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Medicine Phase 2a > Cancer > Flashcards

Cancer Flashcards

1
Q

Define Carcinogenesis

A

The transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations

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2
Q

What is difference between something that is carcinogenic and oncogenic?

A

Carcinogenic - cancer causing

Oncogenic - tumour causing

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3
Q

Name a carcinoma that only invades locally and never spread to other parts of the body

A

Basal Cell Carcinoma of Skin

cured by complete local excision

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4
Q

Where do most/all cancers generally spread?

A

Lymph node(s) that drain the site of that carcinoma

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5
Q

What cancers commonly spread to the bone?

A 
Breast
Prostate
Lung
Thyroid
Kidney
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6
Q

What lymph node can breast cancers often spread to?

A

Axillary node

need axillary node clearance

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7
Q

Define Adjuvant therapy

A

Extra treatment given after surgical excision

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8
Q

Give example of cancer that naturally moves around while body

A

Leukaemia

generally need chemo

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9
Q

what type of tumours does carcinogenesis apply to?

A

Malignant Neoplasms

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10
Q

What types of tumours does oncogenesis apply to?

A

Benign and Malignant

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11
Q

Define carcinogens

A

agents known or suspected to cause tumours

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12
Q

What is meant by carcinogens being mutagenic?

A

act on DNA

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13
Q

WHat percentage of cancer risk is environmental?

A

85%

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14
Q

What problems arise in identifying carcinogens?

A
  • Latent interval may be decades
  • Complexity of the environment
  • Ethical constraints (in exposed humans to things thought to cause cancer)
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15
Q

Name the classes of carcinogens

A 
Chemical
Viral
Ionising and non-ionising radiation
Hormones, Parasites and Mycotoxins
Miscellaneous
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16
Q

Give examples of chemical carcinogens

A

Polycyclic aromatic hydrocarbons
Aromatic amines
Nitrosamines
Alkylating agents

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17
Q

What tumours associate with polycyclic aromatic hydrocarbons

A

Lung and Skin

e.g. smoking or mineral oils

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18
Q

what cancer does aromatic amines associate with?

A

Bladder cancer

e.g. rubber/dye workers

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19
Q

What cancer does nitrosamines associate with?

A

Gut cancer

animal testing

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20
Q

What cancer does alkylating agents associate with?

A

Leukaemia

small risk

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21
Q

What biological agents can cause cancer?

A

Hormones
Mycotoxins
Parasites

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22
Q

Examples of hormones that can cause cancer

A
  • Higher Oestrogen increase chance of endometrial cancer

- Anabolic steroids linked with Hepatocellular carcinoma

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23
Q

Example of mycotoxins that can cause cancer

A

Alfatoxin B1 -> hepatocellular carcinoma

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24
Q

Examples of parasites that can cause cancer

A

Chlonorchis sinensis ->cholangiocarcinoma

Shistosoma ->Bladder cancer

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25
Q

Name 2 miscellaneous carcinogens

A

Asbestos
Metals (nickel, chromium etc)
(?mechanism of action)

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26
Q

Name 5 host factors that can affect cancer development

A 
Race
Diet
Constitutional factors e.g. age, gender etc
Premalignant lesions
Transplacental exposure
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27
Q

Give examples of race (host factor) affecting cancer incidence

A
  • Increased oral cancer in India/SE asia (reverse smoking)

- Decreased skin cancer in blacks as more melanin protecting them from UV

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28
Q

Give examples of constitutional factors (host factor) that can affect cancer development

A
  • Inherited predisposition e.g. familial polyposis coli (chr 5) or retinoblastoma (chr 13)
  • Age (incidence increases with age)
  • Gender (Breast cancer 200xs more common in women)
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29
Q

Give examples of premalignant conditions and define what is meant be the term

A

Identifiable local abnormality associated with increased malignancy risk at that site e.g. Colonic Polyps
Cervical Dysplasia
Ulcerative Colitis
Undescended testis

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30
Q

Give example of transplacental host factor leading to carcinogenesis

A

Diethylstiboestrol (old oestrogen medication) leads to increase in vaginal cancer

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31
Q

How can Herceptin improve cancer prognosis (what receptor does it act on)

A

HER2 receptors

herceptin eliminates these so less intracellular signalling and less cell replication or decreased apoptosis

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32
Q

Give two methods of comparing normal cells to cancerous cells

A

Gene arrays

Tissue microarrays

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33
Q

What gene/protein monitors DNA changes and if mutation has occurred, triggers apoptosis

A

p53

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34
Q

Define tumour

A

Any abnormal swelling e.g. neoplasm, inflammation, hypertrophy, hyperplasia

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35
Q

What is most common cancer in men?

A

Prostate

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36
Q

What is most common cancer to cause death in men and/or women?

A

Lung cancer

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37
Q

What is most common cancer in women?

A

Breast

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38
Q

What 2 things comprise the structure of a neoplasm?

A

Neoplastic cells

Stroma

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39
Q

Why can you often get central necrosis in a malignant neoplasm?

A

As malignant neoplasm often outgrows its blood supply leaving infarcted cells in the centre

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40
Q

What is the stroma of a neoplasm and what are the 2 functions of it

A

Connective Tissue Framework

Mechanical Support and Nutrition

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41
Q

Why does hepatitis increase your risk of hepatocellular carcinoma

A

Virus causes cirrhosis of the liver

therefore increased cell turnover and higher carcinoma risk

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42
Q

Give an example of a tumour that is borderline between benign and malignant

A

some Ovarian lesions

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43
Q

Why can many people get found to have cancer later?

A

Pain is often a late feature of cancer

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44
Q

What is the purpose of classifying neoplasms

A

Determine appropriate treatment

Provide prognostic information

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45
Q

Give 2 methods of classification for neoplasms

A

Behavioural (Benign/malignant)

Histogenic ( specific cell of origin of tumour)

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46
Q

Describe features of benign neoplasms

A
  • Localised, non-invasive
  • Slow growth rate
  • Low mitotic activity
  • Close resemblance to normal tissue (Nuclear morphometry often normal)
  • Circumscribed or encapsulated
  • Necrosis rare
  • Ulceration rare
  • Growth on mucosal surfaces often exophytic
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47
Q

How do benign neoplasms cause morbidity and mortality?

A
  • Pressure on adjacent structures
  • Obstruct flow
  • Production of hormones
  • Transformation to malignant neoplasm
  • Anxiety
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48
Q

What is meant by exophytic and what is opposite?

A

grow outward beyond the surface epithelium from which it originates

endophytic

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49
Q

In notation, how would a benign neoplasm be named?

A

ends in -oma (no sarco or carcin before)

e.g. adenoma is benign tumour of glandular epithelium, but adenocarcinoma is malignant

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50
Q

Describe features of malignant neoplasms

A
  • Invasive
  • Metastases
  • Rapid growth rate (increased mitotic activity)
  • Variable resemblance to normal tissue
  • Poorly defined or irregular border
  • Necrosis common
  • Ulceration common
  • Hyperchromatic nuclei
  • Pleomorphic nuclei
  • Growth on mucosal surfaces and skin often endophytic
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51
Q

How do malignant neoplasms cause morbidity and/or mortality

A 
Destruction of adjacent tissue
Metastases
Blood loss from ulcers
Obstruction of flow
Hormone production
Paraneoplastic effects
Anxiety and pain
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52
Q

Whats purpose of histogenetic classifaction?

A

specific cell of origin of tumour specified via histopathological examination to give tumour type

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53
Q

Where can neoplasms arise from?

A

Epithelial cells
Connective tissues
Lymphoid/haemopoietic organs

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54
Q

Define papilloma

A

Benign tumour of non-glandular, non-secretory epithelium e.g. squamous cell papilloma (prefix with cell type of origin)

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55
Q

Define an adenoma

A

Benign tumour of glandular or secretory epithelium

e.g. colonic adenoma or thyroid adenoma (prefix with cell type of origin)

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56
Q

Define carcinoma

A

Malignant tumour of epithelial cells

e.g. transtitional cell carcinoma (prefixed by name of epithelial cell

57
Q

What is a malignant carcinoma of glandular epithelium called?

A

Adenocarcinoma

58
Q

Give 4 examples of benign connective tissue neoplasms

A

Lipoma
Chondroma
Osteoma
Angioma

59
Q

What is a benign neoplasm of adipocytes called?

A

lipoma

60
Q

What is a benign neoplasm of bone called?

A

osteoma

61
Q

What is a chondroma?

A

benign neoplasm of cartilage

62
Q

What is an angioma?

A

benign neoplasm of vascular system

63
Q

What is a benign neoplasm of striated muscle called?

A

Rhabdomyoma

64
Q

What is a benign neoplasm of smooth muscle called?

A

Leiomyoma

65
Q

What suffix is given to malignant connective tissue neoplasms

A

sarcoma

66
Q

What is a malignant neoplasm of blood vessels called?

A

Angiosarcoma

67
Q

What is an osteosarcoma

A

malignant neoplasm of bone

68
Q

What is a malignant neoplasm of cartilage called?

A

Chrondrosarcoma

69
Q

What is a liposarcoma

A

malignant neoplasm of adipose tissue

70
Q

What is a malignant neoplasm of smooth muscle called?

A

Leiomyosarcoma

71
Q

What is a malignant neoplasm of striated muscle called?

A

Rhabdomyosarcoma

72
Q

When the cell-type of origin is unknown, what is the tumour called?

A

Anaplastic

73
Q

Give 3 examples of conditons that end in ‘oma’ but are NOT neoplasms

A

Granuloma
Mycetoma
Tuberculoma

74
Q

Give 3 examples of malignant tumours that do not end in carcinoma or sarcoma

A

Melanoma
Mesothelioma
Lymphoma

75
Q

What is a melanoma

A

MALIGNANT neoplasm of melanocytes

76
Q

What is a malignant neoplasm of lymphoid cells called?

A

Lymphoma

77
Q

What is a mesothelioma?

A

MALIGNANT neoplasm of mesothelial cells

can result from asbestos exposure

78
Q

How does radon gas cause lung cancer?

A

Alpha particle emitter

if inhaled, can damage DNA

79
Q

What exceptions are there to conventional neoplasm naming

A

Granuloma, Mycetoma, Tuberculoma
Melanoma, Mesothelioma, Lymphoma

Teratoma
Blastomas
mixed tumours
APUDomas (Amine content and/or Precusor Uptake and Decarboxylation)
Carcinosarcomas
80
Q

What are blastomas

A

Embryonal tumours

81
Q

What is a teratoma

A

Tumour made up of several different types of tissue, such as hair, muscle, or bone. They typically form in the ovaries, testicles, or tailbone and less commonly in other areas.
(cause of prostate cancer in women)

82
Q

Where can you get carcinosarcomas?

A

Mix or carcinoma and sarcoma
Can arise in diverse organs, such as the skin, salivary glands, lungs, the oesophagus, pancreas, colon, uterus and ovaries

83
Q

Where are leiomyomas common

A

Myometrium

benign smooth muscle neoplasm

84
Q

*What is an angiolipoma

A

Tumour made of adipose and blood vessels that develops under skin

85
Q

Where would you often find an angiomyolipoma?

A

Kidneys

Although benign, they can grow to impair kidney function or the blood vessels may dilate and burst, leading to bleeding

86
Q

How could a benign neoplasm of fibroid/smooth muscle kill a patient

A

While don’t invade tissue, can push outwards

Can then damage local BVs such as aorta

87
Q

*What is meant by carcinoma in situ?

A

cancer dividing but hasn’t broken through basement membrane (so hasn’t spread)

88
Q

What is meant by a micro-invasive carcinoma

A

Carcinoma that has invaded past basement membrane but hasnt spread far (<1mm)
(therefore local treatment still usually fine)

89
Q

How can cancerous cells invade/pass the basement membrane?

A

Proteases - matrix metalloproteinases

Cell motility

90
Q

Give 3 examples of matrix metalloproteinases that allow invasion of basement membrane by cancerous cells

A

Collagenase
Cathepsin D
Urokinase-type plasminogen activator

91
Q

**Describe the process of metastasis

A
  • Invasion of basement membrane by mutated cancerous cell by proteases and cell motility
  • Intravasation
  • Evasion of host immune system and movement around body
  • Extarvasation
  • Growth at metastatic site (distant target organ) to form metastases (growth factors often present)
  • Angiogenesis of metastases
92
Q

How is tumour cell motility increased?

A

Tumour cell derived motility factors

Breakdown of products of extracellular matrix (e.g. CTissue also)

93
Q

What features of tumour cell allow intravasation?

A

Collagenases

Cell motility

94
Q

How do tumour cells evade the immune system?

A

Aggregation with platelets
Shedding of surface antigens
Adhesion to other tumour cells

95
Q

What allows extravasation?

A

Adhesion receptors
Collagenases
Cell motility

96
Q

What promotes angiogenesis?

A

Vascular endothelial growth factor
Basic fibroblast growth factor
(can be produced by tumour cells)

97
Q

What inhibits angiogenesis?

A

Angiostatin
Endostatin
Vasculostatin

98
Q

Give an example of a drug that inhibits angiogenesis

A

Avastin

99
Q

How does avastin inhibit angiogenesis

A

Interaction between VEGF (VEGF-A) and VEGFR-2 (receptor) is a key drive of angiogenesis.
Avastin specifically binds to and inhibits VEGF extracellularly

100
Q

What are other uses of avastin

A 
Macular degeenration (check)
injected into eye to stop leaking BV
101
Q

Why are lung metastases often

A

Any tumour invading lymph or veins drains into vena cava, which drains into right side of heart. From heart blood is pumped into lung and metastases can get lodged in capillary filter.

102
Q

Why can lung cancers metastasise to many parts of the body?

A

Any metastases that move into BVs will go into left side of heart, from which they could be pumped to anywhere the aorta supplies blood to.

103
Q

Why does colorectal cancer not often metastasise to many parts of the body?

A

Venous drainage of colon and rectum go to liver and metastases can get lodged in capillary filter here. Causes LIVER metastases.

104
Q

Name a cancer type that more commonly metastasises to lung

A

Sarcomas (any common cancer)

105
Q

Name tumours that more commonly metastasise to the liver

A

Colon
Stomach
Pancreas
Carcinoid tumours of intestine

106
Q

Name tumours which more commonly meastasise to bone

A

Lung
Kidney
Thyroid
Breast Prostate

107
Q

*Give example of cancer drugs that can stop cell division

A

Vinblastine
Ifosamide
Cisplatin
Etoposide

also: Cetuximab, Gleevec

108
Q

Which of the following does not commonly metastasise to bone:
Lung, Breast, Liposarcoma, Kidney

A

Liposarcoma

109
Q

Give an example of a cancer that does not have a screening service in the UK

A

Lung cancer

110
Q

Give an example of a breast cancer screening service

A

Mamography for >50 year old women

111
Q

Which of the following is not a known carcinogen in humans:

Hepatitis C, Ionising radiation, Aromatic amines, Aspergillus niger

A

Aspergillus niger (black mould like in shower)

112
Q

What type of cancer are aromatic amines linked with?

A

Bladder cancer

113
Q

What type of cancer is ionising radiation linked with

A

Thyroid cancer

114
Q

Give an example of a fungus that can cause cancer

A

Aflatoxin

increased risk of Hepatocellualr cancer

115
Q

Give 3 features of malignant neoplasms

A

Vascular invasion
Metastasis
Increased cell division

116
Q

While overall growth rates of cancerous and normal cells are different, give an example of a cancer where they can be similar

A

Hamartoma

coin lesions in lung

117
Q

Smoking is the biggest cause of cancer:

If someone smoked 20 cigarettes a day, what is the increase in risk of cancer

A

26x more at risk of lung cancer

118
Q

True or False:

Ovarian cancer often spreads in peritoneum

A

True

No barrier between ovaries and peritoneum so easy spread

119
Q

*Give 3 examples of methods to grade cancer

A 
TMN classification
Dukes Classification (Colon cancer)
FIGO (gynaecology cancers)
120
Q

*In TMN classification, what does each letter stand for

A

Tumour (size/invasion 1-4)
Nodes (0-2 depending on number of nodes)
Metastasis (0-1)

121
Q

True or false: 1 in 3 people will get cancer in UK

A

True

122
Q

Give some examples of environmental factors that can cause cancer

A

UV - skin cancer
Chemicals - Lung cancer
Pathogens - HPV causes cervical cancer; helicobacter causes stomach cancer

123
Q

What % of cancers are inheritable / due to transformation of gremlin cells

A

<10% (Rb, BRCA1, 2)

124
Q

What % of cancers are non-inheritable / due to transformation of somatic cells

A

> 90%

125
Q

What is meant by the term cancer

A

Cancer represents a wide spectrum of conditions caused by a failure of the controls that normally govern cell proliferation, differentiation and cell survival

126
Q

What is the purpose of tumour immunology

A

Goaloftumourimmunologyistoinduce clinicallyeffective anti‐tumour immune responses that would discriminate between tumour cells and normal cells in cancer patients.

127
Q

What is meant by cancer immnosurveillance

A

Immune system can recognize and destroy nascent transformed cells, normal control

128
Q

Describe Tumour Specific Antigens

A

Only found on tumours
Result of point mutations or gene rearrangement
Derive from viral antigens

129
Q

Describe Tumour Associated Antigens

A

Found on both normal and tumour cells but are over expressed on cancer cells
Developmental antigens which become derepressed
Differentiation antigens are tissue specific
Altered modification of a protein could be an antigen

130
Q

**Give examples of antigens that are tumour-specific mutated oncogenes or tumour suppressors

A

Cyclin-dependent kinase 4
Beta Catenin
Caspase-8
Surface Ig/Idiotype

131
Q

What is nature of antigen ‘cyclin-dependent kinase 4’ and in what tumour type is this found?

A

Cell-cycle regulator

Melanoma

132
Q

What is nature of antigen ‘Beta-Catenin’ and in what tumour type is this found?

A

Relay in signal transduction pathway

Melanoma

133
Q

What is nature of antigen ‘Caspase 8’ and in what tumour type is this found?

A

Regulator of apoptosis

Squamous cell carcinoma

134
Q

What is nature of antigen ‘Surface Ig/Idiotype’ and in what tumour type is this found?

A

Specific antibody after gene rearrangements in B cell clone

Lymphoma

135
Q

What is the class and nature of antigen: MAGE-1 or MAGE-3

A 
Class = Germ cell
Nature = Normal testicular proteins
136
Q

In what types of tumour do you find the germ cell antigens MAGE-1 or MAGE-3

A

Melanoma
Breast
Glioma

137
Q 
What is the class and nature of antigen: Tyrosinase
and what tumour type do you find this antigen in?
A 
Class = differentiation
Nature= enzyme in melanin synthesis pathway
Tumour = melanoma
138
Q

What roles does immune response play in tumour awareness

A

Immunosurveillance and immunoediting

139
Q

What is meant by immunoediting in cancer pathology

A

immune responses can change tumours to be hidden from recognition by the immune system and tumours can promote immune suppressor cells: T regs and myeloid-derived suppressor cells (MDSC)

Medicine Phase 2a (22 decks)

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