Th1 cells
Dendritic cell
CD8+ cell
NK cell
Bioactive molecules

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What are the 5 molecules involved in Tumor promoting inflammation?

M2 macrophages/ MDSCs
Th2 cells
Tolerogenic DC
Treg cells
Bioactive molecules

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What is the tumour microenvironment?

not just about the cells
microenvironment helps to support tumour

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What 7 features are in the tumour microenvironment?

Cancer stem cell (CSC)
Cancer cell
Immune inflammatory cells
Invasive cancer cell
Pericyte (PC)
Endothelial cell (EC)
Cancer associated fibroblast (CAF)

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What is Carcinogenesis?

Multistep process that acquires and accumulates mutations which enable the cells to acquire the hallmarks

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What are 7 environmental factors which increase risk of cancer

Tobacco smoking
Excess body weight
Alcohol
Ultraviolet
Diet
Cancer causing pathogens
Physical inactivity

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What is IARC?

International agency for research on cancer

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What are the levels of classification for carcinogens?

Group 1= carcinogenic to humans
Group 2A- Probably carcinogenic to humans
Group 2B= possibly carcinogenic to humans
Group 3= Not classifiable as to its carcinogenicity to humans

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What is the classification of smoking?

Group 1

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What types of cancer is almost exclusive to smokers?

-Small cell lung cancer

What lung cancers are smoking associated?

Non- small cell lung cancer - Squamous cell carcinoma - Proximal disease

What cancer is least associated with smoking?

Adenocarcinoma - Peripheral- causes puckering of pleura

What is HPV associated with?

Disease that directly links to Cervical cancer

What are susceptibility related risks for cervical cancer?

High risk of HPV infection Weak immune response Other stds Genetic

What are microenvironment related risks of cervical cancer?

Multiple HPV infections Smoking Long term use of oral contraceptives

What are genetic and epigenetic risks of cervical cancer?

- HPV integration - Genetic instability - Tumor suppressor gene inactivation - Oncogenes (E6 & E7) expression

What is the timeline of a HPV infection leading to cervical cancer?

HPV infected cervix >1 year Low grade squamous lesions >4-5 yrs High grade squamous lesions >10 yrs Cervical cancer

HPV vaccination

if given before age of 17 reduces risk of HPV to less than 10%

What are Germline mutations?

Changes to your DNA that you inherit from the egg and sperm cell during conception

What are somatic mutations?

changes to your DNA that happen after conception to cells other then the egg and sperm

What is Lynch syndrome?

Inherited mutation that leads to predisposition for bowl cancer AKA Hereditary nonpolyposis colon cancer (HNPCC)

What is mismatch repair in Lynch syndrome?

Mismatch repair genes MLH1 or MSH2---- Microsatellite instablility---- increased lifetime risk of colorectal, endometrial cancer, ovarian, pancreaticobilary, gastric, small intestinal, brain, urinary tract, skin and other cancers

What are 2 germline mutation examples?

Retinoblastoma Cystic fibrosis= autosomal recessive

What is a primary tumour?

Affects function at the exact site of tumour with invasive cancers

What is a distant metastases?

Affects function of sites of metastatic disease (sites away from primary tumour) i.e. liver mets will alter liver function

What are Paraneoplastic syndromes?

Collection of symptoms caused by systemic production of chemicals (hormones/ cytokinds) from a tumour/ immune reaction

What are the combination of effects cancer uses to cause death and disease?

- The primary tumour - Distant metastases - Paraneoplastic syndromes

What are 4 common categories of paraneoplastic syndromes?

Neurological Haematological Endocrine Dermatological

Examples of neurological paraneoplastic syndromes

Myasthenia gravis Eaton- Lambert's syndrome

Example of Haematological paraneoplastic syndromes

Granulocytosis Erythrocytosis Anaemia DIC

Example of Endocrine paraneoplastic syndromes

Hypercalcaemia SIADH Cushing's syndrome

Example of Dermatological paraneoplastic syndromes

Erythroderma Acanthosis nigricans Sweet's syndrome

What are TILs?

Tumour infiltrating lymphocytes

Which TILs are better at evading immune destruction?

Absent TILs Brisk TILs= worse

What is a Kaplan- Meier curve?

Survival rate over time

What is on the X & Y axis

X= survival time in months Y= Survival ratio/ probability

What does a flatter slope indicate?

Lower relapse/ event rate Better survival

What can Kaplan meier curves be used to estimate?

The probability of survival (ratio)

What happens to patients with absent TILs?

Graph shows patients with tumours died more quickly Ten years= less than 20% still alive

What do longer survival durations show?

Lower event frequency Longer since the last person has relapsed

What is a tumour marker?

anything produced by cancer cells or other cells in the body in response to cancer that provides information about a cancer

What information do tumour markers provide?

how aggressive whether it can be treated with a targeted therapy whether it is responding to treatment

How are tumour markers measured?

Via a simple blood test

What is PSA?

prostate specific antigen High levels suggest prostate cancer

What is LDH?

Lactate dehydrogenase High levels indicate melanoma, multiple myeloma, lymphoma, and testicular cancer