Lesson 10 Flashcards
What is the number of new cancer diagnoses (excluding diagnoses for non-melanoma skin cancers)?
305 683
What is the rate of people dying from cancer in England in 2017?
270.1 deaths per 100 000
What are the four malignant neoplasms with the highest incidence?
Breast, prostate, lung, bowel
Predicting outcomes of patients survival from different malignant neoplasms?
age and general health status the tumour site, the tumour type, the grade (i.e. differentiation) the tumour stage (see below) and the availability of effective treatments
What is prognosis?
The likely cause of a disease or ailment
What are prognostic indicators in a report?
Grading, staging, margin status, hormonal or gene status (as in breast cancers)
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?
Is the large tissue which is respected 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.
Describe cellular (microscopic) characteristics of malignancy
- Increasing variation in size, shape of cells, nuclei - pleomorphism.
- Increasing nuclear size + nuclear to cytoplasmic ratio. Clumping of chromatin occurs in the nuclei
- Increase in mitotic figures including abnormal mitosis.
How does grading of tumours work?
Broadly based on how a tumour resembles its parent tissue It is usually a 3 tiers system: G1 (well differentiated) G2 (moderately differentiated) G3 (poorly differentiated) G4 (anaplastic carcinoma)
Explain the modified bloom Richardson grading for breast cancer
- Tubules(1/2/3)
- Mitoses(1/2/3)
- Nuclear pleomorphism(1/2/3) G1=4-5, G2= 6- 7, G3= 8-9
Tubule formation=1, pleomorphism =2, Mitosis=1, =4 ( Grade1)
Tubule formation=3, pleomorphism =3, Mitosis=3, =9( Grade3)
Describe ‘staging’
How far has the tumour spread?
Extent of tumour at primary site (T status)
Regional metastasis (Lymph nodes-N status)
Distant metastasis (M status)
All three then constitute the TNM stage which is divided further into stage 1 -> stage 4
Other staging also specific to tumour sites Dukes staging for colorectal cancer (phased out) and Ann Arbor staging for lymphomas
What is T status?
- At certain tumour sites it is based on size (breast and kidney).
- At other sites it is based on how far the tumour has locally advanced
Breslow’s thickness (malignant melanoma): T1 <= 1.0mm T2 1.01-2.0mm T3 2.01-4.0mm T4 >4.0mm
What is Lymph node (N) status?
Regional lymph nodes- all organs have a specific lymphatic drainage–often first sites to be involved by tumour metastasis
What is distant metastasis (M status)?
Affects other organs distant to primary tumour site
What is Ann Arbour staging?
For lymphomas:
- Lymphoma in single node region
- Two separate regions on one side of the diaphragm
- Spread to both sides of diaphragm
- Diffuse.disseminated involvement on 1+ extra-lymphatic organs such as bone marrow or lungs
What is Dukes staging?
In colorectal carcinoma: A) invasion into, but not, through bowel B) invasion through the bowel wall C) involvement of lymph nodes D) distant metastases
What are some forms of treatment for cancer?
- Surgery
- Radiotherapy
- Chemotherapy
- Hormonal therapy
- Moleculartreatment
Explain how surgery can treat cancer
- Most often the main form of treatment
- Surgical resections of both primary and secondary tumours
- Other forms of treatment can precede surgery/follow surgery.
- Treatments preceding = neoadjuvant treatment where drugs are first line of treatment aimed at curing the patient + aids to shrink tumour for enabling complete surgical disease
- Adjuvant treatment (follows surgery) - aimed at eradicating subclinical disease
Explain how radiotherapy can be used to treat cancer
- Focused on tumour with shielding of surrounding healthy tissue
- Given in fractionated doses - minimise normal tissue damage.
- X-rays or other types of ionising radiation are used
- To shrink tumour as part of neoadjuvant treatment
- May be main form of treatment - anal squamous cell carcinomas
- Used in palliative setting to control bleeding, pain relief
Explain how chemotherapy can be used to treat cancer?
- Curative intent: small cell carcinomas of the lung, lymphomas.
- Neo-adjuvant setting: prior to surgery to shrink the tumour
- Adjuvant setting: which follows surgery - aimed at eradicating subclinical disease
- Palliative setting
What are 4 types of chemotherapeutic agents?
Antimetabolites
Alkylating/platinum drugs
Antibiotics
Plant-derived drugs
What is Mismatch repair protein immunohistochemistry -detection of microsatellite instability?
- PROGNOSTIC - All MSI CRC (those who have a mismatch repair deficiency) patients better prognosis, (selectively pT3N0)
- PREDICTIVE - MSI CRC do not respond to 5FU based chemotherapy
- Identification Lynch syndrome useful for patients & families
- Endoscopic surveillance
- Risk of second primary
- LS patients relatives benefit from testing
How does hormonal treatment treat cancer?
- Treat tumours driven by hormones e.g oestrogen/ testosterone
- Selective oestrogen receptor modulators (SERMs), tamoxifen, bind to oestrogen receptors, preventing oestrogen from binding. Used to treat hormone receptor- positive breast cancer. Androgen blockade used for prostate cancer.
What is targeted therapy (molecular therapy)?
Drugs specifically acting against molecular targets in cancer cells
Can be divided into 2 main categories: antibody drugs (man made versions of immune system proteins, targeting receptors) small molecules (targets abnormal proteins, or enzymes, that form on/inside cancer cells + promote uncontrolled tumour growth)
Explain how Her 2 and herceptin causes breast cancer
Her 2 and herceptin: A quarter of breast cancers have gross over-expression of the HER- 2 gene and Herceptin can block Her-2 signalling
What is chronic myeloid leukaemia (CML)? - molecular therapy
Chronic myeloid leukaemia (CML)
‘chromosomal rearrangement (t9:22) -> abnormal ‘Philadelphia’ chromosome -> oncogenic fusion protein (BCR-ABL) is encoded.
Imatinib (Gleevec) inhibits the fusion protein.
Explain how mutated Kras can cause colorectal disease
When there is metastatic colorectal disease,if the patient has a mutated form of Kras, the patient does not respond to EGFR inhibitors such as cetuximab, and other forms of treatment are required. However, if the patient has the “wild type Kras” EGFR treatment is an option
Explain personalised treatment
Giving patients the best treatment according to:
personal medical history
physiological status
molecular characteristics of their tumours
What are tumour markers and why do we use them?
- Released by cancer cells into the circulation.
- Can be used for diagnosis (PSA, AFP)
- Commonly used for monitoring tumour burden during treatment and follow up.
- Egs: CEA, AFP, hCG, Ca 125
What is the screening population for cervical screening and what test is used?
25-50 year old women (3 yearly)
50-64 (5 yearly)
Pap smear, liquid based cytology, HPV testing
What is the screening population for breast screening and what test is used?
47-73 year old women every 3 years
Mammogram
What is the screening population for bowel cancer screening and what test is used?
60-74 year old men/women every 2 years
Faecal occult, blood
What is the screening population for bowel scope screening programme and what test is used?
55-64 year olds (1 time)
Flexible sigmoidoscopy
