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scientific basis of medicine > The Case Of The Man Who Wanted To Know The Future > Flashcards

The Case Of The Man Who Wanted To Know The Future Flashcards

1
Q

cancer staging

A

a classification system that describes how far a cancer has spread

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2
Q

colorectal cancer stage 1

A

confined to mucosa

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3
Q

colorectal cancer stage 2

A

penetrates muscularis of colon wall

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4
Q

colorectal cancer stage 3

A

tumour penetrates serosa

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5
Q

colorectal cancer stage 4

A

tumour invades other structures, distant metastasis

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6
Q

TNM

A

T = size of T umor N = N ode involvement M = M etastases

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7
Q

how do you look for distant metastasis?

A

CT, occasionally PET

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8
Q

what imaging modalities can assist biopsy?

A

ultrasound or CT

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9
Q

types of new tumour therapies in interventional radiology

A

trans-arterial chemoembolisation
selective internal radiotherapy
particle embolisation
tumour ablation

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10
Q

radiofrequency ablation

A

An interventional radiologic technique in which tumors are removed from tissues by heating

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11
Q

limitation of RFA currently

A

only good for tumours about 2-3cm big, heating zone not wide

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12
Q

cryoablation

A

destroying tumours with liquid nitrogen

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13
Q

what cancer is US ablation promising for?

A

breast cancer

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14
Q

4 subdivisions of colorectal cancer

A

colon cancer
rectal cancer
oligo-metastatic
widespread metastatic

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15
Q

symptoms of colorectal cancer (4)

A

anaemia
rectal bleeding
change in bowel habit
tenesmus

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16
Q

tenesmus

A

The feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.

17
Q

Hallmarks of Cancer

A 
Sustaining proliferative signaling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis
Resisting cell death
18
Q

cancer enabling characteristics

A

tumour promoting inflammation

genome instability

19
Q

key 1st gene affected in colorectal cancer

A

APC gene - a tumour suppressor

20
Q

how do polyps progress to cancer?

A

APC loss causes initial polyp
KRAS mutation causes bigger polyp
more mutations in p53 and Chr 18 then get cancer

21
Q

KRAS

A

Oncogene associated with colorectal cancer

22
Q

how does mismatch repair lead to cancer?

A

epigenetic loss of one of the mismatch repair genes, get multiple point mutations by accident, eventually switch off a tumour suppressor

23
Q

how much colorectal cancer is hereditary?

A

how much colorectal cancer is hereditary?

3-5%

24
Q

Familial Adenomatous Polyposis (FAP)

A

Autosomal dominant disorder characterized by 100s to 1000s of adenomatous colonic polyps, get inevitable subsequent mutations leading to colorectal cancer

25
Q

Hereditary Nonpolyposis Colon Cancer/Lynch Syndrome

A

An autosomal dominant disorder associated with faulty mismatch repair gene so get multiple point mutations

26
Q

which cancers are you at increased risk of if you have Lynch syndrome?

A

colorectal
endometrial
pancreatic
small bowel

27
Q

treating FAP

A

prophylactic pan-colectomy by aged 40

28
Q

treating HNPCC

A

regular screening colonoscopy and preventative aspirin 600mg

29
Q

screening for bowel cancer

A

faecal immunochemical test offered to over 60s, if positive go for a colonoscopy

30
Q

adjuvant chemotherapy

A

the use of chemotherapy after or in combination with another form of cancer treatment such as administering chemotherapy after surgery or with radiation therapy

31
Q

How does colorectal cancer spread?

A

direct extension
via portal circulation to liver
via venous circulation to lung

32
Q

common mutations in colorectal cancer

A

RAS
RAF
MEK
ERK

33
Q

which is the key mutation in CRC which renders EGFR inhibitors useless?

A

RAS mutation

34
Q

Sotorasib

A

a potential upcoming cancer drug for CRC with KRAS mutations

35
Q

prevalence of KRAS mutation in CRC

A

about 40%

36
Q

Cetuximab

A

EGFR inhibitor used in colorectal cancer

37
Q

how can you discover patients at risk of metastatic disease?

A

do blood tests and PCR for circulating tumour cells or DNA, these people can then have adjuvant chemo as well as surgical resection

38
Q

Immune checkpoint inhibitors

A

Take the “brakes” off the immune system, which helps it recognize and attack cancer cells, potential use in CRC that are mismatch repair gene deficient

39
Q

Immune checkpoint inhibitors

A

lots of mutations makes cells more ‘foreign’ so more easily targeted by native immune system

scientific basis of medicine (35 decks)

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