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Pase 2a Notes > Oncology > Flashcards

Oncology Flashcards

1
Q

What is a carcinoma

A

Malignant tumour of epithelium
E.g. basal cell carcinoma = skin

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2
Q

What kind of cancer is leukaemia?

A

White blood cell

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3
Q

Types of treatment

A

Chemotherapy
Local excision
Radiotherapy
Anti oestrogen therapy for breast cancer
Herceptin for certain genes in breast cancer

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4
Q

What is adjuvant therapy?

A

Extra therapy given after surgical excision e.g. radiotherapy

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5
Q

Where may carcinomas spread?

A

To lymph nodes that drain site
Bone
Other organs
(So need to check for micrometastases before treatment)

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6
Q

Define carcinogenesis

A

The transformation of normal cells to neoplasticism cells through permanent genetic alterations or mutations
= applies to malignant neoplasms

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7
Q

Tumour vs neoplasm

A

Oncogenesis causes tumours = abnormal swelling e.g. neoplasm
Carcinogenesis causes neoplasms = a lesion resulting from autonomous abnormal growth of cells after intimidating stimulus has been removed

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8
Q

3 Problems identifying environmental risks of cancer

A

Long interval may last decades
Complexity of environment
Ethical constraints when testing

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9
Q

How do we identify carcinogens?

A

Epidemiology evidence - look at where cancer is common and see common exposures

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10
Q

Some examples of occupational/ behavioural risks

A

Lung cancer - smoking
Bladder cancer - aniline dye and rubber
Scrotal cancer - chimney sweeps

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11
Q

Some example of direct evidence where environment has caused cancer

A

Chernobyl nuclear reactor exploded = radioactive iodine irritated thyroid

Radio graphic contrast medium thorotrast with very long half life caused liver cancer

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12
Q

Classes of carcinogen

A

Chemical - no common structure, may act directly or require enzyme metabolic conversion from pro to ultimate carcinogen
Viral
Ionising radiation - Long term effect
Non ionising radiation - UV A/B
Biological agents - hormones, mycotoxins and parasites
Miscellaneous

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13
Q

Common chemical and viral carcinogens

A

See week 2 notes!!

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14
Q

Host factors affecting carcinogenesis

A

Ethnicity
Constitutional factors - inherited, age, gender
Lifestyle - exercise, alcohol
Premalignant conditions - e.g. polyps
Trans placental exposures - drugs

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15
Q

Define carcinoma in situ

A

Hasn’t breached the Basement membrane or spread

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16
Q

Define micro-invasive carcinoma

A

Has breached basement membrane, but so little has left that risk of spreading is low

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17
Q

Invasion of basement membrane and Extracellular matrix via

A

Proteases
Collagenases
Cathepsin D
Cell motility

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18
Q

List 7 steps of metastasis

A

(Detachment)
1. Invasion of basement membrane
2. Tumour cell motility and breakdown of matrix
3. Intravasion of venules and lymphatics via collagenases
4. Adhesion protects cells in a ball and evades host defence
5. Extravasation
6.Growth (arrest)
7. Angiogenesis promotes growth

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19
Q

3 routes of hematogenous metastasis

A
  1. Metastases to lungs and grows in capillaries
  2. Blood from gut filtered in liver
  3. Adhesion molecules take to bone
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20
Q

Define invasive carcinoma

A

A carcinoma that has breached the basement membrane

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21
Q

What does in-situ neoplasia only apply to?

A

Epithelial neoplasm (basement membrane is intact)

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22
Q

3 routes of metastasis

A
  1. Haemaogenous - by blood
  2. Lymphatic - channels drain
  3. Trans-coelomic - pericardial and peritoneal cavities
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23
Q

Conventional chemotherapy is better for faster or slower growing tumours?

A

FASTER!!

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24
Q

Is conventional chemotherapy selective to tumour cells?

A

No, hits normal cells as well causing hair loss, diarrhoea etc

25
Q

Why is targeted chemotherapy more effective?

A

Exploits differences between cancer and normal cells so less side effects

26
Q

What differences to cancer cells can be exploited?

A

Gene arrays
Proteomics
Tissue microarrays

27
Q

2 examples of cancer cell processes that are different to normal cells

A
  1. Over expression of growth factor A so more proliferation
  2. Mutation for growth factor A receptor means its always switched on and increases proliferation
28
Q

How can we exploit these differences?

A
  1. Monoclonal antibody binds to and block growth factor A from binding to receptor
  2. Small molecular inhibitor of growth factor A receptors (hard to screen)
29
Q

Cetuximab physiology

A

Monoclonal antibody acts against epidermal growth factor receptor (An internal tyrosine kinase activity switch up regulates gees to proliferate and angiogenesis)

30
Q

Herceptin physiology

A

Monoclonal antibody binds to HER2 protein which causes endocytosis of receptors and lymphocytes cause cell cytotoxicity

31
Q

Nivolumab physiology

A

Block PD1 over expression which encourages body to mount an immune response to tumour

32
Q

Benign vs malignant tumour behaviour

A

Benign - non-invasive localise bland cell morphology with low mitotic activity and absent necrosis

Malignant - invasive abnormal cell morphology with high mitotic activity and necrosis

33
Q

4 tumour type classifications

A

Cell of origin:
Epithelial
Connective tissue
Haematopoetic
Other

34
Q

How might we acquire genetic changes?

A

Chance mutation
Environmental exposures
Heriditary
Micro-organisms

35
Q

2 genetic drivers of oncogenesis

A

Proto-oncogenes - promote growth
Tumour suppressor genes - inhibit growth

36
Q

How might we investigate a tumour?

A

Sputum
Radiology-guided biopsy
Bronchoscope
Surgical methods

37
Q

What is small cell carcinoma?

A

Appears as flat, smaller and grows faster, spreading to lymph nodes

38
Q

Tumour grading vs staging

A

Grading - how much tumour cells resemble normal cells
Stage - how much tumour has soread

39
Q

Expand TNM staging

A

Tumour - size, extent, depth
Nodes - extent of lymph node metastasis
Metastases - extent of spread

40
Q

Define neoplasm

A

A lesion resulting from autonomous abnormal growth of cells which persist after the initial stimulus is removed

41
Q

3 most common cancer type deaths

A

Lung
Prostate / breast
Bowel

42
Q

Structure of neoplasms

A

= Neoplastic cells
From monoclonal nucleated cells
= surrounded by fibrous stroma
Connective framework for nutrient

43
Q

What determines size of tumour?

A

Angiogenesis
(Blood supply providing oxygen and nutrients)

44
Q

Behavioural vs Histogenic classification of tumours

A

B - benign / malignant
H - cell of origin

45
Q

Benign vs Malignant neoplasms

A

B - localised, non-invasive, slow growing and low mitotic activity resembling normal tissue

M - Invasive metastasis quickly with poorly defined border

46
Q

Growth direction of benign vs malignant neoplasms

A

B - exophytic (up and out)

M - endophytic (down and in)

47
Q

How do benign vs malignant neoplasms cause morbidity and mortality

A

B - pressure on structures obstruct flow, produce hormones and transform to malignant

M. - Destruction of adjacent tissue, metastases to brain obstructs flow and blood loss from ulcers

48
Q

3 tissue neoplasms may arise from and suffix

A

Epithelial cells
Connective tisssue
Lymphoid / haematopoetic cells

= oma

49
Q

2 benign epithelial neoplasm types

A

Papilloma - non glandular, non secretory
Adenoma - secretory, glandular

Prefix with cell type of origin e.g. thyroid adenoma

50
Q

Malignant epithelial neoplasms called

A

Carcinoma - prefix with epithelial type

E.g. glandular epithelial is adenocarcinoma

51
Q

Benign connective tissue neoplasms

A

Suffix is cell origin
Adipocytes. - Lipoma
Cartilage - chondroma
Bone - osteoma
Vascular - angioma
Skeletal striated muscle - Rhabdomyoma
Smooth muscle - leiomyoma
Nerves - neuroma

52
Q

Malignant connective tissue neoplasms

A

Cell of origin prefix - sarcoma

53
Q

What is degree of differentiation?

A

Further classification of malignant neoplasms by how closely they resemble normal tissue

54
Q

What is an anaplastic neoplasm?

A

Where cell type of origin cannot be determined

55
Q

Exceptions

A

Granuloma, Mycetoma, Tuberculoma

Malignant neoplasms:
Melanoma
Mesothelioma
Lymphoma

56
Q

Sarcomas generally metastasis to

A

Lungs

57
Q

Cancers which metastasis to bone

A

Breast
Lung
Prostate
Renal
Thyroid

58
Q

What are benign tumours that only grow when body grows called?

A

Hamartoma

Pase 2a Notes (6 decks)

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