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Pathology > Neoplasia 4 > Flashcards

Neoplasia 4 Flashcards

1
Q

What are the most common cancers? (4)

A

Breast carcinoma

Lung carcinoma

Prostate carcinoma

Bowel carcinoma

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2
Q

What proportion of cancer do breast, lung, prostate and bowel carcinomas account for?

A

Over half of all cancers

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3
Q

Why are carcinomas more common than other types of cancers?

A

Epithelia is a labile tissue
epithelial cells proliferate a lot
more opportunity to accumulate mutations

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4
Q

Cancer is most common in what age range?

A

65+ years

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5
Q

Cancers in children younger than 14 tend to be…? (3)

A

Leukaemias
Lymphomas

CNS tumours

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6
Q

How is the aggression of cancer measured?

A

By looking at 5 year survival rates

proportion of people with the cancer that are still alive after 5 years

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7
Q

What are some examples of cancers that have a high 5 year survival rate? (4)

A

Testicular

Prostate

Breast

Malignant melanoma

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8
Q

What are some examples of cancers that have low 5 year survival rates?

A

Brain

Lung

Stomach

Oesophagus

Pancreas

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9
Q

Which cancer gives the biggest number of deaths?

A

Lung - high incidence and aggressive

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10
Q

Which cancer gives a low number of deaths?

A

Stomach - aggressive but low incidence

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11
Q

What factors are considered when predicting the outcome of cancer?

A

Age
General health status

Tumour site
Tumour type

Tumour grade
Tumour stage

Availability of effective treatments

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12
Q

What is tumour stage?

A

Measure of neoplasm’s overall burden, including

  • size
  • how far it’s spread
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13
Q

What is the commonest method for assessing stage of tumour?

A

TNM staging system

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14
Q

What does TNM stand for?

A

T - size of tumour

N - regional node metastasis

M - distant metastatic spread

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15
Q

What are the ranges of T?

A

T1 - T4

tumour gets bigger from T1 —–> T4

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16
Q

What are the ranges of N?

A

N0 - N3
no regional node metases in N0
more regional node metastases from N0 —–> N3

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17
Q

What are the ranges of M?

A

M0 - M1

no distant metastases in M0, but are in M1

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18
Q

How does the TNM system give us the stage of the tumour? What does each stage mean?

A

T1, T2 = stage 1 - early local cancer

T3, T4 = stage 2 - locally advanced

N1, N2, N3 = stage 3 - regional metastasis

M1 = stage 4 - distant metastasis

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19
Q

What are two examples of cancers that have their own unique staging system?

A

Lymphoma

Colorectal cancer

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20
Q

What is the unique staging system for lymphoma?

A

Ann Arbor system

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21
Q

What is the Ann Arbor staging system for lymphoma?

A

Stage 1 - lymphoma in a single node region

Stage 2 - lymphoma in two separate regions, one side of diaphragm

Stage 3 - lymphoma in two separate regions, both sides of diaphragm

Stage 4 - involvement of extra-lymphatic organ e.g. bone marrow

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22
Q

What is the unique staging system for colorectal cancer?

A

Dukes staging system

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23
Q

What is the Dukes staging system for colorectal cancer?

A

Stage A - invasion into but not through bowel wall

Stage B - invasion through bowel wall

Stage C - involvement of lymph nodes

Stage D - distant metastases

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24
Q

How does the stage of a cancer relate to the outcome?

A

Stage correlates with outcome

higher stage means poorer outcome - more deaths, earlier on

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25
Q

What is the difference between regional and distal metastases?

A

Local involves lymphatics only

Distant also involves blood circulation
more severe

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26
Q

What is the grade of a tumour based on?

A

The degree of differentiation of the neoplasm

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27
Q

What are the different grades of a tumour? What do they each mean?

A

G1 - well-differentiated

G2 - moderately differentiated

G3 - poorly differentiated

G4 - undifferentiated, anaplastic - doesn’t resemble any tissue

28
Q

Which cancers is the G1 - G4 grading system used for?

A

Squamous cell carcinoma

Colorectal carcinoma

29
Q

Which type of cancer has its own unique grading system? What is the grading system called?

A

Breast cancer

Blood-richardson system

30
Q

What is the Bloom-richardson grading system for cancer?

A

Give points based on presence of

  • tubules
  • mitotic figures
  • nuclear pleomorphism
31
Q

How does tumour grading correlate with outcome?

A

The worse a grade of tumour i.e. the more undifferentiated it is
the poorer the outcome - reduced survival

32
Q

Tumour grading is particularly important in which types of cancer?

A

Breast cancer

Prostate cancer

Primary brain tumour

Lymphomas

33
Q

How is cancer treated?

A

Surgery

Radiotherapy

Chemotherapy

Hormone therapy

Treatment targeted to specific molecule alterations

Therapies targeting immune system

34
Q

What is the MAIN treatment for cancer?

A

Surgery

35
Q

What is adjuvant treatment?

A

Treatment given after surgical removal of primary tumour

to eliminate any micrometastases

36
Q

What is neoadjuvant treatment?

A

Treatment given to reduce size of tumour

in order to allow for removal by surgery

37
Q

How does radiation kill cancer cells?

A

Direct DNA damage

or produces free radicals
which then damage DNA - so is indirectly done

DNA damage means cell is stopped at checkpoint of cell cycle
undergoes apoptosis

38
Q

How is normal tissue protected from radiation?

A

Shield normal tissue

Give radiation in fractionated doses to minimise normal tissue damage

39
Q

What type of radiation is used in radiotherapy?

A

X-rays

40
Q

Radiation kills cancer cells when they are in what phase of the cell cycle?

A

Mostly G2 phase

41
Q

What are the different types of drugs given in chemotherapy?

A

Antimetabolites

Alkylating agents

Antibiotics

Plant-derived drugs

42
Q

How do antimetabolites kill cancer cells?

A

Mimic substrates involved in DNA replication

so DNA replication doesn’t occur

43
Q

What is an example of an antimetabolite?

A

Fluorouracil

44
Q

How do alkylating agents work?

A

Form cross-links between the two strands of DNA

so it can’t replicate

45
Q

What is an example of an alkylating agent?

A

Cisplatin

46
Q

How do antibiotics kill cancer cells?

A

Damage DNA of the cancer cells

induces apoptosis of the cell

47
Q

What are some examples of antibiotics used to treat cancer? How do they each work?

A

Doxyrubicin - inhibits DNA topoisomerase

Bleomycin - causes double-stranded breaks in DNA

48
Q

How do plant-derived drugs kill cancer cells?

A

Block microtubule assembly

interferes with mitotic spindle formation

49
Q

What is an example of a plant-derived drug used to kill cancer cells?

A

Vincristine

50
Q

What is a disadvantage of chemotherapy?

A

Damages healthy cells that proliferate a lot

e.g. epithelia, bone marrow, hair follicles

51
Q

What is an example of a hormone therapy used to treat breast cancer? What does it do?

A

Tamoxifen - binds to oestreogen receptors and blocks them so oestreogn can’t bind

52
Q

When is tamoxifen ideal for treatment of breast cancer?

A

If breast cancer is oestrogen receptor positive

53
Q

What do oestrogen receptors look like under the microscope?

A

Appear brown

54
Q

What is a gene that’s commonly over-expressed in breast cancer?

A

HER-2 gene

55
Q

Which drug is used to block her-2 signalling in breast cancer?

A

Herceptin

56
Q

Which is the genetic alteration that has occurred in chronic myeloid leukaemia?

A

Translocation between chromosomes 9 and 22
creating abnormal fusion protein BCR-ABL
causes excessive cell proliferation

57
Q

How is chronic myeloid leukaemia treated?

A

Imatinib - inhibits the abnormal fusion protein BCR-ABL

58
Q

How do therapies targeting the immune system work?

A

Block immune checkpoints

59
Q

How are tumour markers used clinically?

A

Monitor tumour burden
during treatment
for follow-up

60
Q

What are some of the different types of tumour markers?

A

Hormones

Oncofoetal antigens

Specific proteins

Glycoproteins

61
Q

What is the aim of cancer screening and why?

A

Detect cancers as early as possible

chance of cure is highest earlier on

62
Q

What are some of the disadvantages of screening?

A

Lead time bias

Length bias

Overdiagnosis

63
Q

What is lead time bias?

A

Person gets cancer and dies by cancer at same time

but if diagnosed earlier, seems like they’ve lived longer
but they actually haven’t

64
Q

What is length bias?

A

Slow growing tumours are diagnosed more by screening than rapidly growing tumours
are less aggressive, better outcome to begin with

makes screening seem more effective than it is

65
Q

What is overdiagnosis?

A

Seems that cancer rates are increasing rapidly
but are actually just diagnosing benign tumours
that may not have presented clinically otherwise
because are asymptomatic

Pathology (4 decks)

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