Oncology Flashcards
1
Q
The cancer journey
A
2
Q
Just before we start let’s be clear- What is cancer
A
- Uncontrolled cell proliferation
- Loss of natural apoptotic mechanism
- Decreased cellular differentiation
- Ability to invade surrounding tissues
- Ability to establish new growth at ectopic sites
- If the cancer originates in the breast and metastasizes to the lungs still classed as breast cancer (breast cells)
3
Q
Cancer prevention
A
- An individual’s risk of developing cancer depends on many factors, including age, lifestyle and genetic make-up
- We can not do anything about ageing, other than perhaps better understanding the process and it’s consequences
- We probably can’t or shouldn’t do anything about and individuals genetic make-up
- More than 40% of all cancers in the UK are linked to tobacco, alcohol, diet, obesity, inactivity, infection, radiation, occupation, post-menopaisal hormones or breastfeeding
4
Q
Tobacco
A
- Smoking causes nearly a fifth of all cancers in the UK (including 80% of lung cancers)
- Also linked to pancreatic and bladder cancer
- 20 year lag time between smoking and lung cancer
- Risk increases based on duration of smoking as oppose to number of cigarretes
5
Q
Limit alcohol and tobacco
A
- Combination of alcohol and cigarettes increases the risk of cancer of the Esophagus
- Lag time between smoking and development of cancers
6
Q
Diet: Limit fats and calories
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- Correlation between meat consumption and colon cancer rates in different countries
- 17,000 cases of cancer are linked to being overweight or obese
7
Q
Exercise and cancer
A
- Exercise can help with
- Mood- makes you feel less anxious or depressed
- Fatigue- exercising made people fitter and less tired
- Osteoporosis
- 70,000 post-menopausal women aged 50-74 (American cancer society)
- 50% reported walking as their only form of exercise
- Those that walked more than 7 hours a week are 14% less likely to be diagnosed with breast cancer compared to those that walked less than 3 hours
- Those undertaking more than an hour of vigorous exercise a day were 25% less likely to be diagnosed with breast cancer
8
Q
Low-strength Radiation
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9
Q
Avoid Carcinogens at work
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10
Q
Avoid cancer viruses
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11
Q
Prevention- HPV vaccination
A
- The aim is to vaccinate all 12 to 13-year-old girls
- The vaccination course is two injections, at 0 & 6 months
- There is a catch-up programme for girls up to 18 year old
12
Q
Examples of human cancer viruses
A
- Epstein-Barr virus = Burkitt’s lymphoma
- Human Papillomavirus = cervical cancer
- Hepatitis B = Liver cancer
- Human T-cell lymphotropic virus = Adult T-cell leukaemia
- Kaposi’s sarcoma- Associated herpesvirus = Kaposi’s sarcoma
13
Q
Hereditary component– genetic screening
A
14
Q
Heredity, Behaviors, Other factors
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15
Q
Medicines where repeated use could be an early warning sign for cancer
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- Antacids/PPI = Stomach, Oesophageal/ Bowel
- Creams for itching = Breast/ Skin
- Dry cough mixtures= Lung
- Haemorrhoid = Bowel
- Loperamide = Bowel
- Paracetamol = Bowel/Ovarian/Lung
16
Q
young person and adult- NHS screening program
A
- Chlamydia
- Abdominal Aortic Aneurysm
- Diabetic retinopathy
- Breast cancer (Age 47-73)- every 3 years
- Cervical Cancer (25-49)- Every 3 years & 50-65 every 5 years
- Bowel Cancer (60-69)- Every 2 years
17
Q
The national screening programs
A
18
Q
The national screening programs
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- There are no national screening programmes for
- Prostate cancer
- Digital rectal examination (DRE)
- Transrectal ultrasound (TRUS)
- Measurement of levels of serum prostate-specific antigen (PSA)
- Testicular cancer
- The most common symptom is a painless lump or swelling in the testicles
- Skin cancer
- Prostate cancer
19
Q
Public Awareness Campaigns
A
- CoppaFeel
- Boob tour of summer music festivals
- Boobettes university team
- Bra hijack additional labelling in bras
- Linked up with sun newspaper
- Check’em Tuesday- for breast cancer
- Already found six early-stage cancer
- Feel’em Friday- for testicular cancer
- Check’em Tuesday- for breast cancer
20
Q
Movember the hairy facts
A
- And this is just the tip of the iceberg, with:
- Breast cancer campaign’s- No makeup selfie
- Love your lady parts- national race to end womens cancer
- Go commando for mens cancer
- Feel your fella’s testicular cancer
21
Q
Immediate referral (1)
A
- A lump anywhere in the body- any solid tumour cancer
- A sore that does not heal- head and neck cancer (mouth ulcer), skin-melanoma
- A change in a skin mole- melanoma
- Persistent difficulty in swallowing- head and neck cancer
- Persistent indegestion- bowel/ovarian cancer
- Persistent pain (particularly pain that has a non-obvious cause)- Any cancer
- Change in bowel habit- bowel/ovarian cancer
- Change in urinary frequency and/or persistent pain on passing urine- bladder, prostate cancer
- Unexplained loss of appetite- any cancer
22
Q
Immediate referral (2)
A
- persistent cough or hoarseness and/or coughing blood–head and neck cancer, lung cancer
- any blood in the urine or stools– bladder cancer, prostate cancer, bowel cancer
- any abnormal vaginal bleeding– gynaecological cancer
- visual disturbance – brain cancer
- temporary loss of consciousness – any cancer
- unexplained bleeding or bruising–haematological cancers
- puckering, dimpling or redness of skin on breasts–breast cancer
- change in position of nipple, rash or nipple discharge – breast cancer
- a cough that has lasted longer than three weeks–lung cancer/secondaries
- coughing up blood– lung cancer /secondaries
- heavy night sweats – lymphoma
23
Q
Cancer tends to corrupt surrounding environment
A
24
Q
Detection/Diagnosis- Or what cancer looks like
diagnostic test
A
- Biopsy- The removal of a small amount of tissue for examination to detect cancer
- Blood test- The extraction of blood testing for abnormal cells
- Computerised Tomography (CAT) scan- A series of detailed pictures taken using x-rays from cross-section of the body.
- Endoscopy- Examine inside the body using a tube-like instrument with light + lens (this may be used to remove tissue for biopsy)
- Magnetic Resonance Imaging (MRI)- uses magnetism and radio waves to provide a clear image of a particular body part to determine tumour shape and size
- Mammogram- Radiological (x-ray) used to identify cysts, calcifications and tumours within the breast
- Positron Emission Tomography (PET)- A nuclear medicine imaging technique that produces a 3D image of internal organs
- X-rays- take pictures of cancer, used to treat (radiotherapy)
- Ultrasound- Create a picture from echoes produced by sound waves
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What does cancer look like a macro level
* Pre and post-assessment by PET may give an early indication of response
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Microscopic appearance of cancer cells
* Large number of irregularly shaped dividing cells
* Large, variably shaped nuclei
* Small cytoplasmic volume relative to nuclei
* Variation in cell size and shape
* Loss of normal specialized cell features
* Disorganised arrangement of cells
* Poorly defined tumour boundary
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The size of the problem
* There are more than 360,000 new cancer cases in the UK every year, that's nearly 990 everyday (2013‐2015)
* In males in the UK, there were around 183,000 new cancer cases in 2015
* In females in the UK, there were around 177,000 new cancer cases in 2015
* Every two minutes someone in the UK is diagnosed with cancer
* Breast, prostate, lung and bowel cancers together accounted for over half (53%) of all new cancer cases in the UK in 2015
*
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All cancers average number of new cases per year
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Diagnosis- What we need to know about a tumour
* Benign or malignant
* Histogenesis- What was its tissue of origin
* Grade- How differentiated it is
* Stage- size- the extent of local and distant invasion- TNM
* Metastatic- if it is local what is the likelihood of it been metastatic and not detected, or what are the chances of it becoming metastatic and over what time course
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Malignant versus Benign tumours
* Benign (non-cancer) tumour cell growth only locally and cannot spread by invasion or metastasis
* Malignant (cancer) cells invade neighbouring tissues, enter blood vessels, and metastasize to different sites
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Histogenetic classification of malignant tumours
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Most common types of soft tissue sarcoma and their tissues of origin
* **Muscle**- Leiomyosarcoma, rhabdomyosarcoma
* **Blood vessels-** Angiosarcoma
* **Nerve-** Malignant peripheral nerve sheath tumour (MPNST)
* **Fat and deep skin tissue**- Liposarcoma
* **Joint tissue-** Synovial sarcoma
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What is grade
* A macroscopic assessment of the degree of differentiation which the cells show
* Usually described as well-differentiated or grade 1; Moderately differentiated or grade 2 or poorly differentiated or grade 3
* Tumours with no differentiation are said to be anaplastic
* Well-differentiated grade 1 tumour is less aggressive, and often described as a low-grade cancer
* Poorly differentiated grade 3 tumours are the most aggressive and the poorest prognosis and are described as high grade
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Alternatively- Grades can be classed as low, intermediate, high
* Low‐grade means the cancer cells tend to be slow‐growing, look quite similar to normal cells (are well-differentiated), tend to be less aggressive and are less likely to spread quickly
* Intermediate ‐ grade is a middle grade
* High‐ grade means the cancer cells tend to be fast-growing, look very abnormal (are poorly differentiated), tend to be more aggressive, and are more likely to spread quickly
* Some cancers have a slightly different system of grading. For example
* breast cancers are graded 1, 2 or 3 which is much the same a slow‐grade, intermediate‐grade and high‐grade
* prostate cancer which is graded by a Gleason score. This is similar to the grading systems with a low Gleason score meaning much the same as low‐grade, and a high Gleason score meaning much the same as high‐grade
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What is the stage
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Do the stages of cancer matter
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What are metastases
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Local relapse- metastatic disease or not
* The prognosis is usually poor for patients with locally advanced or metastatic STS
* 5-year survival in patients presenting with distant metastases or after metastatic relapse is 16%
* Common sites of metastases include: lung, local soft tissue, and local, distant lymph nodes
* The 5-year survival rate in patients with lung metastases is 8%
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