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2 - PP > Neoplasm 4 > Flashcards

Neoplasm 4 Flashcards

1
Q

List the most common cancers

A

Breast, lung, prostate and bowel carcinomas account for over half of all new cancer

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2
Q

What cancers are most common in children

A
  • In children, leukaemia, central nervous system tumours and lymphomas common
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3
Q

Which cancers have the highest and lowest 5 year survival rates

A
  • High 5 year survival rates - testis, malignant melanoma, breast, prostate
  • Low 5 year survival rates - pancreas, lung, brain, stomach, oesophageal
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4
Q

Which cancers have the highest death

A

Highest deaths - lung, breast, bowel, prostate

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5
Q

What factors should you consider when predicting cancer outcome

A

Age, general health status, tumour site, tumour type, trade, tumour stage and availability of effective treatment

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6
Q

What does tumour stage measure

A

Tumour stage measures malignant neoplasm’s overall burden

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7
Q

Explain the TNM staging system

A
  • TNM staging system - assess tumour stage
    • T - size of primary tumour
      • T0 - T4
    • N - extent of regional node metastasis
      • N0 - N3
    • M - extent of distant metastatic spread
      • M0 or M1
    • TNM status converted into a stage from I to IV
      • Stage I - early local disease (T1-2)
      • Stage II - advanced local disease (T3-4)
      • Stage III - regional metastasis (N≥1)
        - Stage IV - advanced disease with distant metastasis (M=1)
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8
Q

Explain the Ann Arbour staging system

A
  • Ann arbour staging for lymphoma
    • Stage I - lymphoma in a single node region
    • Stage II - two separate regions on same side of diaphragm
    • Stage III - spread to both sides of the diaphragm
    • Stage IV - diffuse or disseminated involvement of one or more extra-lymphatic organs such as bone marrow or lungs
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9
Q

Explain the Duke’s staging system

A
  • Dukes staging for colorectal cancer
    • Stage A - invasion into but not through bowel
    • Stage B - invasion through bowel wall
    • Stage C - Involvement of lymph nodes
      • Stage D - distant metastases
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10
Q

What does tumour grade measure

A

Tumour grade describes degree of differentiation of neoplasm

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11
Q

Explain how tumour grading occurs

A
  • Grading of neoplasms not standardized, unlike staging
    • G1 - well differentiated
    • G2 - moderately differentiated
    • G3 - poorly differentiated
    • G4 - undifferentiated or anaplastic
  • System used for colorectal carcinoma and squamous cell carcinoma
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12
Q

Explain the Bloom-Richardson grading system

A
  • Bloom-Richardson system describes tumour grade in breast cancer
    • Assesses tubule formation, nuclear variation and number of mitoses
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13
Q

Explain how tumour grading is used

A
  • Tumour grading important in planning treatment and estimating prognosis in certain types of malignancies
    • Soft tissue sarcoma, primary brain tumours, lymphoma, breast cancer, prostate cancer
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14
Q

List cancer treatment methods

A
  • Can be treated by surgery, radiotherapy, chemotherapy, hormone therapy and targeting specific molecular alterations
  • Immune system targets showing promise
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15
Q

What is the main type of cancer treatment

A

Surgery main treatment for cancers but treatment also depends on type of cancer and stage

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16
Q

Explain radiotherapy

A
  • Radiotherapy - kill proliferating cells either by inducing apoptosis or interfering with mitosis
    • Use X-ray radiation to kill rapidly dividing cells particularly in G2 of cell cycle
    • Either direct or free radical induced DNA damage in G2 detected by cell cycle checkpoints, which initiate apoptosis
    • Double stranded DNA breakages cause damaged chromosomes that prevent M phase from completing properly
    • Healthy cells shielded with metal
    • Given in fractionated doses - bigger differential effect, reduce impact on healthy cells
17
Q

Explain chemotherapy

A
  • Antimetabolites - mimic normal substrates involved in DNA replication
    • Compete with normal metabolites in DNA synthesis pathways
    • Eg. Fluorouracil
  • Alkylating and platinum based drugs cross link the two strands of DNA helix
    • Damaged DNA leading to apoptosis
    • Eg. Cisplatin, cyclophosphamide
  • Antibiotics act in different ways
    • Doxorubicin inhibits DNA topoisomerase, which is needed for DNA synthesis
    • Bleomycin causes double-stranded DNA breaks
  • Plant-derived drugs blocks microtubule assembly and interferes with mitotic spindle formation
    • Eg. Vincristine
  • All these treatment target proliferating cells but are non specific - side effects such as loss of hair follicles
18
Q

Explain hormone treatment

A
  • Non toxic treatment for certain malignant tumours
    • Selective oestrogen receptor modulators (SERMs) bind to oestrogen receptors preventing oestrogen from binding
      • Eg. Tamoxifen
      • Used to treat hormone receptor-positive breast cancer
    • Androgen blockade used for prostate cancer
19
Q

Explain how oncogenes can be targeted for treatment

A
  • Target specific mutant proteins using probes
  • Drugs that block immune checkpoints are a new emerging area of treatment
  • Eg. A quarter of breast cancers have overexpression of Her-2 gene and Herceptin can block Her-2 signalling
  • Eg. Chronic myeloid leukaemia shows a chromosomal rearrangement creating an abnormal ‘Philadelphia’ chromosome in which an oncogenic fusion protein is encoded
    • Imatinib inhibits the fusion protein
20
Q

What is curative treatment

A
  • Curative treatment - cure initial diagnosis (disease free) but can have micrometastases
    • Typically surgery
21
Q

What is adjuvant treatment

A

Given after removal of primary tumour to eliminate subclinical disease

22
Q

What is neoadjuvant treatment

A

Given to reduce size of primary tumour prior to surgical excision

23
Q

Describe the use of tumour markers in diagnosis and monitoring of disease

A
  • Various substances released by cancer cells into circulation
  • Useful for monitoring tumour burden during treatment and follow up
  • Include hormones, oncofetal antigens, specific proteins, mucin/glycoproteins
    • Oncofetal - made. In feral tissues but re-expressed in cancer tissue
24
Q

Discuss the use of cancer screenings

A
  • Look for early signs of disease

- Earlier detect of cancer lowers the spread and increase chance of cure

25
Q

What are the limitations of cancer screenings

A
  • Lead time bias - lower 5 year survival rate statistics as cancer not detected at earliest possible stage of detection
  • Length bias - length of time it takes for cancers to present
  • Over diagnosis - seems malignant but actually benign, unpredictable

2 - PP (15 decks)

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