MoD Session 11 Flashcards
Which 6 cancers have the best survival rates?
Testicular Malignant melanoma Breast Hodgkin lymphoma Prostate Uterine
Which 5 cancers have the worst survival rate?
Stomach Brain Oesophagus Lung Pancreas
Why does pancreatic cancer have a disproportionate number of deaths considering it is a rare cancer?
Presents late so there is deceased survival
What factors affect the mean 5-year survival rates of cancers?
Age of patient General health status Tumour site and type Intrinsic aggressiveness Treatment available Stage Amount of differentiation
Which three cancers are specific to children
Leukaemias
CNS
Lymphomas
What does tumour staging indicate?
How much tumour is present in the body
What is T1-4 in the TNM classification of tumour staging?
Size of primary tumour
What is N0-3 in the TNM classification of tumour staging?
Extent of regional node metastasis
What is M0/1 in the TNM classification of tumour staging?
Is distant metastasis present?
What is done before classifying a tumour as stage I-IV?
TNM tumour staging
What sort of treatments are used generally to treat stage IV tumours?
Chemotherapy/radiotherapy
Palliative care
What TNM stages indicate a stage I tumour in a theoretical cancer?
T = 1/2 N = 0 M = 0
What TNM stages indicate a stage II tumour in a theoretical cancer?
T = 3/4 N = 0 M = 0
What TNM stages indicate a stage III tumour in a theoretical cancer?
T = any N = 1 or more M = 0
What TNM stages indicate a stage IV tumour in a theoretical cancer?
T = any N = any M = 1
What type of cancer is Ann Arbor staging used for?
Lymphoma
Describe the four stages of Ann Arbor tumour staging.
I = single node region II = two or more nodes on the same side of the diaphragm III = two or more nodes in either side of diaphragm IV = involvement of one or more extra-lymphatic organs
Which type of staging is used clinically in the UK instead of the worldwide preferred TNM staging for colorectal carcinoma?
Duke’s
What type of cancer is Duke’s staging used for?
Colorectal carcinoma
Describe stages A-D in Duke’s staging.
A = invasion into muscularis propria B = invasion through muscularis propria C = involvement of lymph nodes D = distant metastases
Which stage of Duke’s do most colorectal carcinomas present as?
B-D
How does the 5 year survival rate of colorectal carcinoma compare at Duke’s stage A to stage D?
A = 93% D = 6%
What does tumour grade measure?
Degree of differentiation
Why is tumour grading a more subjective way of classifying tumours than staging?
Grading criteria less defined
Describe the four tumour grades used in squamous cell/colorectal carcinoma.
G1 = well differentiated G2 = moderately differentiated G3 = poorly differentiated G4 = undifferentiated/anaplastic
What grading system is used internationally for breast carcinoma?
Bloom Richardson
What does the Bloom Richardson grading system score?
Presence of tubules
Mitoses
Nuclear pleomorphism
What is the percentage survival difference between G1 and G3 on the Bloom Richardson scale?
~40
Which types of cancer is tumour grading important for both planning treatment and estimating prognosis?
Soft tissue sarcoma Primary brain tumours Lymphomas Breast cancer Prostate cancer
What two things are usually more important for planning treatment and estimating prognosis in cancers where tumour grading is less important?
Age of patient
Stage of cancer
What is mainstay treatment for cancer?
Surgery
How does the intent of surgery performed for stage I tumours differ to that for stage III tumours?
Stage I is curative but III is palliative e.g. removal of an ulcer
What is adjuvant treatment of cancer?
Given after surgical removal of primary tumour to reduce the chance of recurrence (assumed metastasis is present)
What is neoadjuvant treatment of cancer?
Given before surgery to reduce primary tumour size so surgical excision is possible
How does radiation therapy treat cancer?
Triggers apoptosis
Interferes w/mitosis
What type of cells does radiation therapy target?
Rapidly proliferating
Why is a fractionated dose of radiation therapy used to treat cancer?
Allows damaged healthy cells to recover between doses
What type of radiation is used in radiation therapy?
X-Rays
Ionising
What DNA damage can be caused by radiation therapy?
Direct
Free-radical induced
Which stage of there’ll cycle is particularly affected in radiation therapy?
G2
What implications does a double strand DNA break have on cell proliferation?
Damaged chromosomes cannot complete M phase correctly
Why does chemotherapy cause hair loss, bone marrow suppression and nausea?
Non-specific targeting of rapidly proliferating areas
How do anti metabolites work in chemotherapy treatment?
Mimic normal DNA replication substrates
How do alkylating/plantinum-based agents work in chemotherapy?
Cross link DNA double helix
How does Doxorubicin carry out its chemotherapy action?
Inhibits DNA to poisoners thus inhibiting DNA synthesis
Other than inhibiting DNA synthesis, how else can antibiotics be used for chemotherapy?
Cause double strand breaks
How do plant-derived drugs such as vincristine act as chemotherapy agents?
Block microtubule and mitotic spindle formation
What are SERMs?
Selective oestrogen receptor modulators e.g. Tamoxifen
When is tamoxifen used in breast carcinoma?
If the tumour has oestrogen receptors
What hormone therapy is used to treat prostate cancer?
Androgen blockade