Cancer 2 - Pathology, Defining a Neoplasm & Features of Selected Cancers

Question 1

Role of cellular pathology (histopathology) in defining a neoplasm (3)

Answer 1

1. To distinguish between benign and malignant cells
2. To determine cellular origin of cancer, NB for tx -> e.g: in lung cancer smoking causes epithelium cancers
3. To monitor completeness of surgery -> microscopic analysis of an excised lump can tell whether cancer cells occur at the edges and therefore detect efficiency of the removal

Question 2

4 techniques used to identify characteristics of tissues and cells

Answer 2

1. Histopathology
2. Cytology
3. Immunohistochemistry
4. Molecular techniques

Question 3

Histopathology

Histo: what does diagnosis depend on (2)

Answer 3

1. The appearance of cells macroscopically (gross examination)
2. The microscopic appearance of the tissue architecture

Question 4

Histopathology

Microscopic difference between normal and cancer cells, e.g: colon

Answer 4

• Normal colon cells have regular size and shape nuclei
• Cancer: nuclei have heterogeneous size and shape
• Mitotic/proliferating cells evident in the cancer, but not in normal cells

Question 5

Histopathology

what can be seen microscopically invading surrounding tissues and cells

Answer 5

Malignant invasive cancerous cells. Malignant lesions damage surroundings.

Question 6

Histopathology

What can be examined to see if the tumour has spread

Answer 6

Surrounding lymph nodes

Question 7

Cytology

Why is cytology less precise than histo

Answer 7

Loses the benefit of tissue architecture

Question 8

Cytology

Advantage of cytology over histo

Answer 8

Less invasive procedure

Question 9

Cytology

E.g: of cytology testing for cancer

Answer 9

Screening cervical smears for early signs of cervical cancer

Question 10

Immunohistochemistry

How does it reveal more than a standard biopsy test

Answer 10

Enables pathologist to determine exact type/subtype of cancer by looking for unique tomour markers within cancer cells

Question 11

Immunohistochemistry

How are markers identified

Answer 11

Using antibodies that locate and bind with antigens (markers found on cells)

Question 12

Immunohistochemistry

Info that Immunohistochemistry gives thats useful for determining tx (3)

Answer 12

1. Where cancer started
2. Type of cell it started in
3. Whether its going to spread slowly or quickly

Question 13

BREAST

Five year survival rate

Answer 13

90%

Question 14

BREAST

Risk factors (4)

Answer 14

1. Age at first pregnancy -> younger than 30 at first pregnancy, less risk
2. Late menopause
3. Family hx
4. Diet

Question 15

BREAST

Metastasis to (2)

Answer 15

1. Lymph nodes
2. Bone

Question 16

BREAST

Inherited genes

Answer 16

• BRCA1 and BRCA2 are breast cancer suppressor genes.
• Mutations can lead to an increase risk of breast cancer
• These mutations are inherited

Question 17

BREAST

Why is mortality decreasing in developed countries (2)

Answer 17

1. Breast cancer screening regimes
2. Improvements in tx

Question 18

COLON

5 year survival rate

Answer 18

64%

Question 19

COLON

Risk factors (3)

Answer 19

1. Family hx
2. Inflammatory bowel disease
3. Diet

Question 20

COLON

Metastasis to (3)

Answer 20

1. Locally
2. Liver
3. Lymph nodes

Question 21

COLON

Gene mutation in colon cancer

Answer 21

• P53 repressor gene is mutated
• Without functioning P53, cell proliferation is not regulated effectively

Question 22

COLON

What has improved outcome

Answer 22

Colon cancer screening

Question 23

LUNG

5 yr survival rate and why so low?

Answer 23

• 13%
• Lung cancer has a poor response to chemo

Question 24

LUNG

Risk factors (3)

Answer 24

1. Smoking
2. Asbestos
3. Radon gas

Question 25

# LUNG Metastasis to (3)

Answer 25

1. Other lung tissues 2. Surrounding tissues 3. Bone

Question 26

# OVARY 5 yr survival rate

Answer 26

49%

Question 27

# OVARY Metastasis to (2)

Answer 27

1. Surrounding body tissue 2. Other ovary

Question 27

# OVARY Risk factors (3)

Answer 27

1. Family hx 2. Pregnancy has a decreased risk 3. Fertiliy tx increases risk

Question 28

# OVARY Gene mutations (2)

Answer 28

Inherited gene changes in: 1. BRCA1 2. BRCA2

Question 29

# OVARY What is poor prognosis due to (49% 5 yr survival rate )

Answer 29

Late initial detection

Question 30

# PANCREAS 5 yr survival rate

Answer 30

3%

Question 31

# PANCREAS Risk factors (2)

Answer 31

1. Smoking 2. Pancreatitis

Question 32

# PANCREAS metastasis to (7)

Answer 32

1. Bodily tissue (viscera) 2. Lung 3. Bone 4. Liver 5. Kidneys 6. Biliary duct 7. Intestines

Question 33

# PANCREAS Why such poor prognosis (3% 5 yr survival)

Answer 33

1. Most txs relatively ineffective 2. Pancreas has both endocrine and exocrine functions so cancer affects many sytems of the body

Question 34

# PROSTATE 5 yr survival rate

Answer 34

98%

Question 35

# PROSTATE Risk factors (2)

Answer 35

Uncertain but include: 1. Diet 2. Family hx of prostate cancer

Question 36

# PROSTATE metastasis to (2)

Answer 36

1. Lymph nodes 2. Bone

Question 37

# PROSTATE Why is the incidence increasing

Answer 37

* Most common cancer in men * Incidence increasing due to improved diagnostic efficiency

Question 38

# PROSTATE What does autopsy analysis indicate

Answer 38

Most men have occult (hidden) cancers of the prostate

Question 39

# CERVIX 5 yr survival rate

Answer 39

71%

Question 40

# CERVIX Risk factors (4)

Answer 40

1. Early age of intercourse 2. Multiple partners 3. Smoking 4. Exposure to HPV

Question 41

# CERVIX Metastasis to (1)

Answer 41

1. Lymph nodes -> distance metastasis are rare

Question 42

# CERVIX Gene changes

Answer 42

* HPV virus contributes to E6 and E7 oncogenes wich modify cell cycle and cell divison

Question 43

# CERVIX Why should there be a significant reduction o incidence

Answer 43

Introduction of the HPV vaccine

Question 44

# SKIN The three types of cell that can develop into skin cancer

Answer 44

1. **Basal cell** (basal epithelium) carcinoma -> 75% of skin cancers 2. **Squamous cell carcinoma** (keratinocytes) -> 20% of skin cancers 3. **Malignant melanoma** (melanocytes) -> 5% of total

Question 45

# SKIN Are basal cell carcinomas curable and why?

Answer 45

Curable as they rarely metastasise

Question 46

# SKIN Are squamous cell carcinomas curable

Answer 46

Yes, if detected early

Question 47

# SKIN 5 yr survival rate for malignant melanomas

Answer 47

85%

Question 48

# SKIN Risk factors for all types (2)

Answer 48

1. UV light 2. Fair skin

Question 49

# SKIN Melanoma metastasis (3)

Answer 49

1. Lymph nodes 2. Other parts of skin 3. Lung