L18 - Neoplasm 4 Flashcards
Give two of the 4 most common forms of cancer in adults
Breast/lung/prostate/bowel
Give two of the three most common cancers in children
leukemias/CNS tumours/lymphomas
Which cancer is the biggest cause of cancer related death
lung
Give two things you should consider when predicting an outcome of malignant neoplasms
Age/general health/tumour site/tumour type/tumour grade/availability of effective treatments
Tumour stage is a measure of a malignant neoplasms overall burden, how it is spread. TNM staging is the most common. What does each letter refer to?
T - refers to the size of the primary tumour (T1-T4)
N - describes the extent of regional node metastasis (N0-N3)
M - denotes the extent of distant metastatic spread via the blood - it either has or hasn’t spread via the blood (M0-M1)
The letters from the TNM staging are then converted to a stage. Explain each stage. NOTE this is the most important one to know
Stage 1 - early local disease
Stage 2 - advanced local disease bigger T but N and M 0)
Stage 3 - regional metastasis
Stage 4 -advanced disease (N1 or more) with distant metastasis (M1)
Lymphoma has its own special system called ___ ____ staging.
Ann Arbor
Briefly expain the stages in Ann Arbor staging
Stage I - lymphoma in a single node region
Stage 2 - Two separate node regions on one side of the diaphragm
Stage 3 - Spread to both sides of the diaphragm
Stage 4 - involvement of one or more extra-lymphatic organs e.g. lung/bone
Staging is a powerful predictor of survival. What cancer is Duke’s staging used for?
Colorectal carcinoma
Explain the Duke’s stages
Duke’s A - invasion into but not through the bowel
Duke’s B - Invasion through the bowel wall
Duke’s C - involvement of lymph nodes
Duke’s D - distant metastases
What grading system do we use for breast carcinoma?
Bloom Richardson
Tumour grade is important for planning treatment and estimating prognosis in certain types of malignancy, give one such cancer
Primary brain tumours, lymphomas, breast and prostate cancer
Give three different treatments for cancer
Surgery/radiotherapy/chemotherap/yhormone therapy/targeted molecular therapies
Distinguish between adjuvant and neoadjuvant treatment
Adjuvant - Given after surgical removal of a primary tumour to elimintate subclinical (clinically undetectable) disease
Neoadjuvant - Given prior to surgical removal to reduce the size of the primary tumour
How does radiotherapy work?
Ionising radiation is targeted at hthe cancer with shielding of healthy tissue. The ideas is to damage the cells which should be then recognised by cell cycle checkpoints ot trigger apoptosis
Chemotherapy drugs all interfere with DNA replication but are non-specific and can thus affect healthy cells. Give two of the four major classes
Antimetabolites/Platinum-based drugs (e.g. cisplatin)/antibiotics/plant-derived drugs
Hormone therapy is a relatively non-toxic treatment but only is effective on certain malignant tumours. Tamoxifen is an example, explain how it works
Tamoxifen is given in hormone positive breast cancers. It blocks oestrogen receptors.
NOTE - androgen blockade is used in prostate cancer
Identifying specific oncogenic mutations can be used in the treatment of cancer. Explain the effects of the targeted molecular therapies Herceptin and Gleevec (imatinib)
Herceptin - In Her 2+ve breast cacer the Her-2 gene is overexpressed, herceptin blocks Her-2 expression
Gleevec - Used in treatment of Chronic myeloid leukemia - it blocks the BCR-ABL fusion protein
Tumour markers allow us to monitor cancer burden. Gie some examples
Hormones (e.g. HCG in testicular cancer)/oncofetal antigens (in hepatocellular carcinoma)/specific proteins (prostate specific antigen in prostate cancer)/mucins and glycoproteins (like in ovarian cancer
What is the point of cancer screening programmes?
To cach them as early as possible where the chance of cure is the highest
Describe some problems associated with screening programmes
Lead time bias - publishing increases in survival when really its just an increase in diagnosis
Length bias - screening detects slow growing tumours
Overdiagnosis - Some tumours will be diagnosed that won’t have a negative effect
Describe the three major rscreening programmes briefly: Cervix, breast and colorectal (bowel)
Breast - every three years you are invited between the ages of 50 and 70 in women
Bowel - men and women over 60 will be invited every two years to do it at home
Cervical - women - HPV test and smear tests every 3 years 25 -49
