Week 4 Flashcards
carcinogenesis
accumulates mutations leads to abnormal appearance & behavior
carcinoma-in-situ (stage 0 / pre-cancer)
carcinoma that has not invaded basement membrane
3 germ layers
ectoderm (outer), mesoderm (middle), endoderm (inner)
what are ectoderms
epithelium, nervous tissue
what are mesoderms
epithelium, connective, muscle tissues
what are endoderms
epithelium
where do most cancers develop in
epithelial cells
exceptions to benign tumors
melanoma, mesothelioma
asbestos leads to
mesothelioma
alcohol leads to
head, neck, liver, oesophageal cx
diet leads to
stomach, colorectal cx
hepatitis B/C leads to
liver cx
liver fluke leads to
cholangiocarcinoma
HPV leads to
head, neck, cervical cx
UV leads to
skin cx, melanoma
BRCA1/2 mutation leads to
breast cx
RB1 mutation leads to
retinoblastoma
APC mutation leads to
colorectal cx
NF1 mutation leads to
neurofibromatosis
implications of carcinoma-in-situ
histological diagnosis, screening, insurance
mechanism of metastasis
- detaching from neighbouring cells
- invaded other tissue layers
- penetrate blood / lymphatic vessels
- escape from vessels
- establish & growth at new site
mechanism of metastasis sites
first-pass organ, favored sites,
vascular organs
common sites of metastasis
lungs, liver, brain, bones, adrenals, left supraclavicular lymph nodes
colorectal cx leads to
liver cx
prostate cx leads to
bone cx
patterns of metastases
orderly (colorectal, cervical)
random (breast & lung)
general symptoms of cx
pain, bleeding, obstruction / compression fracture
symptoms of breast cx
hard lump, nipple discharge, bleeding, skin ulceration
skin ulceration of breast cx is indicative of __
late stage
symptoms of lung cx
cough, SOB, hemoptysis
symptoms of colorectal cx
rectal bleeding, change in bowel habits, constipation, diarrhoea
mass screening
breast, cervical, colorectal cx
high risk screening
breast, colorectal, liver cx
wilson’s criteria for screening includes
disease
- must be latent & important health problem
test
- available, cheap, reliable
treatment
- available, cheaper if detected earlier
breast cx screening
mammogram
colorectal cx screening
FOBT, colonoscopy
liver cx screening
alpha-fetoprotein (AFP), US liver
cervix cx screening
Pap smear
rationale of staging
prognosis, treatment intent & modality
colorectal type of staging
Duke’s
thymoma type of staging
masaoka
testicular cx type of staging
Marsden
SCLC type of staging
limited & extensive staging
what is the gold standard of investigation diagnosis
histology
clinical investigation for diagnosis
CT, MRI, PET
tumor markers for investigation
CEA, CA19-9, alpha-FP, CA125, CA15-3
types of biopsy
core biopsy, fine needle aspirate (FNA)
conditions when treatment is initiated without histological confirmation
emergency, difficult to access / patient not fit, germ cell tumor markers, hepatocellular carcinoma
elevated germ cell tumor markers
beta-hCG, alpha-FP, LDH
hepatocellular carcinoma is indicative of __
underlying liver cirrhosis
what germ cell tumor marker indicates hepatocellular carcinoma
alpha-FP
what tumor marker indicates prostate cx
PSA
most common CT-PET scan
FDG-PET
radioactive tracer in CT-PET is tagged to __
glucose; increased uptake in metabolically active tissues
CT-PET scan has lower sensitivity for __
brain, liver, urinary tract
MRI allows for greater visualization of ___
brain, CNS, liver, pelvic organs, joints
examples of pelvic organs
prostate, rectum, uterus/cervix
downsides of MRI scan
longer scan time, noisy, expensive, claustrophobic, issues with implants & pacemakers
pre-treatment scans for potential disease complications
blood tests, heart scan, lung function, renal scan
what is the treatment of most cancers
surgery
what is the radical intent of treatment
to cure
what is the palliative intent of treatment
relieve symptoms, delay complications, prolong life
3 types of radical treatment
definitive, neoadjuvant, adjuvant
definitive radical treatment
primary treatment without which cure is not possible
neoadjuvant radical treatment
before definitive treatment to facilitate it
adjuvant radical treatment
after definitive treatment to reduce risk of recurrence
surgery is defined as __
complete resection of many solid tumors
principle of oncological resection
resect all tumors including regional lymph nodes of adequate margins & en-bloc
R0 resection
resect all tumors (gross & microscopic)
R1 resection
incomplete resection (microscopic)
R2 resection
incomplete resection (gross)
second most effective cx treatment
radiotherapy
principle of radiotherapy
irradiate tumors including regional lymph nodes within 1 field
radiotherapy indications
- definitive treatment
- neoadjuvant & adjuvant settings
- improve resectability
- reduce risk of local occurence - palliation
- pain, bleeding, obstruction, impending #
on electromagnetic spectrum, what has shortest wavelength
x-rays
on electromagnetic spectrum, what has longest wavelength
radiowaves
external beam radiotherapy involves use of __
photons, electrons, protons
brachytherapy is a __ radioactive source
sealed
radionuclides is a __ radioactive source
unsealed
radiotherapy involves the use of __
ROS to damage DNA and cause mitotic cell death
in early responding tissues, expression of damage appears __
early
lag time of early & late side effects
early = from 2 weeks
late = >3 months after end of RT
incidence of early & late side effects
early = most will experience
late = most will not experience
outcome of early & late side effects
early = reversible
late = irreversible
systemic therapy indications
- curable cx
- neoadjuvant/adjuvant setting
- palliative treatment in metastatic setting
types of systemic therapy
cytotoxic chemotherapy, hormonal therapy, targeted therapy, immunotherapy
common toxicities of cytotoxic chemotherapy
alopecia, nausea & vomitting, diarrhoea / constipation, bone marrow suppression
what cx are hormonally driven
breast, prostate, uterine
side effects of hormonal therapy
menopausal symptoms, CVS, osteoporosis
targeted therapy includes __
1) structure = small molecules, monoclonal antibodies
2) target / action = tyrosine kinase inhibitors, anti-angiogenic, apoptosis-inducing
benign tumors ends with __
-oma
malignant tumors ends with __
-carcinoma
tumor of connective tissue ends with __
-sarcoma
metathesis
malignant cells do not adhere to each other & often break loose from the mass, infiltrating into adjacent tissue
blood tests for cancer
low Hb & EPO count
systemic effects of cx
- weight loss
- anemia
- severe fatigue
- effusions
- frequent infections
- paraneoplastic syndrome
paraneoplastic syndrome
Tumour cells release
substances that affect neurological function or blood clotting, or may have hormonal effects
tumor seeding
Spread of cancer cells in body fluid or along membranes, usually in body cavity
tumor staging includes __
size of tumor, involvement of regional lymph nodes, spread of tumor
radiotherapy is most effective in __
rapidly dividing radiosensitive cells
chemotherapy involves the use of __
combo of 2-4 antineoplastic drugs
- antimitotics
- antimetabolites
- alkylating agents
- antibiotics
glucocorticoids are used to __
reduce mitosis, inflammation, swelling
increase EPO count, appetite, well being
