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biotechnology and global health > Lecture 13: Cancer and Cancer Screening > Flashcards

Lecture 13: Cancer and Cancer Screening Flashcards

1
Q

What is the cancer pathophysiology?

A
  1. Malignant transformation in target cell
  2. Growth of transformed cell
  3. Local invasion
  4. Distant metastases
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2
Q

What are the different cancer diagnosis?

A
  • Benign Tumor
  • Malignant Tumor
  • Dysplasia
  • Anaplasia
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3
Q

What is dysplasia?

A

precancerous condition in epithelial tissue

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4
Q

What is anaplasia?

A

When the cells and nuclei show pleomorphism

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5
Q

What are the hallmarks of cancer?

A
  1. Self-sufficiency in growth signals
  2. Insensitivity to growth-inhibitory signals
  3. Evasion of apoptosis
  4. Lost capacity for senescene
  5. Acquisition of sustained angiogenesis
  6. Tissue invasion and metastasis
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6
Q

What are the treatment options of cancer?

A
  • Surgical excision (most effective if entire tumor removed)

- Radiation/Chemotherapy (side effects)

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7
Q

What is diagnostic screening?

A
  • Test to identify individuals who have disease, but do not yet have symptoms
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8
Q

When should diagnostic screening be used?

A

When the effectiveness have been demonstrated

  • Resources are sufficient to cover target group
  • Facilities exist for confirming diagnosis
  • Facilities exist for treatment and follow-up
  • When disease prevalence is high enough to justify effort and costs of mass screening
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9
Q

What 4 cancers are routinely screened for in the US?

A
  • Female breast cancer
  • Colon and rectal cancer
  • Cervical cancer
  • Prostate cancer
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10
Q

What are the signs and symptoms for cervical caner?

A

abnormal vaginal bleeding

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11
Q

What are the risk factors for cervical cancer?

A
  • Failure to obtain regular Pap smears
  • HPV infection
  • Cigarette smoking
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12
Q

What are low grade intraepithelial lesions?

A

Bottom 1/3 of epithelium filled with transformed cells

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13
Q

What are high grade intraepithelial lesions?

A

Bottom 2/3 of epithelium filled with transformed cells

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14
Q

What is carcinoma in situ?

A

Complete epithelium transformed

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15
Q

What is micro-invasive cancer?

A

Cancer cells have invaded supporting stroma

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16
Q

What initiated the transformation for cervical canver?

A
  • Infection with HPV virus
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17
Q

Difference between benign growth or wart and malignant tumor pertaining to viral infections.

A

In a benign growth the viral proteins are still controlling replication and the viral DNA has not integrated into the host

  • In a malignant tumor, the viral DNA was integrated into the host DNA and the unbalanced production of viral replications proteins had increased cell replication
18
Q

What screening tools are used for cervical cancer?

A
  • Pap smear
  • Liquid-based cytology
  • Automated screening
  • HPV Testing
  • HPV Vaccines
  • Visual Inspection with Acetic Acid
19
Q

What diagnosis tools are used for cervical cancer?

A
  • Colposcopy + biopsy
20
Q

What treatment exist for cervical cancer?

A
  • Surgery
  • Radiation therapy
  • Chemotherapy
21
Q

What are the levels of Se and Sp for pap smears and limitations?

A

Low Se and high Sp, clinicians only agree w/self 78% of time

  • Infection/inflammation
  • Small # of cells sampled
22
Q

What is liquid-based cytology?

A

Cell samples are rinsed in preservation fluid to remove debris, even layer of cells collected on glass plate through pressure.

23
Q

Compare the conventional vs. liquid based cytology

A

With liquid based cytology more cells are plated in a thin layer. Sensitivity and detection rates are improved but at double the cost.

24
Q

What is automated pap smear screening and how does it compare to other technologies?

A

The slides are viewed by a high speed video microscope at a much faster rate, decrease in false positives/negatives, out performes humans but add to cost

25
Q

HPV Testing

A

Approved by the FDA as routine adjunctive screening with pap test, high Se and Sp

26
Q

HPV Vaccine

A

Licensed for use in females age 9-26, protects against 4 strains of HPV

27
Q

What are the limitations for the HPV Vaccine?

A
  • Difficult to achieve widespread access to a vaccine targeted towards girls
  • Cost
28
Q

What are the current screening recommendations?

A
  • Screening at age 21

- no longer need pap smear every year

29
Q

What are the challenges to screening in the developing world?

A
  • Access
  • Poor govt funding of facilities
  • Medical personel
  • Pathology services generally insufficient for all potential testing
  • Delays in seeking care, patients present often with advances disease (cultural constraints in seeking care)
30
Q

What is VIA?

A

Visual Inspection w/ Acetic Acid

  • cervix swabbed with acetic acid, lesions turn bright white
  • direct, unaided visual inspection
  • Se - 94, Sp 42
  • Fast training
31
Q

What are the pros and cons of VIA?

A

Pros

  • Cheap
  • High Sensitivity
  • Quick trainig
  • No need for complex devices
  • screen & treat same day

Cons

  • Low Sp
  • Learning curve of diagnosis
32
Q

What do we know overall about technologies for cervical cancer screening?

A
  • Effective even with low Se and Sp
  • Slow development precancer to cancer
  • Time and money spent chasing false positives (are resources being wasted in the developing world)
33
Q

Know the development of prostate cancer

A

nuclei of epithelial cells become enlarged, multiple layers of cells stack upon one another
- There is a slow but continuous growth

34
Q

What are the signs and symptoms for prostate cancer?

A
  • Often asymptomatic in early stages
  • Weak or interrupted urine flow
  • Inability to urinate
35
Q

What screening tools are used for prostate cancer?

A
  • Discussion
  • Serum PSA test
  • Digital rectal exam
36
Q

PSA test

A

Test for levels of prostate specific antigen in the blood. PSA associated with prostate cancer

Se - 63-83, Sp - 91-94 (not all will become serious cancers)

37
Q

When and why is a biopsy of the prostate needed?

A

To differentiate between enlarged prostate and cancer.

A needle is inserted into prostate, samples are collected and viewed under a microscope.

38
Q

What treatments are used for localized prostate cancer?

A
  • Radical prostatectomy (remove prostate) - it reduces the chance of metastasis but has serious side effects
  • Conservative management (watch and wait)
39
Q

Does early detection help?

A

For the three grades of prostate cancer, the treatment option makes the biggest differences at Grade III

40
Q

What are the challenges of prostate cancer screening?

A
  • slow growing cancer
  • most men w/prostate cancer die of other causes
  • treatment has significant side effects
41
Q

Should we screen everyone for prostate cancer?

A

Yes

  • high survival rate
  • curative

No

  • can lead to expensive and unnecessary biopsis
  • over detection of latent cancers
42
Q

Is screening for prostate cancer recommended?

A

Nope,

biotechnology and global health (10 decks)

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