Cancer general principles

Question 1

What is signal transduction

Answer 1

Extracellular signalling molecules bind to cell surfcae receptor and activate - alters intracellular singalling pathway and alters cell response

Question 2

What is …oma

Answer 2

Benigin tumour

Question 3

What does a carcinoma significy

Answer 3

Epithelial tunmours

Question 4

What does sarcoma signify

Answer 4

Tumours derived from connective tissue

Question 5

What does terato describe

Answer 5

Germ cell involvement

Question 6

What is anaplastic tumour

Answer 6

Grade IV - so poorly differentiated do not stain well to surface markers, very few tissue specific tissue features - unsure of origing

Question 7

What is tumour grading and what does it signifiy

Answer 7

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

Question 8

What can FNA be perfomred on

Answer 8

AScites, pleural fluid, CSF
Can be diagnositc
Cytology also on sputum, cervix, pleural effusions, and ascites

Question 9

Cytological features of cancer cells

Answer 9

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

Question 10

When is cytogenetic analysis useful in cancer

Answer 10

Childhood tumours
Leukaemia, lymhoma, some sarcomas

Question 11

What cancers is FISH useful in

Answer 11

Ewing sarcoma
Peripheral neuroectodermal tumours - translocation between chromosme 11 and 22

Question 12

What does stage signify

Answer 12

Geography of cancer - extent of cancer in body

Question 13

What staging is used in ovarian cancer

Answer 13

FIGO

Question 14

What staging is used in lymhmoa

Answer 14

Ann arbour
Now lugano

Question 15

Why is performance status importnat

Answer 15

1-4 - ECOG status
If PS4 - chemo may actually shorten life
Determines treatment

Question 16

What organs drain into left supraclavicular node

Answer 16

Breast, lung, oesophagus and stomach

Question 17

Why do you establish the primary tumour site

Answer 17

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

Question 18

What tumours are chemosensitive

Answer 18

Non hodgkins lymphoma
Germ cell tumours
Neuroendocrine tumours incl small lung cancer
Ovarian cancer

Question 19

Hormone sensitive tumours

Answer 19

Breast cancer
Prostate cancer
Endometrial cancer
Thyroid cancer

Question 20

Axial lymphadenopathy primary

Answer 20

breast

Question 21

What are primary peritoneal cancers in women

Answer 21

If cant find primary w peritoneal cancers
Stage III ovarian cancer - papillary serous carcinoma

Question 22

What do primary peritoneal cancers respond well to?

Answer 22

Platinum based chemotherapy

Question 23

What would typical presentation be and markers and treatment in metastatic extragonadal germ cell tumours

Answer 23

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

Question 24

What neuroendocrine carcinomas of unown primary site ass with

Answer 24

Small cell carcinoma, anaplastic islet cell carcinoma, merkel cell tumours and paragnagliomas

Question 25

What therapy used for emtastatic neuroendocrine tumours

Answer 25

platinum based combination therapy

Question 26

Epidemiology of metastatic cancers unkown primary

Answer 26

<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

Question 27

Treatment metastatic cancer unknown primary site

Answer 27

adriamycin, 5-FU, or cisplatin

Question 28

Investigations for cervical cancer

Answer 28

Cervical smear Colposcopy

Question 29

What suggests invasivs vs non invasive disease on colposcopy

Answer 29

Non = leukoplasia, mosaic structure and punctuation on cervix Abnormal vascularity = invasice punch or loop biopsy confirms

Question 30

Why can get headahce/neuro features in SVC obstruciton

Answer 30

Blockage of veinous system -> back up to CSF -> build up -> raised intracranial pressure and any symptoms related to this

Question 31

SVC treatment

Answer 31

Steroids ImAGING -> stenting

Question 32

What investigation do for brain metastases

Answer 32

Gadolinium dye MRI

Question 33

Brain mets treatment

Answer 33

Dexamethasone for oedema Radiotherapy - can remove part of skull

Question 34

What is most likely cancer to metastasis to brain and what do about that risk

Answer 34

Lung cancer Sometimes can have cranioradiotherapy as preventative treatment in SCLC Other common to brian - breast, melanoma

Question 35

If SSC vs adenocarcinoma metastases found is there a high or low likelihood of finding primary cancer

Answer 35

High for SSC - only 5% not found Low for adenocarcinoma - 15% found

Question 36

Common sites for adenocarcinoma

Answer 36

Pancreatic Lung Liver Often multiple mets

Question 37

How investigate metastatic cancer if cant see primary on imaging

Answer 37

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

Question 38

What electrolyte disturbance most likely to see with ectopic ACTH SCLC produciton

Answer 38

Low potassium