Neoplasia 4 Flashcards
What are the 4 most common cancers in the UK?
Breast
Lung
Prostate
Bowel
What are the 3 most common cancers in children under 14?
Leukaemias
CNS tumours
Lymphomas
Which type of cancer causes the most UK deaths?
Lung
Name 5 types of cancer with high 5 year survival rates
Testes Malignant melanoma Breast Hodgkin lymphoma Prostate
Name 5 cancers with very low 5 year survival rates
Pancreas Lung Oesophagus Brain Stomach
What factors do we need to consider in predicting outcome of cancer?
Age General health status Tumour site Tumour type Grade (differentiation) Stage Availability of effective treatment
Tumour stage is a measure of …
Neoplasm burden
Describe the TNM staging system
Most widely recognised system worldwide
T = size of primary tumour (T1-T4)
N = extent of regional node metastasis (N0-N3)
M = distant metastatic spread (M0-M1)
Each cancer has its own specific TNM criteria
Describe (generally) stage I to IV of cancer
I = early local disease II = advanced local disease III = regional metastasis IV = advanced disease with distant metastasis
Which type of cancer do we use the Ann Arbor staging for?
Lymphoma
Describe the Ann Arbor staging?
Used to stage lymphoma
I = lymphoma in single node region
II = 2 separate regions on same side of diaphragm
III = spread to both sides of diaphragm
IV = metastasis to one or more extra-lymphatic organ
Which cancer do we use Dukes’ staging for?
Colorectal carcinoma
Describe Dukes’ staging
For colorectal carcinoma A = invasion into but not through bowel wall B = invasion through bowel wall C = involvement of lymph nodes D = distant metastases
Briefly describe the tumour grading system
Describes the degree of differentiation G1 = well differentiated G2 = moderately differentiated G3 = poorly differentiated G4 = undifferentiated/anaplastic
Which grading system is used for breast carcinoma and what do we have to assess to grade?
Bloom-Richardson System
Assess: tubule formation, nuclear variation and number of mitoses
What is the main treatment for most cancers?
Surgery
What is adjuvant treatment?
Given after surgery
Eliminate any sub-clinical disease remaining (micromets)
What is neoadjuvant treatment?
Given prior to surgery
Reduce the tumour size to make it more operable
How does radiation therapy work?
Kills proliferating cells by triggering apoptosis or interfering with mitosis
Describe the process of radiotherapy
Focused on tumour with shielding of the surrounding tissues
Given in fractionated doses to minimise normal tissue damage
Use ionising radiation (eg. Xray)
Causes direct or free radical induced DNA damage - triggers apoptosis
Or causes double stranded DNA breaks which prevent mitosis
How do anti metabolites work?
Mimic normal substrates involved in DNA replication
Eg. Fluorouracil
How do alkylating and platinum based drugs work?
Cross-link the 2 strands of the DNA helix
Eg. Cisplatin
How do antibiotics work as chemotherapy?
May inhibit DNA topoisomerase needed for DNA synthesis
May causes double stranded DNA breaks (no mitosis)
How do plant-derived drugs work in chemotherapy?
Blocks microtubule formation
Cannot undergo mitosis
What are SERMs?
Selective oestrogen receptor modulators
Eg. Tamoxifen
Binds to oestrogen receptors to prevent oestrogen binding
Limit tumour growth
Treatment for hormone receptor positive breast cancer
What do we call the hormone therapy used to treat prostate cancer?
Androgen blockade
How can we target oncogenes in breast cancer?
25% of breast cancers have over expression of HER-2
Use Herceptin which blocks HER-2 signalling
How can we target oncogenes in chronic myeloid leukaemia?
Shows a chromosomal rearrangement known as Philadelphia chromosome which encodes a oncogenic fusion protein BCR-ABL
Imatinib inhibits this protein
What hormone may be released from testicular tumours?
hCG
Which antigen may be released from hepatocellular carcinoma?
Alpha fetoprotein
What protein may be released from prostate carcinoma?
PSA - prostate specific antigen
What can be used as a marker for ovarian cancer?
CA-125
Name the problems with cancer screening
Lead time bias
Length bias
Over diagnosis
Describe lead time bias
People appear to be living longer with the particular cancer but actually we are just finding it earlier
Describe length bias
Screening preferentially identifies slower growing tumours
Describe over diagnosis
Diagnosing cancers that may never progress or cause a problem to that person during their lifetime
May be giving unnecessary treatment
Which cancers currently have screening programmes for them in the UK?
Breast
Cervical
Bowel
What is cervical cancer strongly associated with?
HPV
Over 90% of cases
What types of cancers occur in the cervix?
90% = squamous cell carcinoma 10% = adenocarcinomas
What is the likelihood for any woman of developing breast cancer?
1 in 8
What is the commonest cancer in men?
Prostate carcinoma
Where does prostate carcinoma metastasise to?
Lymph nodes and bone
Germ cell testicular tumours often release which markers?
AFP
hCG
Which cells are indicative of Hodgkin’s lymphoma?
Reed-Sternberg cells
Multinucleated
