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Semester 2 - Mechanism of Disease > Neoplasia 3 > Flashcards

Neoplasia 3 Flashcards

1
Q

List the 4 carcinomas accounting for over half of all new cancers in the UK

A

Breast, Lung, Bowel, Prostrate

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2
Q

What percentage of malignant neoplasms are diagnosed in people over 65? Under 24?

A

Over 65 = 60%

Under 24 = 1%

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3
Q

What are the most common cancers in children under 14?

A

Leukaemias, central nervous system tumours and lymphomas

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4
Q

Despite a low incidence in the UK, pancreatic cancer accounts for a large percentage of deaths in cancer patients, explain why?

A

Pancreatic cancer has a very poor 5 year survival rate so despite a low incidence, the majority of patients diagnosed with the disease results in mortality

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5
Q

List the cancers with the best and worst five year survival rates

A

Best- Testicular, melanoma and breast

Worst- Pancreatic, lung and oesophageal

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6
Q

Which factors must be considered when predicting the outcome of cancer?

A
  • Age
  • general health status
  • tumour type
  • the grade (differentiation)
  • tumour stage
  • availability of effective treatments
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7
Q

What is tumour stage?

A

Measure of the malignant neoplasm’s overall burden

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8
Q

How is tumour stage measured?

A

Most common method is the TNM staging system

T- refers to the size of the primary tumour (T1-T4)

N- describes the extent of the regional node metastasis e.g. N0- N3

M- denotes the extent of the metastatic spread e.g. M0- M1
The T, N and M are then converted into a stage I to IV

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9
Q

Describe the T1 to T4 stages from the TNM classification for breast cancer

A 
T1= less than 2 cm
T2= 2cm-5cm 
T3= greater than 5cm
T4= local spread
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10
Q

What is the special system for Lymphoma staging?

A

Ann Arbor staging

I= single node region

II= indicates two separate regions on same side of diaphragm

III= indicates spread to both sides of diaphragm

IV= indicates diffuse or disseminated involvement of one or more extra-lymphatic organs

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11
Q

What special system is used for colorectal carcinoma?

A

Dukes staging

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12
Q

Which grading system is used for breast carcinoma and what does the system assess?

A

Bloom-Richardson

Assesses tubule formation, nuclear variation and number of mitoses

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13
Q

How does grading differ from staging?

A

Grading measures the level of differentiation whereas staging measures the amount of tumour present

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14
Q

What are the main forms of cancer treatment?

A

Surgery, radiotherapy, chemotherapy, hormone therapy, treatment targeted to specific molecular alterations

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15
Q

What is adjuvant treatment?

A

Given after surgical removal of a primary tumour to eliminate subclinical disease

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16
Q

What is neoadjuvant treatment?

A

Treatment given to reduce the size of a primary tumour before surgical excision

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17
Q

How does radiotherapy kill cells?

A
  • Kills rapidly dividing cells especially in G2 of cell cycle
  • High dosage causes either direct or free radical induced damage to DNA which is detected by cell cycle check points and so triggers apoptosis to occur
  • Double-stranded DNA breakages also produced damaged chromosomes that prevent M phase in mitosis
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18
Q

What are the different classes of chemotherapy drugs?

A
  • Antimetabolites
  • Alkylating and platinum-based drugs
  • Antibiotics
  • Plant Derived drugs
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19
Q

How do antimetabolites work?

A

Mimic normal substrates involved in DNA replication

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20
Q

How do alkylating and platinum-based drugs work?

A

Cross-link the two strands of the DNA helix

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21
Q

How do antibiotics work?

A

Act in several different ways

For example doxorubicin inhibits DNA topoisomerase needed for DNA synthesis whereas bleomycin causes double-stranded DNA breaks

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22
Q

How do plant derived drugs work?

A

Block microtubule assembly and interfere with mitotic spindle formation

23
Q

Give an example of hormone therapy treatment and how it works

A

Selective oestrogen receptor modulators (SERMs) e.g. tamoxifen bind to oestrogen receptors and prevent oestrogen binding

Used to treat hormone receptor-positive breast cancer

24
Q

What are tumour markers?

A

Various substances that are released into the circulation by cancer cells that allow for monitoring of cancer burden

Examples include: hormones, oncofetal antigens, specific proteins and mucins/glycoproteins

25
Q

List the tumour markers for choricocarcinoma, yolk sac tumours, colon cancer and prostate cancer

A

Choricocarcinoma- HCG
Yolk sac- AFP
Colon- CEA
Prostate- PSA

26
Q

What is cancer screening?

A

Involves looking for early signs of disease in healthy people so can detect cancers as early as possible when the chance of curing is highest

27
Q

What are the problems with cancer screening?

A

Lead time bias (detect cancer 5 years earlier that without the screening programme despite the mortality meaning that they will die anyway)

Length bias (screening programmes are more likely to pick up slow growing tumours with better prognosis)

Over diagnosis (cancer unlikely to cause problems)

28
Q

List the current ages, time intervals and tests used in UK screening programmes for cervix, breast and colorectal cancer

A

Cervix- women aged 24 to 65, 24-49 year olds are screened every 3 years by a smear test whereas women aged 50-65 are screened every 5 years

Breast- women aged 47 to 73 are screened every 3 years

Colorectal- women and men aged 60-69 are screened every 2 years by sending a FOB blood test home to check for blood in the stools

29
Q

HPV is a cause of cervical cancer. Which two other types of cancer are associated with this virus?

A

Anal and Penile cancers

30
Q

How does familial adenomatous polyposis and HNPCC differ?

A

FAP- begins as more than 100 benign polyps in large bowel due to inherited mutation in ANP gene, can become cancerous by the adenocarcinoma sequence

HNPCC- due to inherited mutations to the MSH2 and MLH1 genes

31
Q

Which type of cancer can be caused due to mutations in the RB1 gene, other than retinoblastoma?

A

Osteosarcoma

32
Q

Mutations to BRAC2 gene can cause which form of cancer in males?

A

Male breast cancer

33
Q

How can breast cancer be treated by cancer therapy targeting specific oncogenes?

A

Over-expression of HER-2 gene can be blocked by the drug Herceptin

34
Q

How can chronic myeloid leukaemia be treated by cancer therapy targeting specific oncogenes?

A

Chromosomal rearrangement seen in the disease whereby an abnormal Philidelphia chromosome is produced, codes for an oncogenic fusion protein BCR-ABL

Imatinib drug can inhibit the fusion protein formed

35
Q

Describe the steps of Duke staging?

A

A - inner lining of the bowel

B - invaded muscle

C - invaded nearby lymph nodes

D - cancer metastasized

36
Q

What reason do we measure the blood for tumour markers?

A

To diagnose and to monitor the progress of treatment

37
Q

What cancer is cancer antigen 125 seen elevated in?

A

ovarian

38
Q

Which cell is high in hodgkins lymphoma?

A

Reed Sternberg cell

Eosinophils

39
Q

What cancer is alpha fetoprotein seen high in?

A

Liver, testes and ovaries

40
Q

Why is radiation given to people in fractionated doses?

A

Fractionated to limit damage to normal tissues

41
Q

In the grading system, what would a grade 4 indicate?

A

anaplastic or undifferentiated

42
Q

What is androgen blockade used for?

A

prostate cancer

43
Q

What did chemicals such as 2-napthylamine teach us about carcinogens?

A
  • There is a long delay (sometimes decades) between carcinogen exposure and malignant neoplasm onset
  • The risk of cancer depends on total carcinogen dosage
  • There is sometimes organ specificity for particular carcinogens, e.g. 2-napthylamine causes bladder carcinoma.
44
Q

What did the Ames test show?

A
  • Initiators are mutagens

- Promoters cause prolonged proliferation in target tissues

45
Q

How do pro-carcinogens become carcinogens?

A

Converted by the cytochrome 450 enzyme in the liver

46
Q

How does HPV infection lead to cancer?

A

It expresses the E6 and E7 proteins that inhibit p53 and pRB protein function respectively, both of which are important in cell proliferation - direct carcinogen

47
Q

How can the two hit hypothesis be explained?

A

Both tumour suppressor genes must be inactivated to enhance neoplastic growth

48
Q

Name a condition that arises from inefficient nucleotide excision repair and why does this occur?

A

Xeroderma Pigmentosum

Nucleotide instability

49
Q

Name a condition that arises from inefficient mismatch repair and why does this occur?

A

Hereditary non-polyposis colon cancer (HNPCC)

Microsatellite instability

50
Q

Name a condition that arises from inefficient double strand breakrepair and why does this occur?

A

Breast/ ovarian cancer

Chromosomal instability

51
Q

Cancer mutations affect 6 hallmark cellular behaviours, what are they?

A

1 - Self-sufficiency in growth signals

2 - Resistance to growth stop signals

3- No limit on the number of times a cell can divide (cell immortalisation)

4 - Sustained ability to induce new blood vessels (angiogenesis)

5 - Resistance to apoptosis

6 - The ability to invade and produce metastases

52
Q

What are the 4 most common cancers that make up 54% of al cancer?

A

Breast - 15%
Lung - 13%
Prostate - 13%
Bowel - 13%

53
Q

What cancers have the worst survival rates?

A

Pancreas - 3%
Lung - 10%
Oesophagus - 15%
Brain - 19%

54
Q

In TMN staging, what do each of the letters correspond to?

A

T - size of primary tumour

N - Extent of nodal metastases

M - the extent of distant metastatic spread

Semester 2 - Mechanism of Disease (10 decks)

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