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Mechanisms of Disease > Lecture 10.1: Incidence, Prognosis & Treatment of Malignant Tumours > Flashcards

Lecture 10.1: Incidence, Prognosis & Treatment of Malignant Tumours Flashcards

1
Q

Factors to consider when Predicting Outcome of Cancer Prognosis (7)

A
  • Age
  • General Health Status
  • Tumour Site
  • Tumour Type
  • Grade (i.e. differentiation)
  • Tumour Stage
  • Availability of Effective Treatments
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2
Q

What is Prognosis?

A

The likely course of a disease or ailment

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3
Q

What is a Biopsy?

A
  • Is a a small amount material used to give the.
    primary diagnosis
  • A preliminary grading of tumour is also given at this
    stage
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4
Q

What is a Resection Specimen?

A
  • 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
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5
Q

What does Staging mean?

A

Staging means how big the cancer is and whether it has spread

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6
Q

What does Grading mean?

A

Grading means how abnormal the cancer cells look under a microscope

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7
Q

Cellular (Microscopic) Characteristics of Malignancy (4)

A
  • 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
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8
Q

What are the Categories of Grading?

A
  • G1 (well differentiated)
  • G2 (moderately differentiated)
  • G3 (poorly differentiated)
  • G4 (anapalstic carcinoma)
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9
Q

What are the Factors that contribute to Staging (3)

A
  • 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)
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10
Q

TNM of Stage 1 Cancer

A
  • T1 or T2
  • N0
  • T0
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11
Q

TNM of Stage 2 Cancer

A
  • T2 or T3
  • N0
  • M0
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12
Q

TNM of Stage 3 Cancer

A
  • T1, T2, T3 or T4
  • N1
  • M0
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13
Q

TNM of Stage 4 Cancer

A
  • T1, T2, T3 or T4
  • N0, N1 or N2
  • M1
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14
Q

What Staging is used for colorectal carcinoma instead of TNM?

A
  • Duke’s Staging
  • Even though TNM is preferred worldwide
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15
Q

Duke’s Staging

A
  • 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
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16
Q

What are the options for Treatment of Cancer? (5)

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormonal Therapy
  • Molecular Treatment
17
Q

Surgery for Cancer Treatment

A
  • 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
18
Q

Neoadjuvant Treatment

A

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

19
Q

Adjuvant Treatment following Surgery

A

Aimed at eradicating subclinical disease

20
Q

Radiotherapy for Cancer Treatment

A
  • 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
21
Q

When is Radiotherapy used in Cancer Treatment?

A
  • 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
22
Q

Chemotherapy for Cancer Treatment + When it is used

A
  • 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
23
Q

Types of Chemotherapeutic Drugs: Antimetabolites

A
  • Fluorouracil
  • Mimic normal substrates involved in DNA
    replication
24
Q

Types of Chemotherapeutic Drugs: Alkylating & Platinum-Based Drugs

A
  • Cyclophosphamide & Cisplatin
  • Cross-link the two strands of the DNA helix
25
Q

Types of Chemotherapeutic Drugs: Antibiotics

A
  • Act in several different ways
  • E.g. Doxorubicin inhibits DNA topoisomerase,
    needed for DNA synthesis
  • E.g. Bleomycin causes double stranded DNA breaks
26
Q

Types of Chemotherapeutic Drugs: Plant-Derived Drugs

A
27
Q

Hormonal Treatment

A
  • Mostly used to treat tumours that are driven by
    hormones such as oestrogen and testosterone
  • Non toxic
  • Selective oestrogen receptor modulators (SERMs),
    such as tamoxifen, bind to oestrogen receptors,
    preventing oestrogen from binding
  • They are used to treat hormone receptor positive
    breast cancer
  • Androgen blockade is used for prostate cancer
28
Q

What is Targeted Therapy (Molecular Therapy)?

A
  • Drugs specifically acting against molecular targets in
    cancer cells
29
Q

What are the 2 types of Targeted Therapy (Molecular Therapy)?

A
  • Antibody drugs (man made versions of immune
    system proteins, targeting receptors)
  • Small molecules (targets abnormal proteins, or
    enzymes, that form on and inside cancer cells and
    promote uncontrolled tumour growth)
30
Q

Her 2 & Herceptin

A
  • A quarter of breast cancers have gross over-
    expression of the HER
  • 2 gene and Herceptin can block Her-2 signalling
31
Q

What are Tumour Markers?

A

A biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer

32
Q

Why are Tumour Markers useful? (2)

A
  • Can be used for diagnosis (PSA, AFP)
  • Commonly used for monitoring tumour burden
    during treatment and follow up
33
Q

Examples of Tumour Markers (4)

A
  • CEA
  • AFP
  • hCG
  • Ca 125
34
Q

Modified Bloom Richardson Grading for Breast Cancer

A

1) Tubules (1/2/3)
2) Mitoses(1/2/3)
3) Nuclear pleomorphism (1/2/3)

• G1 = 4-5
• G2 = 6-7
• G3 = 8-9

Mechanisms of Disease (11 decks)

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