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Question 1

What is the TMN staging system?

Answer 1

T = Primary TumourN = Regional Lymph Node involvementM = Metastasis

Question 2

What does T1-T4 measure?

Answer 2

Increasing size in primary lesion, T1 - T4

Question 3

What does N0 –> N3 measure?

Answer 3

No nodes –> Involvement of increasing no/range of nodes

Question 4

What are M0 and M1?

Answer 4

M0 = No distant metastasis M1 = presence of blood born metastases

Question 5

How is increasing size in tumour measured?

Answer 5

T1 - T4

Question 6

What is used to measure involvement of increase no/range of nodes?

Answer 6

N0 –> N3

Question 7

Give TNM staging of breast staging in terms of T?

Answer 7

TIS – Carcinoma in situT1 - 5 cmT4 – Through the chest wall/skin

Question 8

Give regional lymph node involvement of breast cancer staging?

Answer 8

N0 – No nodalN1 – AxillaryN2 – MammaryN3 - Supraclavicular

Question 9

Give metastasis staging for breast cancer?

Answer 9

M0 – No metastasisM1 – Presence of metastasis

Question 10

What is DUkes staging for colorectal cancer divided into?

Answer 10

A, B, C1/C2

Question 11

What is A in dukes staging for colorectal carcinoma?

Answer 11

Confined to bowel wallNot extending through muscularis propria>90% 5 year survival

Question 12

What is B in dukes staging?

Answer 12

Through bowel wall (Muscularis propria)70% 5 year survival

Question 13

What is C1/C2 staging for colorectal cancer?

Answer 13

Lymph nodes involved30% 5 year survivalC1 = Regional Lymph nodes involvedC2 = Apical node (furthest away node) involved

Question 14

Give staging of hodkins disease?

Answer 14

I – One lymph node involvedII – Two lymph nodes on one side of the diaphragmIII - > Two lymph nodes on both sides of the diaphragmIV – Multiple foci (Bloody everywhere)

Question 15

Define grading

Answer 15

Based on the degree of differentiation of tumour cells. Attempts to judge the extent to which tumour cells resemble or fail to resemble their normal counterparts.

Question 16

What are grades 1-4?

Answer 16

Gx = Grade of differentiation cannot be assessedG1 = Well differentiatedG2 = Moderately differentiatedG3 = Poorly differentiatedG4 = Undifferentiated

Question 17

What is the grading system for breast cancer a measure of?

Answer 17

Scarff-Bloom-Richardson Grading systemDegree of tubule formationExtent of nuclear variationNumber of mitoses

Question 18

What are grades 1-3 for scarf bloom-richardson gradin? Survival rates at ten years

Answer 18

Grade 1 – 85% 10-year survivalGrade 2 – 60% 10-year survivalGrade 3 – 15% 10-year survival

Question 19

What is the gleason grading system in prostate cancer?

Answer 19

based on the sum of two numbers: the first number is the grade of the most common tumor pattern, the second number is the highest grade cells found in the tumour

Question 20

What is radiotherapy in cancer treatment?

Answer 20

External radiation to rumour at fractionated doses with shielding of adjacent normal tissuesCauses damage to DNA of rapidly dividing cellsIf DNA damage is extensive  Apoptosis

Question 21

In what cancers is radiotherapy High, Fairly high, Moderate, Low

Answer 21

High – Lymphoma, Leukaemia, Seminoma (Testicular)Fairly High – Squamous carcinomasModerate – GI, BreastLow – Sarcoma

Question 22

What does chemotherapy do?

Answer 22

Effect particular stages of the cell cycle and on rapidly dividing cells

Question 23

Give three types of chemotherapy

Answer 23

CyclophosphamideAct on cells in G1/S and mitosisVincristineBlock cells entering cell cycle/act on mitosisMethotrexateActs on cells in S phase

Question 24

Give two types of hormone therapy?

Answer 24

TamoxifenHerceptin

Question 25

Describe tamoxifen?

Answer 25

Competes for binding to Oestrogen Receptor50-80% of Breast Cancers express oestrogen receptorsSurgical (Orchidectomy)/clinical castration

Question 26

Describe how herceptin is used

Answer 26

HER-2 Growth factor receptorOverexpressed in 20-30% of breast carcinomasHerceptin = Humanised monoclonal antibodySide effects – Cardiac/pulmonary toxicity, can be fatal

Question 27

How is prostate cancer treated?

Answer 27

Depends on androgens, depriving tumours of testosterone

Question 28

What is a carcinoembryonic antigen?

Answer 28

Normally only found in embryonic tissueCancer expresses again, useful in seeing if any disease left over after treatment

Question 29

How is human chorionic gonadotrophin used?

Answer 29

The evaluation of testicular massesTo indicate residual disease after OrchidectomyIn monitoring response to therapy and prediction of recurrenceRaised in nonseminomatous testicular tumours, especially when choriocarcinomatous elements present (high levels)Seminomas with syncytiotrophoblastic giant cells

Question 30

Alpha-fetoprotein use?

Answer 30

Normally synthesised early in foetal life by yolk sac, foetal liver and foetal GIT.Raised plasma levels associated with cancer of liver and yolk sac tumour of testis (nonseminomatous testicular tumours)

Question 31

What is adjuvant treatment?

Answer 31

Given after surgical treatment of a primary tumour to eliminate subclinical disease

Question 32

What is neoadjuvant treatment?

Answer 32

Given before main treatment

Question 33

What does chemotherapy do,

Answer 33

Anti-metabolites mimic normal substrates involved in DNA replication Alkylating and platinum cross link two strands of DNA helix Anti-biotics - Bleomycin causes double stranded DNA breaksPlant derived drugs - block micro tubule assembly and mitotic spindle formation