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Pathology > Incidence Prognosis and Treatment of Malignant Neoplasms > Flashcards

Incidence Prognosis and Treatment of Malignant Neoplasms Flashcards

1
Q

What are the 4 most common neoplasms?

A

Breast Lung Prostate Bowel acount for over half

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2
Q

What are the most common causes of cancer in under 14 yrs old?

A

Leukaemia
Lymphoma
CNS cancers

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3
Q

Name 3 cancers with a high 5 year survival rate and three with a low 5 year survival rate

A

Testicular cancer
Malignant melanoma
Breast cancer have high survival rate

Pancreatic
Lung
Oesophageal cancers have low survival rate

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4
Q

Which cancer is the biggest cause of cancer related deaths in UK?

A

Lung

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5
Q

What factors do you consider when predicting outcome/prognosis of someone with a certain cancer?

A

Age/Health status
Available treatments

Cancer: Grade, stage, location, type of tumour

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6
Q

What is tumour staging a measure of? What is the most common staging criteria? Is it different for different cancers?

A 
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

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7
Q

What is the TNM staging criteria then converted into?

A

Into grades I - IV

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8
Q

What do the grades I-IV roughly mean?

A

I - Early local disease
II - Advanced local disease
III - Regional metastases
IV - Distant metastases

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9
Q

What is the Ann Arbor staging?

A

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

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10
Q

Does staging predict survival? How?

A

Yes because invasion and metastases are the most dangerous characteristics of cancer and staging accounts for both

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11
Q

What is Dukes staging?

A 
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
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12
Q

What does tumour grade describe? What are the different grades? Which two cancers is it particularly useful for?

A

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

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13
Q

Do you grade melanomas?

A

No

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14
Q

What is the Bloom-Richardson system of grading? How is this related to survival?

A

For breast Ca

1) Tubule formation
2) Nuclear variation
3) Number of mitoses

Low grade much higher survival

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15
Q

What is the main treatment of cancer?

A

Surgery

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16
Q

What are some other treatments?

A

Chemo
Radiotherapy
Hormone therapy

New - immune therapy

17
Q

What is an adjuvant vs neoadjuvant treatment?

A

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

18
Q

Why do you give radiation in fractionated doses?

A

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)

19
Q

How does radiotherapy work?

A

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

20
Q

Why does chemotherapy lead to hair loss/nausea/bone marrow suppression?

A

Because rapidly proliferating cells are killed in these regions

21
Q

What are 4 types of chemo?

A

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

22
Q

What is methotrexate method of action?

A

anti-metabolite - competes with normal metabolism - prevents DNA synthesis in cancer cells

23
Q

Describe how hormone treatment can be used in breast cancer? How about prostate?

A

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

24
Q

How would you test to see if a breast cancer would respond to hormone therapy?

A

Immunohistochemistry - brown dye for oestrogen receptors see if test is positive

25
Q

How can oncogenes be targeted in cancer therapy?

A

E.g. HER-2 gene mutation causes over expression of Her-2 receptor which is a human epidermal growth hormone receptor - Herceptin (Trastuzumab) can block this excessive signalling

Imatinib works against chronic myeloid leukaemia (CML) by inhibiting the fusion protein that forms from BCR-ABL chromosomal rearrangement on t9:22

26
Q

Name two newer drugs that are evolving that block immune check points

A

Nivolumab

Ipilimumab

27
Q

What would you use tumour markers for? What are they?

A

Generally for monitoring during treatment and follow up
Sometimes to see initial tumour burden

E.g. tumour cells release substances like proteins, antigens, hormones, oncofetal antigens, mucins/glycoproteins and these can be measured.

28
Q

What is an oncofetal antigen? Give an example of one that can be used as a tumour marker?

A

An antigen that is normally only present in the foetus but also present in cancers in adults

Fetoprotein - in hepatocellular carcinoma

29
Q

Give an example of a cancer that releases mucins/glycoproteins that can be used as a tumour marker?

A

CA-125 released by ovarian cancer

30
Q

Why do many cancer drugs target DNA synthesis/mitosis?

A

Because cancer cells are more likely to be proliferating than normal cells and therefore undergoing DNA replication/synthesis and mitosis

31
Q

When is using tumour grade useful? Which cancers?

A

For estimating prognosis and deciding treatment type e.g. soft tissue sarcoma, primary brain tumours, lymphomas, breast and prostate cancer.

Pathology (13 decks)

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