MoD 11 (Neoplasia 4)

Question 1

Name the most common 4 cancers in the UK, from most common to least:

Answer 1

1) Breast cancer
2) Lung
3) Prostate
4) Bowel

Question 2

What are the most common cancers affecting children < 14 yrs?

Answer 2

• Leukaemia’s
• Lymphoma’s
• CNS tumours

Question 3

Which cancers have the highest 5 year survival rates?

Answer 3

• Testicular cancer
• Malignant melanoma
• Breast cancer
• Hodgekin lymphoma
• Prostate cancer

Question 4

When predicting the outcome of a malignant neoplasm, what factors must be taken into account?

Answer 4

• Age
• General health
• Tumour site
• Availability of effective treatment
• Tumour type
• Tumour grade
• Tumour stage

Question 5

Define tumour stage:

Answer 5

Measure of the malignant neoplasm’s overall burden

Question 6

What is the most commonly used tumour staging system?

Answer 6

TNM staging system

Question 7

Explain the TNM staging system:

Answer 7

T = size of primary tumour (T1-T4)
N = extent of regional node metastasis (N0-N3)
M = extent of distant metastatic spread (M1-M2)

T only = Stage I or II
T + N = Stage III
T + N + M = Stage IV

Question 8

Name the system used to stage colorectal carcinoma:

Answer 8

Dukes’ staging system

Question 9

Explain Dukes’ staging system:

Answer 9

A = Invasion into but not through bowel wall
B = Invasion through bowel wall, not through basement membrane
C = Regional node metastasis
D = Distant metastasis

Question 10

What damage may be caused in Axillary Node Clearance?

Answer 10

• Thorocodorsal nerve damage

- Long thoracic nerve

Question 11

Define tumour grade:

Answer 11

The degree of differentiation of a neoplasm (G1 - G4)

Question 12

What are the microscopic changes seen in a poorly-/undifferentiated neoplasm?

Answer 12

• Increased nuclear:cytoplasmic ratio
• Increased number of mitotic figures
• Hyperchromasia
• Pleomorphism

Question 13

What type of cancer is the Nottingham modification of the Bloom-Richardson Grading Scale used for?
What 3 factors does it base the grade on?

Answer 13

Invasve breast cancer

1) Tubule formation (less tubules = higher grade)
2) Nuclear pleomorphism (if large and vary in shape = higher grade)
3) Mitotic count (higher = higher grade)

Question 14

If an invasive breast cancer is made up of < 10% tubules, is it likely to be low grade or high grade?

Answer 14

High grade

Question 15

What is the main treatment of cancer?

Answer 15

Surgery

Question 16

Define neoadjuvant treatment:

Answer 16

Given prior to surgical excision, to reduce size of tumour

Question 17

Define adjuvant treatment:

Answer 17

Given after surgical removal of tumour, to eliminate subclinical disease

Question 18

How does radiotherapy kill cancer cells?

Answer 18

• Ionising radiation triggers direct or free-radical induced DNA damage = triggers apoptosis

Question 19

Why is radiotherapy given in fractionated doses?

Answer 19

To minimise damage to surrounding healthy tissue

Question 20

Name the 4 classes of chemotherapy:

Answer 20

1) Antimetabollites
2) Alkylating and Platinum-based
3) Antibiotics
4) Plant-derived

Question 21

In what class of chemotherapy is Fluorouracil?

Answer 21

Antimetabollites - it mimics normal substrates (Uracil) in DNA replication

Question 22

In which class of chemotherapy is Cisplatin?

Answer 22

Alkylating and Platinum-based = crosslinks strands of double helix

Question 23

In which type of breast cancers is Tamoxifen used? Which type of cancer does it increase the risk of, and why?

Answer 23

Breast cancers containing Oestrogen receptors (ER)

Increases risk of endometrial cancer, as Tamoxifen is an agonist at the ER’s in the uterus

Question 24

25% of breast cancers are HER2+. Which drug is used to treat these cancers?

Answer 24

Herceptin

Question 25

Which tumour marker does ovarian cancer often release?

Answer 25

CA-125

Question 26

What are the cancer screening programs in the UK?

Answer 26

1) Cervical cancer between ages of 25-64
2) Breast cancer between ages of 50-70
3) Colorectal cancer between ages of 60-74

Question 27

What are the 3 main problems associated with screening programs?

Answer 27

1) Overdiagnosis
2) Length bias
3) Lead-time bias

Question 28

List some risk factors associated with cervical cancer:

Answer 28

• HPV
• Herpes
• Smoking
• Immunocompromised
• the pill

Question 29

What is the most common type of cervical cancer?

Answer 29

Squamous cell carcinoma

Question 30

What is the main symptom of cervical cancer?

Answer 30

Bleeding from the vagina

Question 31

Where does Ovarian cancer usually metastasise to?

Answer 31

• Liver
• Lung
• Peritoneum

Question 32

What is the most common type of Thyroid cancer?

Answer 32

Papillary thyroid cancer (80%)

Question 33

Where does thyroid cancer commonly metastasise to?

Answer 33

• Bone
• Liver
• Lung

Question 34

What is felt when manually palpating a breast cancer lump?

Answer 34

Immobile, hard, painless lump with irregular margin

Question 35

What are the signs/symptoms of breast cancer?

Answer 35

• Immobile, hard, painless lump with irregular margin
• ‘peau d’orange’ = pititng/dimpling of skin
• Change in shape/size of breast/nipple
• Rash on nipple
• Bloody discharge

Question 36

Why are urinary symptoms rarely seen in prostate cancer?

Answer 36

Cancer grows on the outside margin of the prostate, so doesn’t affect the urethra