Cancer Rehabilitation

Question 1

What are some non-modifiable risk factors for cancer?

Answer 1

Age 
Genetics 
Epigenetics 
Immunosuppression 
Radiation 
Sunlight

Question 2

What are modifiable risk factors for cancer?

Answer 2

Alcohol 
Cancer causing substances 
Chronic inflammation 
Diet
Hormones 
Immunosuppression 
Infectious agents 
Obesity 
Radiation
Sunlight
Tobacco

Question 3

What is proliferation for normal cell characteristics?

Answer 3

• increase in cell number
• regulated by growth factors
• Cells go through cycle (controlled by cell inhibitor, to prevent excessive growth)

Question 4

What is differentiations for normal cell characteristics?

Answer 4

• Cells become “Specialized” to carry out particular functions (specific structure and function)

Question 5

What limits the # of cell divisions?

Answer 5

Dictated by telomeres

Question 6

What is contact inhibition?

Answer 6

When cells touch each other, shut off

Question 7

Describe carcinogenesis and what it breaks down into? (2 parts)

Answer 7

Can lead to genetic alterations or epigenetic alterations

Question 8

What are genetic alterations from carcinogenesis?

Answer 8

Point mutation
SNP
Copy # variants (loss of heterozygozity (LOH), homo deletion, gain copy #)

ALL leads to STRUCTURE changes

Question 9

What are epigenetic alterations from carcinogenesis?

Answer 9

Micro RNA
DNA methylation
Histone Modifications (acetlyation, methylation, sumolation, ubiquination, phosphorlyation)

All lead to FUNCTION changes

Question 10

What is a tumor?

Answer 10

Abnormal mass of tissue that results when cells divide more than they should or do not die when they should. May be benign or malignant. Also called neoplasm

Question 11

What are the cellular or tumor characteristics of cancer? (3)

Answer 11

1. Abnormality
2. Uncontrollability
3. Invasiveness

Question 12

Describe the types of carcinogenic drivers

Answer 12

• Proto-oncongene
• Oncogene
• Tumor suppressor gene

Question 13

What is a Proto-onconogene?

Answer 13

A gene involved in normal cell growth (regulation in a normal cell cycle)
Mutations may cause it to become an oncogene, which cause the growth of tumor cells

Question 14

What is an oncogene?

Answer 14

Mutated proto-onconogene

Question 15

What does a tumor suppression gene do?

Answer 15

• negative regulator of growth factor stimulation
• controls cell growth and division
• Suppress or block the development of cancer
• Anti-onconogene
• activation or mutation of tumor suppressor genes results in carcinogenesis

Question 16

How do you find the prevalence of a disease? Difference between point and period prevalence?

Answer 16

of cases / everyone at risk for a disease

Point prevalence - Count only those alive in particular date in time

Period prevalence - counts all cases including new cases and dates between 2 dates (BETTER MEASURE OF THE DIEASE LOAD)

Question 17

What is the difference between prevalence and incidence rates?

Answer 17

Prevalence = All cases

Incidence rates = New Cases
- Frequency of occurrence of NEW cases of disease or injury in a population over a specific period of time

Question 18

What are the most common cancers in the world?

Answer 18

Prostate & Breast cancer 
Colorectal (2nd most consistent for death)
Lung (most consistent for death) M/F 
Stomach 
Corpus uteri 
Bladder
Cervix
Liver
Thyroid

Question 19

What is the Mortality Rate? What is the denominator

Answer 19

Frequency of occurrence of death in a defined population during specified interval

Denominator = Avg population

Question 20

What are the 2 cancers with most death for men and women?

Answer 20

Male: Lung + Colon + Prostate

Women: Lung + breast + colon

Question 21

What are the most common cancers for children and when are they usually diagnosed?

Answer 21

• Acute Lymphocytic leukemia (ALL)
• Brain and other CNS tumors
• Neuroblastoma

Avg age Dx: 6 years

Question 22

What are the high risk populations for cancer?

Answer 22

• Heavy Alcohol use
• Older Adults (cancer is aging disease) #1 risk factor
• Exposure to cancer causing substances
• Obese persons BMI > 30
• high inflammatory dietary habits
• Cancer survivors
• Radiation exposure + treatment
• Persons w/ immunosuppression
• Exposure to tobacco or smoke

Question 23

What should women and men get screened for breast/prostate cancer?

Answer 23

Breast: age 50-74 biennial screening
Prostate: 55-69 years old PSA

Question 24

What should a person get screened for lung cancer?

Answer 24

Low dose computed tomography smoked in age 55-80 who have 30 year smoking and currently smoke or have quit in the past 15 years

Question 25

Describe the primary, secondary, and tertiary prevention strategies

Answer 25

Primary: prevent the disease
Secondary: detect the disease early
Tertiary: Reduce symptoms and improve QoL

Question 26

What is Caution - P

Answer 26

Change in bowels/bladder = Ultrasonography and endoscopy

A sore that doesnt heal = biopsy and oral/skin examination

Unusual bleeding = rectal exam/gynaec exam

Thickening or lump in breast/testicles/elsewhere = Ultrasonography and FNAC

Ingestion or difficulty swallowing = Endoscopy

Obvious change in size of mole = biopsy

Nagging cough = ENT exam

Pain = nocturnal pain, different times,/types, headache in am but improves

Question 27

Describe Benign staging

Answer 27

Slow growing
Localized
Not invasive 
Not cancerous
Recurrence unlikely
Encapsulated
End with OMA 

In capsule

Question 28

Describe malignant staging

Answer 28

Rapid/slow growth 
Invasive
Encapsulated 
Cancerous 
Possible recurrence 
End in Oma  (SARCOMA)

Malignant tumors = Capsule is gone and breaks out for invasion

Question 29

What are characteristics of malignant tumors?

Answer 29

no normal cell organization/differentiation 
Lack control of cell division 
No contact inhibition 
Do not adhere to each other (break loose from mass- invades other tissues and spreads) 
Do not undergo apoptosis 
Abnormal cell membranes
Altered surface antigens 
Compress blood vessels

Question 30

Describe Angiogenesis in cancerl cells

Answer 30

Development of new capillaries (vascular endothelial growth factor - VEGF) for cancer survival

Secretion of matrix metalloproteinase (MMP)- Collagenase (breaks down collagen in ECM)

Question 31

Describe the diagnosis of cancer

Answer 31

• Site: Primary (orgin), secondary - metastasis
• Palpable mass or lump
• Biopsy
• Imaging technologies
• histology
• Tumor markers
• Grading
• Staging

Question 32

Explain the histological grading (general)

Answer 32

GX: cannot be assessed (undetermined grade)
G1: Well differentiated (low grade)
G2: Moderately differentiated (intermediate)
G3: Poorly differentiated (high grade)
G4: Undifferentiated (high grade)

Question 33

Explain Primary tumor grading (TNM system)

Answer 33

TX: primary tumor cannot be evaluated
T0: No evidence of primary tumor (GOOD)
Tis: carcinoma in situ (well contained)
T1,2,3,4: Size and/or extend of tumor

Question 34

Explain Regional Lymph nodes (TMN system)

Answer 34

Nx: cannot be evaluated
N0: no regional lymph node involvement (good)
N1,2,3: degree of involvement # and location

Question 35

Explain distant metastasis

Answer 35

Mx: cannot be evaluated
M0: no distant metastasis
M1: Distant metastasis is present

Question 36

Explain cancer staging

Answer 36

0: carcinoma in situ
1: early stage, localized to the primary organ
2: increased risk of regional spread
3. local cancer has spread regionally
4: metastasis

Question 37

How do malignant tumors spread?

Answer 37

Invasion: local spread to adjacent tissues and destroy

Metastasis: spread to distant sites via blood/lumph

Seeding (implantation) - another form of mets, distant stites, via other body fluids or along membranes

Question 38

What are the most common sites for mets?

Answer 38

Bone, Liver, Lung

Question 39

What are the 3 types of breast biopsies?

Answer 39

1. fine needle (sample of cells)
2. Core needed w/ US or MRI for guide
3. Open (surgical) biopsy