Session 10

Question 1

Which cancers account for over half of all new cancers in the UK?

Answer 1

Breast, lung, prostrate and bowel carcinomas

Question 2

When are most cancers diganosed?

Answer 2

Most diagnoses are made in people aged over 65

Question 3

What cancers are diagnosed in people younger than 14?

Answer 3

Leukaemia, central nervous system tumours and lymphomas

Question 4

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

Answer 4

Lung cancer

Question 5

What factors influence the outcome for different cancers?

Answer 5

Age, general health status, tumour site, type, grade, stage and availability of effective treatments

Question 6

What is tumour stage a measure of?

Answer 6

Measure of the malignant neoplasm’s overall burden

Question 7

How is tumour staging assessed?

Answer 7

Using the TNM model

Question 8

What is the TNM model?

Answer 8

Size of tumour, regional node metastasis and M denotes the extent of metastatic spread

Question 9

Describe stage I cancer

Answer 9

Early local disease

Question 10

Describe stage II cancer

Answer 10

Advances local disease

Question 11

Describe stage III cancer

Answer 11

Regional metastasis

Question 12

What is stage 4 cancer?

Answer 12

Advanced disease with distant metastasis

Question 13

What special staging system do lymphomas use?

Answer 13

Ann Arbor staging

Question 14

What does stage 1 from the Ann Arbor staging indicate?

Answer 14

Lymphoma in a single node region

Question 15

What does stage II lymphoma from the Ann Arbor staging mean?

Answer 15

Two separate regions on one side of the diaphragm

Question 16

What does stage 3 lymphoma on the Ann Arbor staging indicate?

Answer 16

Spread to both sides of the diaphragm

Question 17

What does stage 4 lymphoma from the Ann Arbor staging indicate?

Answer 17

Diffuse or disseminated involvement

Question 18

What is staging a powerful predictor of?

Answer 18

Powerful predictor of survival

Question 19

What staging is used for colorectal carcinoma?

Answer 19

Dukes staging

Question 20

What does dukes’ A indicate?

Answer 20

Invasion into but not through the bowel

Question 21

What dos Dukes’ B indicate?

Answer 21

Invasion through the bowel wall

Question 22

What does Dukes’ C indicate?

Answer 22

Involvement of lymph nodes

Question 23

What does Dukes’ D indicate?

Answer 23

Distant metastases

Question 24

What is the preferred system of staging worldwide?

Answer 24

TNM staging

Question 25

What does the tumour grade describe?

Answer 25

The degree of differentiation of a neoplasm

Question 26

What does G1 describe?

Answer 26

Well differentiated

Question 27

What does G2 describe?

Answer 27

Moderately differentiated

Question 28

What does G3 describe?

Answer 28

Poorly differentiated

Question 29

What does G4 describe?

Answer 29

Undifferentiated or anaplastic

Question 30

What is the standard grading system used for?

Answer 30

Squamous cell carcinoma and colorectal carcinoma

Question 31

For some cancers, an internationally recognised formal grading system is used. Give an example of this

Answer 31

Breast carcinoma uses the Bloom-Richardson system

Question 32

What does the Bloom-Richardson system use?

Answer 32

This assess tubule formation, nuclear variation and number of mitoses

Question 33

What is tumour grading important for?

Answer 33

Important for planning treatment and estimating prognosis in certain types of malignancy

Question 34

When is tumour grade particularly important?

Answer 34

In soft tissue sarcoma, primary brain tumour, lymphomas and breast and prostrate cancer

Question 35

How can cancer be treated?

Answer 35

Surgery, radiotherapy, chemotherapy, hormone therapy and treatment targeted to specific molecular alterations

Question 36

What is adjuvant treatment?

Answer 36

Given after surgical removal of a primary tumour to eliminate subclinical disease

Question 37

What is neoadjuvant treatment?

Answer 37

Given to reduce the size of a primary tumour prior to surgical excision

Question 38

How does radiation therapy work?

Answer 38

Kills proliferating cells by triggering apoptosis or interfering with mitosis

Question 39

What is radiotherapy focused on?

Answer 39

Focused on the tumour with shielding of surrounding healthy tissues.

Question 40

How is radiation therapy given?

Answer 40

Given in fractionated doses to minimise normal tissues damage

Question 41

What type of radiation is used?

Answer 41

X rays or other types of ionising radiation

Question 42

Why are these types of radiation used?

Answer 42

They kill rapidly dividing cells, especially in G2 of the cell cycle. This is because high dosage causes either direct or free-radical induced DNA damage that is detected by the cell cycle check-points, triggering apoptosis

Question 43

How can chemotherapy drugs affect proliferating cells?

Answer 43

Antimetabolites, alkylation, antibiotics and plant derived

Question 44

How do antimetabolites work?

Answer 44

Mimic normal substrates involved in DNA replication

Question 45

Give an example of an antimetabolite?

Answer 45

Florouracil

Question 46

How do alkylating chemotherapy drugs work?

Answer 46

Cross link the two strand of the DNA helix

Question 47

Give some examples of alkylating chemotherapy drugs

Answer 47

Cyclophosphamide and cisplatin

Question 48

How do antibiotics work as chemotherapy drugs?

Answer 48

Doxorubicin inhibits DNA topoisomerase which is needed for DNA synthesis. Bleomycin causes double stranded DNA breaks

Question 49

How do plant derivative chemotherapy drugs work?

Answer 49

Block microtubule assembly and interferes with mitotic spindle formation

Question 50

Give an example of a plant derived chemotherapy drug

Answer 50

Vincristine

Question 51

What is a relatively non-toxic treatment for certain malignant tumours?

Answer 51

Hormone therapy

Question 52

Give an example of a hormone therapy used for cancer and how does it work?

Answer 52

Selective oestrogen receptor modulators (SERMs) such as tamoxifen bing to oestrogen receptors and prevent oestrogen form binding.

Question 53

What is tamoxifen used to treat?

Answer 53

Hormone-receptor positive breast cancer

Question 54

What hormone therapy is used for prostrate cancer?

Answer 54

Androgen blockade

Question 55

Give two early examples of oncogenes that are targeting be cancer therapy.

Answer 55

Trastuzumab (herceptin) and imatinib (gleevec)

Question 56

What does herceptin do?

Answer 56

Herceptin can block Her-2 signalling since most breast cancers have over-expression of the Her-2 gene

Question 57

How do nivolumab and ipilimumab work?

Answer 57

They are drugs that block immune checkpoints

Question 58

How is cancer burden monitored?

Answer 58

Tumour markers

Question 59

Give examples of tumour markers

Answer 59

Hormones, oncofetal antigens, specific proteins and muffins/glycoproteins

Question 60

Give example of hormonal tumour markers

Answer 60

Human chorionic gonadotropin released by testicular tumours

Question 61

Give examples of oncofetal antigens

Answer 61

Alpha fetorptoein released by hepatocellar carcinoma

Question 62

Give examples of specific proteins used as tumour markers

Answer 62

Prostrate-specific antigen released by prostrate carcinoma

Question 63

Give examples of muffins/glycoproteins that are used as tumour markers?

Answer 63

Ca-125 released by ovarian cancer

Question 64

What is the purpose of cancer screening?

Answer 64

They involve looking for early signs of disease in healthy people

Question 65

What problems are associated with cancer screening programmes?

Answer 65

Time bias, length bias and over diagnosis

Question 66

In the UK, what are the different established national screening programmes?

Answer 66

Cervical, breast and bowel cancer