Session 10 - Neoplasia 4

Question 1

Incidence

• Worldwide
• Top 3 most prevalent cancers in men and women
• Most common cancers in children
• *Mortality:
• **Survival rates for different cancer types
• Top 3 highest mortality cancers in men and women

Answer 1

• Worldwide: >14 million new cases of cancer worldwide
• Men: 1. Prostate, 2. Lung, 3. Bowel
  Women: 1. Breast, 2. Lung, 3. Bowel
• Most common cancers in children: Leukaemia’s, central nervous system tumours, lymphomas

Mortality:
• Survival for different cancer types in the UK is very variable
e.g.: Testicular cancer 98%, Melanoma 90%, Pancreatic 1%
• Top 3 highest mortality cancers in men:
1. Lung, 2. Prostate, 3. Bowel
Women:
1. Lung, 2. Breast, 3. Bowel

Question 2

Predicting outcome

Answer 2

• Which individual will have a favourable outcome
• Far from exact
• Age, general health status, tumour site, tumour type, differentiation, tumour stage
• Availability of effective treatments

Question 3

Tumour stage - for solid tumours

• name
• explain

Answer 3

• TNM Staging System
• Solid Tumours
• Standardised across the world
- T = size of primary tumour
- N = extent of regional lymph node involvement
- M = metastatic spread via the blood

Question 4

Tumour stage

Answer 4

• Tumour stage is a measure of the overall burden of the malignant neoplasm • Converted to a stage 1-4 usually
• Vary for each cancer
• Stage 1 = early local disease
• Stage 2 = Advanced local disease (N0, M0)
• Stage 3 = regional metastasis (N1 or more with M0)
• Stage 4 = advanced disease with distant metastasis (M1)

Question 5

Ann Arbor System

• Which cancer?
• Explain this system

Answer 5

• Lymphoma (as not a solid tumour)

II - Lymphoma is on two seperate lymph node regions but on one side of the diaphragm
III - Lymphoma is on two seperate lymph node regions but on both side of the diaphragm

Question 6

Duke Staging System

• Which cancer
• Explain

Answer 6

• Bowel grading system

Question 7

Grading
- What do G1, G2, G3, G4 mean?

Answer 7

• Grade describes the degree of differentiation of a neoplasm
• G1 = well-differentiated
• G2 = moderately differentiated
• G3 = poorly differentiated
• G4 = undifferentiated or anaplastic (anplastic - looks nothing like the tissue of origin)

Question 8

Gleason’s Pattern
- Type of cancer

Answer 8

• Prostate cancer

Question 9

Treatments - list some

Answer 9

• Surgery
• Radiotherapy
• Chemotherapy
• Hormone Therapy
• Treatments targeted to specific molecular alterations
• Immunotherapy

Question 10

Treatment - Surgery

Answer 10

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

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

Question 11

Treatment - Radiation

Answer 11

• Kills proliferating cells by triggering apoptosis or interfering with mitosis
• Given in fractionated doses to minimise normal tissue damage
• This kills rapidly dividing cells in G2 of the cell cycle
• Causes either direct or free-radical induced DNA damage that is detected by cell cycle checkpoints triggering apoptosis
• Double stranded DNA breakages causes damaged chromosomes that prevent M phase from completing correctly

Question 12

Treatment - Chemotherapy

Answer 12

• Antimetabolites – Mimic normal substrates involved in DNA replication – E.g. Fluorouracil
• Alkylating and Platinum Based Drugs – Cyclophosphamide and Cisplatin – Cross link the two strands of the DNA helix
• Antibiotics – Doxorubicin inhibits DNA topoisomerase needed for DNA synthesis – Bleomycin causes double stranded DNA breaks
• Plant derived drugs – Vincristine from Periwinkles – Block microtubules assemble and interferes with mitotic spindle formation

Question 13

Side effects of chemotherapy

Answer 13

Question 14

Treatment - Hormone Therapy

Answer 14

Selective oestrogen receptor modulators (SERMs)
– Tamoxifen ->
– Bind to oestrogen receptors thus preventing oestrogen receptors to prevent oestrogen from binding ->
– Used to treat hormone receptor positive breast cancer

Question 15

Targeting Oncogenes

Answer 15

• Identifying cancer specific alterations such as oncogene mutations allows us to create targeted drugs specifically at cancer cells
• Trastuzumab (Herceptin)
• Imatinib (Gleevec)

BLOCKING ONCOGENES

Question 16

Treatment - Immunotherapy

Answer 16

• Target immune system to help it fight cancer by recognising and attacking cancer cells
• Cancer immunity cycle highlights points where immune treatments can be used
• Immune checkpoint inhibitors

Question 17

Tumour Markers

Answer 17

• Various substances are released by cancer cells into the circulation (and urine and faeces)
• They can be measured:
– Sometimes for diagnosis
– Most useful for monitoring tumour burden during treatment and follow-up
– Assess recurrence

• Examples:
– Human Chorionic Gonadotrophin - testicular tumours
– Alpha fetoprotein – hepatocellular carcinoma
– Prostate specific antigen – prostate carcinoma
– CA125 – ovarian cancer

Question 18

Cancer screening

• How does it work>
• Breast - age range?
• Cervical - age range
• Bowel - age range

*refer to PASS about bias

Answer 18

• Meant for healthy people with no symptoms at all
• Attempts to detect cancers as early as possible when the chance of cure is the highest
• Established national screening programmes in the UK

Screening programs:
• Breast screening – Women, 47 – 73 years of age
• Cervical screening – Women, 25-64 in UK – Every 3 years for women aged 25-49 – Every 5 years for women aged 50-64
• Bowel screening – Home testing kit: Men and women aged 60-74 – Bowel scope screening: Offered to men and women at the age of 55 in some parts of England