Neoplasia 4 Flashcards
What are the four most common types of cancer?
- Breast
- Prostate
- Trachea bronchus and lung
- Colon and rectum.
These four alone make up 53% of all new cancers in the UK.
These big four range from 35,000-45,000 new cases
The rest range at about 10,000 with a steady decrease
In what age group is cancer most common?
- The great majority is diagnosed in people aged over 65
- Only a small proportion in people up to age 24.
- In children younger than 14, leukaemias, central nervous system tumours and lymphomas are most common
What cancers have the best survival rates?
- Testiclular (98% 5 year survival)
- Melanoma (90% 5 year survival)
- Breast (87% 5 year survival)
What cancers have the worst survival rates?
- Pancreatic (3% 5 year survival rate)
- Lung (10% 5 year survival rate)
- Oesophageal cancer (15% 5 year survival rate)
What cancer is the biggest cause of death?
Lung cancer because it is both common and aggressive.
What factors can you use to predict the outcome of the cancer?
- Age
- General health status
- Tumour site
- Tumour tyoe
- Grade (differentiation)
- Tumour stage
- Availabiliy to effective treatments.
What is the most common method for assessing the extent of tumour?
TNM staging sytsem. This is standardised across the world for various types of cancer.
T = size of primary tumour (T1-T4)
N = extent if regional node metastasis via lymphatics (N0-N3)
M = the extent of distant metastatic spread via blood (M0-M1)
How do you convert TNM to stage?
The details vary for each cancer but very broadly speaking:
- Stage I is early local disease
- Stage II is advanced local disease (i.e. N0, M0),
- Stage III is regional metastasis (i.e. any T, N1 or more, M0)
- Stage IV is advanced disease with distant metastasis (i.e. any T, any N and M1).
What is the Ann Arbor staging?
This is used for lymphoma.
Stage I = lymphoma in a single node region
Stage II = Indicates two separate regions on one side if the diaphragm
Stage III = Spread to both sides of of the diaphragm
Stage IV = Diffuse or disseminated involvement of one or more extra-lymphatic organs such as bone marrow or lung
What is Dukes staging?
Used for colorectal carcinoma.
- Dukes’ A: Invasion into but not through the bowel,
- Dukes’ B: Invasion through the bowel wall,
- Dukes’ C: Involvement of lymph nodes,
- Dukes’ D: Distant metastases
But, TNM staging is the preferred system worldwide.
How does tumour grade describe the degree of differentiation of a neoplasm?
In general, grading of malignant neoplasms is not as standardised as for staging.
- Typically, G1 is well-differentiated,
- G2 is moderately differentiated,
- G3 is poorly differentiated
- G4 is undifferentiated or anaplastic.
For example, this system is used for squamous cell carcinoma and colorectal carcinoma.
What is the Bloom-Richardson system?
This is an internationally recognised formal grading system for breast cancer,
This assesses tubule formation, nuclear variation and number of mitosis.
Is grade immortant in all cancers?
No! Whereas staging is. (e.g. in Myeloma)
Tumour grade is more important for planning treatment and estimating prognosis in certain types of malignancy, such as soft tissue sarcoma, primary brain tumours, lymphomas, and breast and prostate cancer.
What different treatments can be used for cancer?
- Surgery
- Radiotherapy
- Chemotherapy
- Hormone therapy
- Treatment targeted to specific molecular alterations.
- Immune therapies
Surgery is the main method of treatment for cancer but the precise role for each type of treatment varies for each cancer and also depeds on the cancer’s stage.
Define Adjuvant
This is treatment give after surgical removal of a primary tumour to elminate subclinical disease.
How can we interfere in the immune system to treat cancer?
The cancer immunity cycle highlights points where immune treatments can be used.
Examples include nivolumab (Enhance T cell killing) and ipilimumab, (activating T cells) which block immune checkpoints (both known as immune checkpoint inhibitors).
