L17: Neoplasia 4 Flashcards
Where does cancer rank in terms of lethal disease?
Second most
>14 million new cases worldwide in 2012
Estimated 9.6 million deaths in 2018
In the UK in 2015 how many people were diagnosed with malignant neoplasms?
360,000
What are the most common cancers in men and women in the UK?
Men- prostate, lung, bowel
Women- Breast, lung, bowel
Make up >50% cancers in the UK (53%)
What is the most common age group to be affected?
Over 65 yrs
Small proportion up to 24
Children under 14 normally have leukaemias, CNS tumours and lymphomas
What is the survival rate for different neoplasms?
Survival rates for different cancers is variable Women ↑ survival rate--> more likely to seek medical advice, notice changes more, men more likely to be embarrassed Survival rate doubled in last 40 years 50% people diagnosed survive 10 years 5 year survival rate -Testicular cancer 98% - Melanoma 90% - Breast cancer 87%
Which neoplasms have the worst survival rates?
Pancreas <25% 1 year survival rate
Lung, brain and stomach also very low
Which cancer is the biggest cause of cancer-related deaths?
Lung cancer
One of the most common
How have survival rates changed? Why?
Most cancers have had a big improvement in survival rate
Advancement in treatment
Public health campaigns
Pancreas–> no change
Lung cancer–> little improvement–> main cause of death
Testicular cancer used to have a poor prognosis, nowadays it has the best survival rate, how come?
Treatment got better–> platinum based treatments
Public health campaigns–> encouraged men to check
Detect early, treat early
What needs to be considered when predicting the outcome for malignant neoplasms?
Age, general health status, tumour site, tumour type, grade (differentiation), stage availability of treatment
What is meant by health status?
Performance stage
How well patient will be able to tolerate treatment
How are tumours staged?
Measure of malignant neoplasms overall burden on the body
Measured using the TNM staging system
Standardised across the world for certain cancers
What is the TNM staging system?
TNM gives you a status which is converted to a stage
T- Tumour size–> size of primary tumour T1- T4
N- Nodes–> describe extent of regional node metastasis via lymphatics e.g. N0- N3 (N0 - no lymph node involvement, N1- one lymph node or group …)
M- Metastases–> extend of distant metastatic spread via the blood M0 (no metastases) or M1 (metastases)
How is the TNM status converted to a stage?
Stage I- IV
Varies for each cancer but in general
Stage I- Early local disease (T1-2, N=0, M=0)
Stage II- Advanced local disease (T3-4, N=0, M=0)
Stage III- Regional metastasis (T1-4, N=1+, M=0)
Stage IV- Advanced disease with any distant metastasis (any T, any N, M1)
What is the staging system for lymphoma called? How does it work?
Ann Arbor staging
Stage I –> Lymphoma in single node region
Stage II –> Indicate two separate regions but on same side of diaphragm
Stage III –> Indicates spread on opposite sides of diaphragm
Stage IV –> Indicates diffuse or disseminated involvement of one or more extra-lymphatic organs such as bone marrow or lung
What has been used for staging of colorectal cancers?
Dukes staging
Dukes’ A: Invasion into but not through the bowel
Dukes’ B: Invasion through the bowel wall
Dukes’ C: Involvement of lymph nodes
Dukes’ D: Distant metastases
TNM is the preferred system worldwide
What does the tumour grade describe?
How well differentiated a tumour is
Low grade/ G1–> well differentiated
G2–> moderately differentiated
High grade/ G3–> Undifferentiated or anaplastic
What do we mean by differentiated?
How well it resembles the original tissue
What is tumour grade used for?
Planning treatment and estimating prognosis
What grading systems is used by breast carcinomas?
Bloom-Richardson system
Assess tubule formation, nuclear variation and number of mitoses (mitotic figures)
What are the methods for treating cancers?
Surgery Radiotherapy Chemotherapy Hormone therapy Treatment targeted to specific molecular alterations Immune system targeted therapy
What is the mainstay of cancer treatment?
Surgery
Precise role varies in each cancer
Most successful for remission (cure)–> never be 100% sure about microtumours
Good for early non metastasised tumour
Idea is to remove whole tumour with a wide enough border to ensure you have it all
What is the difference between Adjuant and Neoadjuvant treatment?
Both given when treatment is surgery
Adjuvant treatment–> after –> eliminate subclinical disease (attempt to eliminate microtumours)
Neoadjuvant treatment–> before –> shrinkage of tumour before surgery –> hopefully remove whole thing
How does radiation therapy work?
Kills proliferating cell by triggering apoptosis or interferring with mitosis
Directed on tumour, shielding of surrounding tissues
Cells in G2 phase of cell cycle
High dosage–> direct or free radical induced DNA damage, detected by cell checkpoints, triggering apoptosis
Double strand DNA breakages cause damaged chromosomes that prevent M phase from completing
