Imaging, Biopsy & Principles of treatment in Cancer - (Imaging)

Question 1

When staging a cancer upon diagnosis, does the staging change if new information regarding the cancer is provided?

Answer 1

• no, staging remains the same
• additional information is added to the initial staging

Question 2

The TNM staging used in cancer relates to:

T = primary Tumour
N = local Nodal involvement
M - metastatic disease

How many stages of T are they typically?

1 - 6
2 - 4
3 - 3
4 - 2

Answer 2

1 - 6
- Tx = tumour cannot be measured
- T0 = tumour cannot be found
- T1-T4 = increases from T1 to T4

Question 3

The TNM staging used in cancer relates to:

T = primary Tumour
N = local Nodal involvement
M - metastatic disease

How many stages of N are they typically?

1 - 6
2 - 5
3 - 4
4 - 3

Answer 3

2 - 5
- Nx = cancer in nearby lymph nodes cannot be measures
- N0 = no cancer in nearby lymph nodes
- N1-N3 = increasing number of local lymph node involvement

Question 4

The TNM staging used in cancer relates to:

T = primary Tumour
N = local Nodal involvement
M - metastatic disease

How many stages of M are they typically?

1 - 6
2 - 5
3 - 4
4 - 3

Answer 4

4 - 3
- Mx = metastasis cannot be measured
- M0 = cancer has not spread to other body parts
- M1 = cancer has spread to other body parts

Question 5

What is the staging process used in lymphoma (cancer of the lymph tissue)?

1 - TNM staging
2 - Nodal staging
3 - Ann Arbor staging system
4 - Dukes staging

Answer 5

3 - Ann Arbor staging system
- stage 1 = 1 lymph node region involved above diaphragm
- stage 2 = 2 lymph node regions involved above diaphragm
- stage 3 = 2 lymph node regions involved, one above and 1 below the diaphragm
- stage 4 = multiple lymph node regions affected and multiple organs

Question 6

Prior to imaging some tests can be performed in a patient suspected of having cancer. Which of the following are cancer specific?

1 - FBC
2 - Blood chemistry test function
3 - Urinalysis
4 - Cytogenetic analysis
5 - Immunophenotyping

Answer 6

4 - Cytogenetic analysis
- genetic analysis of a tumour biopsy

5 - Immunophenotyping
- immunohistochemistry to diagnose specific cancer, stage, and monitor blood cancers disorders, identify tumour markers and antibodies to help personalise treatment

Question 7

In the image we can see lymphoma, with spleen and lymph nodes in the hilum region of the lungs. What stage according to the Ann Arbor staging system would this be?

1 - stage 4
2 - stage 3
3 - stage 2
4 - stage 1

Answer 7

2 - stage 3
- lymph nodal involvement above and below diaphragm

Question 8

Which of the following is most commonly use to stage cancers?

1 - ultrasound
2 - X-ray
3 - CT
4 - MRI

Answer 8

3 - CT
- MRI is good for local staging

Question 9

What is commonly the 1st line imaging for thyroid nodules and potentially malignancy?

1 - ultrasound
2 - X-ray
3 - CT
4 - MRI

Answer 9

1 - ultrasound

Question 10

Which imaging is flourodeoxyglucose (FDG) used in?

1 - PET-CT
2 - MRI
3 - CT fluroscopy
4 - radiotherapy

Answer 10

1 - PET-CT
- tumours use a lot of glucose so tumours show up well on imaging

Question 11

Which radioactive marker can be injected into patients to accurately identify neuroendocrine tumours?

1 - flourodeoxyglucose (F18-FDG)
2 - iodine-131
3 - gallium Ga-68
4 - scandium-46

Answer 11

3 - gallium Ga-68
- still used PET-CT
- can also use this approach with theranostics, which is where radioactive compound targets the tumour

Question 12

What is a sentinel lymph node?

1 - furthest lymph node affected from primary site
2 - biopsy of lymph node draining tumour
3 - lymph nope biopsy of all lymph nodes in local area
4 - all of the above

Answer 12

2 - biopsy of lymph node draining tumour
- if the lymph node draining tumour is negative then the change the tumour has spread is unlikely
- common in breast cancer

Question 13

Does cancer typically begin at the somatic or germline level?

Answer 13

• somatic level

Question 14

Match the definition of adjuvant and neoadjuvant with each of the definitions below:

• therapy given prior to primary intervention to reduce the tumour size
• therapy given following primary intervention

Answer 14

• adjuvant = therapy given following primary intervention
• neoadjuvant = therapy given prior to primary intervention to reduce the tumour size

Question 15

Oligometastatic and polymetastatic relate to how many metastatic sites there are from the primary tumour. Which relates to lots of metastatic sites?

Answer 15

• polymetastatic
• oligo relates to a few metastatic sites

Question 16

Is Radiotherapy a?

1 - Loco-regional treatment
2 - Systemic treatment
3 - Palliative treatment
4 - Radical treatment
5 - All of the above

Answer 16

5 - All of the above
- can vary depending on the type of cancer

Question 17

What type of cell does chemotherapy typically target?

1 - proliferative cells
2 - differentiating cells
3 - specialised cells
4 - all of the above

Answer 17

1 - proliferative cells
- this is when cells increase in number
- BUT chemotherapy does NOT just target cancer cells, hence the side effects
- can target any stage of the cell cycle

Question 18

Which side effect of chemotherapy can be life-threatening?

1 - Infertility
2 - Maculo-popular skin rash
3 - Febrile neutropenia
4 - Mucositis

Answer 18

3 - Febrile neutropenia
- low number of WBC in the presence of a fever

Question 19

What is primary drug resistance in cancer treatment?

1 - cancer develops resistance to drug following initial treatment
2 - drug increases growth of cancer
3 - cancer is resistant to drug prior to any treatment
4 - no drugs are effective on cancer

Answer 19

3 - cancer is resistant to drug prior to any treatment

Question 20

What is secondary drug resistance in cancer treatment?

1 - cancer develops resistance to drug following initial treatment
2 - drug increases growth of cancer
3 - cancer is resistant to drug prior to any treatment
4 - no drugs are effective on cancer

Answer 20

1 - cancer develops resistance to drug following initial treatment

Question 21

Small molecules are used to treat cancer. What do they typically target?

1 - antigens
2 - receptors
3 - enzymes
4 - phospholipid membranes

Answer 21

3 - enzymes
- tyrosine kinase is an example

Question 22

What is Synthetic Lethality?

1 - mutation in one of 2 genes can cause cell death
2 - mutation in 2 genes can cause cell death
3 - cell death can occur with 2 normal genes
4 - all of the above

Answer 22

2 - mutation in 2 genes can cause cell death
- in cancer a mutation of one gene can cause cell to grow and development as it has a 2nd gene to help
- however, if there are 2 mutated genes then the cancer cell has no back up gene to help it grow and develop
- in cancer treatment if a cancer cell has the mutated gene we can target the healthy gene, causing the cell to die

Question 23

Synthetic Lethality is when there is a relationship between 2 genes that are important for cell survival. For example, BRCA2 and PAPR are both involved in DNA repair. Breast cancer causes a mutation in BRCA2, but PAPR can continue to function.

BUT if you target PAPR with cancer treatment the cell can no longer repair and the cancer cell will die

Question 24

What is Immunotoxin in relation to cancer therapy?

1 - when immunoglobulins are able to detect the cancer and initiate apoptosis
2 - when cancer cells have antigens that immunoglobulins bind with and become toxic
3 - toxic substance is added to immunoglobulins or monoclonal antibody
4 - all of the above

Answer 24

3 - toxic substance is added to immunoglobulins or monoclonal antibody

• once immunoglobulin or monoclonal antibody binds with the cancer cell the toxic substance can then enter the cancer cell and induce apoptosis