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Pathological Processes > Session 10: Neoplasia 4 > Flashcards

Session 10: Neoplasia 4 Flashcards

1
Q

What cancer/s account for over half of all new cancers in the UK?

A

Breast, lung, prostate and bowel carcinomas.

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2
Q

Age of the majority of diagnosed individuals.

A

Over 65

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3
Q

Most common cancers in children younger than 14.

A

Leukaemias, CNS tumours and lymphomas.

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4
Q

Rank 5-year survival rates for the following cancers: (Top being highest survival rate and bottom being lowest.) Oesophageal cancers Pancreatic cancers Lung cancers Testicular cancers Melanoma Breast cancers

A

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

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5
Q

Biggest cause of cancer-related deaths in the UK.

A

Lung cancers

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6
Q

Factors influencing favourable outcome for malignant neoplasms.

A

Age General health status Tumour site Tumour type Grade Stage Availability of effective treatments.

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7
Q

What is tumour stage?

A

A measure of the malignant neoplasms overall burden.

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8
Q

What is the most common method for assessing extent of tumour. (What type of staging system.)

A

TNM staging system.

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9
Q

TNM staging system is standardised across the world for various types of cancer. The letters refer to different characteristics of the tumour. Explain each letter.

What does each letter range from?

A

T refers to the size of the primary tumour and ranges from T1 to T4.

N refers to the extent of regional node metastasis via lymphatics. Ranges from N0 to N3.

M refers to the extent of distant metastatic spread via blood. Ranges only from M0 to M1.

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10
Q

How is the TNM staging data processed?

A

By converting the different values into a stage from I to IV.

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11
Q

Very broadly describe stage I.

A

Early local disease i.e. no spread.

T will range from T1 and up.

N and M will be at 0 since it hasn’t metastasised.

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12
Q

Very broadly describe stage II.

A

Advanced local disease.

T can be anything.

N and M still at 0.

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13
Q

Very broadly describe stage III.

A

Regional metastasis.

T can be anything.

N1 or more.

M0 since it is still regional

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14
Q

Very broadly describe stage IV.

A

Advanced disease with distan**t metastasis.

Any T

Any N

M1

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15
Q

What kind of staging system does lymphoma use?

A

Ann Arbor staging.

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16
Q

Briefly describe stages of Ann Arbor staging.

A

Stage I: Lymphoma in one single node region.

Stage II: Lymphoma in two separate regions on one side of diaphragm

Stage III: Lymphoma spread to both sides of diaphragm

Stage IV: Lymphoma in on or more extra-lymphatic organs such as bone marrow or lungs.

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17
Q

In what cancers is Dukes staging used?

A

In colorectal carcinoma.

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18
Q

Briefly explain differents stages of Dukes staging.

A

Dukes’ A: Invasion into but not through bowel.

Dukes’ B: Invasion through bowel wall.

Dukes’ C: Involvement of lymph nodes.

Dukes’ D: Distant metastases.

19
Q

What is tumour grade?

A

Description of degree of differentation of neoplasm.

20
Q

In one or a few words describe each grade.

A

Grade 1: Well differentiated

Grade 2: Moderately differentiated

Grade 3: Poorly differentiated

Grade 4: Undifferentiated or anaplastic

21
Q

What is modified Bloom-Richardson system?

A

A formal grading system used in breast carcinoma.

22
Q

What does modified Bloom-Richardson system evaluate?

A

It assesses tubule formation, nuclear variation and number of mitoses histologically.

23
Q

Why is tumour grade important?

A

Planning of treatment and estimating prognosis.

24
Q

Give treatments of cancer.

A

Surgery

Radiotherapy

Chemotherapy

Hormone therapy

Treatment targeted to specific molecular alterations

Immune treatments

25
Q

What is curative treatment?

A

Mainly surgical treatment to completely remove a cancer.

26
Q

What is adjuvant treatment?

A

Adjuvant treatment is a treatment which is given after the curative treatment.

Let’s say treatment given after surgical removal of a primary tumour to eliminate any subclinical disease.

27
Q

What is neoadjuvant treatment?

A

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

28
Q

Explain how radiation therapy works.

What type of radiation is used?

A

Kills proliferating cells by triggering apoptosis or interfering with mitosis.

X-ray or other types of ionising radiation are used.

Kills rapidly dividing cells especially in G2 of cell cycle.

High dosage causes either direct or free-radical induced DNA damage detected by cell cycle check-points triggering apoptosis.

Double stranded DNA breakages cause damage to chromosomes which will prevent M phase from completing correctly.

29
Q

Give classes of chemotherapy agents.

A

Antimetabolites.

Alkylating and platinum-based drugs

Antibiotics

Plant-derived drugs

30
Q

Explain how antimetabolites work.

A

Mimic normal substrates involved in DNA replication and prevents it from working.

31
Q

Explain how alkylating and platinum-based drugs work.

A

Cross-linkage of two strands of DNA helix.

32
Q

Explain how antibiotics work.

A

Can work in multiple ways.

Inhibition of DNA topoisomerase needed for DNA synthesis.

Double-stranded DNA breaks.

33
Q

Explain how plant-derived drugs work.

A

Blockage of microtubule assemblys.

Interfering with mitotic spindle formation due to the blockage of microtubules.

34
Q

Explain how hormone therapy works.

(Both in women and in men)

A

In women in the case of breast cancer selective oestrogen receptor modulators aka SERMs are used such as tamoxifen. This is by binding to oestrogen receptors and preventing oestrogen from binding.

In prostate cancer androgen blockades are used.

35
Q

What is Trasuzumab (Herceptin)?

A

An early example of a drug targetting oncogenes. In 25% of breast cancer there is an over-expression of HER-2 gene (oncogene) and Herceptin can block the HER-2 signalling.

36
Q

What is imatinib (Gleevec)?

A

Another early example of a drug targetting oncogenes. In Chronic Myeloid Leukaemia there is a chromosomal rearrangement (robertsonian translocation) creating an abnormal philadelphia chromosome in which the oncogenic fusion protein BCR-ABL is encoded.

Imatinib inhibits BCR-ABL.

37
Q

What is nivolumab and ipilimumab.

A

Immune treatments.

38
Q

Briefly explain how nivolumab and ipilimumab works.

A

They block immune checkpoints.

Immune checkpoints inhibit T-cells from seeing and attacking neoplasms.

This means that nivolumab and ipilimumab block the immune checkpoints so T-cells can keep attacking neoplasms.

39
Q

What are tumour markers?

A

Various substances released by cancer cells which are used for diagnosis and monitoring of tumour burden during treatment and follow up.

40
Q

Give examples of tumour markers.

A

Hormones

Oncofetal antigens

Specific proteins

Mucins and glycoproteins

41
Q

Problems of screening.

A

Lead time bias

Length bias

Over diagnosis

42
Q

Established screening programmes in the UK.

(What type of cancers)

A

Cervical

Breast

Bowel

43
Q

Why is staging important?

A

It is a crucial part for a clinician in order to know which treatment to use.

Each stage uses different treatments.

Stage gives a prognosis, outcome etc.

Pathological Processes (14 decks)

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