Oncology & Palliative Care Flashcards
Name 4 histological features of cancer.
Abnormal cellular morphology Increased mitotic rate Multinucleated cells Increased nuclear DNA Increased nuclear:cytoplasmic ratio Less organised/differentiated tissue structure
Why is histology so useful in cancer diagnosis and management?
It provides GROSS FEATURES (tumour size, lymph node size & number)
and MICROSCOPIC TUMOUR FEATURES (grade, margins, lymphovascualar invasion, mitotic rate and immunochamical staining).
The features indicate the TYPE of cancer and HOW AGGRESSIVE it is, which in tern GUIDE MOST EFFECTIVE MANAGEMENT.
Name 3 infections that are associated with cancers and they cancer they are associated with.
Human papilloma virus (HPV) - cervical cancer. HPV is the most important risk factor for developing cervical cancer (also associated with anal cancer). Subtypes 16, 18 & 33 are the most carcinogenic.
Helicobacter pylori - gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphomas.
Hepatitis B & C - cause 75% of hepatocallular carcinomas. Also associated with chronic liver cirrhosis and cholangiocarcinoma.
Herpes (EBV & HHV8) - Burkitt’s lymphoma, Hodgkin’s Lymphoma, gastric & nasopharyngeal cancers and Kaposi’s sarcoma.
Retrovirus - adult T-cell leukaemia.
Liver fluke parasite - hepatocellular carcinoma.
Schistosoma haematobium - squamous cell bladder cancer.
Which infection is associated with cervical cancer?
Which subtypes of this infection are the most carcinogenic?
Human papilloma virus (HPV). Infected cervical cells undergo changes to become koilocytes, which have an enlarged nucleus, irregular membrane contour, nuclear hyperchromasia +/- peri-nuclear halo.
Subtypes 16, 18 & 33 are the most carcinogenic.
6 & 11 are very common but are non-carcinogenic - they cause warts.
What features indicate that a cancer may have a hereditary component?
Unusually early presentation Unusual presentation (e.g. male breast cancer) Multiple primaries/bilateral disease Rare histology Clusters within a family
Most inherited predisposition syndromes have what inheritance pattern?
Autosomal dominant
Exceptions include: ataxia telangiectasia, Bloom syndrome and xeroderma pigmentosa.
Name 3 inherited cancer syndromes and the cancers they are associated with.
Lynch Syndrome (HNPCC) - colorectal & colorectal cancers (80% lifetime risk - using the Amsterdam criteria).
Familial adenomatous polyposis (FAP) - colorectal & upper GI cancer.
Peutz-Jaghers Syndrome - colorectal cancer.
Neurofibromatosis 1 - neurofibrosarcoma
Neurofibromatosis 2 - vestibular schwannoma
Von-Hippel-Lindau Syndrome - haemangiosarcoma of the retina and CNS
Wilm’s Tumour - Nephroblastoma
Li-Fraumeni Syndrome - sarcomas and leukaemias
Gardener’s Syndrome - colorectal polyposis (a variant of FAP).
Name 2 cancers associated with BRCA1/2 mutation.
Breast cancer
Prostate cancer
What are the 10 hallmarks of cancer?
Genome instability & mutation
Resisting cell death - decreased apoptosis due to decreased Tp53
Sustaining proliferative signalling
Evading growth supressors, e.g. Rb & Tp53
Enabling replicative immortality - increased telomerase
Inducing angiogenesis - increased VEGF & PDGF
Activating invasion and metastasis - mutation on CDH-1 gene = reduced cadherin
Reprogramming energy metabolism
Tumour promoting inflammation
Evading immune destruction
