Neoplasia 4 Flashcards
What are the commonest cancers in Men and Women
Men: Lung, Bowel, Prostate
Women: Lung, Bowel, Breast
What are the commonest cancers in Children (below 14)
Leukaemias
CNS tumours
Lymphomas
State the survival rates for;
- Testicular cancer
- Melanoma
- Breast cancer
- Pancreatic cancer
- Lung cancer
- Oesophageal cancer
- Testicular: 98%
- Melanoma: 90%
- Breast: 87%
- Pancreatic: 3%
- Lung: 10%
- Oesophageal: 15%
Which cancer is the biggest cause of deaths in the UK?
Lung cancer
What are 7 factors that influence the outcome of a malignant neoplasm?
- Age
- General health status
- Tumour site
- Tumour type
- Grade (differentiation)
- Tumour stage
- Availability of effective treatments
Tumour stage is a measure of the malignant neoplasm’s overall burden.
The most common system used to measure this is the TNM system. Explain this system
T: Refers to size of primary tumour (T1-T4)
N: Describes the extent of regional lymph node involvement (N0-N3)
M: Denotes the extent of metastatic spread via blood (M0 or M1)
For a given cancer the T,N and M status are usually converted to stages 1-4. The staging varies for each cancer.
Give broad descriptions of each stage
Stage I: Early local disease
Stage II: Advanced local disease (N0, M0)
Stage III: Regional metastasis (M0 with N1 or more)
Stage IV: Advanced disease with distant metastasis (M1)
Name and describe the staging system used for Lymphoma (Has its own staging system)
Ann Arbor Staging System
Stage I: Lymphoma in a single node region
Stage II: Lymphoma in 2 separate regions on same side of diaphragm
Stage III: Spread of lymphoma to both sides of diaphragm
Stage IV: Indicates diffuse/ disseminated involvement of 1/ more extra-lymphatic organs (Such as lungs, bone marrow)
Dukes’ Staging System used to be used specifically for one kind of cancer.
It is now incorporated into the TNM system.
Which cancer was it, and is still used for?
Colorectal carcinoma (bowel cancer)
Describe the Stages in Dukes’ Staging System (Colorectal carcinoma)
Dukes’ A: Invasion into, but not through bowel
Dukes’ B: Invasion through bowel wall
Dukes’ C: Involvement of lymph nodes (outside bowel wall)
Dukes’ D: Distant metastases (such as in liver)
Tumour grade describes the degree of differentiation of a neoplasm
What do the 4 grades mean?
G1: Well-differentiated
G2: Moderately differentiated
G3: Poorly differentiated
G4: Undifferentiated or Anaplastic
For what 2 cancers, is the Tumour Grading system used?
Squamous cell carcinoma
Colorectal carcinoma
Name the grading system used for Breast Carcinoma
What 3 things does it asses?
Bloom-Richardson System
Assesses;
- Tubule formation
- Nuclear variation
- Number of mitoses/ mitotic figures
Tumour grade is more important than tumour stage, for planning treatment and estimating prognosis in certain types of malignancy.
Name 4 of these malignancies
- Soft tissue sarcoma
- Primary brain tumours
- Lymphomas
- Breast and prostate cancer
List 6 types of Cancer Treatment
- Surgey
- Radiotherapy
- Chemotherapy
- Hormone therapy
- Targeted molecular therapies
- Immunotherapy
In reference to cancer, when is Adjuvant Treatment given? What is its purpose?
- Given after surgical removal of a primary tumour
- To eliminate subclinical disease (micrometastases)
In reference to cancer, when is Neoadjuvant Treatment given? What is its purpose?
- Given before surgical removal of a primary tumour
- To reduce size of the primary tumour
Radiotherapy kills proliferating cells by triggering apoptosis or interfering with mitosis.
What are 2 ways it minimises damage to normal tissues
- Focused on tumour (with shielding of surrounding healthy tissue)
- Given in fractionated doses
How does Radiotherapy kill rapidly dividing cancer cells (especially in G2 of cell cycle)?
High dosage causes either Direct or Free-radical Induced DNA damage.
This is detected by cell cycle check points triggering apoptosis
How does Radiotherapy interfere with mitosis in cancer cells?
Causes double strand DNA breaks, leading to damaged chromosomes
Thus, M phase is prevented from completing correctly
List 4 classes of Chemotherapy agents
- Antimetabolites
- Antibiotics
- Plant derived drugs
- Alkylating and Platinum based drugs
Antimetabolites are a class of chemotherapy agents.
How do they work?
Give 1 example
- Mimic normal substrates involved in DNA replication
- Fluorouracil
Antibiotics are a class of chemotherapy agents.
Give 2 examples
How does each one work?
Doxorubicin;
- Inhibits DNA topoisomerase (needed to make DNA)
Bleomycin;
- Causes double strand DNA breaks
Plant derived drugs are a class of chemotherapy agents.
Give 1 example
How does it work?
Vincristine (from Periwinkles);
- Blocks microtubule assembly and interferes with mitotic spindle formation
Alkylating and Platinum based drugs are a class of chemotherapy agents.
How do they work?
Give 2 examples
Cross link the 2 strands of the DNA helix
- Cyclophosphamide
- Cisplatin
List 4 side effects of Chemotherapy, other than Pain, Vomiting and Hair loss
- Mouth sores
- Weakened immune system
- Rashes
- Nausea/ vomiting
- Constipation/ diarrhoea
- Bruising/ bleeding
Hormone therapy is a relatively non-toxic treatment for certain malignant tumours
What kind of drugs do use to treat hormone receptor positive breast cancer?
Give an example?
Selective Oestrogen Receptor Modulators (SERMs)
Tamoxifen
How do Selective Oestrogen Receptor Modulators (SERMs) work?
One example is Tamoxifen
Bind to oestrogen receptors, preventing oestrogen from binding
Give an example of using Selective Oestrogen Receptor Modulators (SERMs) to treat prostate cancer
Androgen blockade
Identifying cancer specific alterations (such as oncogene mutations) allows us to create drugs targeted specifically at cancers cells
Give 2 examples of such drugs
Herceptin (trastuzumab)
Gleevec (imatinib)
(These are oncogene targeting drugs)
A quarter of breast cancers have over-expression of the HER2 gene (Encodes a GF receptor).
Suggest 1 oncogene targeting drug that can be used, and how it works
Herceptin, blocks HER2 signalling
Chronic Myeloid Leukaemia (CML) creates an abnormal Philadelphia chromosome in which an oncogene could fusion protein (BCR-ABL) is encoded.
Suggest an oncogene targeting drug that can be used
How does it work?
Gleevec (imatinib), inhibits the fusion protein
Cancer cells release various substances into circulation. These are called Tumour Markers.
What are they used for?
- Mainly, to monitor tumour burden during treatment and follow up
- Some have a role in diagnosis
List 4 types of Tumour Markers
- Hormones
- Oncofetal antigens
- Specific proteins
- Mucins/ glycoproteins
Given an example of a Hormone Tumour Marker
What kind of cancer releases it?
- Human Chorionic Gonadotropin (HCG)
- Testicular tumours
Given an example of an Oncofetal antigen Tumour Marker
What kind of cancer releases it?
- Alpha fetoprotein (AFP)
- Hepatocellular carcinoma
(Another example is CEA- Carcinoembryonic Antigen)
Given an example of a Specific Protein Tumour Marker
What kind of cancer releases it?
- Prostate specific antigen (PSA)
- Prostate carcinoma
Given an example of a Mucin/ Glycoprotein Tumour Marker
What kind of cancer releases it?
- CA125 (cancer antigen 125)
- Ovarian cancer
Cancer screening is meant for healthy people with no symptoms.
What are 3 possible problems with screening?
- Over diagnosis
- Lead time bias
- Length bias
In the UK, name 3 cancers that have established national screening programmes
- Cervical cancer
- Breast cancer
- Bowel cancer
Who is offered Breast cancer screening?
Women, aged 50-71
2 tests every 3 years, looks for tumours that can be surgically removed
Who is offered Cervical Cancer Screening in the UK?
How often?
(Tests for HPV)
Women aged 25-64
Every 3 years for women aged 25-49
Every 5 years for women aged 50-64
Describe Bowel Cancer Screening in the UK
2 methods
- Home testing kit: For men and women aged 60-74 (Every 2 years)
- Bowel scope screening: For men and women 56 or above (Only in some parts of England)
