CLASP Cancer Flashcards
What is hyperplasia?
An increase in cell number in response to a stimulus, which can lead to an increase in organ/tissue size
What is hypertrophy?
An increase in cell size due to an increase in demand
What is atrophy?
Decrease in cell size/number due to withdrawal of signals; hormonal/mechanical
What is metaplasia?
Reversible change from one mature cell type to another; usually in response to injury
What is neoplasia?
Growth without a stimulus
What are the four types of neoplasia in order of severity?
1) Benign neoplasia
2) Dysplasia (pre-malignant)
3) Carcinoma-in-situ (last step before malignancy)
4) Malignant
What is malignancy?
Autonomous growth that has invaded beyond its normal location and has metastatic potential
What cancers can result from obesity?
1) Oesophageal
2) Pancreatic
3) Liver
4) Colorectal
5) Breast + endometrial
What cancers can result from too much consumption of red/processed meat?
1) Colorectal
2) Stomach
How does breastfeeding relate to cancer?
Causes modest reduction in risk of ovarian, endometrial and breast cancers
How does beta-carotene relate to cancer?
- Decreased risk if you get RDA
- Increased risk if high dose in tobacco users
What cancer can result from too much calcium and dairy consumption?
Prostate cancer
What cancer can result from too much alcohol?
1) Mouth (throat + oesophageal)
2) Stomach
3) Breast
4) Bowel
5) Liver
What is acrylamide?
Chemical found when starchy food is cooked until dark brown (coffee, burnt toast); limited evidence in relation to cancer
What are the four types of cancer?
1) Epithelial/carcinoma
2) Mesenchymal/sarcoma
3) Haematological
4) Neuroectoderm/melanoma
Who gets epithelial cancers/carcinomas?
Elderly people due to an accumulation of environmental risk factors; rare in children
What are the characteristics of epithelial cancers/carcinomas?
- Local growth
- Spread through hematogenous and lymphatic routes
- Local lymph node involvement
What is the pattern of spread for colorectal cancer?
Lymphatic spread to local lymph nodes in mesentery + follow vascular supply
What is the pattern of spread of testicular cancer?
Spread to para-aortic lymph nodes
What are metastases commonly found in lung and breast cancers?
- Bone
- Brain
- Adrenal
- Liver
Where do GI malignancies metastasise?
Rarely to bone, mainly liver
What is the pattern of spread of prostate cancer and melanoma?
Wide spread, metastases can be anywhere
What are the characteristics of mesenchymal cancers/sarcomas?
- Local growth, can get very big
- Haematogenous spread, late and can disseminate widely with time
- Lymphatic spread is very rare
Describe the morphology of mesenchymal cancers
- Spindle cell lesions
- Elongated, tapered shape to cells
- Solid, follow textbooks
- Often associated with specific large translocations (FISH/karyotyping)
What is Ewing’s sarcoma?
Rare cancer affecting bones/tissue around bones; genetically characterised by t(11, 22)
What are the primary indicators of haematological cancer?
- Large lymph nodes across areas which don’t fit with epithelial drainage
- Diffuse orgnanomegaly (liver and spleen)
- FBC crucial, malignant cells replace normal blood cells
What is the morphology of haematological cancer?
- Solid white masses
- Cells resemble origin cells
- Look very similar, not pleomorphic
- Monotonous and clonal
What are some features of neuroectoderm tumours?
- Brain lesion, never benign as brain is compressed
- No mets due to BBB
- 3 grades, primary stay within the brain
What are the symptoms of prostatism?
Urinary hesitation, difficulty in voiding, post-micturition dribbling
How do you proceed with prostatism?
Measure PSA (prostate specific antigen)
What are alkaline phosphatases?
- Enzymes found in high amounts in bone and liver and released by osteoblasts which regard bone turnover
- Measures in patients with previous cancers/suspected mestastases
What are the local biochemical effects of an obstructed liver?
- Bile duct blocked or obstructed due to malignancy
- Decrease in bilirubin levels
- Back pressure to liver
- Abnormal liver enzymes
Explain the serum ascites albumin gradient (SAAG)
Serum albumin - ascitic fluid albumin = value which correlates with pressure in portal circulation
How to proceed in hypercalcaemia as a systemic tumour effect?
- Measure parathyroid hormone PTH (may be responsible)
- Give IV fluid and biphosphonate (stops bone reabsorption)
What are the 4 main types of cancer treatment?
1) Radical treatment
2) Palliative treatment
3) Adjuvant treatment
4) Neoadjuvant treatment
Describe radical cancer treatment?
Curative intent; aims to eradicate a tumour, often at expense of treatment side effects
Describe palliative cancer treatment?
Non-curative; aims to improve symptoms, length and quality of life, not at expense of significant side effects
Describe adjuvant cancer treatment?
Post-op; aims to reduce risk of cancer recurrence
Describe Neo-adjuvant cancer treatment?
Pre-op; aims to shrink a tumour before surgical removal
What are the 4 cancer treatment end-points?
1) Overall survival
2) Disease-free survival
3) Progression-free survival
4) Local control
What is progression-free survival?
Time living with cancer not getting worse
What is local control in cancer end-points?
Time without recurrence/progression at a specific tumour site
What are the main cytotoxic chemotherapy mechanisms?
- Alkylating agents -> attach alkyl group to DNA
- Platinum salts -> DNA cross-linking
- Anti-metabolites -> interfere with DNA/RNA growth
- Taxanes -> mitotic inhibitors
- Anthracyclines -> interfere with DNA copying enzymes
- Topoisomerase inhibitors -> prevent DNA strands unwinding
What are some chemotherapy side effects?
Malaise, fatigue, lethargy, alopecia, nausea, diarrhoea, mucositis, (mouth ulcers), altered taste, haematological abnormalities, peripheral neuropathy, renal/liver impairment, nail changes, changes in fertility, menopause
What is the mechanism behind radiotherapy?
Specific wavelengths (0.1 - 100 micron) cause a double-strand break in DNA and prevent cell division
What are some acute radiotherapy toxicities (weeks)?
Fatigue, erythema/desquamation, head and neck [mucositis, pain and odynophagia], diarrhoea, N+V, cystitis, oesophagitis
What are some late radiotherapy toxicities (months/years)?
Skin fibrosis/ulceration, dysphagia, bowel dysfunction, incontinence, bladder instability, pneumonitis (cough + dyspnoea), menopause, infertility and secondary cancer
How is radiotherapy prescribed?
- Prescribed in Grays (Gy), split into fractions, Mon-Fri is 5 fractions
- Radical treatments 4-6 weeks, combines with chemo
- Palliative treatments 8-30 Gy in 1-10 fractions
How is cancer described in genetics?
Disease of mosaicism largely caused by post-zygotic mutations (due to imperfect DNA repair)
How do oncogenes and tumour suppressors relate to cell division?
- Oncogenes; switched on for cell division
- Tumour suppressors; switched on to stop cell division
What is an association study?
Tests completed to identify if a certain polymorphism is associated with a disease
