Tutorials Flashcards
What are the risk factors for prostate cancer?
- Male gender
- African American
- BRCA gene
- Family history
How is prostate cancer different in African Americans?
More aggressive
What is considered to be a ‘family history’ of prostate cancer?
Close family member contracting it under 50 years old
How does prostate cancer present?
Hesitation
Nocturia
What investigations can be done to detect prostate cancer?
- PSA
- DRE
- USS and biopsy
What is the problem with PSA?
It is also raised in many other situations, e.g. Age, infection, stones, BPH
What is the problem with DRE?
Doesn’t feel the transitional zones
How is a prostate biopsy carried out?
TRUS system -fires biopsy needles through perineum and into the prostate
How is prostate cancer treated if it has not metastasised?
Hormone control - testosterone reduction therapy (LH/FSH antagonists)
Prostatectomy
Active surveillance
What is the problem with testosterone reduction therapy?
Can loose libido, become impotent, and get osteoporosis
What is the prognosis of prostate cancer?
Earlier presenting ones tend to be more aggressive, late presenting ones tend to be benign
Where does prostate cancer like to metastasise to?
Bone
Describe the difference between primary bone cancer and prostatic metastases to bone?
Bone cancer normally lowers bone density, but prostate metastasised cancer tends to form sclerotic bone metastases, leading to greater deposition of bone + white x-ray appearance
What are the risk factors for breast cancer?
Hereditary (BRCA 1/2, Li-Fraumeni) Oestrogen exposure Georgraphy Radiation Klinefelter's syndrome
What can increase oestrogen exposure?
Early menarche
Late menopause
Obesity post menopause
Geographically, where is breast cancer more common?
West
How does breast cancer present?
Abnormal screening result
Skin changes
Nipple changes/discharge
Lump
When is breast cancer screening offered?
Between 50-70 years
What conditions might cause calcifications on mammography?
DCIS Papillary lesion Cancer Fibroadenomas Normal breast tissue
What investigations follow a positive breast cancer screening?
Fine needle aspiration and cytology or needle biopsy
Invasive lobular carcinoma patients also get MRI scans to pick up any malignancies not otherwise detected
What feature on biopsy might indicate breast cancer?
Lack of myoepithelial cells
How is breast cancer staged?
TNM
How is breast cancer graded?
Bloom-Richardson
What receptors to early stage breast tumours tend to have?
Oestrogen receptors
What is the result of the presence of oestrogen receptors in a lot of early stage tumours?
Tamoxifen is a viable option
What receptor to late stage breast tumours tend to have?
HER2 receptors
What is the result of a lot of late stage tumours having HER2 receptors?
Herceptin is a good option
When is lymph node dissection given in breast cancer?
When cancer has been shown to spread beyond the axillary nodes
What feature to breast cancers that present before menopause tend to have?
Tend to lack HER-2 or oestrogen receptors, meaning no treatment options are really viable
What part of the breast structure is affected in ductal or lobular carcinomas?
The epithelium
What part of the breast structure is affected in a Phyllodes tumour?
Stroma
What are the categories of cervical cancer?
HPV related
Non-HPV related
What causes HPV related cervical cancer?
Produces viral proteins E6 and E7, which inhibit p53 and pRB.
P53 normally stimulates cell death following cellular damage, and pRB inhibits the continuation of the cell through the cell cycle
What causes non-HPV cervical cancer?
Sporadic p53 mutations
How does cervical cancer present?
Abnormal screening result
Bleeding outside of menstrual bleeding, e.g. Post coital, post-menopausal
What does cervical cancer screening involve?
Smear and PAP stain
What is observed in screening?
Celllular and HPV composition
Look for CIN (cervical intraepithelial neoplasia) - stage 1, 2, or 3
What happens when there is an abnormal cervical screening result?
Cut out the tumour using hot wire
How is cervical cancer staged?
FIGO staging
How is cervical cancer treated?
Loop biopsy may be enough to remove entire tumour
If not, may have to remove cervix - tracholectomy (cervical removal without uterus removal) or hysterectomy
Why are melanomas thought to be so aggressive?
Because they arise from neural crest cells, where the cells de-differentiate and become more motile
What are melanomas prone to?
Dormancy
Where can melanomas metastasise to?
Almost everywhere, including the bowel and embryo, but not the heart or cornea
How do melanomas that have developed immunity appear?
Darker patches of skin, which are pigment laden macrophages
Where are the risk factors for melanoma?
5 or more large moles (10x risk) Red hair (2x risk) Inability to tan (2x) Sunburn (2x) Family history (2x)
Where do melanomas tend to have a peak occurrence rate?
50
What mutation do melanomas tend to have?
BRAF
How do melanomas present?
New mole, or mole that has changed
Major features - size, shape colour
Minor features - diameter >7mm, oozing, parasthesia, inflammation
How is melanoma staged?
TNM, but T = Breslow thickness
What is Breslow thickness?
The distance from the granulocyte layer of the epidermis to the lowest melanocyte
What are the different stages of melanoma?
I - early primary
II - late primary
III - nodal involvement
IV - metastasis
How is stage I and II melanoma treated?
Excise with margin around tumour
How is stage III melanoma treated?
Surgery
Adjuvant chemotherapy
When is treatment offered in stage IV melanoma?
When there are only a few metastases, or immune checkpoints are found
How does ipiliminab treat melanoma?
It blocks CTLA-4 on T cells, which prevents MHC binding of APC to T cells, therefore there is a lack of T cell inhibition, and T cells react more to APCs
How does penbrolizumab treat melanoma?
It prevents T cell inhibition, leading to greater immune response on tumour
What are the steps in the MAPK pathway?
RAS → RAF → MEK → ERK → Cyclin D activated → CDK-4 activated → RB phosphorylated to allow S phase to continue
What steps in the MAPK pathway are frequently mutated in melanoma?
Ras 15%
Raf 50%
What tumour suppressor is often mutated in melanoma?
P16
What does p16 normally do?
Inhibits CDK4
