Cancer Pathophysiology Flashcards
Is cancer overall more prevalent in men or women
More prevalent in men
T/F Cancer is the leading cause of death in Canada
True
What type of cancer is most common in males and females
Males
- prostate cancer
Female
- Breast cancer
What is the most common cancer based on age
<14
15-29
30-49
50-69
70-84
85+
<14
- #1 Leukemia
- CNS lymphoma
15-29
- Thyroid
- Testis, hodgkin lymphoma
30-49
- breast cancer
50-69
- breast
70-84
- lungs and bronchus
85+
- colorectal
Which gender has a slightly higher risk of death
Males
Which cancer is the deadliest cancer? Why?
Lung cancer
- No good way of screening for it
- Presentation is very generalized
- Not symptomatic until stage 4
Which cancer has the highest mortality in
0-14
30-49
50+
0-14
- Brain/CNS (many inoperable)
30-49
- Breast cancer (more aggressive in this age group)
50+
- lung/bronchus
How do we screen for breast cancer? What age? Frequency?
High risk?
Mammograms q2years for women between 45-74
High risk screen at 30 (family history)
How do we screen for colorectal cancer? What age? Frequency?
Fecal occult blood test q2years for everyone 50+
How do we screen for prostate cancer?
Digital rectal exam (DRE)
Prostate-specific antigen (PSA)
How do we screen for high risk lung cancer?
Low dose spiral CT for smokers
How do we screen for cervical cancer? Who?
PAP in sexually active people ages 25-70
What are the general cancer MODIFIABLE risk factors (7)
- Tobacco
- Poor diet
- Lack of physical activity
- Solar radiation (tanning beds)
- Exposure to environmental carcinogens
- Infection (eg. HPV)
- Alcohol use
What are the general cancer NON-MODIFIABLE risk factors (4)
- Genetics
- Gender at birth
- Age (older)
- Race
What is the leading cause of preventable illness and death including cancer
Tobacco
T/F does quitting smoker reduce cancer risk
True
- Reduce 30-50% after 10 years
What kind of food are considered carcinogens
What is the recommendation for these?
Red meat and processed meats are carcinogens
Recommend
- no more than 3 servings of red meat/week
- Processed meat should be avoided (can eat in moderation)
What BMI is considered a risk factor for developing cancer
BMI >30
What infections are linked to cancer (6)
- HPV (most common)
- Hep B & C
- Epstein-Barr virus (lymphoma)
- Kaposi’s sarcoma associated herpesvirus
- Merkel cell polyomavirus
- H. pylori
What is the recommendation of alcohol intake in cancer patients
No more than 2 standard drinks/week
- Alcohol is a carcinogen
How does genetic play a role in cancer? How is it passed on?
Can be a new mutation or a heritable mutation
- new mutations cannot be passed on
Define proto-oncogenes. Give examples (4)
(normal genes that can become oncogenic when mutated or increased expression)
- RAS, Raf, MEK, ERK
What type of mutations are in cancer? Which genes (2)
Tumour suppressor genes
- BRCA 1 and 2, p53
What do malignant cells do pathophysiologically
- Replicate out of control
- Don’t die when they’re supposed to
- Metastasize to and invade other areas of the anatomy (main reason for cancer death)
- Do not require growth signals
- Able to recruit a constant blood supply
Define a benign tumour (2)
When can they cause problems (3)
Benign tumours
- do not grow in a unlimited, aggressive manner
- Lack the ability to metastasize and invade
Cause health problems when:
- compresses other anatomic structures
- overproduction of hormones if grown on endocrine tissue
- Have potential to be malignant
How are suspected malignancies discovered?
Through screening or appearance of symptoms (cough, weight loss, hemoptysis (coughing blood))
What do tissue diagnosis tell us? (3)
Tumour origin
Histology
Grade
- these factors are important in guiding treatment
What are the categories of histology and where are they derived from i.e their origin (5)
- Carcinoma (epithelial cells)
- Sarcoma (connective tissue)
- Hematologic (hematopoetic cells)
- Germ-cell (totipotent cells)
- Blastoma (immature precursor cells)
How is the histologic grade given i.e grading
Well-differentiated cells are given low grades as they are easier to identify
- ex. skin cells, muscle cells, gilal cells
Poorly differentiated cells are given high grades as they do not look like the parent tissue (difficult to identify) and carry a poorer prognosis
Symptoms of metastasis in the..
Liver (4)
- May be asymptomatic
- jaundice
- RUQ pain
- Nausea
Symptoms of metastasis in the..
Brain (4)
- Headache
- altered mental status
- Cushing’s triad (severe, bradycardia, hypertension, abnormal breathing)
- Focal Neurological signs (hemiparesis, aphasia, seizures, parasthesias)
Symptoms of metastasis in the..
Bone (3)
- Pain
- Fracture
- Hypercalcemia
Symptoms of metastasis in the..
Spinal cord (4)
- Back pain
- Parasthesias (tingling in skin)
- Cauda equina syndrome (compressed nerves at the end of spinal cord)
- Cord compression
Symptoms of metastasis in the..
Lung (3)
- Dysnea
- Hemoptysis
- Cough
Describe the TNM staging in solid tumours and their scores
T = size of tumour and whether it has spread
- 0-4
N = regional lymph nodes involved
- 0-2
M = distant metastasis (either yes or no)
- 0-1
Describe stage 1-4 cancer
Stage 1 and 2: Early stage (curative intent)
Stage 3: Locally advanced
Stage 4: Metastatic (widespread)
Differentiate between grading and staging of cancer
Grading
- how aggressive patient’s tumour is BY APPEARANCE under a microscope
- (well/poorly differentiated from parent tissue)
Staging
- how advanced a patient’s disease is according to how WIDESPREAD
- i.e TNM staging (size, lymph nodes, metastasis)
What are the types of biomarkers we use in cancer (5)
- Diagnostic (whether they have it or not)
- Prognostic (independent of treatment)
- Predictive (how well they will respond)
- Resistance (predict for resistance)
- Surrogate (can correlate with real clinical endpoint)
Why are predictive biomarkers the most important (3)
- Can make treatment more effective
- Can reduce cost (right drug, right patient)
- Can minimize risk of clinical trial failure
What are some common symptoms of cancer
- Pain
- Weight loss (rapid)
- Cachexia (weakness)
- Fatigue
- Loss of appetite
- Night sweats (bad in heme malignancies)
- Anemia
- Thrombosis
- Paraneoplastic syndromes (overproduction of hormones)
(hypercalcemia, cushing’s triad, dermatomyositis)
