Cancer Flashcards
what is hyperplasia?
increase in the number of cells
when does hyperplasia occur?
in response to a stimulus
when does hyperplasia regress?
when the stimulus is removed
what is hypertrophy?
increase in cell size
what is atrophy?
loss of cell size or number
when does atrophy occur?
with the withdrawal of a stimulus
what two things can atrophy be?
hormonal or mechanical
what is metaplasia?
reversible change from one mature cell type to another
what does metaplasia occur in response to?
injury
what is neoplasia?
new growth without a stimulus
what are the three types of neoplastic growth?
benign
premalignant
malignant
what do benign growths not have?
any malignant potential
describe a premalignant growth
dysplastic but still benign as there is no invasion
what is the closest a growth can be to malignancy whilst still being benign?
carcinoma in-situ
what is malignancy?
growth that has invaded and has metastatic potential
who gets screened for colonic cancer?
patients with positive FOB tests
what is the gold standard for colonic cancer screening?
optical colonoscopy
what does radical treatment mean?
treatment with curative intent
what is the aim of radical treatment?
to eradicate a tumour, often at the expense of side effects
what does palliative treatment mean?
non-curative
what is the aim of palliative treatment?
to improve symptoms or prolong life
what is adjuvant treatment?
treatment done after surgery
what is the aim of adjuvant surgery?
reducing risk of recurrence
what is neo-adjuvant treatment?
treatment done before surgery
what is the aim of neoadjuvant treatment?
to shrink a tumour before surgical removal
name four descriptors of treatment endpoint
overall survival
disease free survival
progression free survival
local control
what is overall survival?
the patients time alive
what is disease free survival?
time without any symptoms or signs of cancer
what is progression free survival?
the time living with cancer that is not getting worse
what is local control?
time without recurrence or progression at a specific tumour site
name four non surgical treatment modalities
external beam radiotherapy
brachytherapy
radionuclide therapy
systemic anti cancer therapy
how does radiotherapy cause cancer cell death?
radiation causes a double strand break in DNA that prevents cell division, resulting in cell death
what is brachytherapy?
chips with radiation inserted into a patient
name three things included in systemic anti cancer therapy (SCAT)
cytotoxic chemotherapy
targeted therapy
immunotherapy
name three chemotherapy agents
alkylating agents
taxanes
anthracyclines
how do alkylating agents work?
attach an alkyl group to DNA
how do platinum salts work?
DNA cross linking
how do anti metabolites work?
interfere with RNA/DNA growth
how do taxanes work?
mitotic inhibitors
how do anthracyclines work?
interfere with enzymes for DNA copying
how does topoisomerase work?
prevents DNA strands from unwinding
what unit is a radiotherapy prescription given in?
grays (Gy)
what is Gy the unit of?
absorbed dose
what are targeted agents?
monoclonal antibodies
what monoclonal agent can be used to treat some breast cancers?
Herceptin/Trastuzumab
what does Herceptin target?
HER2
what are the three broad groups that most cancers fall under?
epithelial
mesenchymal
haematological
what is the term for epithelial malignancy?
carcinoma
who is more likely to get carcinoma, children or the elderly?
the elderly
what is carcinoma progression characterised by?
local growth
what two ways does a carcinoma spread?
haematogenous and lymphatic orutes
where is lymphatic spread to in colorectal cancer?
local lymph nodes in the mesentery
where is lymphatic spread to in testicular cancer?
para-aortic lymph nodes
where do lung cancers metastasise to via the blood?
bone
brain
adrenal glands
the liver
where do GI malignancies commonly spread to in the blood?
the liver
where does prostate cancer spread in the blood?
anywhere
what are mesenchymal tumours called?
sarcomas
what is a benign tumour of smooth muscle called?
leiomyoma
what is a benign tumour of skeletal muscle called?
rhabdomyoma
what is a benign tumour of fat called?
lipoma
what is a benign tumour of bone called?
osteoma
what is a benign tumour of cartilage called?
chondroma
what is a benign tumour of blood vessels called?
haemangioma
what is a benign tumour of nerves called?
neuroma
what is a malignant tumour of smooth muscle called?
leiomyosarcoma
what is a malignant tumour of skeletal muscle called?
rhabdomyosarcoma
what is a malignant tumour of fat called?
liposarcoma
what is a malignant tumour of bone called?
osteosarcoma
what is a malignant tumour of cartilage called?
chondrosarcoma
what is a malignant tumour of blood vessels called?
angiosarcoma
what is a malignant tumour of nerves called?
malignant peripheral nerve sheath called (MPNST)
are sarcomas common or rare?
rare
what is the defining feature of sarcoma progression?
local growth
what type of spread is very rare in a sarcoma?
lymphatic spread
describe the morphology of a sarcoma cell
spindle cell
very long tapered shape
can haematological tumours metastaised?
no
what is a lymphoma?
tumour like masses in lymph nodes
what is crucial in haematological tumours?
FBC
what is a brain tumour often called?
glioma
what are lesions in the brain considered to be until proven otherwise?
metastases
where do primary brain tumours metastasise to?
nowhere, they can’t cross the blood brain barrier
what does TNM stand for?
tumour size
lymph node involvement
metastasis
what does Tis stand for?
tumour in situ
what does tumour in situ mean?
the tumour is contained within the lamina propria
what does T1 mean?
the tumour has invaded the submucosa only
what does T2 mean?
the tumour has invaded the muscularis propria and has not extended beyond it
what does T3 mean?
the tumour has invaded into the subserosa but not into the serosa or any adjacent tissues
what does T4 mean?
the tumour has directly invaded other organs or structures
what does NX mean?
lymph nodes cannot be assessed
what does N0 mean?
no regional lymph node metastasis
what does N1 mean?
metastasis to 1-3 nearby lymph nodes
what does N2 mean?
metastasis to four or more regional nodes
what does M0 mean?
no metastasis
what does M1 mean?
metastasis to distant tissues, including lymph nodes
what stage is a tumour with T1N1M0?
III A
what stage is a tumour with T2N2M0?
III C
what stage is a tumour with T2N0M1?
IV
describe the TNM score for a stage I cancer?
T1/2
N0
M0
describe the TNM score for a stage II A cancer?
T3
N0
M0
describe the TNM score for a stage II B cancer?
T4
N0
M0
describe the TNM score for a stage III A cancer?
T1/2
N1
M0
describe the TNM score for a stage III B cancer?
T3/4
N1
M0
describe the TNM score for a stage III C cancer?
T ANY
N2
M0
describe the TNM score for a stage IV cancer?
T ANY
N ANY
M1
what staging system can be used for bowel cancer?
duke’s staging
describe duke’s stage A bowel cancer
confined to the bowel wall with no lymph node metastases
describe duke’s stage B bowel cancer
local spread out of the bowel wall with no lymph node metastasis
describe duke’s stage C bowel cancer
lymph node metastasis
describe duke’s stage D bowel cancer
metastatic disease
what is the prognosis for stage A bowel cancer?
95%
what is the prognosis for stage B bowel cancer?
85%
what is the prognosis for stage C bowel cancer?
60%
what is the prognosis for stage D bowel cancer?
8%
what does PSA stand for?
prostate specific antigen
what is PSA?
a protein produced only by the prostate
what is prostatism?
a collection of symptoms including urinary hesitation and difficulty in emptying the bladder
what causes the symptoms of prostatism?
enlargement of the prostate which narrows or completely closes the urethra
what are two possible causes of prostatism?
prostate cancer
benign prostate hyperplasia (BPH)
what should be measured in people with prostatism?
PSA
what is a normal range for PSA?
0-4
what are differentials of high PSA?
prostate cancer
benign prostate hyperplasia
what examination can be done to differentiate between BPH and prostate cancer?
PR exam, BPH feels smooth while prostate cancer feels rough
besides PSA and PR exam, what other test needs to be done to diagnose prostate cancer?
biopsy
name two enzymes that are raised in muscle damage
CK
AST
name four enzymes that are raised in liver damage
ALT
AST
ALP
GGT
name four enzymes that are raised in heart damage
troponin
CK
AST
LDH
name two enzymes that are raised in pancreas damage
amylase
lipase
name an enzyme that is raised in bone damage
ALP
what is the normal range for alkaline phosphatase?
30-130
name two types of cells that contain ALP?
hepatocytes
osteoblasts
what does high alkaline phosphatase in a cancer patient suggest?
metastasis to either the liver or bone
what test can be done to determine whether raised ALP is due to liver or bone pathology?
GGT, if elevated it is liver pathology
which type of pleural effusion is more likely to be caused by malignancy?
exudate
what is the reference interval for calcium?
2.10-2.55
what is the most important thing to measure in someone with raised calcium?
PTH
what does it mean if someone has high calcium and high PTH?
the high PTH is what is causing the high calcium, as PTH stimulates calcium production when levels are low
what is PTHrP?
PTH related protein
is PTHrP seen upon measuring PTH?
np
what may be causing high calcium in a patient whose PTH levels are normal?
PTHrP
what do oncogenes do?
promote cell division
what do tumour supressors do?
stop cell division
what do DNA repair genes do?
repair DNA damage
what do drug metabolism genes do?
metabolise carcinogens
name four types of genes that are involved in cancer
oncogenes
tumour suppressor genes
DNA repair genes
drug metabolism genes
what is a driver mutation?
a mutation that drives carcinogenesis
what is a passenger mutation?
an incidental mutation that develops because the tumour is unstable