Tutorials 1 - 4 - Skin, Oral, Colon, Cervical

Question 1

What are the risk factors for melanoma?

Answer 1

M - moles - atypical/over 100
R - red hair/freckles
I - inability to tan
S - sun burn - >10 severe episodes
K - kindred - family Hx

Question 2

What is a mole?

Why are they described as both precursors of and signposts to melanoma?

Answer 2

Benign melanocytic tumour
Pre-cursor - may turn malignant
Signpost - increased risk of developing de novo melanoma

Question 3

How does incidence of melanoma vary?

What is different between the two major groups?

Answer 3

• Younger people - trunk - genetic?

- Older people - H+N - sun exposure

Question 4

What is the diagnostic criteria for melanoma?

Answer 4

Major criteria - 2 points each:
- Change in size, irregular shape, irregular colour
Minor criteria - 1 point each:
- Diameter >7mm
- Inflammation, oozing, change in sensation

Question 5

What is the Breslow thickness?

Why is it significant?

Answer 5

• Depth of melanoma below skin

- Good prognostic indicator - >4mm

Question 6

List some possible treatments for melanoma

Answer 6

• Surgical excision
• Adjuvant therapy
• BRAF inhibitors/immune checkpoint inhibitors

Question 7

What is the most common cancer type in the H+N?

Answer 7

Squamous cell carcinoma

Question 8

Where is the most common site of H+N cancer?

Answer 8

Tonsils

Tongue

Question 9

What are the 3 major causes of H+N cancer?

Answer 9

Smoking
Alcohol
HPV

Question 10

Describe the genetic differences between HPV positive and negative H+N cancers

Answer 10

• HPV -ve - Hras, p53, p16 mutations
• HPV +ve - E6/E7 genes
  E6 binds to and inactivates p53
  E7 binds to and inactivates Rb protein

Question 11

Why is drug therapy not that useful in H+N cancers?

Answer 11

Mainly due to knocking out of TSGs rather than activation of oncogenes - no therapeutic target

Question 12

Which subtype of H+N cancers has a better prognosis?

Why is this somewhat paradoxical?

Answer 12

HPV +ve has better prognosis even though it presents later as deeper into throat

Question 13

Give 3 risk factors for colorectal cancer

Answer 13

• Environment - diet etc…
• IBD
• Genetic - FAP

Question 14

Outline the colorectal cancer screening programme

Answer 14

Faecal occult blood
60 - 74 year olds, every 2 years
Colonoscopy if abnormal

Question 15

Give some possible symptoms of colon cancer

Answer 15

• GI bleeding (PR)
• Anaemia
• Abdo pain
• Change in bowel habit

Question 16

Describe the adenoma to carcinoma sequence

Answer 16

Methylation/APC inactivation leads to hyperproliferation
Kras/p53 mutation then leads to adenoma
Further accumulation of mutations leads to adenocarcinoma

Question 17

What are the 2 hereditary conditions which give rise to colon cancer?

Answer 17

• FAP - chromosomal instability

- Lynch syndrome - MMR defiency

Question 18

Give 2 drugs used in colon cancer

Answer 18

Cetuximab

Bevacizumab

Question 19

What sort of cancer(s) affect(s) the cervix?

Answer 19

Mainly SSC

Sometimes adenocarcinoma

Question 20

What is the precursor of cervical cancer?

Answer 20

Cervical intraepithelial neoplasia - CIN

Question 21

Outline the cervical cancer screening programme

Answer 21

• 25 - 49 - every 3 yrs
• 50 - 64 - every 5 years
• 65+ - only if not been screened since 50

Question 22

What sort of cancer occurs in the endometrium?

Answer 22

Adenocarcinoma

Question 23

How is endometrial cancer diagnosed?

Answer 23

Pipelle biopsy

Question 24

List some possible treatments for endometrial cancer

Answer 24

• Radical hysterectomy
• RT
• Copper coil