Cancer general principles Flashcards
What is signal transduction
Extracellular signalling molecules bind to cell surfcae receptor and activate - alters intracellular singalling pathway and alters cell response
What is …oma
Benigin tumour
What does a carcinoma significy
Epithelial tunmours
What does sarcoma signify
Tumours derived from connective tissue
What does terato describe
Germ cell involvement
What is anaplastic tumour
Grade IV - so poorly differentiated do not stain well to surface markers, very few tissue specific tissue features - unsure of origing
What is tumour grading and what does it signifiy
Grade 1 -3 and anaplastic
How similar cells are to original tissues - how differentiated they are
Can have more than one grade within one tumour - based on largest number fo cells of that grade
Tumour can also all go from grade I to grade III
What can FNA be perfomred on
AScites, pleural fluid, CSF
Can be diagnositc
Cytology also on sputum, cervix, pleural effusions, and ascites
Cytological features of cancer cells
Increased number of mitoses + cytological features relating to state of tumour cell differentation
Altered polarity, tumour cell enlargement, increased nuclear to cytoplasmic ration, pleomorphism (varied size and shape) of tumour cells + nuceli, clumoing of nucelae chromatin and distribution along nucelea membrane
Enlarged nuceloli, atypical or bizarre mitoses eg tripolae
Tumour giant cells >1 nuclei
When is cytogenetic analysis useful in cancer
Childhood tumours
Leukaemia, lymhoma, some sarcomas
What cancers is FISH useful in
Ewing sarcoma
Peripheral neuroectodermal tumours - translocation between chromosme 11 and 22
What does stage signify
Geography of cancer - extent of cancer in body
What staging is used in ovarian cancer
FIGO
What staging is used in lymhmoa
Ann arbour
Now lugano
Why is performance status importnat
1-4 - ECOG status
If PS4 - chemo may actually shorten life
Determines treatment
What organs drain into left supraclavicular node
Breast, lung, oesophagus and stomach
Why do you establish the primary tumour site
Diagnosing treatable disease (see table below)
Avoiding over treating unresponsive disease (iatrogenic morbidity in resistant disease)
Preventing complications related to occult primary, e.g. bowel obstruction, pathologic fracture
Prognostic clarification
What tumours are chemosensitive
Non hodgkins lymphoma
Germ cell tumours
Neuroendocrine tumours incl small lung cancer
Ovarian cancer
Hormone sensitive tumours
Breast cancer
Prostate cancer
Endometrial cancer
Thyroid cancer
Axial lymphadenopathy primary
breast
What are primary peritoneal cancers in women
If cant find primary w peritoneal cancers
Stage III ovarian cancer - papillary serous carcinoma
What do primary peritoneal cancers respond well to?
Platinum based chemotherapy
What would typical presentation be and markers and treatment in metastatic extragonadal germ cell tumours
Young men w pulmonary or lymph node metastases and germ cell tumour (alpha fetoprotein and hCG)
i12p mutation 90% + in cytogenic analysis
Cisplatin chemo treat
What neuroendocrine carcinomas of unown primary site ass with
Small cell carcinoma, anaplastic islet cell carcinoma, merkel cell tumours and paragnagliomas
What therapy used for emtastatic neuroendocrine tumours
platinum based combination therapy
Epidemiology of metastatic cancers unkown primary
<20% response to chemo
2/3s of unknown primary site have metastatic adenocarcinmoa involvement 2 or more visceral sites, liver, lungs, lymph nodes
Median survival <12 months
Treatment metastatic cancer unknown primary site
adriamycin, 5-FU, or cisplatin
Investigations for cervical cancer
Cervical smear
Colposcopy
What suggests invasivs vs non invasive disease on colposcopy
Non = leukoplasia, mosaic structure and punctuation on cervix
Abnormal vascularity = invasice
punch or loop biopsy confirms
Why can get headahce/neuro features in SVC obstruciton
Blockage of veinous system -> back up to CSF -> build up -> raised intracranial pressure and any symptoms related to this
SVC treatment
Steroids
ImAGING -> stenting
What investigation do for brain metastases
Gadolinium dye MRI
Brain mets treatment
Dexamethasone for oedema
Radiotherapy - can remove part of skull
What is most likely cancer to metastasis to brain and what do about that risk
Lung cancer
Sometimes can have cranioradiotherapy as preventative treatment in SCLC
Other common to brian - breast, melanoma
If SSC vs adenocarcinoma metastases found is there a high or low likelihood of finding primary cancer
High for SSC - only 5% not found
Low for adenocarcinoma - 15% found
Common sites for adenocarcinoma
Pancreatic
Lung
Liver
Often multiple mets
How investigate metastatic cancer if cant see primary on imaging
Blood tests for any cancer tumour markers that could locate it
Camera imaging - endoscopy, colposcopy etc
Biopsy of tumour have found - test for receptors eg ER/HER2 in breast
What electrolyte disturbance most likely to see with ectopic ACTH SCLC produciton
Low potassium
