S10) Incidence, Prognosis & Treatment of Neoplasms Flashcards

1
Q

Outline the incidence of different malignant neoplasms in the UK

A

Breast, lung, prostate and bowel carcinomas accounted for over half of all new cancers in the UK (53%)

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2
Q

Outline the incidence of malignant neoplasms in terms of age

A
  • The great majority is diagnosed in people aged over 65 but only a small proportion in people up to age 24
  • In children younger than 14, leukaemias, CNS tumours and lymphomas are most common
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3
Q

What is the significance of understanding survival rates and mortality for cancer?

A

Survival rates and mortality rates indicate how aggressive a cancer is

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4
Q

The survival rates for different malignant neoplasms in the UK is variable.

State the 5 year survival rates for the following:

  • Testicular cancer
  • Melanoma
  • Breast cancer
  • Pancreatic cancer
  • Lung cancer
  • Oesophageal cancer
A
  • Testicular cancer (98%)
  • Melanoma (90%)
  • Breast cancer (87%)
  • Pancreatic (3%)
  • Lung (10%)
  • Oesophageal cancers (15%)
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5
Q

What is the biggest cause of cancer-related deaths in the UK?

A

Lung cancer

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6
Q

Which 7 factors should one consider to predict the outcome from malignant neoplasms?

A
  • Age
  • General health status
  • Tumour site
  • Tumour type
  • Tumour grade (i.e. differentiation)
  • Tumour stage
  • Availability of effective treatments
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7
Q

Describe the use of tumour stage

A

Tumour stage is a measure of the malignant neoplasm’s overall burden

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8
Q

The commonest method for assessing the extent of tumour is the TNM staging system that is standardised across the world.

Outline TNM staging

A
  • T refers to the size of the primary tumour (T1 –T4)
  • N refers to the extent of regional node metastasis (N0 to N3)
  • M refers to the extent of distant metastatic spread (M0 or M1)
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9
Q

For a given cancer the T, N and M status are then converted into a stage from I to IV.

Outline how cancers are staged from I - IV using TMN staging

A
  • Stage I is early local disease
  • Stage II is advanced local disease (i.e. N0, M0)
  • Stage III is regional metastasis (i.e. any T, N1/more, M0)
  • Stage IV is advanced disease with distant metastasis (i.e. any T, any N and M1)
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10
Q

Lymphoma has its own special system called Ann Arbor staging.

Outline this form of tumour staging

A
  • Stage I indicates 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 e.g. bone marrow or lung
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11
Q

Dukes staging has been used to determine survival rates for colorectal carcinoma.

Outline this form of tumour 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 but TNM staging is the preferred system worldwide
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12
Q

Describe the use of tumour grade

A
  • Tumour grade describes the degree of differentiation of a neoplasm
  • It is more important for planning treatment and estimating prognosis in certain types of malignancy e.g. soft tissue sarcoma, primary brain tumours, lymphomas, breast and prostate cancer
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13
Q

Outline the tumour grading system used for squamous cell carcinoma and colorectal carcinoma

A
  • G1 is well-differentiated
  • G2 is moderately differentiated
  • G3 is poorly differentiated
  • G4 is undifferentiated or anaplastic
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14
Q

Some cancers use an internationally recognised formal grading system.

Identify and describe the grading system used for breast carcinoma

A

Bloom-Richardson system – assesses tubule formation, nuclear variation and number of mitoses

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15
Q

How can cancer be treated?

A

Cancer can be treated by surgery, radiotherapy, chemotherapy, hormone therapy and treatment targeted to specific molecular alterations

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16
Q

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

Describe the surgical treatment of cancer in terms of adjuvant and neoadjvant treatment

A
  • Adjuvant treatment is given after surgical removal of a primary tumour to eliminate subclinical disease
  • Neoadjuvant treatment is given to reduce the size of a primary tumour prior to surgical excision
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17
Q

Explain how radiation therapy kills proliferating cells by triggering apoptosis or interfering with mitosis

A

X-rays, etc kill rapidly dividing cells (especially in G2 phase):

  • High dosage causes either direct or 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
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18
Q

How is normal tissue damage minimised in the radiotherapy treatment of cancer?

A
  • Radiotherapy is focused on the tumour with shielding of surrounding healthy tissue
  • It is given in fractionated doses to minimise normal tissue damage
19
Q

Several classes of chemotherapy agents exist.

Identify them

A
  • Antimetabolites
  • Alkylating and platinum-based drugs
  • Antibiotics
  • Plant-derived drugs
20
Q

Chemotherapy drugs affect proliferating cells in different ways.

Explain the action of antimetabolites

A

Antimetabolites mimic normal substrates involved in DNA replication e.g. Fluorouracil

21
Q

Chemotherapy drugs affect proliferating cells in different ways.

Explain the action of alkylating and platinum-based drugs

A

Alkylating and platinum-based drugs cross-link the two strands of the DNA helix e.g. cyclophosphamide and cisplatin

22
Q

Chemotherapy drugs affect proliferating cells in different ways.

Explain the action of antibiotics

A

Antibiotics act in several different ways e.g. doxorubicin inhibits DNA topoisomerase, which is needed for DNA synthesis, while bleomycin causes double-stranded DNA breaks

23
Q

Chemotherapy drugs affect proliferating cells in different ways.

Explain the action of plant-derived drugs

A

Plant-derived drugs block microtubule assembly and interferes with mitotic spindle formation e.g. vincristine

24
Q

Hormone therapy is relatively non-toxic treatment for certain malignant tumours.

Explain the use of selective oestrogen receptor modulators to treat breast cancer

A
  • Selective oestrogen receptor modulators bind to oestrogen receptors, preventing oestrogen from binding e.g. tamoxifen
  • They are used to treat hormone receptor-positive breast cancer
25
Q

Hormone therapy is relatively non-toxic treatment for certain malignant tumours.

Explain the use of hormone therapy to treat prostate cancer

A

Androgen blockade is used for prostate cancer

26
Q

Oncogenes can be targeted by cancer therapy.

Explain the use of Hercepetin in breast cancer

A
  • ¼ of breast cancers have gross over-expression of the HER-2 gene
  • Herceptin can block Her-2 signalling
27
Q

Oncogenes can be targeted by cancer therapy.

Explain the use of Imatinib in chronic myeloid leukaemia

A
  • CML shows a chromosomal rearrangement creating an abnormal ‘Philadelphia’ chromosome in which an oncogenic fusion protein (BCR-ABL) is encoded
  • Imatinib inhibits the fusion protein
28
Q

Explain how tumour markers allow for the monitoring of the cancer burden

A
  • Various substances are released by cancer cells into the circulation
  • Although some have a role in diagnosis, in general they are most useful for monitoring tumour burden during treatment and follow up
29
Q

Identify four types of tumour markers and provide examples of each

A
  • Hormones e.g. human chorionic gonadotrophin released by testicular tumours
  • Oncofetal antigens e.g. alpha fetoprotein released by hepatocellar carcinoma
  • Specific proteins e.g. prostate-specific antigen released by prostate carcinoma
  • Mucins/glycoproteins e.g. CA-125 released by ovarian cancer
30
Q

What does cancer screening involve?

A

Cancer screening involves looking for early signs of disease in healthy people

31
Q

What are the aims of cancer screening?

A

Cancer screening attempts to detect cancers as early as possible when the chance of cure is highest

32
Q

Identify some issues with cancer screening

A
  • Lead time bias
  • Length bias
  • Over diagnosis
33
Q

Identify three established national screening programmes in the UK

A
  • Cervical cancer
  • Breast cancer
  • Bowel cancer
34
Q

Cervical carcinoma is quite a common malignancy in women in the UK.

What is known about its aetiology?

A
  • Cervical carcinoma is associated with infection with high-risk HPV
  • HPV disrupts the normal cell cycle and extends the life-span of genital epithelial cells
  • Vaccination against HPV can prevent carcinoma
35
Q

Identify 6 predisposing factors to cervical carcinoma

A
  • Early age at first intercourse
  • Multiple sexual partners
  • Increased parity
  • Lower social class
  • Oral contraceptives and nicotine
  • Genital infection
36
Q

Describe the sequence of events which occur in cervical epithelium which result in the development of invasive cervical carcinoma

A

- Sequence: normal cervical epithelium → viral infection → CIN I →CIN II → CIN III → invasion

  • Involves a progressive loss of differentiation and increasing atypia in more layers of the epithelium
37
Q

What is the value of cervical screening?

A

It picks up CIN (pre-cancerous lesions) and treatment can be given before invasion occurs (therefore curative)

38
Q

Which women are invited for cervical cancer screening and at what intervals?

A
  • 25-49 years – every three years
  • 50-64 years – every five years
  • 65+ years – only those not screened since age 50 years or those with recent abnormal tests
39
Q

Identify the relevant tumours to match these descriptions:

  • A rare type of cancer that usually affects the bones of children and adolescents
  • Often produces CEA
  • Commonest cause of cancer death in the UK
A
  • Ewing’s sarcoma: rare type of cancer that usually affects the bones of children and adolescents
  • Colon cancer: often produces CEA
  • Lung cancer: commonest cause of cancer death in the UK
40
Q

Identify the relevant tumours to match these descriptions:

  • Has a known association with Aspergillus flavus
  • Tumour that can produce 5HT (well differentiated neuroendocrine tumour)
  • Associated with EBV
A
  • Hepatocellular carcinoma: has a known association with Aspergillus flavus
  • Carcinoid tumour: tumour that can produce 5HT (well differentiated neuroendocrine tumour)
  • Burkitt’s lymphoma: associated with EBV
41
Q

Identify the relevant tumours to match these descriptions:

  • A cancer of the skin that rarely metastasises
  • Produces vanillyl mandelic acid
  • Another name for nephroblastoma
A
  • Basal cell carcinoma: a cancer of the skin that rarely metastasises
  • Phaeochromocytoma: produces vanillyl mandelic acid
  • Wilm’s tumour: another name for nephroblastoma
42
Q

Identify the relevant tumours to match these descriptions:

  • A tumour often within the skin and frequently associated with HIV infection
  • A tumour of the thyroid gland that can produce calcitonin
A
  • Kaposi’s sarcoma: a tumour, often within the skin and frequently associated with HIV infection
  • Medullary carcinoma: a tumour of the thyroid gland that can produce calcitonin
43
Q

Identify the relevant tumours to match these descriptions:

  • Associated with asbestos exposure
  • A type of lung tumour most often associated with ectopic production of ADH
A
  • Malignant mesothelioma: associated with asbestos exposure
  • Small cell carcinoma: type of lung tumour most often associated with ectopic production of ADH