Neoplasia

Question 1

Name 5 clinical problems associated with benign tumours.

Answer 1

Obstruction
Hormone production 
Pressure 
Anxiety 
Transform -> neoplasm

Question 2

Name some clinical problems associated with malignant tumours.

Answer 2

Pressure and destruction - adjacent tissues
Metastasis - secondary tumour
Blood loss - ulceration
Hormone production 
Paraneoplastic effect 
flow obstruction 
Anxiety/ pain 
Pruritis 
Abnormal pigmentation

Question 3

Name a type of mixed tumour.

Answer 3

Epithelial lined glands or clefts embedded in a loose fibrous tissue matrix.

Fibroadenoma^^^^

Question 4

What 3 factors contribute to cellular immortalisation?

Answer 4

Autocrine growth receptors
Reduced apoptosis
Telomerase

Question 5

What carcinogen is scrotal cancer associated with?

Answer 5

Soot

Question 6

What carcinogens is lung carcinoma associated with?

Answer 6

Smoking
Alcohol
Atmospheric pollutants

Question 7

What carcinogen is bladder carcinoma associated with?

Answer 7

Beta-naphthylamime

Question 8

Name some chemical carcinogens.

Answer 8

Aromatic amines (B-naphthylamine)
Azo dyes
Alkylating agents
Polycyclic aromatic hydrocarbons 
Nitrosamines

Question 9

What are the following oncogenic viruses associated with

HPV
EBV
HepB/C
RNA retrovirus

Answer 9

HPV - carcinoma of the cervix
EBV - Burkitt’s lymphoma
Hep B/C - hepatocellular carcinoma
RNA retrovirus - T cell leukaemia/ lymphoma

Question 10

What two cells does UVB have an associated risk of?

Answer 10

Basal cell carcinoma

Malignant melanoma

Question 11

What cancers are the following hormones associated with

Exogenous oestrogens
Androgens and anabolic steroids
Oestrogenic steroids

Answer 11

Mammary and epithelia carcinomas
Hepatocellular tumouras
Pre-existing lesions - more vascular

Question 12

What are the 3 genetic alterations that are needed to transform a cell into a neoplastic cell?

Answer 12

Telomerase expression
Reduced expression of tumour suppressor genes
Increased or abnormal expression of dominant oncogenes.

Question 13

Give 2 examples of tumour suppressor proteins.

Answer 13

pRB

P53

Question 14

What is the difference between a initiator and a promoter?

Answer 14

Initiators are mutagenic agents whereas promotes cause cellular proliferation.

Question 15

What is a fungal carcinogen?

Answer 15

Aflatoxin B

Question 16

What cancer is UC linked to?

Answer 16

Colorectal

Question 17

What do mutations in the following genes result in

BRCA1
BRCA2

Answer 17

BRCA1 - ovarian and breast

BRCA2 - breast, prostate and pancreatic

Question 18

What are 2 things that can happen to a proto-onco gene that turns it into an oncogene?

Answer 18

Mutated

Abnormally expressed

Question 19

Name 4 key features of the metastatic cascade.

Answer 19

Downregualtion of Catherine’s
Cycling-regulation of integrins
Reduced MHC I - defence from NK cells
Endothelial adherence - CD44 upregulation

Question 20

What is neoadjuvant treatment compared to adjuvant treatment?

Answer 20

Neoadjuvant reduces the size of the primary tumour whereas adjuvant focuses on eliminating any sub-clinical conditions following surgery.

Question 21

What type of doses is radiation therapy administered in and what is the overall effect of it?

Answer 21

Fractionated

Generates free radicals + directly damages DNA of rapidly diving cells - especially during G2 - preventing M phase.

Question 22

Name 3 types of drugs that can be used in chemotherapy

Answer 22

Alkylating/platinum drugs
(Cis-platinum + cyclophosphamide)
Antibiotics 
Anti-metabolite (fluorouracil)
Plant derived (interferes with microtubule assembly)

Question 23

What type of drug is tamoxifen and what is it used to treat?

Answer 23

SERM

Oestrogen receptor positive breast cancers

Question 24

How can prostrate cancers be treated?

Answer 24

Androgen blockade

Question 25

What can herceptin be used to treat and how?

Answer 25

Breast cancers by blocking HER-2 signalling

Question 26

What inhibits BCR ABL?

Answer 26

Imatinib

Question 27

What do drugs nivolumab and ipilimumab do?

Answer 27

Block immune checkpoints

Question 28

In which cancers do you get the following elevated markers? hCG alpha fetoprotein Prostate-specific antigen CA-125

Answer 28

Testicular tumour Hepattocellular carcinoma Prostate carcinoma Ovarian cancer

Question 29

What are the 4 common sites of blood borne metastasis?

Answer 29

Liver Bone Brain Lung BBLL(ood)

Question 30

2 ways in which a colon cancer can present as an emergency?

Answer 30

Perforation | Bowel obstruction

Question 31

Colloquial and correct name for tumour of uterine myometrium?

Answer 31

Fibroid | Leiomyoma

Question 32

What is a struma ovarii?

Answer 32

Teratoid tumour of the ovaries - mainly thyroid tissue

Question 33

Name 4 primary neoplasms that occur within the brain

Answer 33

Oliodendroglioma Glioma Astrocytoma Ependyoma

Question 34

How does malaria cause Burkitt’s lymphoma?

Answer 34

Inactivate p53 gene causing polyclonal proliferation of B cells. EBV becomes reactivated which is latent in the B cells

Question 35

What cancer does fibre reduced the risk of and how?

Answer 35

Binds - carcinogens | Increased transit time - less exposure of gut to carcinogens

Question 36

What effect does early first pregnancy have in terms of developing the following cancers Breast cancer Cervical Carcinoma

Answer 36

Low incidence of breast cancer - Breast cells proliferate during pregnancy therefore an early first pregnancy means initially there is less DNA damage Increased incidence of cervical carcinoma - Prolonged exposure to HPV

Question 37

What cancer is schistosomiasis linked to?

Answer 37

Bladder carcinoma

Question 38

What cancer are aflatoxins linked to?

Answer 38

Liver cell carcinoma

Question 39

How does HPV cause cervical cancer?

Answer 39

E6 binds/ degrades p53 + activates telomerase | E7 binds RB protein

Question 40

What cancers are associated with asbestos?

Answer 40

Lung Malignant mesothelioma GI carcinoma

Question 41

What cancer is Helicobacter pylori associated with?

Answer 41

Gastric adenocarcinoma

Question 42

What is a triple negative breast cancer?

Answer 42

No oestrogen, progesterone or HER-2 receptors.

Question 43

What is FAP? What is the risk? What gene is defective?

Answer 43

Familial adenomatous polyposis Many polyps in the large intestine Untreated - colon cancer APC

Question 44

What is HNPCC?

Answer 44

Hereditary non-polyposis colon cancer

Question 45

Out of FAP and HNPCC which one has a higher chance of development of colon cancer? Which one has more polyps developing?

Answer 45

FAP FAP

Question 46

What is a tumour marker for monitoring cancers of the large intestine?

Answer 46

Carcinoembryonic antigen

Question 47

What age do you have to be to be offered bowel cancel screening? How often?

Answer 47

55 | Every two years Bowel scope screening test first time then home testing kit from then on

Question 48

What are the 2 most common aetiologies for cervical cancer?

Answer 48

HPV and chlamydia

Question 49

Who is eligible for cervical cancer screening and when will they be invited for screening? What is another name for a cervical screening test?

Answer 49

All registered women 25-49 - every 3 years 50-64 - every 5 years >65 - only women who haven’t been screened since 50 or have abnormal tests Smear test

Question 50

Why do both alleles of tumour suppressor genes need to be mutated in order for cancer to develop whereas proto-onco genes need only one allele to be mutated?

Answer 50

Mutations - TSGs - inactivating - therefore btoh need to be mutated to be ineffective Mutation - protooncogenes - activating - only one allele needed to favour and enhance neoplastic growth.

Question 51

What are the 2 classes of tumours that can occur in the testis?

Answer 51

Seminomatous and non-seminomatous

Question 52

Name some non-seminomatous tumours.

Answer 52

Teratomas Embryonal carcinomas Choriocarcinoma Yolk sac tumours

Question 53

Describe Ann Arbor staging for Lymphomas.

Answer 53

Stage I - single node region Stage II - 2 or more nodes on one side of the diaphragm Stage III - 2 or more nodes on both sides of the diaphragms Stage IV - Diffuse involvement of one or more extra-lymphatic organs - lungs, bone marrow etc.

Question 54

Describe the T1-T4 stages for TNM Classification for breast cancer.

Answer 54

<2cm 2-5cm 5+ Skin or chest wall involvement

Question 55

Name 5 tumours that produce ectopic EPO.

Answer 55

``` Hepatocellular carcinoma Renal cell carcinoma Cerebellar haemangioblastoma Uterine tumours Phaeochromocytoma ```