MoD Neoplasia4 Flashcards
What cancers are most common in children under 14?
Leukaemias
Central nervous system tumours
Lymphomas
What are the 4 most common cancers in adults?
Breast
Lung
Prostate
Bowel
Make up just over half of all cancers and theres about 50K cases of each each year. The the number of cases drops to around 10K for the other cancers
Which cancers have the highest and lowest survival rates?
Highest: testicular (98%), melanoma and breast
Lowest: Pancreatic, lung and oesophageal
What are the general factors used to predict outcome of individuals with malignant neoplasms?
- age and general health status
- tumour type and site
- tumour grade eg differentiation
- tumour stage
- availability of effective treatments
What is the TNM staging system?
T stands for tumour: size of primary tumour and is typically T1-T4
N stands for nodes: extend of node metastasis eg N0- none, N1 - some, N2 - lots
M stands for metastasis: extent of distant metastatic spread M0 - none, M1 - spread
Standardised across the world and slightly different TNM criteria for each type of cancer.
What is tumour staging a measure of?
Tumour stage is a measure of the malignant neoplasm's overall burden and a powerful predictor of survival. Generally: Stage I = early local disease Stage II = advanced local disease Stage III = regional metastasis Stage IV = Distant metastasis
What is the special staging for lymphoma called?
Ann Arbor staging
Stage I = lymphoma in single node region
Stage II = 2 separate regions on the same side of the diaphragm
Stage III = spread to both sides of diaphragm
Stage IV = involves other organs eg bone marrow or lungs
What is the special staging for colorectal carcinoma called?
Dukes staging A = invasion into bowel B = invasion through the bowel wall C = involvement of lymph nodes D = distant metastasis
What is tumour grading?
Grading describes the degree of differentiation. Not as standardised as for staging
G1 - well differentiated
G2 - moderately differentiated
G3 - Poorly differentiated
G4 - anaplastic
(this system used for squamous cell carcinoma and colorectal carcinoma)
What is the grading used for breast carcinoma?
The bloom-richardson system
Assesses tubule formation, nuclear variation (pleomorphism) and number if mitoses
What are the different methods of cancer treatment? (broadly)
Surgery Radiotherapy Chemotherapy Hormone therapy Treatment targeted to specific molecular alterations
What is adjuvant, neoadjuvant and curative treatment?
Adjuvant treatment is given after surgical removal of a primary tumour to eliminate subclinical disease eg micrometastasese
Neoadjuvant treatment is given to reduce the size of a primary tumour prior to surgical excision
Curative treatment is typically surgery
How does radiotherapy work?
Kills proliferating cells by triggering apoptosis or interfering with mitosis.
Radiotherapy is focuses on the tumour (surrounding healthy tissue is shielded) and is given in fractionated doses to minimise normal tissue damage.
The high dosage of ionising radiation induces DNA damage (direct or free radical) which is detected by cell cycle check points triggering apoptosis.
How does chemotherapy work? give examples
- antimetabolites mimic normal substrates involved in DNA replication eg fluorouracil
- Alkylating and platinum based drugs cross link the 2 strands of DNA eg cyclophosphamide, cisplatin
- antibiotics
- plant derived drugs eg vincristine blocks microtubule assembly and interferes with mitotic spindle formation
How does hormone therapy work?
A relative non-toxic treatment for certain malignant tumours
Selective oestrogen receptor modulators (SERMs) eg tamoxifen prevent oestrogen binding. They are used to treat hormone receptor positive breast cancer.
Androgen blockage used for prostate cancer
