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CLASP > Cancer > Flashcards

Cancer Flashcards

1
Q

what is hyperplasia

A

increase in cell number occurring in response to stimulus

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2
Q

what causes hyperplasia to stop

A

withdrawal of stimulus

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3
Q

give two examples of hyperplasia

A

lining of the uterus, liver regeneration after resection

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4
Q

give an example of hypertrophy

A

cardiac (LVH, HOCM, aortic stenosis) and skeletal muscle

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5
Q

what is hypertrophy

A

increase in cell size (more organelles etc)

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6
Q

what is a risk of LVH

A

arrhythmia and death

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7
Q

what is atrophy

A

loss of tissue (size/number of cells)

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8
Q

what causes atrophy

A

withdrawal of a stimulus (hormonal, damage to a nerve )

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9
Q

what is metaplasia

A

reversible change of one mature cell type to another mature cell type

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10
Q

metaplasia with what has a high risk of malignancy

A

dysplasia

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11
Q

what usually lines the bronchi

A

respiratory epithelium

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12
Q

what is respiration epithelium

A

cilliated pseudostratified columnar epithelium

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13
Q

what type of epithelium is usually found in the lungs

A

columnar

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14
Q

what are the commonest types of lung cancer

A

small cell, adeno, and squamous

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15
Q

why do you get squamous cell carcinoma in the lung

A

metaplasia of the columnar epithelium

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16
Q

what metaplasia occurs in barretts oesophagus

A

oesophageal squamous to intestinal type columnar

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17
Q

what type of cancer do you get in barretts

A

adenocarcinoma

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18
Q

what cell types overs any surface that is exposed to the external environment

A

squamous

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19
Q

what cells secrete mucous

A

goblet cells

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20
Q

how do you tell stratified squamous

A

has lots of layers

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21
Q

what cell type is shiny and exposed to external environments (give examples of locations)

A

non keratonised stratified squamous epithelium

nose, mouth, vagina, oesophagus, lips

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22
Q

what is neoplasia

A

new growth without stimulus- can be benign/ pre malignant

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23
Q

what is dysplasia

A

disordered growth, pre malignant

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24
Q

what is malignancy

A

autonomous growth that invades other tissue (passes basement membrane) or has metastatic potential

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25
Q

give examples of benign growths/ tumours

A

carcinoid tumour in the lung, squamous papilloma, squamous dysplasia, carcinoma in situ

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26
Q

what is carcinoma in situ

A

sever abnormality and is closest to becoming full blown malignancy, that has not spread yet- is pre malignant

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27
Q

what is caseating necrosis with granulomatous inflammation

A

TB

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28
Q

what does stellate mean

A

star like

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29
Q

what does opacity on an x ray mean

A

white- denser than air

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30
Q

what does haziness on an CXR mean

A

consolidation

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31
Q

what can cause the pancreas to become diffusely firm

A

inflammation, infection, deficiency in hormone/ vitamin

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32
Q

does cystic suggest benign or malignant

A

benign

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33
Q

what is a cyst

A

thin walled round structure lined by epithelium

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34
Q

what is a pseudocyst

A

fluid filled cavity that lacks wall/lining

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35
Q

what does ‘pancreas with pseudo cysts, diffusely form and white spots’ suggest

A

pancreatitis

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36
Q

what are the white spots in pancreatitis

A

necrosis of pancreas and surrounding tissue

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37
Q

what are the causes of chronic pancreatitis

A

alcohol, gall stones, idiopathic

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38
Q

what suggests a gastric malignancy

A

shallow ulcer with heaped up edges

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39
Q

where in stomach are you more likely to get a malignancy

A

in the lesser curvature

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40
Q

where are you more likely to get a gastric ulcer

A

in the greater curvature

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41
Q

what does a gastric ulcer look like

A

more punched out

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42
Q

what type of cancer produces intracellular mucin

A

adenocarcinoma

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43
Q

does malignancy have high/ low nuclear to cytoplasm ratio

A

high

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44
Q

what is pleomorphism and what is it suggestive of

A

differences in size and shape, malignancy

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45
Q

what are signet rings seen in

A

adenocarcinoma and bronchiectasis

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46
Q

what cells does a neuroectoderm tumour affect

A

melanocytes and glial cells of the central nervous system

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47
Q

where are epithelial cells found

A

lining all internal and external surfaces

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48
Q

what types of epithelium is exposed to external environments

A

squamous

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49
Q

what type of epithelium is the skin

A

keratinised with adnexal structures

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50
Q

where is non keratinising epithelium found

A

internal- mouth, oesophagus, ear canal, cervix, vagina, anus

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51
Q

what cells make up the glandular cells of the stomach and hat do they secrete

A

G cells (gastrin), parietal cells (HCL and intrinsic factor), chief cells (pepsinogen and chymosin)

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52
Q

what type of cells are cilliated

A

pseudostratified ciliated columnar

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53
Q

what type of endothelium is found in the bladder

A

transitional

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54
Q

what is a carcinoma

A

epithelial malignancy

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55
Q

why are epithelial malignancies very rare in children

A

as low exposure to environmental risk factors

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56
Q

what cancers are more common in children

A

blood, brain, and bone

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57
Q

where does a colorectal cancer usually spread

A

lymphatic spread to local lymph nodes in the mesentery

follow vasculature supply in blood

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58
Q

where do testicular tumour spread to

A

do not spread to the groin

because of embryological development of the testes act as intra abdominal organ and so will spread to para aortic nodes

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59
Q

what cancers spread to the groin

A

from leg, scrotum or vulva

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60
Q

where does a primary lung tumour usually metastasise to

A

bone, brain, adrenal and liver

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61
Q

where does a liver tumour metastasise to

A

liver (other sites too but rare)

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62
Q

what cancers commonly spread everywhere

A

melanoma, prostate and small cell

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63
Q

what is mesenchymal

A

connective tissue

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64
Q

what is a sarcoma

A

cancer of the mesenchymal

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65
Q

give examples of sarcomas

A

bone, cartilage, fibrous tissue, fat, smooth muscle, skeletal muscle, nerves, blood vessels

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66
Q

what is a smooth muscle cancer called (benign and malignant)

A

LEIO myoma/sarcoma

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67
Q

what is a skeletal muscle cancer called (benign and malignant)

A

RHABDO myoma/sarcoma

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68
Q

what is a fat caner called (benign and malignant)

A

LIPO ma/sarcoma

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69
Q

what is a bone cancer called (benign and malignant)

A

oesteo ma/sarcoma

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70
Q

what is a cartilage cancer called (benign and malignant)

A

chrondro ma/sarcoma

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71
Q

what are blood vessel cancers called (benign and malignant)

A

haemangio ma/ angiosarcoma

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72
Q

what are nerve cancers called (benign and malignant)

A

neuroma / MPNST

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73
Q

what is more common in children sarcomas or carcinomas

A

sarcomas- still q rare

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74
Q

how do sarcomas spread

A

mostly blood- can widely disseminate

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75
Q

what do cells in sarcomas look like

A

spindle cell lesions, very elongated tapered shaped to cell, solid

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76
Q

what mutations are associated with sarcomas

A

large translocations- Ewings carcinoma t(11;22)

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77
Q

what are the types of haematological cancers

A

myeloid, lymphoid

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78
Q

what is a myeloid cancer

A

cancer of red blood cells, platelets, granulocytes

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79
Q

what is a lymphoid cancer

A

B cells, T cells

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80
Q

why dont blood cancers metastasise

A

as already in the blood and lymphatics

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81
Q

what is leukaemia

A

circulating malignant in the blood and bone marrow

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82
Q

what is leukaemia

A

circulating malignant cells in the blood and bone marrow

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83
Q

what is lymphoma

A

tumour like masses in lymph nodes

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84
Q

what would suggest a blood cancer

A

strange distribution of lymph node involvement that doesn’t fit with anatomical drainage, and may involve liver and spleen diffusely (organeomegaly)

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85
Q

what are the symptoms of bone marrow involvement

A

make less red cells, platelets, granulocytes, B cells- low blood cells

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86
Q

what can cause big liver and spleen (organomegaly)

A

alcohol or malignancy

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87
Q

what are the b-symptoms of blood cancers

A

sweating, night sweats, weight loss

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88
Q

what do lymphoma look like

A

solid white masses, cells often pleomorphic, monotomous and clonal

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89
Q

what is a melanoma

A

a malignant tumour of melanoctyes (neuroectoderm)

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90
Q

what are the most common type of brain tumours

A

carcinomas- gliomas (mets until proven otherwise)

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91
Q

do brain tumours spread

A

no, only really to spinal chord- primary cancers stay in the brain

92
Q

are brain tumours mostly benign or malignant

A

NEITHER- get classifies on molecular abnormalities instead

93
Q

what are weinberg hallmarks

A 
1- self sufficiency in growth signals
2- insensitivity to anti growth signals 
3- evade apoptosis 
4- limitless replication potential 
5- sustained angiogenesis (growth of blood vessels)
6- tissue evasion and metastases
94
Q

what are the components of prostatism

A

urinary hesitation, difficulty in voiding, post micturation dribbling

95
Q

what is sensitivity

A

% of people with disease who have a positive test result

96
Q

what is specificity

A

the likelihood of someone without out the disease being identified by the test as healthy

97
Q

what is the positive predictive value

A

likelihood of having the disease following a positive predictive value

98
Q

what is the negative predictive value

A

likelihood of someone being healthy following a negative result

99
Q

where is ALP found

A

bone, biliary tree, placenta, intestine

100
Q

what makes bone

A

osteoblasts

101
Q

what cell degrades bone

A

osteoclasts

102
Q

what is the albumin of neonates

A

AFP

103
Q

what are the germ cell tumours

A

AFP and HCG

104
Q

what is the LDH requirement for exudate

A

fluid LDH >/= ULN (164U/L)

105
Q

cancer causes hyper/ hypo calcaemia?

A

hyper- consider cancer is calcium >3 mmol/L

106
Q

what are the symptoms of hypercalcaemia

A

stones (renal stones), moans (psyciatric overtones), bones (painful bones), groans (abdominal groans)

107
Q

what can be used to treat hypercalcaemia

A

IV fluids and pamidronate

108
Q

who do people with hypercalcaemia get dehydrated

A

as sodium and water reabsorption from tubules prevented

109
Q

what controls serum calcium

A

parathyroid glands

110
Q

what causes PTH secretion

A

low serum calcium

111
Q

how does PTH secretion cause

A

bone re absorption (calcium from bones goes into blood- rickets), and more calcium reabsorped from renal tubules

112
Q

what causes a low serum calcium

A

vit d deficiency

113
Q

what does final activation of vit D cause

A

reabsorption of calcium in the gut

114
Q

what is secreted in malignancy that causes hypercalcaemia

A

PTHrP

115
Q

what does not pick up PTHrP

A

PTH assay

116
Q

what secretes HCG

A

cholangiocarcinoma

117
Q

what secrets CEA

A

colorectal

118
Q

what secretes AFP

A

HCC

119
Q

what cancer causes cushings and why

A

small cell cancer as secretes ACTH whuch stimulates adrenal glands

120
Q

what usually secretes ACTH

A

the pitruatry

121
Q

what is the aim of radical treatment

A

to eradicate the cancer often at the expense of treatment related side efffects

122
Q

what is the aim of palliative treatment

A

non curative, aims to improve symptoms and quality of life or to prolong life

123
Q

what is adjuvant therapy

A

after surgery, aims to reduce risk of recurrence

124
Q

what is neo adjuvant surgery

A

aims to shrink tumour before surgery

125
Q

what is systemic anticancer therapy

A

(all systemic cancer therapy) cytotoxic chemotherapy, targeted therapy, immunotherapy

126
Q

what are the types of treatment for cancer

A

surgery, external beam radiotherapy, brachytherapy, radionucletide therapy, systemic anticancer therapy

127
Q

what is brachytherapy

A

radioisotopes placed locally at site of tumour

128
Q

what does chemotherapy treat cancer

A

damages cells as they divide and stops them reproducing

129
Q

what are the chemotherpay toxicities

A

malaise, fatigue, lethargy, alopecia, gi (diarrhoea, nausea, mucocitis (mouth ulcers), altered taste), haemotological, peripheral neuropathy, renal/ liver failure, nail changes, fertility changes/ menopause

130
Q

what are the radiotherapy toxicities

A

site specific, cause local side effects

131
Q

what is radio sensitising

A

when chemotherapy enhances they effects of radiotherapy

132
Q

what is more likely to be cure by radiotherapy- squamous or adeno

A

squamous

133
Q

do different parts of the body have different/ the same tolerance to radiation

A

different- ovaries v sensitive

134
Q

Which inherent feature of cancer cell is most important in facilitating the acquisition of new features of a tumour

A

genomic instability

135
Q

what is the commonest pattern of inheritance for risk of cancer

A

multifactorial inheritance

136
Q

what type of mutation is likely to activate an oncogene

A

missense- change in sequence of amino acids

137
Q

what mutations will stop a gene from working

A

deletions, nonsense and splice site

138
Q

who should you treat first in a family if you suspect a inherited condition

A

affected relatives

139
Q

what is a synonymous mutation

A

change in sequence of DNA that doesn’t change amino acid sequence

140
Q

what causes somatic mosaicism

A

when cells proliferate the acquire somatic differences

141
Q

what is the pathophysiology of cancer

A

mutation
proliferation
invasive
metastases

142
Q

what allows cancers to evolve

A

genomic instability

143
Q

what is drug metabolism in relation to cancer

A

drugs that metabolise carcinogens

144
Q

what switches on for cell division

A

oncogenes

145
Q

what do driver mutations do

A

drive carcinogenesis

146
Q

what are passenger mutations

A

just there due to unstable genome

147
Q

what are the chromosome mutations

A

duplications, translocations, multiple extra chromosomes

148
Q

what determines the characteristic of cancer

A

the driver mutation

149
Q

what determines the treatment of cancer and why

A

oncogene signature- as therapy targets pathways

150
Q

can different cell types exist within each cancer

A

yes, in lots

151
Q

what is knudsons 2 hit hypothesis

A

that cancer is the result of the accumulation of multiple mutations- e.g. two somatic or inherit one and acquire one

152
Q

what activates the gene promoter

A

a change in amino acid sequence

153
Q

a mutation in what is common in melanomas, leading to the activation of what pathway

A

mutation in BRAF

activates the KRAS pathway

154
Q

what is the philadelphia chromosome

A

translocation of chromosome 22 in leukaemia cancer cells

155
Q

what gene is associated with hereditary bowel cancer

A

MHL1

156
Q

what is multifactoral inheritance

A

mixture of genes and environment

157
Q

how can you modify the risk of hereditary cancer

A

screening, hormonal manipulation, surgical intervention

158
Q

what is seen histologically in cancer

A

loss of normal structure, pale disorganised nuclei, mitosis

159
Q

when can you genetically test children

A

if they are competent or there is a clinical benefit

160
Q

name cytotoxic therapies

A

taxane, alkylating agent

161
Q

radiations interaction with what mainly kills cells

A

DNA

162
Q

which of the following is a risk factor for oesophageal squamous cell carcinoma;

  • plummer vinson syndrome
  • hiatus hernia
  • barretts oesophagus
  • kartageners syndrome
  • intestinal metaplasia
A

plummer vinson syndrome

163
Q

what are the symptoms of plummer vison syndrome

A

dysphagia, iron-deficiency anaemia, glossitis, cheilosis and oesophageal webs

164
Q

what is kartageners syndrome

A

rare autosomal recessive disorder that causes defects in the action of the cilia lining the reps tract

165
Q

which of the following is the strongest risk for developing cholangiocarcinoma;

  • autoimmune hepatitis
  • hep c
  • primary sclerosing cholangitis
  • primary biliary cirrhosis
  • haemachromatosis
A

primary sclerosing cholangitis

166
Q

where does lung cancer not commonly metastasise to

A

spleen

167
Q

what are common side effects of chemotherpay

A

diarrhoea, neutropenic fever, alopecia, altered taste

168
Q

what does a chest x ray showing multiple ill defined round opacities throughout lung fields show

A

metastatic renal cell carcinoma

169
Q

what are the common late side effects of radiography

A

bladder instability, menopause, faecal urgency, skin fibrosis

170
Q

what is the type of asbestos fibre that is associated with mesothelioma

A

chrysolite

171
Q

does a T1 colorectal adenocarcinoma have metastatic potential

A

yes

172
Q

what is vasogenic oedema

A

accumulation of fluid in brain due to break down of BBB

173
Q

carcinoma= cancer from what cells?

A

epithelium

174
Q

which cancer is most associated with smoking

A

pulmonary small cell carcinoma

175
Q

name the cancer: a well circumscribed tumour protruding into the bronchus with a yellow cut surface

A

carcinoid tumour

176
Q

how does HPV promote carcinogenesis

A

degrading normally produced p53

177
Q

what is a mutation in a promoter most likely to result in

A

absence of a protein

178
Q

what does a small cell carcinoma of the lung usually produce in excess

A

anti diuretic hormone

179
Q

what tumour markers are used to monitor germ cell cancer (testes)

A

human chorionic gonadotrophin (HCG) and alpha feto protein (AFP)

180
Q

what are the recorded end points for cancer treatment

A

disease free survival, toxicity free survival, progression free survival, overall survival

181
Q

what is lynch syndrome

A

autosomal dominant condition carrying high risk of colon cancer (and ovarian, kidney, stomach, small intestine, liver sweat glands) - no other symptoms , may have benign polyps in the colon

182
Q

what does grading describe

A

the degree of cytological atypia

183
Q

what is PSA used in prostate cancer in

A

diagnosis and monitoring

184
Q

what is the best investigation for initial presentation of respiratory cancer red signs

A

contrast enhanced CT chest and abdomen

185
Q

what is a PET-CT scan

A

nuclear imaging that shows metabolically active areas

186
Q

for a potential tumour marker which of the following test characteristics is most important in the diagnosis of malignancy:

  • PPV
  • sensitivity
  • efficiency
  • NPV
  • specificity
A

sensitivity

187
Q

what radiological investigations should be undertaken to stage this cancer- 57 y/o w/ rectal bleeding and altered bowel habit. PR shows palpable rectal mass that is biopsied and malignant

A

contrast enhanced CT chest, abdomen and pelvis plus MRI rectu,

188
Q

where are pulmonary squamous cell carcinomas most commonly located

A

centrally in the lung

189
Q

what does the drug herceptin target

A

epidermal growth factor

190
Q

what type of cancer is derived from smooth muscle

A

leiomyoma

191
Q

abnormalities in mismatch repair proteins as seen in lynch can be identified by what

A

presence of microsatelitte instability

192
Q

BcI2 refers to which weinberg hallmark

A

evasion of apoptosis

193
Q

which one of these is a malignant lesion;

  • hepatoma
  • lipoma
  • pleomorphic adenoma
  • rhabdomyoma
  • leiomyoma
A

hepatoma

194
Q

what virus is hepatocellular carcinoma most strongly associated with

A

Hep c

195
Q

what are gastric marginal lymphomas most associated with

A

H. pylori infection

196
Q

what cancer is NOT associated with obesity

A

gastric cancer

197
Q

where can p53 cause cell cycle arrest

A

between G1 and S phase

198
Q

where are cancers in lynch syndrome most commonly found

A

in the transverse colon

199
Q

what structures does the aorta sit directly infront of

A

the pancrease

200
Q

why are metastases from colon cancer in the liver darker

A

as they are hypovascular

201
Q

what does ‘multiple round soft tissue’ suggest

A

lung metastases

202
Q

what can cause cavitating metastases and what else can cause look a likes

A

renel cell carcinoma

cavitating septic emboli/ TB

203
Q

where do metastases in the lungs tend to e

A

basal

204
Q

where do TB usually affect the lung

A

apices

205
Q

what do primary lung neoplasms look like

A

in upper lobes and stellate in shape

206
Q

what can cause you to see too many ribs on an xray

A

emphysema

207
Q

what are paraneoplatic syndromes

A

rare disorders triggered by an altered immune response to a neoplasm

208
Q

what cancer releases SiADH

A

small cell

209
Q

what cancer releases PTHrP

A

squamous cell carcinoma

210
Q

what cancer releases ACTH

A

neuroenodcrine tumours

211
Q

what is lambert eaton myasthenic syndrome

A

rare autoimmune disorder that is characterised by muscle weakness of the lungs

212
Q

what do melanocytes produce

A

brown pigments

213
Q

how a metastases named

A

after site of origin

214
Q

name two cancers that metastasise early

A

small cell and melanoma

215
Q

is radiotherpay/ chemotherapy local/systemic treatment?

A

radiotherpay- local

chemotherapy systemic

216
Q

why do aggressive cancers respond better to treatment

A

as treatment targets dividing cells

217
Q

is mesothelioma a lung cancer?

A

no- its a pleural malignancy

218
Q

why is mesothelioma an endothelial injury/ cancer

A

as mesothelial cells rest on the basement membrane

219
Q

what can asbestos exposure cause

A

asbestosis, pleural effusion, rounded atelectasis, pleural plaques, adencarcinoma (different from mesothelioma)

220
Q

what is asbestosis

A

long term inflammation and scarring due to asbestos exposure- breathlessness, cough, wheezing, chest pain

221
Q

how does HPV cause carcinogenesis

A

E6 targets p53

E7 targets pRB

222
Q

how does EBV cause cancer

A

latency, integration with DNA

223
Q

what viruses are associated with cancer

A

HPV, EBV, polyomavirus, HHV-8, HIV, hep C

224
Q

how does HIV cause cancer

A

malignancy associated with immunosuppression

225
Q

what type of cancer does plummer vision increase the risk of

A

oesophageal SCC

226
Q

what do you screen for in lynch sydnrome

A

micro satellite instability and DNA missmatch repair

CLASP (3 decks)

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