Incidence Prognosis and Treatment of Malignant Neoplasms Flashcards
What are the 4 most common neoplasms?
Breast Lung Prostate Bowel acount for over half
What are the most common causes of cancer in under 14 yrs old?
Leukaemia
Lymphoma
CNS cancers
Name 3 cancers with a high 5 year survival rate and three with a low 5 year survival rate
Testicular cancer
Malignant melanoma
Breast cancer have high survival rate
Pancreatic
Lung
Oesophageal cancers have low survival rate
Which cancer is the biggest cause of cancer related deaths in UK?
Lung
What factors do you consider when predicting outcome/prognosis of someone with a certain cancer?
Age/Health status
Available treatments
Cancer: Grade, stage, location, type of tumour
What is tumour staging a measure of? What is the most common staging criteria? Is it different for different cancers?
The malignant neoplasms overall burden TNM (Size, Nodes, Metstases) T T1-T4 N - N0-N3 M - M0 or M1
Different TNM staging for different cancers but international staging criteria
What is the TNM staging criteria then converted into?
Into grades I - IV
What do the grades I-IV roughly mean?
I - Early local disease
II - Advanced local disease
III - Regional metastases
IV - Distant metastases
What is the Ann Arbor staging?
Specific staging used for lymphoma
I - Lymphoma in single node region
II - Two separate regions on one side of the diaphragm
III - Spread to both sides of the diaphragm
IV - Diffuse or disseminated involvement of one of more extra lymphatic organs such as bone marrow or lung
Does staging predict survival? How?
Yes because invasion and metastases are the most dangerous characteristics of cancer and staging accounts for both
What is Dukes staging?
For colorectal carcinoma A: Invasion into but not through the bowel B: Invasion through the bowel wall C: Involvement of lymph nodes D: Distant metastases
What does tumour grade describe? What are the different grades? Which two cancers is it particularly useful for?
The degree of differentiation of a neoplasm
G1 - Well-differentiated, similar to host tissue
G2 - Moderately differentiated
G3 - Poorly differentiated
G4 - Anaplastic/undifferentiated
Squamous cell carcinoma and colorectal carcinoma
Do you grade melanomas?
No
What is the Bloom-Richardson system of grading? How is this related to survival?
For breast Ca
1) Tubule formation
2) Nuclear variation
3) Number of mitoses
Low grade much higher survival
What is the main treatment of cancer?
Surgery
What are some other treatments?
Chemo
Radiotherapy
Hormone therapy
New - immune therapy
What is an adjuvant vs neoadjuvant treatment?
Adjuvant is post surgery no clinical sign of cancer but risk of micro metastases around body that could develop so used secondary treatment e.g. chemo to kill off
Neoadjuvant is pre surgery using a treatment e.g. radiotherapy to reduce size of tumour so a tumour goes from inoperable to operable, or to make the surgery more simplistic
Why do you give radiation in fractionated doses?
Gives better outcomes as less cancer cells survive fractionated doses, the differential is larger between cancer cell death and normal cell death (so normal cells are spared damage)
How does radiotherapy work?
Kills proliferating cells by inducing apoptosis or by interfering with mitosis
Xrays/other types of ionising radiation used and kill rapidly dividing cells
Either direct DNA damage or indirect via free radicals - damage is then detected by cell cycle check points and triggers apoptosis of those cells esp in G2
DSB DNA damage also cause breakages in chromosomes that prevent M phase from completing correctly
Why does chemotherapy lead to hair loss/nausea/bone marrow suppression?
Because rapidly proliferating cells are killed in these regions
What are 4 types of chemo?
1) Antimetabolites - mimic normal substrates involved in DNA replication e.g. Fluorouracil
2) Alkylating - and platinum based drugs - e.g. cyclophosphamide and cisplatin, cross-link the two strands of the DNA helix
3) Antibiotics - act in several ways e.g. doxorubicin inhibits DNA topoimerase which is needed for DNA synthesis, bleomycin cause double stranded DNA breaks
4) Plant-derived - drugs include vincristine which blocks microtubule assembly and interferes with mitotic spindle formation
What is methotrexate method of action?
anti-metabolite - competes with normal metabolism - prevents DNA synthesis in cancer cells
Describe how hormone treatment can be used in breast cancer? How about prostate?
Relatively non toxic treatment for breast cancer if have oestrogen receptors.
SERMS (selective oestrogen receptor modulators) e.g. Tamoxifen bind to oestrogen receptors preventing oestrogen binding
Same for prostate but androgen blocking
How would you test to see if a breast cancer would respond to hormone therapy?
Immunohistochemistry - brown dye for oestrogen receptors see if test is positive
