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03. Respiratory > L30. Neoplasia 3 > Flashcards

L30. Neoplasia 3 Flashcards

1
Q

What are the most usual clinical effects of the primary tumour?

A

Can remain small and asymptomatic

But is usually has local effects

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2
Q

What are the clinical effects of metastases?

A 
Local lymphadenopathy
Bone pain or features related to hypercalcaemia
Jaundice
Seizures
Depends on sites of metastasis
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3
Q

What are systemic clinical effects of cancer? What are they caused by?

A

Weight loss, anorexia

From TNF alpha and IL-1 produced by tumour cells or microenvironment (especially macrophages). These produce changes in the basal metabolic rates leading to weight loss.

Signals a severe or advanced tumour

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4
Q

What are paraneoplastic effects? What are the main broad categories of paraneoplastic effects?

A

Set of signs and symptoms that are a consequence of cancer in the body but are not mass effect of the tumour itself (a flow on consequence as a result of its presence)

  • endocrine (eg. ATCH or PTH)
  • immunologic (eg. nephrotic syndrome)
  • Other: clubbing, vascular and haematologic (thrombi)
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5
Q

What are clinical features of lung cancer?

A

The local effects: cough, haemoptysis, wheeze, dyspnoea, pneumonia, Pancoast’s syndrome

Metastasis: bone pain, jaundice, seizures

Weight loss, anorexia and paraneoplastic effects (especially small cell)

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6
Q

What are some investigations done in cancers?

A

Clinical history and examination
Blood tests (Hb for anaemia, Liver function tests, tumour markers)
Radiology
Endoscopy and biopsy

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7
Q

What are some tumour marker cells? Are they commonly used diagnostically?

A 
Prostate Specific Antigen
Carcinomembryonic Antigen (CEA)

They are not used in diagnosis, may be used in follow up. They are not specific (often see elevations in non-cancer conditions)

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8
Q

What is done after/with tissue sampling (biopsy)?

A 
Histopathological diagnosis (ESSENTIAL for confirming a diagnosis and for prognosis and management)
- asses for cytological features
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9
Q

What are the different investigations done on tissue samples?

A
  • Cytology: fine needle aspiration or exfoliative cytology (no stroma or organisation visualisation)
  • Histopathology (H&E, special stains, immunohistochemistry)
  • Molecular and cytogenic techniques (in situ hybridisation, PCR, chromosome rearrangements)
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10
Q

Once a diagnosis of malignancy is made, what other things do we need to know?

A 
Specific tumour type and subtype
Grade (differentiation)
Stage (size and spread of metastases)
Presence of lymphovascular invasion
Other - depends on tumour type
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11
Q

What is this additional information important for?

A

Prognosis, Management and Comparing Treatment (Research)

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12
Q

Describe the stage of a cancer

A

Refers to the progression of the malignancy in terms of local spread and metastasis

Incorporates size or depth of invasion and local extent of the primary tumour by radiological and pathological assessment.

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13
Q

What are the four stages of cancer?

A

TNM system is commonly used:

T: extent of primary tumour (0-4)
N: regional lymph node assessment (0-3)
M: absence or presence of distant metastases (0-1)
X: cannot be assessed or unknown

These are combined to give a grouping and stage IV is distant metastases

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14
Q

What are the four stages of cancer?

A

TNM system is commonly used:

T: extent of primary tumour (0-4)
N: regional lymph node assessment (0-3)
M: absence or presence of distant metastases (0-1)
X: cannot be assessed or unknown

These are combined to give a grouping and stage IV is distant metastases

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15
Q

What does vascular invasion in the primary tumour indicate?

A

Usually an indication that the tumour has metastasised

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16
Q

Are are predictive factors? And how are they used in cancer?

A

They predict the most likely response to certain therapies. So cancers expressing certain receptors can be targeted using anti-receptor therapies. = targeted therapy

17
Q

What are the main management methods for cancer?

A

Surgery

18
Q

What is target therapy?

A

Block the growth of cancer cells by INTERFERING WITH FUNCTION OF SPECIFIC MOLECULES (like oncoproteins) that drive the carcinogenesis and tumour growth.

This means they are less harmful to normal cells.

  1. small molecules (inhibit driving factors)
  2. monoclonal antibodies targeting specific proteins or receptors
19
Q

What is target therapy?

A

Block the growth of cancer cells by INTERFERING WITH FUNCTION OF SPECIFIC MOLECULES (like oncoproteins) that drive the carcinogenesis and tumour growth.

This means they are less harmful to normal cells.

  1. small molecules (inhibit driving factors)
  2. monoclonal antibodies targeting specific proteins or receptors
20
Q

What are the epidermal growth factor receptor (EGFR) mutations? Describe the targeted therapy

A

Mutations involving these EGFR tyrosine kinases increasing its activity leading to hyperactivation of downstream signalling pathways.

New targeted therapies like Gefitnib and erlotinib inhibit EGFR tyrosine kinase and can be used to reduce signal transduction and the drive for cell proliferation.

  • some are sensitive, others not
  • thus tumours need to be tested
  • danger in acquiring new mutations after treatment (resistance)
21
Q

What are the epidermal growth factor receptor (EGFR) mutations? Describe the targeted therapy

A

Mutations involving these EGFR tyrosine kinases increasing its activity leading to hyperactivation of downstream signalling pathways.

New targeted therapies like Gefitnib and erlotinib inhibit EGFR tyrosine kinase and can be used to reduce signal transduction and the drive for cell proliferation.

  • some are sensitive, others not
  • thus tumours need to be tested
  • danger in acquiring new mutations after treatment (resistance)
22
Q

What causes death in patients?

A

Cachexia - wasting away
Secondary infection related to poor nutrition and immunosuppression and other side effects of treatment
Damage to vital organ or system by primary or secondary tumours

23
Q

What are some preventative methods for cancer?

A

Public education programs
Personal measures: healthy diet, exercise, no smoking, sunscreen
Screening programs
Laws relating to exposure and safety

03. Respiratory (29 decks)

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