Neoplasia 4 Flashcards
most common cancer in men
prostate
most common cancer in women
breast
symptoms of cancer
lethargy weight loss loss of apetite
most cancers are diagnosed in people over the age of
65
- takea a long time for intitiationa dn promtoion to turn into a malignant neoplasm
in children younger than 14
leukaemis, CNS tumour and lymphomas are common
1/2 of people diagnosed with cancer in Uk will surive their disease for
10 years or more
(higher in women)
testicular cancer survival (5 years)
98%
melanoma surivival (5 year)
90%
survival rate of pancreatic (5 years)
1%
why is survival increasing
better diagnosis
- screening etc
- better education so people will come to doctors
better targeted therapy
which cancers shown little improvement in survival from 19702
lung and pancreas
which cancer is the worst for mortality in both men and women
lung cancer
how are outcomes predicted
age
general health status
tumour site
tumour type
differentiation
tumour stage
availability of effective treatments
age
older people bhave weakened immune system and tolerate treatment less well
cancer type
e. g. basal cell carcinoma never metastasise
e. g. melanoma will metastise even when small
what is used to stage solid tumours
TNM staging system
T stands for
tumour
- size of primary tumour
N stands for
node- extent of regional lymph node involvement
M stands for
metastatic
- metastatic spread via blood
T1 is
the smallest tumour
T4
is the the biggest tumour
N0
no lymph nodes invovles
N1
1 lymph node involved
N3
all involved
M0
no metastasise
M1
there are metastasise
each cancer has its own
specific TNM criteria
tumour stage is a measur eof the
overall burden of the malignant neoplasms
- coverted to a stage 1-4
stage 1=
early local disease
stage 2=
advanced lcoal disease (N0,M0)
stage 3=
regional metastasis (N1 or more with M0)
stage 4=
advaned diseasde with distant metastasis (M1)
example of TNM staging for breast cancer
Anna arbor staging system
Lymphoma staging system based in the USA
stage 1 lymphoma= single node
stage 2= two nodes invovled but on the same side of the diaphragm
stage 3= multple lymph nodes invovled but on both side of the diaphragm
stage 4= invovlement of lympahtic organs e.g. bone marrow or lungs
duke staging system
for bowel cancer (can also use TNM now)
grading
describes the degree of differentiation of a neoplasm
- how closely it resembles its tissue of origin e.g. squamous cell carcinoma
G1
well differentiated
G2
moderlalty differneitated
G3
poorly differentiated
G4
undiffernetiated or anaplastic (cant recongise where the tissue comes from)
G1 vs G3 surival
more likely to surive if lower grade
Gleasons pattern
for prostate cancer
`Grading helps ifnorm
treatment
- each if the mass is moderately differentiated - watch and wait
- if the mass is poorly differentiated- surgery
treatments for cancer
- Surgery
- Radiotherapy
- Chemotherapy
- Hormone Therapy
- Treatments targeted to specific molecular alterations
- Immunotherapy
surgery
most successful treatment for cure
- good for early tumours which have not metastised
- want to remove tumour and have clear margins
which cancers require chemotherapy instead of surgery
lymphoma and leukemia
adjuvant therapy
treatment given after surgical removal of a primary tumour to eliminate subclinical disease
neoadjuvant
treatment is given prior to surgical excision to reduce the size of the primary treatment
radiation therapy
kills proliferating cells by tirggering apoptosis or intefering with mitosis
- kills rapidly dividing cells in G2 of the cell cycle
- causes either direct or free-radical idncue DNA dmaage that is detected by cell cycle checkpoints triggering apoptossis
- doube stranded DNA breakages causes damaged chromsosmes that prevent M phase from completing correctlty
how is radiation therapy given
given in fractionated dosease to minimise normal tissue damage
-with lead shields- targeted therapy so doenst damage normal tissue
what happens if you give one large dose of radiation vs multiple smaller doses
give healthy cells time to repair between therapies
chemotherapy types
- antimetabolites
- alkylating and platinum based drugs
- antibiotics
- plant derived drugs
antimetabolites
mimic nromal substrate invovled in DNA replication
- e.g. fluorouracil
alkylating and platinum based drugs
cross link ghe two strands of the DNA helix
- cyclophosphamide
- cisplatin
antibiotics
- doxorubicin inhibit DNA topoisomerase needed for DNA synthesis
- bleomycin causes double stranded DNA breaks
plant dervived drugs
block microtubules assemble and interers with mitotic spindle formation
- vincristine from periwinkles
effects chemotherapy has on the body
affects systems with rapidly proliferating cells
- hair loss (hair cells)
- pain
- mouth sores (mucosa)
- trouble breathing
- nausea and vomiting (GI tract)
- weakened immune system (bone marrow)
- bruising and bleeding
- constipation/ diarrhea
- rashes
- neuropathy
hromone therapy example
selective oestrogen receptor modulators (SERMS)
e. g. Tamoxifen
- binds to eostrogen receptors preventing oestrogen from binding to its receptors
- used to treat hormone receptor positive breast cancer
targeting oncogenes
- Identifying cancer specific alterations such as oncogene mutations allows us to create targeted drugs specifically at cancer cells
- Trastuzumab (Herceptin)
- Imatinib (Gleevec)
immunotherapy
targets immune system to help it fight cancer by recognising and attacking cancer cells
cancer immunity cycle highlights
points where immune treatments can be used
e.g. immune checkpoint inhibitors
tumour markers
various substances released by cancer cells into the ciruclation (and urine and faeces
tumour marker measurment
- somtimes used for diagnosiss
- most useful for monitoring tumour burdne during treatment and follow-up
- assess recurrence
examples of tumour markers
– Human Chorionic Gonadotrophin - testicular tumours
– Alpha fetoprotein – hepatocellular carcinoma
– Prostate specific antigen – prostate carcinoma
– CA125 – ovarian cancer
cancer screening
meant for healthy people with no symptoms
- attempt sto detect cancers as early as possible when the chance fo cure is the highest
what screening programmes are available in the UK?
Breast screening
– Women, 47 – 73 years of age
Cervical screening
– Women, 25-64 in UK
– Every 3 years for women aged 25-49 – Every 5 years for women aged 50-64
Bowel screening
– Home testing kit: Men and women aged 60-74
– Bowel scope screening: Offered to men and women at the age of 55 in some parts of England
problems with screening
- over diagnsosis (would the cancer ever have caused a clinical problem)
- lead time bias
- lag time
