Cancer the disease and how its treated

Question 1

how does cancer spread

Answer 1

invasion
metastasis
non metastatic effects

Question 2

invasion

Answer 2

• grows and invades
• pressure/construction on surrounding structures
• destruction and loss of function

Question 3

metastasis

Answer 3

• they can set up smaller tumors around the body

- can be localised or distant

Question 4

non metastatic effects

Answer 4

• 25% will die from cancer related cachexia

- whole body metabolic and physiologically effect, not directly due to the tumour

Question 5

Invasion mode of spread-

Answer 5

• path of least resistance
• tissue destruction
• perineural spread, picks up nerves and grows along them therefore can travel from the primary area quicker

Question 6

metastasis mode of spread

Answer 6

• invasion of vessels – embolism or permeation, gets through the wall of the vessel and can grow along the lumen of the vessel as a solid (permeation) or break off and flow in the flow of the lymph fluid to the lymph nodes
• spread to draining lymph nodes

Question 7

lymphatic drainage

Answer 7

• runs throughout the body
• eventually returns lymphatic fluid into the blood supply just before the heart
• lots of lymph nodes along the lymphatic channels

Question 8

what are under highest risk of metastasis

Answer 8

draining lymph nodes

Question 9

types of metastasis spread

Answer 9

haematogenous spread

transcoelomic spread

Question 10

haematogenous spread

Answer 10

• invasion mainly veins, then returned to heart

- organs most likely to have blood metastasis : liver, lung, bone and brain

Question 11

transcoelomic spread

Answer 11

• spread across serous cavities
• cavities lined with a thin layer of fluid
• eg abdominal cavities

Question 12

why is the liver most likely to be affected by haemoatogenous spread

Answer 12

• blood supply from the colon passes through the liver

- colon cancer can spread to liver via the blood stream

Question 13

Metastatic cascade

Answer 13

1) Primary tumour invades into underlying tissue
2) eventually invades into vessel either blood or lymph via intravasation, for this it has to be able to degrade tissues i.e. get through vessel wall
3) survival in circulation, need to be robust to survive this
4) need to be able to arrest at distant organ site, correct adhesion molecules to stop at the specific site
5) then needs to exit and also be able to survive in the different environment

Question 14

what do tumour cells interact with

Answer 14

cells and molecule in local envuroment

- need to gain new abilities to invade

Question 15

metastatic cascade leads to

Answer 15

• motility is enhanced
• alter adhesion molecules
• make poor basement membrane
• increase protease production or reduce inhibitors
• alter ECM

Question 16

patterns of spread for different cancers

Answer 16

1) Carcinomas
- firstly lymphatics
- blood (often later)
2) Sarcomas
- blood (lymphatic spread rare)
3) Predictable patterns of spread
- lung to local nodes, then liver, bone ad brain
- tongue to neck nodes, later lung to spine

Question 17

carcinomas spread

Answer 17

firstly lympatics

blood

Question 18

sarcoma spread

Answer 18

blood

lympatic rare

Question 19

predictable patterns of spread

Answer 19

• lung to local nodes, then liver, bone ad brain

- tongue to neck nodes, later lung to spine

Question 20

effect of tumour spread

Answer 20

1) Pressure and obstruction
2) destruction
3) haemorrhage
4) infection
5) pain
- often after spread to bone
6) anaemia
7) starvation and cachexia

Question 21

what are non metastatic effects know as

Answer 21

paraneoplastic syndrome

- not directly related to the tumour there at the site

Question 22

what causes non metastatic effects

Answer 22

often caused by biochemical substances released by tumour cells

Question 23

non metastatic effects

Answer 23

1) Fever, anorexia and weight loss/cachexia
2) endocrine syndromes
- eg crushing syndrome
- metabolic effects eg hypocalcaemia
3) neurological problems
- eg neuropathy
4) haematological syndromes
- due to the upset to the bone marrow
- eg erthrocytosis

Question 24

how to grade tumorus

Answer 24

histological assessmetn
relates to differentiator
links to proglnosos

Question 25

staging of tumour defines the

Answer 25

clinical extent of tumour

Question 26

staging of tumours system

Answer 26

TNM
tumour 
nodes
metastases
these are graded 
1.2.3.4

Question 27

grades of tumours

Answer 27

T1-4 – T1 small tumours, 4 large that have invaded into structures
N0- no lymph nodes metastases, then increase 234 (either graded by the size of the metastasis or the number of nodes affected)
M0 or 1 – present of absent
Specific staging systems for tissue/tumour
Stage 1 (T1or 2)
- not in lymph nodes and not through the wall
stage 1 and 2 – early stage cancer, better prognosis
Stage 3
- tumour through wall and mestasiis

Question 28

diagnosis of cancer

Answer 28

biopsy
cytologu
imaging - ct and MR
molecular analusis

Question 29

incisions biopsy

Answer 29

small piece of tumour

Question 30

excisional biopsy

Answer 30

removal of all the tumour

Question 31

cytolocy

Answer 31

aspirate
sample of cells taken out
disrupted cells taken out

Question 32

treatment of cancer

Answer 32

surgery 
radiotherapy 
chemotherapy
biological therapy 
supportive care

Question 33

side effects of radiotherapy

Answer 33

• tiredness
• feeling sick
• difficulty eating and drinking
• skin reaction
• hair loss
• haematological changes
• possible long term side effects

Question 34

what do chemotherapy agents do

Answer 34

target DNA structure or segredation of DNA as chromosomes in mitorsis