neoplasia Flashcards

Question

What is radiation sensitivity?

Answer 1

Most sensitive- labile (rapidly renewed) ``` Most to least- ~embryonic tissue ~haematopoietic organs (spleen, bone marrow) ~gonads ~epidermis ~intestinal mucous membranes ~c. tissue ~muscle/nerve tissue ```

Answer 2

DNA viruses- ~more common ~viral DNA inserted into host DNA ``` RNA viruses ~reverse transcribed then inserted into host ~may contain oncogenes ~importance not certain ~act w other factors ``` Epstein-Barr virus- Burkitts lymphoma (change in c-myc protein) Human papilloma virus- cervical/oropharyngeal carcinoma (sexually transmitted, viral protein binds to and inactivates tumour suppressors p53 and pRb) Hep B/C- hepatocellular carcinoma

Answer 3

Often act as promoters Hormones (breast cancer, prostate cancer) Drugs, inc alcohol Inflammation (long term, chronic- increased risk, esp. stomach [chronic gastritis], in oral cavity oral lichenplanus- higher risk)

Answer 4

Alcohol itself- not carcinogenic, when ethanol is metabolised can grt some metabolites (acetaldehyde) which causes DNA damage Together- - Ethanol acts as solvent - Increases permeability of oral mucosa to larger numbers of carcinogens in smoke

Answer 5

Glandular epithelium- Adenoma, adenocarcinoma Cartilage- Chondroma, chrondrosarcoma Smooth muscle Leiomyoma, leiomyosarcoma Surface epithelium Papilloma, carcinoma

Answer 6

``` 9.5M deaths (1 in 6) 2nd most common cause of death 30% population will have cancer Caries by geography, age, race etc 90% carcinoma, 10% lymphoma/sarcoma ```

Answer 7

de novo- salivary gland neoplasm Benign neoplasm- adenocarcinoma of colon Premalignant lesion- HNSCC

Answer 8

Changes in cells and tissue architecture before invasion Disorganisation of tissue- dysplasia Abnormalities- increased risk of cancer Basis of cancer screening (cervical smears, oral cancer)

Answer 9

White patch in mouth- increased risk of developing cancer

Answer 10

``` Invasion (local spread) ~pressure/obstruction ~destruction and loss of function Metastasis Non-metastatic effects- ~25% will die from cancer related cachexia ```

Answer 11

Invasion- path of least resistance, tissue destruction, perineural spread Metastasis- ~lymphatic spread- invasion of vessels (embolism/permeation) and spread to draining lymph nodes ~haematogenous spread- invasion of veins spreading to organs (liver, lung, bone, brain) ~seeding in body cavities- spread across serous cavities eg. Abdominal cavities

Answer 12

``` Neoplastic cells interact w cells and molecules in the local environment New abilities- ~motility enhanced ~alter adhesion molecules ~make poor basement membrane ~increase protease production/reduce inhibitors ~alter ECM Happens throughout ‘metastatic cascade’ ```

Answer 13

Carcinomas- lymphatic then blood later Sarcomas- blood (rarely lymphatic) Lung cancer to local nodes in hilum, to liver, bone, brain Tongue cancer to neck nodes then lungs and spine Prostate cancer to bones Melanoma to lungs Colorectal cancer to liver

Answer 14

``` Pressure and obstruction Destruction Haemorrhage Infection Pain (esp bone) Anaemia (colonisation of marrow) ```

Answer 15

Paraneoplastic syndrome ~often caused by biochem substances released by tumour cells eg. TNF-alpha Fever, anorexia, weight loss/cachexia Endocrine syndromes (Cushings, metabolic effects eg. Hypocalcaemia) Neuro problems eg. Neuropathy Haematological syndrome eg. Erythrocytosis

Answer 16

Histological assessment ~Well differentiated- looks like tissue it arose from- not as bad ~Poorly differentiated- looks nothing like tissue it arose from- much more aggressive Linked to prognosis Various methods- ~numerical grades 1,2,3 ~low, intermediate, high ~well, moderate, poor

Answer 17

Defines clinical extent of tumour Done by radiologist first Then done by pathologist after surgery ``` TNM system (WHO) Tumour (size), nodes (regional), metastasis (distant) ``` T 1-4 N 0-3 M 0 or 1 (present/absent) ``` COLORECTAL CARCINOMA Early stage cancer Stage 1- small tumour w/o metastasis Stage 2- larger tumour w/o metastasis Later stage cancer Stage 3- tumour w regional metastasis Stage 4- tumour w distant metastasis ```

Answer 18

Stage 1- 90% Stage 2- 65% Stage 3- 15%

Answer 19

``` Prognostic- likely? Diagnostic- type? Predictive- optimal drug? Pharmacodynamics- optimal dose? Recurrence- return? ```

Answer 20

Biopsy Cytology (Fine Needle Aspirates) Imaging- CT/MR/PET scanning Molecular analysis (assess genetic changes)

Answer 21

``` Surgery Radiotherapy Chemotherapy Biological (immune) therapy Supportive care ```

Answer 22

``` Tiredness Feeling sick Difficult eating/drinking Skin reaction Hair loss Haematological changes Possible long term side effects ``` Affecting rapidly dividing cells?

Answer 23

Intensity modulated radiotherapy allows you to reduce area of dose to make sure it directly targets tumour

Answer 24

``` Conventional agents (cytotoxic) ~targets DNA structure or segregation of DNA as chromosomes in mitosis (targets every cell undergoing cell division) ``` Targeted agents ~small molecules interact w molecular target maintaining malignancy/selectively expressed by tumour Hormonal therapies ~target biochem pathways of oestrogen and androgen function Biological therapies ~macromolecules w particular target/ability to regulate immune response to kill

Answer 25

Generally cytotoxic ``` Mucositis Nausea/vomiting Diarrhoea Cystisis Sterility Myalgia Neuropathy Alopecia Pulmonary fibrosis Cardio toxicity Local reaction Renal failure Myelosuppression Phlebitis ```

Answer 26

Dry mouth Immunocompromised Difficulty in maintaining oral hygiene ``` Therefore- ~oral mucosal disease ~dental disease ~discomfort ~social embarrassment ```