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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
How is the grading of malignant neoplasms expressed?
G1 - G4
26
Describe what the stages G1-G4 mean in the grading of malignant neoplasms
G1 - well-differentiated G2 - moderately differentiated G3 - poorly differentiated G4 - undifferentiated or anaplastic
27
Which system is used for the grading of breast carcinoma?
Bloom-Richardson system
28
What does the Bloom-Richardson system assess in the grading of breast carcinoma? (3)
Tubule formation Nuclear variation Number of mitoses
29
Tumour grade is important for... Give 3 examples of types of cancer where tumour grading is particularly important
Planning treatment and estimating prognosis Lymphomas Breast Prostate
30
Name 5 types of treatment for cancer
``` Surgery Radiotherapy Chemotherapy Hormone therapy Treatment targeted to specific molecular alterations Treatments targeting the immune system ```
31
What is the mainstay of treatment for most cancers?
Surgery
32
What is adjuvant treatment?
Treatment given after surgical removal of a primary tumour to eliminate subclinical disease
33
What is neoadjuvant treatment?
Treatment given to reduce the size of a primary tumour prior to surgical excision
34
Radiation therapy kills proliferating cells by.. (2)
Triggering apoptosis Interfering with mitosis
35
Why is radiotherapy given in fractioned doses?
To minimise normal tissue damage
36
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?
G2
37
How does high dosage radiation therapy kill cancer cells?
Causes either direct or free-radical induced DNA damage detected by cell-cycle checkpoints, triggering apoptosis
38
Double stranded DNA breakages cause damaged chromosomes that prevent...
M phase from completing
39
Chemotherapy drugs affect which type of drugs?
Proliferating cells
40
Do chemotherapy drugs act in a specific or non-specific way?
Non-specific
41
Give 4 different classes of chemotherapy agents
Antimetabolites Alkylating and platinum-based drugs Antibiotics Plant-derived drugs
42
How do antimetabolites work as chemotherapy agents? Give an example
Mimic normal substrates involved in DNA replication Fluorouracil
43
How do alkylating agents/platinum based drugs work as chemotherapy agents?
Cross-link the two strands of the DNA helix
44
Give an example of an antibiotic that is used in chemotherapy and its mechanism of action
Doxorubicin Inhibits DNA topoisomerase
45
Give an example of a plant-derived chemotherapy agent and its mechanism of action
Vincristine Blocks microtubule assembly and interferes with mitotic spindle formation
46
Give some examples of side effects of chemotherapy due to the non-specific action of the agents
Hair loss - hair follicles damaged GI upset - GI tract Immunosuppression - bone marrow suppression
47
Is hormone therapy a relatively toxic or non-toxic treatment for certain malignant tumours
Non-toxic treatment
48
What is a disadvantage of hormone therapy?
It has limited scope and can only be used for some malignancies
49
Give an example of a cancer that hormone therapy is used to treat and how it works
Hormone receptor-positive breast cancer Selective oestrogen receptor modulators (SERMs) such as tamoxifen bind to oestrogen receptors preventing the binding of oestrogen
50
Give an example of a SERM (selective oestrogen receptor modulator)
Tamoxifen
51
Androgen blockage is used as hormone therapy for the treatment of...
Prostate cancer
52
Give two examples of drugs that work by targeting cancer-specific molecular alterations in cells What are usually the cancer-specific alterations?
Herceptin (Trastuzumab) | Gleevec (Imatinib)
53
Herceptin can be given in the treatment of which type of cancer? How does it work?
Breast cancer Many breast cancers have over-expression of the HER-2 gene. Herceptin can block the HER-2 signalling.
54
Gleevec can be given in the treatment of which type of cancer? How does it work?
Chronic myeloid leukaemia Inhibits the fusion protein produced by an oncogene
55
Give an example of a drug that blocks immune checkpoints
Nivolumab
56
Tumour markers allow the monitoring of...
Cancer burden
57
What are tumour markers useful for?
Monitoring of tumour burden
58
Give 4 examples of types of tumour markers
Hormones Oncofetal antigens Specific proteins Mucin/glycoproteins
59
What is the aim of cancer screening?
To detect cancers early as possible when the chance of cure is the highest
60
Name three problems associated with cancer screening
Lead time bias Length bias Overdiagnosis
61
Describe what is meant by the lead time bias seen in cancer screening
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
Describe what is meant by the length bias seen in cancer screening
Slower growing tumours are more likely to be detected
63
In the UK there are established national screening programmes for which cancers?
Cervical Breast Bowel
64
What colour does immunohistochemistry stain?
Brown
65
What does H&E stain contain?
Haemotoxylin Eosin
66
What does H&E stain in a cell?
Haemotoxylin stains the nucleus most strongly blue Eosin stains the cytoplasm/ECM most strongly pink
67
What is histology? What is cytology?
Histology - study of sections of tissues Cytology - study of disaggregated cells in fluid
68
Give three examples of histological procedures
Core biopsies Cancer resection specimens Excised skin lesions
69
Give three examples of cytological procedures
Cervical smears Fine needle aspirates of breast/thyroid/salivary glands Urine
70
Give three advantages of using histological investigations rather than cytological investigations
Often therapeutic as well as diagnostic Can assess tissue architecture as well as cell atypia Can differentiate invasive from in situ disease
71
Give three advantages of using cytological procedures over histological procedures
Faster and cheaper Non-invasive/minimally invasive Can be used for cells in fluid
72
How do lymphocytes typically appear under a microscope?
High nucleus:cytoplasm ratio, so stain dark blue/purple
73
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...
Inflammation | Neoplasm
74
How do neutrophils appear under a microscope?
With a multi-lobe nuclei (polymorphs)
75
How do eosinophils appear under a microscope?
Sunburnt face with glasses (bilobe nucleus, red cytoplasm)
76
How do macrophages appear under a microscope?
With a kidney shaped nucleus to one side and foamy cytoplasm
77
Name the cells that are commonly seen in lymphoma
Reed-Sternburg cells
78
>____ % occlusion of coronary arteries results in a risk of sudden cardiac death
80

Pathological Processes (10 decks)

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