Lecture 17 - Neoplasia 5 Flashcards
What are the most common cancers world wide?
Female breast
Prostrate cancer
Lung
Bowel
What are the 4 most common cancers world wide?
Female breast
Prostrate cancer
Lung
Bowel
What are the most common causes of cancer in Males?
What are the most common causes of cancer in Females?
Males = Prostate
Females = Breast
Why are most cancers diagnosed at age over 65yrs?
There’s more time for initiation, promotion and progression to take place
What are some common cancers in children?
Leukaemia
CNS tumour
Lymphomas
What is a commonly used chemotherapeutic drug for prostate cancer?
Cisplatin
Why have the incidences of malignant melanoma decreased?
Inc public awareness
Better suncream usage
What can be biopsied to see if a malignant melanoma has spread?
Sentinel lymph nodes
Why are brain cancers difficult to treat?
Hard for chemotherapy agents to cross blood brain barrier
Radiotherapy damages surrounding healthy brain
What determines whether an individual will have a favourable outcome with cancer?
Co-morbidities
Age
Tumour site
Tumour type
Tumour stage
Well differentiated
Availability of treatment
What is the definition of cancer specific survival?
% of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time after diagnosis
What is the definition of relative survival?
% of cancer patients who have survived for a certain period of time after diagnosis compared to people who do not have cancer
What is the definition of disease free survival?
% of patients who have no signs of cancer during a certain period of time after treatment
What is the definition of Cure?
There are no traces of cancer after treatment and the cancer will NEVER come back
What is the definition of Resmission?
Signs and symptoms of your cancer have reduced
What are the 2 types of remission?
Partial remission
Complete remission
What is partial remission?
Signs + symptoms of the cancer have reduced
What is complete remission?
Signs + symptoms have disappeared
Why is it risky to say that a patient is cured from cancer?
May still be some cancer cells in the body and these can come back one day to causes cancer
(Melanoma does this a lot)
How are tumours/cancers classified?
TNM staging system (can only be used for solid tumours
What does the TNM staging system mean?
T = size of primary Tumour
N = extent of regional lymph Node involvement
M = Metastatic spread via the blood
What are the tumour sizes?
T1 (smallest)
T2
T3
T4 (largest)
What are the (N) regional lymph node involvement classifications?
N0
N1
N2
N3
What does N0 mean?
No evidence of lymph node metastasis
What does N1, N2 and N3 mean?
N1 = evidence of a single group of lymph nodes with metastasis
N2 = more lymph nodes affected
N3 = many lymph nodes affected
What does M0 mean in terms of metastatic spread?
Don’t have metastasis
What does M1 mean in terms of metastatic spread?
Do have Metastatic spread
What is meant by tumour stage?
A measure of the overall burden of the malignant neoplasm
What does a Stage 1 tumour/cancer mean?
Early local disease
What does a Stage 2 tumour/cancer mean?
Advanced LOCAL disease
So N0 and M0 (Large size like T3 or T4)
What does a Stage 3 tumour/cancer mean?
Regional metastasis
(Does not spread through blood so is M0)
What does a Stage 4 tumour/cancer mean?
Advanced disease with distant metastasis (M1)
METASTATIC
What is the Ann Arbor Staging system used to classify?
Lymphomas
What are the 4 stages of the Ann Arbor Staging system?
I - Lymphoma affects only 1 set of lymph nodes
II - more than 1 lymph nodes affected
III - lymph nodes that are affected are on different sides of the diaphragm
IV - non lymph nodes are also affected
What is the Dukes Staging System used to classify?
Bowel cancers
What are the 4 classes of the Duke Staging System for bowel cancer?
A - Cancer only penetrated inner lining of bowel
B - Cancer penetrates through inner lining penetrating muscle wall
C - Cancer all way through muscle wall affect lymph nodes
D - Cancer metastasises
What is tumour grading?
When the degree of differentiation of the neoplasm is described
What does G1, G2, G3 and G4 mean?
G1 = well-differentiated
G2 = moderately differentiated
G3 = poorly differentiated
G4 = undifferentiated or anaplastic
How does a Grade 1 breast tumour compare to a Grade 3 tumour in a microscopic view?
G1:
-low mitotic count
-low pleomorphism
-low nuclear to cytoplasm ratio
G3:
-high mitotic count
-high pleomorphism
-High nuclear to cytoplasm ratio
When a patient has a prostate cancer to you treat them straight away?
Depends how serious it is
Normally you would monitor their PSA levels
What are some examples of different types of treatments for cancer?
Surgery
Radiotherapy
Chemotherapy
Hormone therapy
Immunotherapy
What are treatments that can be given before or after surgery?
Adjuvant
Neoadjuvant
What is an adjuvant (surgery)?
Treatment is given AFTER a surgical removal of a primary tumour to eliminate sub clinical disease (any excess cancer cells floating at distant site)
What is a Neoadjuvant?
Treatment that is given PRIOR/BEFORE surgical excision to reduce the size of the primary tumour (hopefully making surgery easier)
What is radiation therapy?
Where high dosage ionising radiation (like x-rays, gamma rays, alpha particles) are used to kill proliferating cells
How does Radiation therapy kill proliferating cells?
Triggering apoptosis or interfering with mitosis
DIrect DNA or free radicals induced damage which is detected by cell cycle triggering apoptosis
Double stranded DNA breaks
What sort of doses are given for Radiation therapy?
Why is this done?
Fractioned doses
Minimise damage to normal cells
What are the 2 types of radiation therapy?
External beam radiotherapy
Internal radiation therapy
What is external beam radiotherapy?
External machine aims radiation at the cancer
What are the 2 types of internal radiation therapy?
Brachytherapy - seeds of radiation particles, ribbons or capsules are place in or near the tumour
Systemic - radioactive iodine (I-131
What must people undergoing systemic internal radiation therapy no do?
Go near children or pregnant women
What is therapy induced cancer?
What helps reduce this when radiation therapy is being given to treat cancer?
When cancer s acquired as a result of exposure to radiation from treatment
Fractioned doses (multiple smaller doses of radiation)
What is Chemotherapy?
Systemic treatment kills cancer cells that have spread to other parts of the body
How do alkylating and Platinum based drugs work?
Cross link the 2 strands of the DNA helix
What are some examples of Alkylating and Platinum based chemothrapeutic drugs?
Cisplatin
Cyclophosphamide
How do Antimetabolite chemotherapeutic drugs work?
Mimics normal substrates involved in DNA replication
How does Vincristine act as a chemotherapeutic drug?
Blocks microtubules assemble and interferes with mitotic spindle formation
Why does chemotherapy have a negative side effects on the body?
Targets rapidly proliferating cells
What are some negative side effects of chemotherapy on the body?
Hair loss
Mouth sores
Weakened immune system
Bruising
Bleeding
Nausea, vomiting
Constipation, diarrhoea
Ulcers of GI tract
Why is the bodies immune system weakend as a result of chemotherapy?
Stops blood cells proliferating
Low WBC = Low immunity
Low RBC = Anaemia
Low Platelets = Bruising + bleeding
What is bio marker testing?
Precision medicine where specific genes, proteins and other bio makers are looked for
What type of breast cancers can be treated with Selective Oestrogen Receptor Modulators? (Hormone Therapy)
ER +ve (Oestrogen Receptor positive)
What is an example of a Hormone (Selective Oestrogen Receptor modulator)?
Tamoxifen
How does Tamoxifen act as a Hormone Therapy to ER +ve Breast cancer?
It is a Selective Oestrogen Receptor Modulator
Binds to oestrogen receptors preventing oestrogen binding to oestrogen receptors
What 2 drugs can be used to target oncogenes so will target cancer cells?
Trastuzumab(Herceptin)
Imatinib(Gleevec)
What is Herceptin/Trastuzumab used to treat?
HER2 +ve breast cancers
What is imatinib used to treat?
Lymphoma (Targets their oncogenes)
What does HER2 stand for?
Human epidermal growth factor receptor 2
How can HER2 +ve breast cancers be identified?
Monoclonal antibodies
What is used to treat HER2 +ve breast cancer?
Trastuzumab/Herceptin
What is immunotherapy?
When the immune system is targeted to help it by recognising and attacking
Are tumour infiltrating lymphocytes a good sign?
What do they indicate?
Good sign
TILs indicate that the immune system is responding to the tumour
What are some examples of immuotherapeutic drugs that can attack and shrink tumours?
Ipilimumab
Nivolumab
How do immune checkpoint inhibitors work in immunotherapy?
Block immune checkpoints allowing immune cells to respond more strongly
How do monoclonal antibodies be used in immunotherapy?
Proteins bind to specific targets making cancer cells stand out
What is an example of a vaccine used to help treat a cancer?
Oncolytic virus therapy
How does oncolytic virus therapy work?
Herpes simplex virus type 1 given
Virus infects cancer cells and healthy cells
Healthy cells can destroy virus
Cancer cant
Cancer cells destroyed by virus
What are tumour markers?
Substances released by cancer cells into circulation
Can be measured assessing response to therapy, recurrence, diagnosis
What is a tumour marker used to detect a Testicular Tumour and Choriocarinoma?
HCG (human Chorionic Gonadotrophin)
What is a tumour marker used to detect a hepatocellular carcinoma and germ cell tumours?
Alpha fetoprotein
What is a tumour marker used to detect a prostate carcinoma?
Prostate specific antigen (PSA)
What is a tumour marker used to detect Ovarian cancer?
CA125
What is a tumour marker used to detect pancreatic, gallbladder, bile duct and gastric cancers?
CA19.9
What is a tumour marker used to detect colorectal cancer?
CEA
What is a tumour marker used to detect neuroendocrine tumours?
Chromgranin A
