Lecture 10.1: Incidence, Prognosis & Treatment of Malignant Tumours Flashcards
Factors to consider when Predicting Outcome of Cancer Prognosis (7)
- Age
- General Health Status
- Tumour Site
- Tumour Type
- Grade (i.e. differentiation)
- Tumour Stage
- Availability of Effective Treatments
What is Prognosis?
The likely course of a disease or ailment
What is a Biopsy?
- Is a a small amount material used to give the.
primary diagnosis - A preliminary grading of tumour is also given at this
stage
What is a Resection Specimen?
- The large tissue which is resected surgically
with a curative intent - The tumour extent and assessment of metastasis in
tissue provided (usually regional nodes) helps in
staging the tumour - A final grading is also given at this stage
What does Staging mean?
Staging means how big the cancer is and whether it has spread
What does Grading mean?
Grading means how abnormal the cancer cells look under a microscope
Cellular (Microscopic) Characteristics of Malignancy (4)
- Increasing variation in the size & shape of cells and
nuclei aka pleomorphism - Increasing nuclear size and nuclear to cytoplasmic
ratio - Clumping of chromatin occurs in the nuclei
- Increase in mitotic figures including abnormal
mitosis
What are the Categories of Grading?
- G1 (well differentiated)
- G2 (moderately differentiated)
- G3 (poorly differentiated)
- G4 (anapalstic carcinoma)
What are the Factors that contribute to Staging (3)
- Extent of tumour at the primary site- its size (T
status: T1,T1,T3,T4) - Regional metastasis- Lymph Nodes (N-status:
N0,N1,N2) - Distant metastasis (M status:M0,M1)
TNM of Stage 1 Cancer
- T1 or T2
- N0
- T0
TNM of Stage 2 Cancer
- T2 or T3
- N0
- M0
TNM of Stage 3 Cancer
- T1, T2, T3 or T4
- N1
- M0
TNM of Stage 4 Cancer
- T1, T2, T3 or T4
- N0, N1 or N2
- M1
What Staging is used for colorectal carcinoma instead of TNM?
- Duke’s Staging
- Even though TNM is preferred worldwide
Duke’s 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
What are the options for Treatment of Cancer? (5)
- Surgery
- Radiotherapy
- Chemotherapy
- Hormonal Therapy
- Molecular Treatment
Surgery for Cancer Treatment
- Most often the main form of treatment
- Surgical resections of both primary and secondary
tumours - Other forms of treatment can precede surgery or
follow surgery
Neoadjuvant Treatment
Where the drugs are the first line of treatment aimed at curing the patient and aids to shrink the tumour for enabling complete surgical disease
Adjuvant Treatment following Surgery
Aimed at eradicating subclinical disease
Radiotherapy for Cancer Treatment
- Radiotherapy is focused on the tumour with
shielding of surrounding healthy tissue - It is given in fractionated doses to minimise normal
tissue damage - X-rays or other types of ionising radiation are used
When is Radiotherapy used in Cancer Treatment?
- To shrink tumour as part of neoadjuvant treatment
- May be the main form of treatment
- Used in a palliative setting to control bleeding and
for pain relief
Chemotherapy for Cancer Treatment + When it is used
- Curative intent: small cell carcinomas of the lung,
lymphomas - Neo-adjuvant setting: prior to surgery to shrink the
tumour - Adjuvant setting: aimed at eradicating subclinical
disease - Palliative setting
Types of Chemotherapeutic Drugs: Antimetabolites
- Fluorouracil
- Mimic normal substrates involved in DNA
replication
Types of Chemotherapeutic Drugs: Alkylating & Platinum-Based Drugs
- Cyclophosphamide & Cisplatin
- Cross-link the two strands of the DNA helix
