Cancer + Genetics + Markers

Question 1

What are carcinoma

Answer 1

Cancer that begins in epithelial tissue

• Adenocarcinoma
• SCC
• TCC
• Small cell

Question 2

What are adenocarcinoma

Answer 2

Glandular epithelium

• Stomach
• Intestine

Question 3

What are SCC

Answer 3

Affects squamous epithelium

• Cervix
• Anus
• Head and neck
• Skin

Question 4

What are TCC

Answer 4

Uroepithelium

• Renal pelvis
• Ureter
• Bladder

Question 5

What is a sarcoma

Answer 5

Begins in mesenchyme

• Bone
• Caritlage
• Fat
• Muscle
• Blood vessels

Question 6

What is leukaemia / lymphoma

Answer 6

Leukaemia - starts in blood forming tissue e.g. marrow

Lymphoma - begin in cells of immune system

Question 7

What are germ cell tumour

Answer 7

Originate from germ cells in testis or ovaries

• Seminoma
• Non seminoma

Question 8

How does cancer spread

Answer 8

Direct
Lymphatic to regional LN - follow vascular
Haematenous
Trans-coleomic ( across body cavity e.g. pleura -> peritoneum -> pericardium)

Question 9

Staging of cancer

Answer 9

TNM = most common
T1-4
NO-1
MO - 1

Question 10

When does MDT management plan occur

Answer 10

After historical Dx and staging
After pathological Dx
Relevant TNM stage assigned

Question 11

What type of treatment in cancer

Answer 11

Local
Regional
Systemic

Question 12

Local Rx

Answer 12

Aim at anatomical target
Surgical resection
RT

Question 13

Regional Rx

Answer 13

Aimed at Rx draining nodal region

Surgical resection + RT of nodes

Question 14

Systemic Rx

Answer 14

Effect on distant mets

4 types described later

Question 15

Most common cancers UK

Answer 15

Breast
Lung
Colorectal
Prostate
Bladder
NHL
Melanoma
Stomach
Oesopahgus
Pancreas

Question 16

Most common cause of cancer death

Answer 16

Lung
Colorectal
Breast
Prostate
Pancreas
Oesophagus
Stomach
Bladder 
NHL
Lymphoma

Question 17

What is Li Fraumeni

Answer 17

AD mutation in p53 suppressor gene

Causes high incidence of sarcoma/. leukaemia

Question 18

When do you suspect

Answer 18

Sarcoma <45

1st degree relative with sarcoma <45 + another family member with malignancy <45 or sarcoma at any age

Question 19

What is BRCA 1 and 2 linked with

Answer 19

BRCA 1 - breast and ovarian

BRCA 2 - prostate, breast and ovarian

Question 20

What is Lynch syndrome / HNPCC

Answer 20

AD mutation

Develop colonic and endometrial cancer at younger age

Question 21

How do you identify Lynch

Answer 21

3+ family confirmed colorectal (1+ 1st degree)
2 successive generation
1+ colon <50
FAP excluded

Question 22

What is Gardner’s syndrome / FAP

Answer 22

AD mutation of APC gene causing

• Multiple colonic polyp
• Skull osteoma
• Thyroid cancer
• Epidermoid cyst

Question 23

If Dx with FAP what happens

Answer 23

Colectomy to reduce risk of colon cancer

Question 24

Aflatoxin produced by Aspergillus

Answer 24

Liver HCC

Question 25

Aniline dyes

Answer 25

Bladder TCC

Question 26

Asbestos

Answer 26

Mesthelioma

Bronchial

Question 27

Nitrosamine

Answer 27

Oesophageal

Gastric

Question 28

Vinyl chloride

Answer 28

Hepatic angiosarcoma

Question 29

What type of tumour markers can you get

Answer 29

Monoclonal Ab
Tumour antigen
Enzymes
Hormones

Question 30

Monoclonal AB
Ca125
Ca 19-9
Ca 15-3

Answer 30

Ovarian
Pancreatic
Breast

Question 31

Tumour antigen 
PSA
AFP
hCG 
CEA
S-100
Bombesin

Answer 31

PSA = prostatic
AFP = HCC or teratoma
hCG = testicular / germ cell 
CEA = colorectal
S-100 = melanoma / schwanomma
Bombesin = SCLC / gastric / neuroblastoma

Question 32

Calcitonin

ADH

Answer 32

Medullary thyroid

SIADH - lung cancer

Question 33

What are useful tumour markers for monitoring

Answer 33

AFP and HCG in testicular / germ
CEA in colorectal
CA125 in ovarian