Session 12 - Neoplasia III Flashcards
What is the TMN staging system?
T = Primary Tumour N = Regional Lymph Node involvement M = Metastasis
What does T1-T4 measure?
Increasing size in primary lesion, T1 - T4
What does N0 –> N3 measure?
No nodes –> Involvement of increasing no/range of nodes
What are M0 and M1?
M0 = No distant metastasis M1 = presence of blood born metastases
How is increasing size in tumour measured?
T1 - T4
What is used to measure involvement of increase no/range of nodes?
N0 –> N3
Give TNM staging of breast staging in terms of T?
TIS – Carcinoma in situ T1 - < 2cm T2 – 2-5cm T3 - > 5 cm T4 – Through the chest wall/skin
Give regional lymph node involvement of breast cancer staging?
N0 – No nodal
N1 – Axillary
N2 – Mammary
N3 - Supraclavicular
Give metastasis staging for breast cancer?
M0 – No metastasis
M1 – Presence of metastasis
What is DUkes staging for colorectal cancer divided into?
A, B, C1/C2
What is A in dukes staging for colorectal carcinoma?
Confined to bowel wall
Not extending through muscularis propria
>90% 5 year survival
What is B in dukes staging?
Through bowel wall (Muscularis propria)
70% 5 year survival
What is C1/C2 staging for colorectal cancer?
Lymph nodes involved
30% 5 year survival
C1 = Regional Lymph nodes involved
C2 = Apical node (furthest away node) involved
Give staging of hodkins disease?
I – One lymph node involved
II – Two lymph nodes on one side of the diaphragm
III - > Two lymph nodes on both sides of the diaphragm
IV – Multiple foci (Bloody everywhere)
Define grading
Based on the degree of differentiation of tumour cells. Attempts to judge the extent to which tumour cells resemble or fail to resemble their normal counterparts.
What are grades 1-4?
Gx = Grade of differentiation cannot be assessed G1 = Well differentiated G2 = Moderately differentiated G3 = Poorly differentiated G4 = Undifferentiated
What is the grading system for breast cancer a measure of?
Scarff-Bloom-Richardson Grading system
Degree of tubule formation
Extent of nuclear variation
Number of mitoses
What are grades 1-3 for scarf bloom-richardson gradin? Survival rates at ten years
Grade 1 – 85% 10-year survival
Grade 2 – 60% 10-year survival
Grade 3 – 15% 10-year survival
What is the gleason grading system in prostate cancer?
based on the sum of two numbers: the first number is the grade of the most common tumor pattern, the second number is the highest grade cells found in the tumour
What is radiotherapy in cancer treatment?
External radiation to rumour at fractionated doses with shielding of adjacent normal tissues
Causes damage to DNA of rapidly dividing cells
If DNA damage is extensive Apoptosis
In what cancers is radiotherapy
High, Fairly high, Moderate, Low
High – Lymphoma, Leukaemia, Seminoma (Testicular)
Fairly High – Squamous carcinomas
Moderate – GI, Breast
Low – Sarcoma
What does chemotherapy do?
Effect particular stages of the cell cycle and on rapidly dividing cells
Give three types of chemotherapy
Cyclophosphamide Act on cells in G1/S and mitosis Vincristine Block cells entering cell cycle/act on mitosis Methotrexate Acts on cells in S phase
Give two types of hormone therapy?
Tamoxifen
Herceptin
Describe tamoxifen?
Competes for binding to Oestrogen Receptor
50-80% of Breast Cancers express oestrogen receptors
Surgical (Orchidectomy)/clinical castration
Describe how herceptin is used
HER-2 Growth factor receptor
Overexpressed in 20-30% of breast carcinomas
Herceptin = Humanised monoclonal antibody
Side effects – Cardiac/pulmonary toxicity, can be fatal
How is prostate cancer treated?
Depends on androgens, depriving tumours of testosterone
What is a carcinoembryonic antigen?
Normally only found in embryonic tissue
Cancer expresses again, useful in seeing if any disease left over after treatment
How is human chorionic gonadotrophin used?
The evaluation of testicular masses
To indicate residual disease after Orchidectomy
In monitoring response to therapy and prediction of recurrence
Raised in nonseminomatous testicular tumours, especially when choriocarcinomatous elements present (high levels)
Seminomas with syncytiotrophoblastic giant cells
Alpha-fetoprotein use?
Normally synthesised early in foetal life by yolk sac, foetal liver and foetal GIT.
Raised plasma levels associated with cancer of liver and yolk sac tumour of testis (nonseminomatous testicular tumours)
What is adjuvant treatment?
Given after surgical treatment of a primary tumour to eliminate subclinical disease
What is neoadjuvant treatment?
Given before main treatment
What does chemotherapy do,
Anti-metabolites mimic normal substrates involved in DNA replication
Alkylating and platinum cross link two strands of DNA helix
Anti-biotics - Bleomycin causes double stranded DNA breaks
Plant derived drugs - block micro tubule assembly and mitotic spindle formation
