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MCD > Cancer > Flashcards

Cancer Flashcards

1
Q

Name the three types of non-neoplastic lesions

A
  • Metaplasia
  • Dysplasia
  • Hamartoma
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2
Q

Define metaplasia, list its characteristics.

A
  • Metaplasia = a reversible change in which one adult cell type changes to another cell type
  • Non-cancerous (because changes are reversible)
  • Metaplasia can lead to cancer
  • Change in morphology but not increased proliferation
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3
Q

Define dysplasia, list its characteristics.

A
  • Dysplasia = an abnormal pattern of growth in which s_ome of the histological features of malignancy are present_
  • **Non-cancerous **
  • Loss of architectural orientation (the cells “forget” where they are)
  • Loss in uniformity of individual cells
  • Variability in size and shape
  • Nuclei hyperchromatic (enlarged)
  • Mitotic figures abundant
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4
Q

List the common sites of dysplasia and their causes.

A
  • Cervix – HPV infection
  • Bronchus – smoking is an irritant (causes the turnover of cells to increase)
  • Colon – uc (ulcerative colitis à increase risk of colon cancer)
  • Larynx - smoking
  • Stomach -pernicious anaemia
  • Oesophagus- barrett’s metaplasia
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5
Q

Define hamartoma, list its characteristics.

A
  • Hamartoma = relative overgrowth of part of a tissue with disorderly structural arrangement
  • Restrained overgrowth
  • Tumour-like malformations
  • Vascular origin – haemangioma
  • Naevus of skin – mole/birth mark cf skin cancer (type of hamartoma)
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6
Q

What is a neoplastic lesion?

A

Neoplastic lesions = tumours

They can either be benign or malignant

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7
Q

What is a benign neoplastic lesions? List its characteristics.

A
  • Benign tumours are caused by loss of growth control & feedback regulation
  • Normal regulation of motility (i.e. benign tumours stay where they are – key differentiation between benign and malignant)
  • Mostly slow growth
  • Growth = expansive, non-destructive & non-invasive
  • Well differentiated; normal cells, r_esembles architecture_ of host tissue
  • Non-metastatic
  • Rarely fatal
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8
Q

List the conditions which would render a benign tumour fatal

A

Benign tumours are rarely fatal, unless:

  • They are in a dangerous place [eg: brain/meninges]
  • The s_ecreting dangerous products_ [eg: insulinoma]
  • They get infected [common in the bladder]
  • They bleed [eg: gastric tumours] or rupture
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9
Q

What is a malignant neoplastic lesions? List its characteristics.

A
  • Malignant tumours = loss of growth control, feedback regulation & loss of regulation of motility
  • Loss of regulation of motility (i.e. malignant tumour cells can escape from the lesion)
  • Frequently rapid growth (this is not all or nothing – but generally, carcinomas will grow faster than adenomas)
  • Growth invasive and destructive
  • Many mitoses
  • Poorly differentiated (i.e. “forgotten” originating tissue)
  • Pleomorphic (variation in morphology), abnormal cells
  • Metastatic (will grow in a different tissue - often, but not always)
  • Invariably fatal if untreated
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10
Q

Concerning nomenclature, what to the following suffixes mean:

(a) tissue type + oma
(b) tissue type + carcinoma
(c) tissue type + sarcoma

A

(a) oma = benign
(b) carcinoma = malignant epithelial
(c) sarcoma = malignant connective tissue

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11
Q

What are leukaemias and lymphomas?

A

Both are tumours of white blood cells

  • Leukaemia is a malignant tumour of primitive bone marrow derived cells which circulate in blood stream.
  • Lymphoma is a malignant tumour of lymphocytes
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12
Q

What is a teratoma? List its characteristics

A
  • Teratoma = **enbryonic tumour derived from germ cells **
  • Has the potential to develop into tumours of all three germ cell layers
  • Sites of development - nests of germ cells (i.e. not differentiated correctly and have jdeveloped into the three cell layers, almost like miniature embryos)
  • Common in the gonads, but occur in midline situations.
  • Gonadal teratomas - in males, all malignant, in females, most are benign
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13
Q

Invaision is a characteristic of what type of tumour?

A

Invasion distinguishes malignant tumours from benign & can make a difference in treatment of the patient

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14
Q

Define: carcinoma in situ & invasive carcinoma

A
  • Carcinoma in situ - malignant epithelial cells are still separated from the adjacent tissue by the basement membrane and do not invade the underlying tissue
  • Invasive carcinoma - invasion of underlying tissue by cells which have penetrated the basement membrane
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15
Q

What are the 4 signs of invasion?

A
  • Cells lose adherence
  • Cells become motile
  • Penetrate the basement membrane
  • Produce proteolytic enzymes that dissolve the ground substance in the adjacent tissues
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16
Q

What are the two types of invasion?

A

Direct & Metastasis

  • Direct = invasion of surrounding tissue
  • Metastasis = “breaking off” of tumour cells and embedding in completely different locations
17
Q

Define metastasis

A

Metastasis is the development of secondary tumours at sites remote from the primary

18
Q

What are the 4 mechanisms of metastasis?

A
  • Associated with genetic changes
  • Ability to penetrate vessels and to exit vessels
  • Ability to survive in the circulation
  • Ability to **colonise **
19
Q

List the major mechanisms of transport of metastases throughout hte body

A
  • Via blood vessels to organs
  • Via lymphatics to lymph nodes
  • Transcoelomic - across body cavities
  • **Iatrogenic - **when tumours are cut into they can be spread – therefore when they are removed, it is best for the whole tumour to be removed with a margin around it
20
Q

Define grading and staging

A

Grading = how bad is the primary tumour

  • Architectural pattern of the tumour
  • Nuclear size and nuclear :cytoplasmic ratio
  • Number and type of mitoses
  • Similarity to the cell type from which they have arisen

Staging = how far has the tumour spread

  • Clinical assessment of how much and far the tumour has spread
21
Q

What are the 6 major risk factors for breast cancer? Briefly explain them

A
  • Age - breast cancer is a disease of > 50 (in general)
  • Hormonal Factors - there is an increased risk to women that: menarch < 12, later menopause, first child over 30, don’t breast feed.
  • Dense Breast Tissue - larger proportion of glandular/connective tissue, less proportion of fat
  • Radiation - Radiotherapy to chest under 35 yo
  • Lifestyle - lack of exercise, alcohol, overweight (more of a risk to post-menopausal women)
  • Genetics - 5-10% of cancers are linked to mutations in teh BRCA1/2 genes
22
Q

Name and describe the two major biological markers for breast cancer

A

​ER (oestrogen receptor)

  • ER is over expressed in around 75% of breast cancers.
  • Presence is indicative of a better prognosis.
  • More common in older women
  • Oestrogen withdrawal or competition for binding to the ER using anti-oestrogens results in a response in about 70% of ER-positive cancers

HER2

  • HER2 is over-expressed in cancer cells (multiple copies on chromosome 17 – i.e. point mutation resulting in amplification)
  • Amplification must be presence for the drug to be given as an appropriate treatment
23
Q

Outline the four major sub-types of breast cancer and which biochemical markers they are positive for

A
  • Luminal A = ER+, PR+ and HER2 -
  • Luminal B = ER+, PR + and HER2 +
  • HER2 = ER-, PR- and HER2 +
  • _Basal-like = ER-, PR- and HER2 - _
24
Q

What are the five major treatment options available for breast cancer?

A
  • Surgery - removing the tumour with good margins is usually the best treatment
  • Radiotherapy
  • Chemotherapy - neoadjuvant [before surgery – purpose is to shrink the tumour] and adjuvant [after surgery – purpose is if the whole tumour could not be removed]. Can have negative fertility effects in younger women
  • Endocrine therapy - neoadjuvant and adjuvant
  • Targeted agents (e.g. herceptin) - this is the future of breast cancer therapy
25
Q

Which type of breast cancers are treated with endocrine therapy?

A

Endocrine (or hormone) therapy is only indicated for ER+ breast cancers

26
Q

What is the purpose of endocrine therapy (as a treatment for ER+ cancers)?

A

Purpose is to interfere with oestrogen receptor signalling

27
Q

What are the 6 types of chemotherapeutic agents?

A
  • **Alkylating agents **
  • Antimetabolites
  • **Anti-tumour antibiotics **
  • **Topoisomerase inhibitors **
  • **Mitotic inhibitors **
  • Corticosteroids
28
Q

How does age affect tumour growth?

A

the environment affects the growth of the tumour, and age affects the environment

29
Q

List the 8 major risk factors associated with skin cancer

A
  • Intermittent exposure to high-intensity sunlight
  • History of sunburn
  • Long-term occupational exposure to sunlight.
  • Skin type
  • Hair & eye colour
  • **Large number or unusually shaped moles **
  • Family history of melanoma
  • **History of dysplastic moles **
30
Q

Which type of UV light is more important for skin cancer

A

UVB

31
Q

Name the three categories of skin cancer

A
  • Basel cell carcinoma
  • Squamous cell carcinoma
  • Melanoma
32
Q

List the characteristics of basal cell carcinoma

A
  • Generally a tumour of the elderly
  • Commonest in certain sun exposed areas – face, ears, neck and are frequently seen on the back, chest and legs
  • Tumours arise from pluripotent stem cells within the epidermis
  • Locally destructive but generally not metastatic
33
Q

List the characteristics of squamous cell carcinoma

A
  • Tumours of the elderly
  • These tumours develop from basal keratinocytes
  • Tumours are commonest in sun exposed areas
  • Tumours are metastatic spreading to regional lymph nodes then to solid organs particularly the lung
  • May arise from precursor lesions – solar keratoses and Bowen’s disease
34
Q

What are the four clinical sub-types of melanoma?

A
  • Superficial spreading melanoma (spreads along the skin) - 30% arise from pre-existing melanocytic naevus. Horizontal growth phase through the epidermis is followed by vertical growth
  • Nodular - no horizontal growth phase
  • Lentigo maligna melanoma - mainly elderly developing in a lentigo maligna (non-invasive melanoma, surface)
  • Acrolentigenous - starting on feet or hands (palms), commonest in Afrocarribbeans
35
Q

What are teh potential pre-cursor lesions for melanoma?

A
  • Junctional or compound acquired melanocytic naevae
  • Dermal naevae
  • **Giant bathing trunk naevae **
  • Dysplastic naevae
36
Q

What are the risk factors of melanoma

A
  • Presence of dysplastic naevae (when they look rough around the edges)
  • Family history
  • Higher socioeconomic groups (due to sun exposure, multiple times a year)
  • Arsenic exposure in farmers
  • Airline pilots have 3X risk (due to ionising radiation)
  • Airline cabin crew have 1.5X risk (sun with stop-overs)
37
Q

What is breslow thickness?

A
  • This is a method of staging melanomas
  • It invovles the spread the tumour into the skin (i.e. the depth)
  • Generally speaking, the deeper it is in the skin the further stage it is
  • Affects survival rates
38
Q

What are the four major treatment possibilities for skin cancer?

A
  • Surgery
  • Radiotherapy (if surgery not an option or to reduce possibility of relapse – this is rare)
  • Immunotherapy (melanoma)
    • Patients with cancer do not mount a good immune response, you want to stop the tumour from turning this off (i.e. maintain this response – the immune response to the tumour)
    • This is a risky response as you can end up with autoimmune issues (particularly within the kidneys) (autoimmunity because you have essentially upregulated the system à over-expression à autoimmunity if unregulated)
  • Targeted agents for melanomas - anti-BRAF/VEGFR etc (this is an active area of research)

MCD (13 decks)

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