Oncology

Question 1

The cancer journey

Answer 1

Question 2

Just before we start let’s be clear- What is cancer

Answer 2

• 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)

Question 3

Cancer prevention

Answer 3

• 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

Question 4

Tobacco

Answer 4

• 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

Question 5

Limit alcohol and tobacco

Answer 5

• Combination of alcohol and cigarettes increases the risk of cancer of the Esophagus
• Lag time between smoking and development of cancers

Question 6

Diet: Limit fats and calories

Answer 6

• Correlation between meat consumption and colon cancer rates in different countries
• 17,000 cases of cancer are linked to being overweight or obese

Question 7

Exercise and cancer

Answer 7

• 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

Question 8

Low-strength Radiation

Answer 8

Question 9

Avoid Carcinogens at work

Answer 9

Question 10

Avoid cancer viruses

Answer 10

Question 11

Prevention- HPV vaccination

Answer 11

• 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

Question 12

Examples of human cancer viruses

Answer 12

• 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

Question 13

Hereditary component– genetic screening

Answer 13

Question 14

Heredity, Behaviors, Other factors

Answer 14

Question 15

Medicines where repeated use could be an early warning sign for cancer

Answer 15

• Antacids/PPI = Stomach, Oesophageal/ Bowel
• Creams for itching = Breast/ Skin
• Dry cough mixtures= Lung
• Haemorrhoid = Bowel
• Loperamide = Bowel
• Paracetamol = Bowel/Ovarian/Lung

Question 16

young person and adult- NHS screening program

Answer 16

• 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

Question 17

The national screening programs

Answer 17

Question 18

The national screening programs

Answer 18

• 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

Question 19

Public Awareness Campaigns

Answer 19

• 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

Question 20

Movember the hairy facts

Answer 20

• 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

Question 21

Immediate referral (1)

Answer 21

• 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

Question 22

Immediate referral (2)

Answer 22

• 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

Question 23

Cancer tends to corrupt surrounding environment

Answer 23

Question 24

Detection/Diagnosis- Or what cancer looks like

diagnostic test

Answer 24

• 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

Question 25

What does cancer look like a macro level

Answer 25

• Pre and post-assessment by PET may give an early indication of response

Question 26

Microscopic appearance of cancer cells

Answer 26

• 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

Question 27

The size of the problem

Answer 27

• 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
  *

Question 28

All cancers average number of new cases per year

Answer 28

Question 29

Diagnosis- What we need to know about a tumour

Answer 29

• 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

Question 30

Malignant versus Benign tumours

Answer 30

• 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

Question 31

Histogenetic classification of malignant tumours

Answer 31

Question 32

Most common types of soft tissue sarcoma and their tissues of origin

Answer 32

• Muscle- Leiomyosarcoma, rhabdomyosarcoma
• Blood vessels- Angiosarcoma
• Nerve- Malignant peripheral nerve sheath tumour (MPNST)
• Fat and deep skin tissue- Liposarcoma
• Joint tissue- Synovial sarcoma

Question 33

What is grade

Answer 33

• 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

Question 34

Alternatively- Grades can be classed as low, intermediate, high

Answer 34

• 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

Question 35

What is the stage

Question 36

Do the stages of cancer matter

Answer 36

Question 37

What are metastases

Answer 37

Question 38

Local relapse- metastatic disease or not

Answer 38

• 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%