cancer Flashcards
HPV types and associations
6, 11 ➡️ genital warts
16, 18, 31, etc. ➡️ cervical cancer
stages of prostate regulation throughout lifetime (4)
- Development → puberty: paracrine effects; androgens act on stromal AR → growth factor production → epithelial cell proliferation
Epithelial cells also secrete factors that maintain stromal cells in differentiated state - Adult: AR in epithelial cells important at this stage
- Second growth spurt: due to breakdown of regulation w ↑age
investigations for prostate cancer (3)
- DRE
- PSA (can have temporary increases e.g. from DRE, also false positives)
- USS: tumours outside prostate capsule
prostate cancer Tx options (4)
Low grade tumour, older patients → active surveillance (periodic PSA tests)
Confined to prostate gland (stage T1, T2) → radical prostatectomy
(nerves nearby control erection & urination ∴ risk of incontinence & impotence)
Confined or local spread (T1 to T3) → radical radiotherapy (external or implants)
Metastatic cancer → hormone therapy
possible mechanisms behind castration-resistance prostate cancer (4)
Amplified response to low levels of residual/administered hormones due to:
- Overexpression/amplification of AR
- Overexpression/amplification of coactivator genes
- Reduced expression/deletion of corepressor genes
- Mutation or alternative splicing of AR (can drive AR target gene expression and growth in absence of ligand)
treatment for breast cancer (4)
- SERMs e.g. tamoxifen, bind competitively to ER
- ovarian ablation (prevention of oestrogen production by ovaries): surgery/hormone therapy e.g. goserelin (LHRH analogue)
- SERDs e.g. fulvestrant, bind competitively to ER and induce receptor degradation
- aromatase inhibitors: prevent conversion of androstenedione to estrone and testosterone to estradiol
mechanisms of resistance to hormone therapy in breast cancer
- de novo endocrine resistance: tumour independent of estrogen, despite being ERα-positive
- acquired endocrine resistance: growth promotion of initially estrogen-dependent tumours, by other mitogenic pathways
- transcription coactivators/repressors
- ER mutations
what type of virus is HPV
dsDNA
HPV screening
- methods
- schedule
- Smear test: taken from SCJ
25-50: 3 yearly, 50-65: 5 yearly (1/4 false negatives) - HPV DNA test will replace smear test (more sensitive; detected in 99.7%)
- CIN 2/3 → colposcopy and loop excision
Remove affected tissue + assess extent of neoplasia
presentation of cervical cancer
Early disease asymptomatic
Irregular bleeding: after intercourse, in between periods
Advanced disease → offensive discharge, backache, leg pain/oedema, haematuria, bowel changes, malaise, weight loss, anaemia
endometrial cancer: types + mutations
oestrogen dependent: PTEN mutation
more common, younger women, better prognosis
non-oestrogen dependent: p53 mutation
mainstay treatment of endometrial cancer
TAH + BSO
radiotherapy (after surgery; pre-op makes surgery more difficult)
HPV interaction w host genome
integrates into host genome -> overexpression of E6 and E7 genes -> proteins degrade tumour suppressors e.g. p53, pRb -> aneuploidy, increased cell cycling and survival
composition of HPV vaccine
virus like particle: L1 protein of HPV capsid
breast cancer biomarkers (3)
ER: nuclear transcription factor
PR: nuclear transcription factor
- ER and PR -> better response to endocrine therapy
Her-2-neu: growth factor receptor
important in deciding on management (also prognostic factors)