Lecture 11 - Neoplasia IV Flashcards
define staging
the extent of spread of tumour
what is the tnm staging system?
t = primary tumour n = regional lymph node involvement m = metastasis
how does T progress?
increasing size in primary lesion, T1 -> T4
how does N progress?
N0 = no nodal involvement
increasing involvement, N1 -> N3
how does M progress?
M0 = no distant metastases M1 = presence of blood borne metastases
what is the T staging for breast cancer?
TIS - carcinoma in situ
T1 - 5cm across
T4 - spread to chest wall and/or skin
what is the N staging for breast cancer?
N0 - no nodal
N1 -axillary
N2 - mammary
N3 - supraclavicular
what is the M staging for breast cancer?
M0 - no metastasis
M1 - metastasis
what is the dukes staging for colorectal carcinomas?
a, b, c1/2
what is the A of the dukes staging?
confined to bowel wall
not extending through muscularis propria
>90% 5 year survival
what is the B of the dukes staging?
through bowel wall (muscularis propria)
70% 5 year survival
what is the C1/2 of the dukes staging?
lymph nodes involved
30% 5 year survival
C1 = regional lymph nodes involved
C2 = apical node (furthest away) involved
what is the ann arbor classification of hodgkins disease?
I = one lymph node involved II = two lymph nodes on one side of diaphragm III = > two lymph nodes on both sides of diaphragm IV = multiple foci
define grading
based on the degree of differentation of tumour cells; attempts to judge the extent to which tumour cells resemble or fail to resemble their normal counterparts
what is the scarff-bloom-richardson grading system?
degree of tubule formation
extent of nuclear variation
number of mitoses
what is the survival rates of breast carcinoma based on scarff-bloom-richardson?
grade 1 = 85% 10 year survival
grade 2 = 60% 10 year survival
grade 3 = 15% 10 year survival
what grading system is used for prostate carcinoma?
gleason
explain radiotherapy
external radiation to tumour at fractionated doses with shielding of adjacent normal tissues
causes damage to dna of rapidly dividing cells
if dna damage is extensive - apoptosis
what has a high sensitivity to radiotherapy?
lymphoma
leukaemia
seminoma
what has a fairly high sensitivity to radiotherapy?
squamous carcinomas
what has a moderate sensitivity to radiotherapy?
GI
breast
what has a low sensitivity to radiotherapy?
sarcoma
name 3 chemotherapy drugs
cyclophosphamide
vincristine
methotrexate
what is the action of cyclophosphamide?
acts on cells in g1/s and mitosis
what is the action of vincristine?
block cells entering cell cycle
act on mitosis
what is the action of methotrexate?
acts on cells in s phase
name 2 hormone therapy drugs
tamoxifen
herceptin
what is the action of tamoxifen?
competes for binding to oestrogen receptor
50-80% of breast cancers express oestrogen receptors
what is the action of herceptin?
her-2 growth factor receptor
overexpressed in 20-30% of breast carcinomas
name 3 tumour markers in diagnosis and monitoring of disease
carcinoembryonic antigen
human chorionic gonadotrophin
alpha-fetoprotein
what is the use of carcinoembryonic antigen?
normally only in embryonic tissue
useful to see if there is any residual disease after removal of tumours
what are 5 uses of human chorionic gonadotrophin?
1) evaluation of testicular masses
2) indicate residual disease after orchidectomy
3) monitoring response to therapy and prediction of recurrence
4) raised in nonseminomatous testicular tumours
5) seminomas with syncytiotrophoblastic giant cells
what is the use of alpha-fetoprotein?
normally synthesised in early foetal life
raised plasma levels associated with cancer of liver and yolk sac tumour of testis
what is the value of screening?
detect premalignant, non invasive and early invasive cancers to improve prognosis
when is the first invitation to cervix screening?
age 25
how often is cervical screening age 25-49?
3 yearly
how often is cervical screening age 50-64?
5 yearly
how often is cervical screening age 65+?
only if not been screened since 50 or have had recent abnormalities
what is the value of cervical screening?
cytological smears to detect early precancerous changes
what is the value of breast screenig?
identify invasive cancers before they can be felt
relies on mammography
50-69 years every 3 years
