Neoplasia III: Epidemiology & Principles of Management

Question 1

How have male cancer incidence rates in the UK changed over the past 20 years?

Answer 1

Lung & stomach cancer incidence rate has decreased but head & neck cancer has increased by 20% and liver by 80.

Question 2

How have female cancer incidence rates in the UK changed over the past 20 years?

Answer 2

Bladder and stomach cancer had decreased incidence rates but head & neck cancer was up by 26% (melanoma, liver, & kidney cancer had all also increased).

Question 3

What are the trends with HPV-associated cancers over the years

Answer 3

They are rising e.g. incidence of oropharynx cancer excluding soft palate rose from ~1 in 100,000 in 1990 to ~2.5 in 100,000 in 2006.

Question 4

What are the 2 cancers with the highest worldwide incidence?

Answer 4

Breast cancer
Prostate cancer

Question 5

What 2 cancers are associated with Epstein-Barr Virus (EBV)?

Answer 5

Burkitt lymphoma (prevalent in central & southeast Africa)

Nasopharyngeal carcinoma (prevalent in southeast Asia)

Question 6

Where is the global incidence of lip & oral cancer the highest?

Answer 6

Europe, North America, Australia, India subcontinent and parts of south-east Asia

Question 7

What cancer is human herpesvirus-8 associated with?

Answer 7

Kaposi sarcoma (prevalent in central & southeast Africa).

Question 8

How can you diagnose cancer?

Answer 8

Incisional biopsy- histopathological diagnosis

Fine needle aspiration- cytological diagnosis

Question 9

What is an example of screening and what is it used for?

Answer 9

Example- mammography

It’s used to look for early lesions in patients who don’t have obvious symptoms of cancer

Types of scans used: CT, MRI, PET and US

Question 10

Why is cross-section imaging important in patients with cancer diagnoses?

Answer 10

Because you need to determine exact location, metastasis, how large it is, if it’s growing so you know what viable treatment options there are to go for.

Question 11

What kind of tumours is surgery a good option for?

Answer 11

Solid tumours i.e. carcinomas, sarcomas, melanomas

Not lymphomas.

Surgically remove entirely

Is the patient well enough?

Is the surgery safe? Will it damage any other area e.g artery, spinal cord

Question 12

What is radiotherapy?

Answer 12

Treatment of disease using radiation

Use of ionising radiation to kill tumour cells

Question 13

What are the limitations of radiotherapy?

Answer 13

It relies on apoptotic mechanisms working and not mutated.

If apoptotic pathways aren’t working, the cell cannot be killed off.

You can cause more damage to the DNA leaving the cell more damaged than it was before.

Question 14

How does radiotherapy work?

Answer 14

External beam fires ionising radiation (usually X rays & gamma rays) directed onto a patient & it’s proton beam therapy so it has a high precision.

You rely on the ionising radiation to damage the DNA- with the intention of sending targeted cells down the apoptosis pathway.

This also relies on the apoptotic mechanisms working & not being mutated.

Question 15

What are a couple of other ways you can deliver radiotherapy?

Answer 15

Brachytherapy- radioactive sources placed within body e.g. Cs-137 for cervical cancer

Radionuclides- certain radioisotopes are taken up by a particular tumour cell type e.g. Iodine-131 for thyroid cancer

Question 16

What are the early side effects of radiotherapy?

Answer 16

Anorexia
Malaise

Damage to highly proliferating tissue:
-Mouth & GI- mucositis, ulcers
-Hair follicle- alopecia
-Bone marrow- myelosuppression

Question 17

What are the different types of radiotherapy and what are they commonly used for?

Answer 17

adical radiotherapy - small cancers that can be treated with radiotherapy.

Neoadjuvant radiotherapy - making large cancers smaller before surgery. If surgeons try take out large cancers during surgery, this can be damaging.

Adjuvant radiotherapy - post-operative treatment in case there may be some suspicion.

Palliative radiotherapy - radiotherapy for metastatic disease, not to cure patient but to help with symptoms. Enhancing QOL

Question 18

What are the late side effects of radiotherapy?

Answer 18

-Fibrosis
-Bowel stenosis
-Infertility
-Xerostomia
-Endarteritis obliterans - blood supply in area of radiation is affected
-Osteonecrosis - jaw bones can die off/fall apart
-Second malignancies

Question 19

What is chemotherapy?

Answer 19

Use of chemical substances to treat disease and it’s usually for disseminated/systemic disease

In cancer this includes:

cytotoxic drugs; hormonal therapies; biologicals or targeted therapies

Question 20

What are the different types of chemotherapy and what are they commonly used fo

Answer 20

look at slides

Question 21

Describe cytotoxic chemotherapy in more detail.

Answer 21

-It’s systemically administered through a vein

-It has many different modes of action depending on the drugs used

-Some damage DNA promoting apoptosis and necrosis like -radiation treatment

-However, tumours develop resistance to single agents so drugs are combined

-This chemotherapy is not cancer specific and damage normal tissue as well

-There is also a narrow window between therapeutic and toxic doses

Question 22

What is an example of a DNA-damaging agent used in chemotherapy and how does it work?

Answer 22

Cisplatin- platinum compound that causes DNA cross links so the cell should recognise the cross links and send itself into apoptosis

Common head and neck cancer dru

Question 23

What are some examples of other types of drugs used in chemotherapy and how do they work?

Answer 23

Antimetabolites- interfere with normal synthesis of nucleic acids e.g. 5-fluorouracil blocks synthesis of thymine

DNA repair inhibitors- inhibit topoisomerase II so DNA breaks are caused e.g. doxorubicin

Question 24

What are the side effects of cytotoxic chemotherapy?

Answer 24

-Malaise
-Fatigue
-Vomiting
-Myelosupression
-Mucositis
-Alopecia
-Organ toxicity
-Infertility

Question 25

Why is hormonal chemotherapy used sometimes?

Answer 25

Because some cancers are hormone sensitive e.g.

tamoxifen binds and blocks oestrogen receptor- slows/stops growth of breast cancer

Question 26

What is an example of a monoclonal antibody used in cancer treatment?

Answer 26

Cetuximab: Anti-EGFR

Used with radiotherapy to treat advanced head and neck cancers

Question 27

What are some new developments in oncological treatments?

Answer 27

look at slides