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Flashcards in cancer Deck (44)
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1

what is a tumour?

a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant

2

Benign

Benign
Localized growths of tissue

3

malignant

Malignant
Abnormal cells growth
Structural and functional alterations
Invasion of nearby tissues
Migrate and colonize other organs via blood and lymph
Success of therapy and survival depend on extent and control of metastases

4

Cells require six characteristics to become fully malignant

Production of growth signals
Lack of sensitivity to antigrowth signals
Resistance towards apoptosis
Immortalization
Stimulation of blood vessel production
Ability to invade and metastasize

5

cancer approaches

Approaches
Epidemiological approach
Study designs
Exposures vs outcomes
Distribution

Experimental approach
Identification of carcinogens via lab testing
Experimental animals, mostly rodents-long term
No universal criteria to translate this data to cancer risk in humans
Effects of chemical agents on end-points belonging to DNA damage, mutagenicity, chromosome testing- short term
Mechanical tests
Identification of intermediate steps in compound-specific carcinogenic process
Limitations
Non-genotoxic carcinogens such as hormones and obesity with no bio-markers

6

Classification of carcinogenic chemicals by the IARC (International Agency for Research on Cancer

Group: 1
Evidence of carcinogenicity in humans:
-Derived from epidemiological studies; sufficient
GROUP 2A
Evidence of carcinogenicity in humans :Limited; agent is experimental carcinogen

GROUP 2B
Evidence of carcinogenicity in humans: Experimental agent; inadequate or non-existent evidence

GROUP 3
Evidence of carcinogenicity in humans
:Non-classifiable as to its carcinogenicity in humans

Group 4
Evidence of carcinogenicity in humans:
Probably non-carcinogenic to humans

7

Risk factors leading to cancer

1.Genetic predisposition (small percentage)
-Family

2.Tobacco smoking
Single major cause of human cancer globally- 30% of all cancers in HICs; less in LMICs because later start of tobacco epidemic

3.Behavioural
Diet and obesity
Exposure to aflatoxin( produced by fungi in tropical areas)
liver cancer
High intake of red meat and processed meat colorectal cancer
Alcohol

4.Viruses

5.Bacteria
6.Parasites
7.Occupation and pollution
8.Ionizing and non-ionizing radiation
-Acute lymphocytic leukemia
Acute and chronic myeloid leukemia
Cancers of breast, lung, bone, brain, thyroid

8

lung cancer histology

Histology
Small cell carcinoma
Non-small cell
Squamous cell
decreasing
Adenocarcinoma
increasing
Large cell

9

Staging System?

way cancer is thought to
spread

10

Non-Small Cell Lung Cancer:
Staging

T = Main Tumor
N = Regional Nodes
M = Distant Metastasis

11

TNM Staging: Regional Lymph Nodes

NO
No tumor spread to regional lymph
nodes

N1
Spread detected in nodes close to
the tumor

N2
Spread found in nodes in middle of
chest

12

TNM Staging: Primary Tumor (T)

Based on Size of Tumor - bigger more chance
of breaking off and spreading

T1 < or equal 3 cm diameter
T2 >3 m diameter

13

TNM Staging: Distant Metastasis

MO No spread or metastasis outside
of chest

M1 Spread or metastasis present
outside of chest, for example in brain
or bone or liver

14

A etiology and risk factors of lung cancer

Tobacco smoke
Increases risk by 20-40 fold, even for moderate smokers
Cumulative risk of lung cancer is 16%
Excess risk levels off in ex-smokers
Exposure to involuntary smoking increases risk among non-smokers-20% excess risk compared to unexposed non-smokers
Contribution of all aspects of smoking
Average consumption
Duration of smoking
Time since quitting
Age at start
Type of tobacco product
Inhalation pattern

15

Protective factor of lung cancer

Intake of cruciferous vegetables
High content of isothiocyanates

16

Ionizing radiation of lung cancer

Underground miners
Atomic bomb survivors
Radiotherapy for breast cancer or ankylosing spondylitis
Annual low dose CT scan among smokers

17

Lung cancer prevention

Prevention
Control tobacco smoking, including involuntary
Reduction in exposure to occupational an environmental carcinogens-indoor pollution and radon
Increase consumption of fruits and vegetables

18

Liver cancer risk factors

Risk factors and causes
Hep B and C
Main causes of hepatocellular carcinoma (HCC)-75% of liver cancers
Risk increases with early age at infection
Presence of liver cirrhosis is a pathogenic step

Risk factors and causes
Contamination of foodstuffs with aflatoxins especially B1( mycotoxins produced by fungi Aspergillus Flavus and parasiticus)

From improper storage of cereals, peanut's, other vegetables

Alcoholic cirrhosis-VIP
In populations with low prevalence of HBV and HCV, and low exposure to aflatoxins

Tobacco smoking
Use of oral contraceptives
Diabetes/overweight/obesity
Development of non-alcoholic fatty liver disease (NAFLD)
Excess fat accumulation in liver
Ranges from isolated hepatic steatosis to non-alcoholic steatohepatitis (NASH)
NASH is aggressive and progresses to cirrhosis and HCC

19

Liver cancer prevention

Prevention
HBV vaccination in perinatal period
Aflatoxin reduction in foods
Limited by logistic and economic factors
Control of transmission for HCV
Medical treatment for carriers of HCV and HBV (interferons and newer antiviral drugs)
Control of tobacco smoking and alcohol drinking

20

Liver cancer screening

Fetal antigen α-fetoprotein secreted by HCC and not normal liver
No evidence of impact of screening such as decreased mortality at a population level

21

Stomach cancer risk factors

Risk factors
Helicobacter pylori
High prevalence in developing countries
Precancerous stages
Chronic and atrophic gastritis
Not sufficient cause
Interaction between virulence factors and immune subversion and manipulation mechanisms
5% of all cases
Tobacco smoking
10% of all cases
Salt and salted foods
Strong environmental influence on disease
More varied affluent diet
Better food conservation-refrigeration
Control of H.pylori

22

Protective factors for stomach cancer

Protective factors
Supplements with beta-carotene, vitamin E and selenium

23

Prevention of stomach cancer

Prevention
Decreased consumption of cured meats and salt preserved foods
Eradication of H.pylori
Childhood
Adolescence
Mother-to-child transmission

24

Screening of Stomach cancer

Early detection in Japan by X-ray photofluorography to identify early lesions followed by gastroscopy

25

Histology of Colorectal cancer

Histology
Adenocarcinoma
Preceded by adenomatous polyp

26

General risk factors of Colorectal cancer

Risk factors
Carriers of one adenoma larger than 1 cm
Risk increases if multiple adenomas present
Prevalence of adenomas detected during colonoscopy parallels incidence of colon cancer
Alcohol consumption
Tobacco smoking
Ulcerative colitis and Crohn’s disease
Higher for young age at diagnosis and presence of dysplasia
Diabetes
Cholecystectomy
Women: cancers of endometrium, ovary, breast-due to shared hormonal or dietary factors
Cancer of the colon
Hereditary rare conditions
First degree relative of colon cancer patients
high intake of meat and smoked, salted, or processed foods

27

Colorectal cancer prevention

Primary prevention
Increased physical activity
Avoidance of overweight and obesity
Reduce alcohol intake
Quitting smoking
No routine recommendation of aspirin

Secondary prevention
Removal of adenomas via flexible colonoscopy

28

Protective factor of Colorectal cancer

Vitamin D
Aspirin
NSAIDS
Hormone therapy in menopause and other female hormones (OC)

29

Surveillance of colorectal cancer

Surveillance
Flexible colonoscopy for adenomas
Faecal occult blood
Detection of adenoma
Low specificity
To a lesser extent-low sensitivity
Sigmoidoscopy for distal colon
Current recommendations
Individuals over 50
Annual faecal occult blood testing OR one colonoscopic examination ( not need to be repeated for 10 years if results are normal)

30

genetic factors of breast cancer

Genetic factors
Carriers of mutations of several high-penetrance and low frequency genes
BRCA1, BRCA2, PTEN, TP53
High risk breast cancer
Defined as inherited breast cancer syndrome
Cumulative lifetime risk in carriers >50%, but rare in most populations except the AshKenazi Jews
Moderate risk
Group of low penetrance and low frequency DNA repair genes
Similarities and differences in risk profiles between TNBC and ER+ breast cancer
Similar risk factors
BMI
Lack of physical activity
Breast density

31

risk factors of Breast cancer

Causes and risk factors
Endogenous hormones
Oestradiol concentrations in post-menopausal women; not so distinct in pre-menopausal
Gender
Less than 1% occur in men
Risk factors: conditions involving high oestrogen levels
Gonadal dysfunction
Alcohol abuse
Obesity
Genetics: BRCA2 mutations more common than BRCA1 in male familial breast cancers
Little evidence for geographic and interracial variations
Fibrocystic disease and fibroadenoma
Not pre-neoplastic
Share with breast cancer epithelial proliferation, linked to hormonal alterations
History of breast cancer in a first degree relative
Role of family history related to low penetrance genes associated with hormonal metabolism and regulation, and DNA damage and repair

32

Nulliparity

TNBC triple negative: Decreased risk
ER+: Increased risk

33

Number of deaths

TNBC triple negative: Positively associated
ER+: Inversely associated

34

Age at mernache and menopause

TNBC triple negative: No association
ER+: Modestely association

35

Tobacco

TNBC triple negative: No association
ER+: Risk factor

36

Alcohol

TNBC triple negative: Protective
ER+ : Risk factor

37

Breast cancer prevention

Primary
Control of weight gain especially in post menopausal women

Secondary
Mammography
Effective in patients >50 years. Not well demonstrated for <50
Breast self examination
No proven reduction in mortality

38

Protective factors of breast cancer

Protective factors
Physical exercise

39

Esophageal cancer histology

high risk areas
Squamous cell carcinoma (SqCC)

Decreasing incidence
Adenocarcinoma of lower oesophagus
On the rise

40

Esophageal cancer prevention

Prevention
SqCC
Avoidance of smoking
Reduction in alcohol drinking
Improved diet
Increased consumption of fresh fruits and vegetables
Adenocarcinoma
Avoidance of smoking
Control of obesity
Increased physical activity
Treatment of reflux

41

Adenocarcinoma of esophageal cancer

Adenocarcinoma
Lower third of oesophagus
Increasing incidence among white people and high social classes
Preneoplastic
Barret’s oesophagus-columnar metaplasia of epithelium
Main risk factor: persistent reflux oesophagitis
Overwight
Lack of physical activity
Tobacco smoking
Salty foods
Protective factor: high intake of fruits and vegetables

42

Esophageal risks and causes

Risk factors and causes
90% SqCC from tobacco smoking and alcohol drinking in HICs
Smoking
Quitting smoking reduces the risk
Smoking black tobacco, high-tar, hand-rolled cigarettes, pipes, chewing tobacco
Snuff use
Genetic factors
Genes responsible for keratosis palmaris and plantaris(tylosis)
Mycotoxins and N-nitroso compounds
Eating Bracken fern
Ionizing radiation
Radiotherapy for breast cancer

43

Other Risk factors and causes of esophageal cancer

Risk factors and causes
Diet rich in foods from animal origin and poor in vitamins and fibre
Low intake of fresh fruits and vegetables
Low intake of fish
High intake of red meat and processed meat
Plummer-Vinson syndrome
Sideropenic dysphagia
Deficit of iron, riboflavin, and other vitamins
Coeliac disease
Nutritional deficiencies
Family history of oesophageal cancer

44

Normal characteristics of benign

Normal characteristics
Amenable to surgery
Minor symptoms
Fatal
Compression
Difficult area for surgery
Production of hormones