General

Question 1

How does ionising radiation affect DNA?

Answer 1

Induces double stranded DNA breaks

Question 2

How does radiotherapy kill cancer cells?

Answer 2

Induces DNA damage beyond the point of repair, triggering apoptosis

Question 3

How does UV radiation induce DNA damage?

Answer 3

Formation of pyrimidine dimers

Question 4

Name two viruses associated with cancers

Answer 4

EBV and HPV

Question 5

List 4 methods of by which mutations arise

Answer 5

1. Radiation
2. UV
3. Viruses
4. Chemicals (cigarettes)

Question 6

How is malignancy defined?

Answer 6

The ability to invade local tissues and metastasize

Question 7

Name 4 hallmarks of cancer (malignancy)

Answer 7

1. Inducing angiogenesis
2. Avoidance of immune system
3. Resisting cell death
4. Sustaining proliferative signals
5. Tumour promoting inflammation

Question 8

List the four cancers with the highest mortality in order of highest to lowest mortality rates

Answer 8

1. Lung
2. Bowel
3. Prostate
4. Breast

Question 9

List the four most commonly diagnosed cancers in order of highest to lowest prevalence

Answer 9

1. Breast
2. Prostate
3. Lung
4. Bowel

Question 10

What is neoadjuvant chemotherapy?

Answer 10

Given before primary course of treatment

Question 11

What is adjuvant treatment?

Answer 11

Therapy that follows the primary treatment. Neoadjuvant –> curative treatment –> adjuvant therapy (inhibit micro-metastasis)

Question 12

GP discovers malignant lymph node in left axilla. Name three other regions the GP should examine and which cancers they would be worried about

Answer 12

1. Neck- lymphoma/lymphadenopathy elsewhere
2. Left arm- malignant skin lesion on left arm as lymph drains to axillary region
3. Breasts- breast cancer

Question 13

Name two benefits of cancer screening

Answer 13

1. Patient requires less treatment

2. Reduction in mortality

Question 14

Name three potential harms of cancer screening

Answer 14

1. Overdiagnosis and therefore unnecessary treatment
2. False positives -> anxiety
3. Radiation exposure

Question 15

How would you obtain samples for pathology analysis from

a) Skin
b) Liver
c) Muscosal lesion e.g. bladder
d) Fluid in lungs

Answer 15

a) Surface of skin- punch biopsy/excision
b) Deep- US/CT
c) Mucosal lesion- scope (camera)
d) Fluid accumulation- drain

Question 16

In which context would Beta-HCG detection be sufficient to diagnose a cancer?

Answer 16

Young man with testicular mass

Question 17

In which clinical context would PSA be sufficient to diagnose a cancer?

Answer 17

Older man with sclerotic bone metastases

Question 18

In which cancer is CEA commonly raised?

Answer 18

Colorectal cancer

Question 19

In which cancer is CA-125 commonly raised?

Answer 19

Ovarian cancer

Question 20

Expression of which proteins are stained for in immunohistochemsitry for breast cancer analysis?

Answer 20

1. Oestrogen receptor
2. Progesterone receptor
3. HER2 expression

Question 21

Which staging method is used for breast cancers?

Answer 21

TNM + stages I-IV

Question 22

What is the WHO performance status?

Answer 22

Determines mobility of patient, referred to as PS, scaled 0-5, 0 being completely active and 5 being dead. Patients will be scored 0-4 (4 is bed/chair-bound).

Question 23

Name four ways in which intent of cancer treatment can be described

Answer 23

1. Radical
2. Adjuvant
3. Neoadjuvant
4. Palliative

Question 24

What is meant by best supportive care?

Answer 24

When cure is not achievable with existing treatments. Therefore palliative management- pain, anti-emetic, anxiolytics. Communication with patient and family, anticipatory care planning.