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Mechanisms of Disease > Session 11 - Neoplasia 4 > Flashcards

Session 11 - Neoplasia 4 Flashcards

1
Q

In what age group are the majority of new diagnoses of cancer made in?

A

-Over 65

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2
Q

What are the 3 most common cancers in children younger than 14?

A
  • Leukaemias
  • Central nervous system tumours
  • Lymphomas
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3
Q

Which 3 cancers have the highest 5 year survival rate?

A
  • Testicular
  • Melanoma
  • Breast
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4
Q

Which 3 cancers have the poorest 5 year survival rate?

A
  • Pancreatic
  • Lung
  • Oesophageal
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5
Q

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

A

-Lung

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6
Q

What factors are considered when predicting the outcome of a malignant neoplasm?

A
  • Tumour Site
  • Tumour type
  • Grade
  • Stage
  • Age and general health
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7
Q

What is meant by the tumour type?

A

-The characteristics which a tumour possesses (eg malignant melanoma almost always invades and is agressive whereas basal cell carcinoma almost never metastasises)

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8
Q

What is the most common method of staging?

A

-TNM

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9
Q

What does T refer to in TNM staging?

A

-T is primary tumour size, typically expressed between T1 and T4

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10
Q

What does N describe in TNM staging?

A

-The extent of regional node metastases (N0 to N3)

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11
Q

What does M describe in TNM staging of tumours?

A

-M is the extent of the metastatic spread (M0 or M1)

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12
Q

What happens to the T, N and M scores calculated for a given cancer?

A

-They are converted into a stage from I to IV

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13
Q

Describe the levels of staging I to IV, generally

A

Stage I -> Early local disease
Stage II -> Advanced local disease
Stage III-> Regional metastases
Stage IV -> Advanced disease with distant metastases

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14
Q

Is staging the same for every type of cancer?

A

-No it alters depending on the specific cancer to incorporate specific characteristics (size, invasion etc)

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15
Q

What is the ann arbour system? Briefly describe its stages

A
  • The staging system used in lymphoma
  • Stage 1 indicates lymphoma in a single node region
  • Stage 2 indicates 2 separate regions on one side of the diaphragm
  • Stage 3 indicates spread to both sides of the diaphragm
  • Stage 4 indicates diffuse or disseminated disease with involvement of one or more extra-lymphatic organs (BM or lungs)
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16
Q

What is Dukes staging? Breifly describe the stages?

A

-A type of staging used in colorectal cancer
A-> Invasion into but not through the bowel into muscularis propria
B-> Invasion into or through the muscularis propria
C-> Involvement of lymph nodes
(D -> distant metasteses (not original dukes))

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17
Q

What doe the grade of a neoplasm refer to?

A

-How well differentiated the tumour is

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18
Q

What does stage of a tumour refer to?

A

-Tumour burden and how much tumour is present in the body

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19
Q

What is the usual method of treatment to ‘cure’ cancer?

A

-Surgery

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20
Q

What are the possible grades of cancer and what do they generally mean?

A

G1 -> Well differentated
G2-> Moderately differentiated
G3-> Poorly differentiated
G4-> Undifferentiated or anaplastic

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21
Q

Is grading the same for all types of cancer?

A

-No some have theyre own specific grading system

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22
Q

What is the Bloom-Richardson system?

A

-The grading system used in breast cancer

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23
Q

What characteristics does the Bloom-Richardson grading system for breast cancer assess?

A
  • Tubule formation of cells
  • Nuclear variation
  • Number of mitoses
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24
Q

In which malignancys is grade important for planning treatment and prognosis?

A
  • Soft tissue sarcoma
  • Primary brain tumours
  • Lymphomas
  • Breast and prostate cancer
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25
Q

What are the 5 groups of possible treatments of cancer?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormone therapy
  • Treatment targeted to specific molecular alterations
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26
Q

What is the aim of advanced cancer surgery?

A

-For palliative intent to ease the symptoms and pain for the patient

27
Q

Are all cancers treated in the same way?

A

-No, whilst surgery is the mainstay of treatment for most cancers, the precise role of each type of treatment varies for each cancer and also depends on the cancer’s stage

28
Q

What is adjuvant treatment?

A

-Treatment which is given after surgical removal of a primary tumour to eliminate subclinical disease (ie limits the possibility of relapse by attempting to erradicate any micrometastases)

29
Q

What is neoadjuvant treatment?

A

-Treatment given before surgical excision of the tumour to try and reduce the size of the primary tumour

30
Q

Briefly, how does radiotherapy treat cancer?

A

-X-rays or other types of ionising radiation used to kill rapidly dividing cells by triggering apoptosis or interfering with mitosis

31
Q

What is important to ensure when using radiotherapy?

A

-That the surrounding healthy tissue is shielded as much as possible

32
Q

Why is radiotherapy given in fractionated doses?

A

-To minimise damage to normal tissues

33
Q

How does radiotherapy trigger apoptosis in cells?

A

-Directly damages DNA or induces free radical DNA damage which is detected by the cell cycle check points in G2 and triggers apoptosis

34
Q

How does radiotherapy interfere with mitosis?

A

-Causes double stranded DNA breaks damage chromosomes and prevent completion of M phase

35
Q

Why are cancer cells effected more that healthy cells in cancer treatments such as radiotherapy and chemotherapy?

A

-The treatments effect all cells but target highly proliferating cells

36
Q

What are the 4 major classes of chemotherapy agents?

A
  • Antimetabolites
  • Alkylating and platinum-based drugs
  • Antibiotics
  • Plant-derived drugs
37
Q

How do antimetabolites act as a chemotherapy agent?

A

-Mimic normal substrates which the cells use during DNA replication and thus interfere with the replication, preventing completion and resulting in cell death

38
Q

Give an example of an antimetabolite chemotherapy agent

A

-Fluorouracil -> mimics thiamine

39
Q

How do alkylating agents and platinum derived drugs act as chemotherapy agents?

A

-Crosslink the two strands of the DNA double helix which interferes with replication and induces apoptosis

40
Q

Give an example of an alkylating chemotherapy agent

A

-Cyclophosphamide (cisplatin is platinum based)

41
Q

How does the antibiotic doxorubicin act as a chemotherapy agent?

A

-Inhibits DNA topoisomerase which is essential for correct DNA synthesis

42
Q

How does the antibiotic bleomycin act as a chemotherapy agent?

A

-Causes double stranded DNA breaks

43
Q

Name a plant-derived drugs which acts as a chemotherapy agent? State its mechanism of action

A
  • Vincristine

- Block microtubule assembly and interferes with mitotic spindle formation

44
Q

Why does hair loss, vomiting and nausea occur with chemotherapy?

A

-Chemotherapy agents are not specific for cancer cells, they just target highly proiferating cells and this the epithelium is effected

45
Q

Name two types of hormone therapy used for treatments of cancers

A
  • Selective oestrogen receptor modulator (SERMS) eg tamoxifen
  • Androgen blockade
46
Q

When is tamoxifen used? State its mechanism of action

A
  • Hormone-receptor positive breast cancer
  • Bind to oestrogen receptors, prevents oestrogen from binding which has shown to stop progression of the cancer and sometimes reduce the size of the tumour
47
Q

When are androgen blockades commonly used?

A

-Prostate cancer

48
Q

What is the benefit of treatments which target specific molecular alterations?

A

-Provides an opportunity to target drugs specifically at cancer cells

49
Q

What are the two common, well known examples of drugs which target specific genetic alterations?

A
  • Herceptin

- Gleevec

50
Q

When and why is Herceptin used?

A
  • In the treatment of HER-2 positive breast cancers
  • A quarter of breast cancers have gross over-expression of HER-2 gene and herceptin blocks HER2 signalling which has shown to prevent progression/reduce the tumour size
51
Q

When is gleevec used and why?

A
  • Gleevec is used in the treatment of chronic myeloid leukaemia
  • In CML there is a chromosomal rearrangement (t9:22) creating an abnormal ‘Philadelphia’ chromosome in which an oncogenic fusion protein is encoded
  • Gleevec inhibits the fusion protein
52
Q

In which sites are tumour markers present?

A

-Tissues, blood, urine and faeces

53
Q

What is a tumour marker?

A

-Various substances are released by cancer cells into the circulation which are most useful for monitoring tumour burden during treatment

54
Q

What types of tumour markers are there?

A
  • Hormones
  • Oncofetal antigens
  • Specific proteins
  • Mucins/glycoproteins
55
Q

What is a useful tumour marker released from testicular tumours?

A

-Human Chorionic Gonadotrophin hormone (hCG)

56
Q

Name a oncofetal antigen used as a tumour marker and state the possible types of tumours related to it

A
  • Alpha fetoprotein
  • Hepatocellular carcinoma
  • Yolk sac tumour
57
Q

What is a tumour marker released in prostate cancer? What is this tumour marker non-specific?

A
  • Prostate-specific antigen

- High variation in the natuarl levels, also secreted in benign hypertrophic prostate

58
Q

Name a glycoprotein often used as a tumour marker for ovarian cancer

A

-Cancer Antigen-125

59
Q

What is the purpose of screening programs?

A

-To detect cancer as early as possible when there is the highest chance of cure

60
Q

What is length bias?

A

-Fast tumours will grow in between screens so are not detected where as slow growing tumours are often detected -> can lead to screening looking better than it is

61
Q

Why is overdiagnosis a potential problem with screening?

A

-Detects things that would have never progressed to kill the patient

62
Q

Describe Breast screening in the UK

A
  • Women who have BRCA1/BRCA2 or are related to a woman who does
  • Woman over 50
  • Every 3 years unless risk factors are present
63
Q

Which 4 cancers have the highest incidence rate in the UK?

A
  • Breast
  • Lung
  • Prostate
  • Bowel

Mechanisms of Disease (11 decks)

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