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TIN > WK 12- BREAST, LUNG, AND COLON CANCER > Flashcards

WK 12- BREAST, LUNG, AND COLON CANCER Flashcards

1
Q

What are the 3 types of neoplasia of the breast

A
  • Benign neoplasia
  • non invasive carcinoma
  • invasive carcinoma
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2
Q

What are the 2 types of non invasive carcinoma

A

Lobular and ductal

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3
Q

Where is the most common location of tumours within the breast

A

Upper outer quadrant

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4
Q

What are the risk factors for breast cancer

A

age and female gender, estrogen exposure (early menarche, nullparity, late menopause, oral contraceptive pill, HRT), high calorie intake during childhood and adolescence, obesity, excessive alcohol during adolescence

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5
Q

what are the protective factors against breast cancer

A

parity (having had children) and breast feeding

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6
Q

What genes are involved in inherited breast cancer

A

BRCA 1/2 mutations

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7
Q

What genes are involved in sporadic breast cancer

A

HER2 over expression

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8
Q

What are the 4 molecular subtypes of breast cancer

A

ER positive, HER2 negative, HER2 positive and ER pos/neg, Triple neg ( ER neg, HER2 neg and progesterone negative)

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9
Q

What is meant by triple negative breast cancer

A
  • triple negative cancer cells lack receptors for estrogen, progesterone and HER2
  • these have a poor prognosis for treatment with hormone treatments (receptor targeted treatments) but a good response to chemotherapy
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10
Q

What does median survival mean

A

measure of central tendency (most common outcome/prognosis)

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11
Q

What is the 5 year survival

A

percentage based on population of patients who have cancer

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12
Q

What are the clinical features that a pt with breast cancer presents with

A

Present with screen detected cancers and other features such as a palpable mass, skin tethering, nipple discharge

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13
Q

What factors influence the prognosis of breast cancer

A

Dependent on both the biologic type of cancer (molecular or histologic type) and the extent of cancer at the time of diagnosis
-large tumour size, higher grade, lymph node metastases, ER and PR -ve are poor prognostic factors (eg triple negative)

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14
Q

How is early breast cancer management

A
  1. Surgery- wide local excision and sentinel node biopsy
  2. Adjuvant radiotherapy after breast conservation to prevent local recurrence (radio after surgery to treat micrometastasis)
  3. Hormone receptor blockers: if a tumour has receptors to oestrogen/progesterone (ER+, HER2+, Progesterone+) it will feed off these hormones and grow- blocking these receptors can prevent tumour growth
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15
Q

What medicates are used in HER2+ patients

A

Trastuzamab/herceptin- monocloncal antibody that binds to and blocks the HER2 gene to prevent over expression and EGFR

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16
Q

How are locally advanced breast cancers treated

A

cancers that are fixed to the pec muscle or skin they are considered inoperable so are treated with neoadjuvant approach to make them operable (treat with chemo/radiotherapy to make them operable) and control micrometastatic disease

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17
Q

How is metastatic breast cancer treated

A

Cannot be cured, but symptomatic relief through anti-estrogen and radiotherapy can be provided

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18
Q

What are the 2 morphological subgroups that invasive carcinomas can be put in

A
  • 2/3 are grouped together and called “ductal” or no special type
  • 1/3 can be classified morphologically into special histologic types, some of which are strongly associated with clinically relevant biologic characteristics
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19
Q

What is the most common malignant tumour in the lung

A

metastasis from another primary cancer- most commonly breast, kidney, uterus, melanoma, colorectal, testes and thyroid

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20
Q

What are the risk factors for lung cancer, apart from smoking

A

Exposure to arsenic, radiation, iron oxide, coal mining

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21
Q

What genetic mutations occur to cause lung cancer

A
  • activation of oncogenes EGFR, K-Ras, Myc, EML4-ALK

- inactivation of tumour suppressor genes→ 3p, 9p, p16, 13q, 17P and TP53 (bolded are most common)

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22
Q

What are the 2 broad categories of lung cancer

A

Small cell lung cancer and non-small lung cancer

23
Q

What are the 3 sub types of non-small lung cancer

A

Adenocarcinoma, squamous cell carcinoma and large cell carcinoma

24
Q

Which of the non-small cell lung cancers has the poorest diagnosis

A

Large cell carcinoma–> more undifferentiated, metastisize early and have poor prognosis

25
Q

What cells do small cell lung cancers arise from

A

Arise from neuroendocrine cells (neoplastic tumour due to parathyroid)-> very aggressive and considered a systemic disease at diagnosis due to the endocrine effects

26
Q

What do adenocarcinoma cells arise from

A
  • arise from mucous cells in bronchial epithelium
  • non-smokers most often have adenocarcinoma
  • slow growing and progresses to mediastinal lymph nodes and pleura and spreads to bone and brain
  • often present late with distant metastases at time of diagnosis
27
Q

What is the most common form of NSCLC

A

adenocarcinoma

28
Q

What are the clinical presentations associated with lung cancer

A
  • respiratory symptoms of persistent dry cough, haemoptysis, wheezing, “recurrent” pneumonia or dyspnea
  • physical examination is often normal
29
Q

What tools are used to form a diagnosis of lung cancer

A

-chest X-ray, CT scan. abdo CT for nodal spread and metastases→ TNM system used

30
Q

Which has a better prognosis- NSCLC or SCLC

A

SCLC has a poorer prognosis with median survival at 12 months for metastatic SCLC

31
Q

What combination combination of treatment is used to treat SCLC

A

platinum and etoposide (combo used in lung cancer) with radiation to the primary tumour also highly recommended

32
Q

What treatment is recommended for NSCLC

A
  1. for curative small tumours= surgery
  2. for operable tumours with spread to the lymph nodes= chemotherapy plus surgery
    3, for widespread disease= chemotherapy doublets such as cisplatin with vinorelbine, or gemcitabine or paclitaxel with carboplatin
    -in some lung cancers, agents targeted at the EGFR can be beneficial
33
Q

What is the MOA for chemotherapy doublets used in treatment of NSCLC (cisplatin-intercalating agent, gemcitabine- antimetabolite agent)

A

Cisplatin- acts to wedge between base pairs and stops the DNA strands coming apart during transcription
Gemcitabine- interfere with the incorportation of nucleic acid bases into the DNA during DNA synthesis and inhibits ribonucleotide reductase

34
Q

What is the most common benign neoplasia of the colon

A

Colonic adenomas

35
Q

What 2 genetic syndroms are associated with colonic polyps and increased rates of colon cancer

A

FAP (APC mutation) and Lynch syndrome (MSH2, MLH1)

36
Q

What are the risk factors for colon cancer

A
  • highest frequency in Western societies
  • diet high in red meat, fat, high caloric intake; tobacco and alcohol use, sedentary lifestyle
  • inflammatory bowel disease
  • family history
  • familial syndromes eg FAP and Lynch Syndrome
37
Q

What genes are involved somatic colon cancer

A

APC, KRAS, TP53, B-cantenin

38
Q

What are the clinical signs of colon cancer

A

variable presentation

  • change in bowel habits
  • non-obstructing tumours may cause anaemia, rectal bleeding
  • large bowel obstruction requires emergency surgery
39
Q

What tools are used for diagnosis of colon cancer

A

colonoscopy / biopsy for histological diagnosis

  • CT scan of abdomen for detection of nodal and liver metastases
  • staging is performed using the TNM system or historical Dukes system
40
Q

What was the 5 year survival from colorectal cancer

A

69%

41
Q

How is early stage (Stage 1) colon cancer managed

A

surgery

42
Q

How is locally advances (Stage 2-3) colon cancer managed

A

surgery plus adjuvant chemotherapy combination for those with nodal involvement

43
Q

How is metastatic colon cancer manage

A

usually considered incurable
→ systemic chemotherapy combination regimens
→ targeted therapies eg bevacizumab show further improvement -anti-EGFR antibodies and cetuximab effective in KRAS wild type metastatic colorectal cancers
→ tyrosine kinase inhibitors of benefit in patients with refractory metastatic colorectal cancer
→ some patients with solitary metastases in the liver or lung may be cured with surgical resection

44
Q

What are the 3 types of skin cancer

A

NMSC; squamous cell carcinoma and basal cell carcinoma

Melanoma

45
Q

What is the most fatal (poorest prognosis) type of skin cancer

A

melanoma

46
Q

Out of the NMSC, which has low potential for metastasis and which rarely ever metastasises

A

SCC has ability to metastasize, BCC will barely ever

47
Q

What is the commonest type of NMSC

A

BCC

48
Q

What are the risk factors for skin cancer

A
  • environmental exposure -UV intensity and duration
  • previous diagnosis of melanoma
  • family history
  • skin type, eye colour, hair colour (fair skin, blonde hair)
  • less melanin pigmentation
  • smoking- particularly for BCC
49
Q

Which genetic components may play a role in skin cancer

A

B-raf, Mek and C-kit

50
Q

What are the clinical presentations of SCC, BCC and melanoma

A
  • BCC: pink, nodular, raised lesion with ‘pearly’ edges; or flat pink
  • SCC: whitish-pink, scaly, crusted, raised lesion; or pink flat lesion
  • Melanoma: many clinical forms, typically a pigmented, variegated (multicolour) skin lesion with recent changes in size, shape, colour→ may involve the keratinised skin of the sun-exposed, as well as occasionally the non-exposed regions of the body
51
Q

What are the diagnostic tools for staging

A

diagnosis by pathology using excision biopsy for primary lesions and fine /core needle biopsy for secondaries, CT scan / MRI for metastases

  • LDH may be a useful bio-marker in melanoma for metastatic disease or recurrence
  • TNM classification usually used; other systems
52
Q

What are the management options for skin cancer

A
  1. Surgery
  2. -dacarbazine and fotemustine chemotherapy, but low rates of response and cure
  3. kinase inhibitors (MEK, BRAF) checkpoint inhibitors (CTLA, PD1) have improved response rates and survival (immune checkpoint inhibs→ drugs that overcome immune response)
  4. adjuvant radiotherapy for symptom control, especially for bone metastases
53
Q

What is triple negative breast cancer

A

triple negative cancer cells lack receptors for estrogen, progesterone and HER2

  • these have a poor prognosis for treatment with hormone treatments (receptor targeted treatments)
  • on a positive note, this type of breast cancer is typically responsive to chemotherapy
54
Q

What is tumour marker for colon cancer

A

CEA

TIN (14 decks)

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