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ESA 2- Mechanisms of Disease > Neoplasms 4 > Flashcards

Neoplasms 4 Flashcards

1
Q

What accounts for over half of all new cancers in the UK?

A

Breast, lung, bowel and prostate carcinomas

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2
Q

What % of malignant neoplasms are diagnosed in those over the age of 65?

A

More than 60%

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3
Q

What % of malignant neoplasms are diagnosed in those under the age of 24?

A

1%

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4
Q

What type of malignant neoplasms are most common in children younger than 14?

A

Leukaemias, central nervous system tumours and lymphomas

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5
Q

What is the survival rate for different cancer types?

A

Very variable

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6
Q

What cancers have the best outcomes in women, and what are there 5 year survival rates?

A

Melenoma (90%)
Hodgkin’s lymphoma (83%)
Breast cancer (79%)

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7
Q

What cancers have the worst outcomes in women, and what are there 5 year survival rates?

A

Pancreatic (2%)
Lung (6%)
Oesophageal (8%)

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8
Q

What cancers have the best outcomes in men, and what are there 5 year survival rates?

A

Testicular (95%)
Hodgkin’s lymphoma (84%)
Melanoma (78%)

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9
Q

Overall, what cancers account for the greatest proportion of cancer deaths, and what % of deaths do they account for?

A

Lung (22%), colorectal (10%), breast (7%) and prostate cancer (7%)

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10
Q

What factors should be considered when determining which individuals will have a favourable outcome for malignant neoplasms?

A 
Age
General health status 
Tumour site
Tumour type 
Grade (i.e. differentiation)
Tumour stage 
Availability of effective treatments
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11
Q

What is the most common method for assessing the extent of a tumour?

A

The TNM staging system

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12
Q

Why is the TNM method the most common?

A

It is standardised across the world

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13
Q

What does the T in TNM refer to?

A

The size of the primary tumour

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14
Q

How is T in TNM typically expressed?

A

T1 through to T4

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15
Q

What does the N in TNM describe?

A

The extend of regional node metastasis

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16
Q

How is N in TNM expressed?

A

N0 to N3

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17
Q

What does the M in TNM denote?

A

The extent of distant metastatic spread

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18
Q

How is M in TNM expressed?

A

M0 or M1

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19
Q

What happens to the TNM for a given cancer?

A

It is converted into a stage, from I to IV

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20
Q

What to the stages of cancer mean?

A

The details vary for each cancer, but broadly speaking-
Stage I is early local disease
Stage II is advanced local disease
Stage III is regional metastasis
Stage IV is advanced disease with distant metastasis

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21
Q

What would the TNM be for stage I and II cancers?

A

N0, M0

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22
Q

What would the TNM be for stage III cancers?

A

Any T, N1 or more, and M0

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23
Q

What would the TNM be for stage IV cancers?

A

Any T, any N, M1

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24
Q

What cancer has its own special staging system?

A

Lymphoma

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25
Q

What is the lymphoma staging system called?

A

Ann Arbor staging

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26
Q

Describe the Ann Arbor staging system

A

Stage I indicates a lymphoma in a single node region
Stage II indicates two separate regions on one side of the diaphragm
Stage III indicates spread to both sides of the diaphragm
Stage IV indicates diffuse or disseminated involvement of one or more extra-lymphatic organs, such as bone marrow or lungs

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27
Q

Why is cancer staging useful?

A

It is a powerful predictor of survival

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28
Q

What staging system has been used for colorectal carcinoma?

A

Dukes staging

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29
Q

Describe Dukes staging?

A

Dukes A- invasion into, but not through, the bowel
Dukes B- invasion through the bowel wall
Dukes C- Involvement of lymph nodes
Dukes D- distant metastases

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30
Q

What does tumour grade describe?

A

The degree of differentiation of a neoplasm

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31
Q

How does tumour grading differ from tumour staging?

A

It is not as standardised

32
Q

Describe the tumour grading system

A 
Typically-
G1 well-differentiated 
G2 moderately differentiated 
G3 poorly differentiated 
G4 undifferentiated or anaplastic
33
Q

What is the tumour grading system used for?

A

Squamous cell carcinoma and colorectal carcinoma

34
Q

What is used to grade some cancers?

A

An internationally recognised formal grading system

35
Q

What is used to grade breast carcinomas?

A

The Bloom-Richardson system

36
Q

What does the Bloom-Richardson system assess?

A

Tubule formation
Nuclear variation
Number of mitoses

37
Q

Where is tumour grading used?

A

In planning treatment and estimating prognosis

38
Q

What malignancies is tumour grading more important in?

A 
Soft tissue sarcomas 
Primary brain tumours 
Lymphomas 
Breast cancer
Prostate cancer
39
Q

How can cancer be treated?

A 
Surgery 
Radiotherapy 
Chemotherapy 
Hormone therapy 
Treatment targeted to specific molecular alterations
40
Q

How does cancer treatment vary between different cancers?

A

Surgery is the mainstay of treatment for most cancers, but the precise role of each treatment varies for each cancer, and also depends on the cancers stage

41
Q

What is adjuvant treatment?

A

Treatment given after surgical removal of a primary tumour to eliminate subclinical disease

42
Q

What is neoadjuvant treatment?

A

Treatment given to reduce the size of a primary tumour primary to surgical excision

43
Q

What does radiation therapy do?

A

Kills proliferating cells by triggering apoptosis or interfering with mitosis

44
Q

How is normal tissue protected in radiotherapy?

A

Radiotherapy focused on the tumour, with shielding of the surrounding healthy tissue
Given in fractionated doses to minimise damage to normal tissues

45
Q

What is given in radiotherapy?

A

X-rays or other type of ionising radiation

46
Q

How does radiotherapy work?

A

It kills rapidly dividing cells, especially in G2 of the cell cycle. This is because high dosage causes either direct of free-radical induced DNA damage that is detected by the cell-cycle check points, triggering apoptosis
Double-stranded DNA breakages cause damaged chromosomes that prevent M phase from completing correctly

47
Q

What classes of chemotherapy agents exist?

A

Antimetabolites
Alkylating and platinum-based drugs
Antibiotics
Plant-derived drugs

48
Q

What do antimetabolites do?

A

Mimic normal substrates involved in DNA replication

49
Q

Give an example of an antimetabolite

A

Fluorouracil

50
Q

What do alkylating and platinum-based drugs do?

A

Cross-link the two strands of the DNA helix

51
Q

Give two examples of alkylating and platinum-based drugs

A

Cyclophosphamide and cisplatin

52
Q

Give 2 examples of antibiotics that can act as chemotherapy agents

A

Doxorubicin

Bleomycin

53
Q

What does doxorubicin do?

A

Inhibits DNA topoisomerase, which is needed for DNA synthesis

54
Q

What does bleomycin do?

A

Causes double-stranded DNA breaks

55
Q

Give an example of a plant-derived drug

A

Vincristine

56
Q

What does vincristine do?

A

Blocks microtubule assembly and interferes with mitotic spindle formation

57
Q

What is the advantage of hormone therapy?

A

It is a relatively non-toxic treatment for certain malignant tumours

58
Q

What do selective oestrogen receptor modulators (SERMs) do?

A

Bind to oestrogen receptors, preventing oestrogen from binding

59
Q

Give an example of a SERM?

A

Tamoxifen

60
Q

What are SERMs used to treat?

A

Hormone receptor-positive breast cancer

61
Q

What is used to treat prostate cancer?

A

Androgen blockade

62
Q

Give an example of a cancer-specific alteration?

A

Oncogene mutations

63
Q

What can identifying cancer-specific alterations provide?

A

An opportunity to target drugs specifically at cancer cells

64
Q

Give two early examples of drugs targeted specifically at cancer cells

A

Trastuzumab (Herceptin)

Imatinib (Gleevec)

65
Q

What is herceptin used to treat?

A

Some breast cancers

66
Q

How does herceptin treat breast cancer?

A

Up to a quarter of breast cancers have gross over-expression of the HER-2 genes, and herceptin can block Her-2 signalling

67
Q

What does imatinib treat?

A

Chromic myeloid leukaemia

68
Q

How does imatinib treat chronic myeloid leukaemia?

A

Chronic myeloid leukaemia (CML) shows a chromosomal rearrangement (t9:22), creating at abnormal ‘Philadelphia’ chromosome in which an ontogenic fusion protein (BCR-ABL) is encoded. Imatinib inhibits the fusion protein

69
Q

What do cancer cells release?

A

Various substances into the circulation

70
Q

What are the substances released by cancer cells used for/

A

Some have a role in diagnosis

Most useful for monitoring tumour burden during treatment and follow up

71
Q

What kind of molecules are tumour markers?

A

Hormones
‘Oncofetal’ antigens
Specific proteins
Mucins/glycoproteins

72
Q

Give an example of a hormone tumour marker

A

Human chorionic gonadotropin released by testicular tumours

73
Q

Give an example of an ‘oncofetal’ antigen tumour marker

A

Alpha fetoprotein released from heptocellular carcinoma

74
Q

Give an example of a specific protein tumour marker

A

Prostate-specific antigen released by prostate carcinoma

75
Q

Give an example of a mucin/glycoprotein tumour marker

A

CA-125 released by ovarian cancer

76
Q

What does cancer screening attempt to do?

A

Detect cancers as early as possible when a cure is still possible

77
Q

What problems can screenings have?

A

Lead time bias
Length bias
Over diagnosis

ESA 2- Mechanisms of Disease (11 decks)

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