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Pathological Processes > Session 10 > Flashcards

Session 10 Flashcards

1
Q

What are the four most common cancers accounting for over half of all new cancers in the UK?

A

Breast
Lung
Prostrate
Bowel

All carcinomas

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2
Q

Why are the four most common cancers all carcinomas?

A

Epithelium is a labile tissue with a high turnover —> increased chance for mutation

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3
Q

The great majority of cancer is diagnosed amongst which ages?

A

Over 65

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4
Q

In children younger than 14, which cancers are most common? (3)

A

Leukaemias
CNS tumours
Lymphomas

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5
Q

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

A

Lung cancer

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6
Q

The survival for different cancer types in the UK is very variable.

Name 3 cancers that have a particularly high 5 year survival rate

A

Testicular
Melanoma
Breast cancer

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7
Q

The survival for different cancer types in the UK is very variable.

Name 3 cancers that have a particularly low 5 year survival rate

A

Pancreas
Lung
Oesophagus

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8
Q

What factors can be used to predict the outcome of malignant neoplasms on individuals? (7)

A 
Age
General health status
Tumour site
Tumour type
Grade 
Stage
Availability of effective treatments
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9
Q

The commonest method for assessing the extent of a tumour is…

A

The TNM staging system

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10
Q

What does the letters in the TNM staging system stand for?

A

Tumour

Nodes
Metastases

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11
Q

What does the T in TNM stand for? What does it describe? How is it expressed?

A

Tumour

Size of the primary tumour

T1 - T4 (increasing size of tumour)

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12
Q

What does the N in TNM stand for? What does it describe? How is it expressed?

A

Nodes

Extent of regional node metastasis

N0 - N2 (increasing spread in regional nodes, N0 = no presence in regional nodes)

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13
Q

What does the M in TNM stand for? What does it describe? How is it expressed?

A

Metastases

Extent of distant metastatic spread

M0 or M1

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14
Q

For a given cancer the T, N and M status are then converted into a…

A

Stage

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15
Q

Cancer is staged in stages…

A

I - IV

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16
Q

Describe the broad status of cancer in stages I - IV

A

Stage I - early local disease (T, 1 or 2)

Stage II - advanced local disease (T, 3 or 4)

Stage III - regional metastasis (T, any, N, 1+)

Stage IV - advanced disease with distant metastasis (T, any, N, any, M1)

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17
Q

Which system is used for the staging of lymphoma?

A

Ann Arbor staging

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18
Q

What is Ann Arbor staging used for?

A

The staging of lymphoma

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19
Q

Describe the Ann Arbor staging of lymphoma

A

Stage I - single node region

Stage II - two separate regions on one side of the diaphragm

Stage III - spread to both sides of the diaphragm

Stage IV - disseminated involvement of one or more extra-lymphatic organ (e.g. Bone marrow, Lung)

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20
Q

Staging of cancer is a powerful predictor of…

A

Survival

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21
Q

What staging system is used for colorectal carcinoma?

A

Dukes staging

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22
Q

Describe the Dukes staging of colorectal carcinoma

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

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23
Q

Tumour grade describes…

A

The degree of differentiation of a neoplasm

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24
Q

Which is more standardised, grading or staging of cancer?

A

Staging of cancer

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25
Q

How is the grading of malignant neoplasms expressed?

A

G1 - G4

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26
Q

Describe what the stages G1-G4 mean in the grading of malignant neoplasms

A

G1 - well-differentiated

G2 - moderately differentiated

G3 - poorly differentiated

G4 - undifferentiated or anaplastic

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27
Q

Which system is used for the grading of breast carcinoma?

A

Bloom-Richardson system

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28
Q

What does the Bloom-Richardson system assess in the grading of breast carcinoma? (3)

A

Tubule formation
Nuclear variation
Number of mitoses

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29
Q

Tumour grade is important for…

Give 3 examples of types of cancer where tumour grading is particularly important

A

Planning treatment and estimating prognosis

Lymphomas
Breast
Prostate

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30
Q

Name 5 types of treatment for cancer

A 
Surgery 
Radiotherapy 
Chemotherapy 
Hormone therapy 
Treatment targeted to specific molecular alterations 
Treatments targeting the immune system
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31
Q

What is the mainstay of treatment for most cancers?

A

Surgery

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32
Q

What is adjuvant treatment?

A

Treatment given after surgical removal of a primary tumour to eliminate subclinical disease

33
Q

What is neoadjuvant treatment?

A

Treatment given to reduce the size of a primary tumour prior to surgical excision

34
Q

Radiation therapy kills proliferating cells by.. (2)

A

Triggering apoptosis

Interfering with mitosis

35
Q

Why is radiotherapy given in fractioned doses?

A

To minimise normal tissue damage

36
Q

X-rays or other types of ionising radiation are used in radiation therapy to kill rapidly dividing cells.

These cells are typically in which phase of the cell cycle?

A

G2

37
Q

How does high dosage radiation therapy kill cancer cells?

A

Causes either direct or free-radical induced DNA damage detected by cell-cycle checkpoints, triggering apoptosis

38
Q

Double stranded DNA breakages cause damaged chromosomes that prevent…

A

M phase from completing

39
Q

Chemotherapy drugs affect which type of drugs?

A

Proliferating cells

40
Q

Do chemotherapy drugs act in a specific or non-specific way?

A

Non-specific

41
Q

Give 4 different classes of chemotherapy agents

A

Antimetabolites

Alkylating and platinum-based drugs

Antibiotics

Plant-derived drugs

42
Q

How do antimetabolites work as chemotherapy agents?

Give an example

A

Mimic normal substrates involved in DNA replication

Fluorouracil

43
Q

How do alkylating agents/platinum based drugs work as chemotherapy agents?

A

Cross-link the two strands of the DNA helix

44
Q

Give an example of an antibiotic that is used in chemotherapy and its mechanism of action

A

Doxorubicin

Inhibits DNA topoisomerase

45
Q

Give an example of a plant-derived chemotherapy agent and its mechanism of action

A

Vincristine

Blocks microtubule assembly and interferes with mitotic spindle formation

46
Q

Give some examples of side effects of chemotherapy due to the non-specific action of the agents

A

Hair loss - hair follicles damaged

GI upset - GI tract

Immunosuppression - bone marrow suppression

47
Q

Is hormone therapy a relatively toxic or non-toxic treatment for certain malignant tumours

A

Non-toxic treatment

48
Q

What is a disadvantage of hormone therapy?

A

It has limited scope and can only be used for some malignancies

49
Q

Give an example of a cancer that hormone therapy is used to treat and how it works

A

Hormone receptor-positive breast cancer

Selective oestrogen receptor modulators (SERMs) such as tamoxifen bind to oestrogen receptors preventing the binding of oestrogen

50
Q

Give an example of a SERM (selective oestrogen receptor modulator)

A

Tamoxifen

51
Q

Androgen blockage is used as hormone therapy for the treatment of…

A

Prostate cancer

52
Q

Give two examples of drugs that work by targeting cancer-specific molecular alterations in cells

What are usually the cancer-specific alterations?

A

Herceptin (Trastuzumab)

Gleevec (Imatinib)

53
Q

Herceptin can be given in the treatment of which type of cancer?

How does it work?

A

Breast cancer

Many breast cancers have over-expression of the HER-2 gene. Herceptin can block the HER-2 signalling.

54
Q

Gleevec can be given in the treatment of which type of cancer?

How does it work?

A

Chronic myeloid leukaemia

Inhibits the fusion protein produced by an oncogene

55
Q

Give an example of a drug that blocks immune checkpoints

A

Nivolumab

56
Q

Tumour markers allow the monitoring of…

A

Cancer burden

57
Q

What are tumour markers useful for?

A

Monitoring of tumour burden

58
Q

Give 4 examples of types of tumour markers

A

Hormones
Oncofetal antigens
Specific proteins
Mucin/glycoproteins

59
Q

What is the aim of cancer screening?

A

To detect cancers early as possible when the chance of cure is the highest

60
Q

Name three problems associated with cancer screening

A

Lead time bias
Length bias
Overdiagnosis

61
Q

Describe what is meant by the lead time bias seen in cancer screening

A

Screening may not affect survival but may affect survival statistics, as it was detected earlier, so will survive longer with the disease according to statistics - appearing that screening was effective

62
Q

Describe what is meant by the length bias seen in cancer screening

A

Slower growing tumours are more likely to be detected

63
Q

In the UK there are established national screening programmes for which cancers?

A

Cervical
Breast
Bowel

64
Q

What colour does immunohistochemistry stain?

A

Brown

65
Q

What does H&E stain contain?

A

Haemotoxylin

Eosin

66
Q

What does H&E stain in a cell?

A

Haemotoxylin stains the nucleus most strongly blue

Eosin stains the cytoplasm/ECM most strongly pink

67
Q

What is histology? What is cytology?

A

Histology - study of sections of tissues

Cytology - study of disaggregated cells in fluid

68
Q

Give three examples of histological procedures

A

Core biopsies
Cancer resection specimens
Excised skin lesions

69
Q

Give three examples of cytological procedures

A

Cervical smears
Fine needle aspirates of breast/thyroid/salivary glands
Urine

70
Q

Give three advantages of using histological investigations rather than cytological investigations

A

Often therapeutic as well as diagnostic
Can assess tissue architecture as well as cell atypia
Can differentiate invasive from in situ disease

71
Q

Give three advantages of using cytological procedures over histological procedures

A

Faster and cheaper
Non-invasive/minimally invasive
Can be used for cells in fluid

72
Q

How do lymphocytes typically appear under a microscope?

A

High nucleus:cytoplasm ratio, so stain dark blue/purple

73
Q

Lymphocytes have a high nucleus:cytoplasm ratio and so stain darkly blue under a microscope. Dark staining and the presence of many cells in a microscope slide may indicate…

A

Inflammation

Neoplasm

74
Q

How do neutrophils appear under a microscope?

A

With a multi-lobe nuclei (polymorphs)

75
Q

How do eosinophils appear under a microscope?

A

Sunburnt face with glasses (bilobe nucleus, red cytoplasm)

76
Q

How do macrophages appear under a microscope?

A

With a kidney shaped nucleus to one side and foamy cytoplasm

77
Q

Name the cells that are commonly seen in lymphoma

A

Reed-Sternburg cells

78
Q

> ____ % occlusion of coronary arteries results in a risk of sudden cardiac death

A

80

Pathological Processes (10 decks)

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