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Medicine 2 > Cancer > Flashcards

Cancer Flashcards

1
Q

Difference between hyperplasia and neoplasia

A

Hyperplasia stops when stimulus removed
Neoplasia continues even when stimulus removed

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2
Q

Why is differentiation in cancer very important ?

A

Failure to achieve cellular differentiation is a particular feature of malignant neoplasms

Allows to predict the likely behaviour of a tumour

Differentiation is the term used to describe how different in appearance the cells of a tumour are to the cell type from which they are derived.

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3
Q

Define these terms :

Well differentiated tumour
Poorly differentiated tumour
Undifferentiated/anaplastic tumour

A
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4
Q

What are the common metastatic sites of lung cancer?

A

Adrenal gland, bone, brain, liver, other lung

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5
Q

Compare benign and malignant tumours

A

Benign : stay at their site of origin and do not spread ; compress adjacent tissue and grow by expansion; well circumscribed (spherical mass within solid organs and papillary outgrowth on epithelial surfaces)

Malignant - can spread to distant sites ; grow by expansion and infiltration ; compress adjacent tissues; irregular outline

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6
Q

Are all benign tumours harmless?

A

No - some can even be fatal due to compression of adjacent tumours

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7
Q

What are the common metastatic sites of lung cancer?

A

Adrenal gland, bone, brain, liver, other lung

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8
Q

Complete the table for the different naming of epithelial tumours

A
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9
Q

Complete the table for the different naming of mesenchymal tumours

A
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10
Q

Describe 3 common tumour markers

A

HCG- from testicular cancer
AFP - released in liver cancer and germ cell tumours
PSA - prostate specific antigen

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11
Q

How is the grade of tumour determined

A

Pleomorphism - variation in size and shape of tumour cells

Mitotic index

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12
Q

TNM system

A

Used to classify the extent of the spread of cancer

T (TUMOUR) describes the size of the tumor and any spread of cancer into nearby tissue;

N (NODES) describes spread of cancer to nearby lymph nodes;

M (METASTASIS) describes metastasis (spread of cancer to other parts of the body).

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13
Q

Tumours with excellent prognosis

A

Thyroid

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14
Q

Tumours with moderate prognosis

A

Kidney
Prostate
Cervix
Breast

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15
Q

Tumours with very poor prognosis

A

Pancreas
Brain
Oesophagus

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16
Q

Grade vs stage of cancer

A

Stage looks at how far a tumour has grown
Grade looks at differentiation and proliferation

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17
Q

Define dysplasia

A

cells that appear abnormal; often increased nuclear to cytoplasmic ratio and loss of features of differentiation. Not always cancer but can be ; often invasive if cancerous

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18
Q

Describe the 4 cell cycle checkpoints

A

G1 - main checkpoint for cell size, nutrients, GFs, and DNA damage ; where it is decided if cell will divide or not ; if cell proceeds past G1 , it is committed to division

G2 - further checks for DNA damage and completion of DNA replication (done during S phase)

Metaphase - spindle attachment checkpoint

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19
Q

Telomere shortening and cancer

A

Inactivation of tumour suppressor genes allows bypass of senescence in response to telomere shortening which should happen in healthy cells

Telomeres shortening leads to chromosome instability :
End to end fusion of unprotected chromatid ends - sister chromatids can’t be separated during mitosis
There may also be pairing of non homologous chromosomes = genetic catastrophe
In cancer, TERT gene is reactivated allowing cells to continue to proliferate with severely damaged chromosomes; inactivation of tumour suppressor gene p53 or Rb may occur

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20
Q

Fucntion of TERT gene

A

Gene for making telomerase
Telomerase counteracts the shortening of telomeres by adding small repeated segments of DNA to the ends of chromosomes each time the cell divides. It is active in highly proliferating cells such as stem cells, germ line cells, haemopoietic cells

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21
Q

Symptoms of lung cancer

A

a persistent cough
coughing up blood
persistent breathlessness
unexplained tiredness and weight loss
an ache or pain when breathing or coughing

voice hoarseness

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22
Q

Adenocarcinoma

A

Adenocarcinoma is a type of cancer that starts in mucus-producing glandular cells of your body. Many organs have these glands, and adenocarcinoma can occur in any of these organs. Common types include breast cancer, colorectal cancer, lung cancer, pancreatic cancer, and prostate cancer.

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23
Q

Benign tumours have the suffix

A

-oma

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24
Q

Malignant epithelial tumours are usually known as

A

Carcinomas

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25
Q

Malignant mesenchymal tumours are usually known as

A

Sarcomas

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26
Q

What allows tumour cells to become self sufficient of growth signals (this means they do not rely on growth signals for proliferation to occur)

A

Through mutations that cause :

Increased secretion of growth factors

Upregulation of growth factor receptor

Activation of growth factor receptors

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27
Q

How can tumour cells evade apoptosis

A

Up-regulation of anti-apoptotic factors
Down-regulation of pro-apoptotic factors
Loss of function of pro-apoptotic factors

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28
Q

c-Kit mutations (GIST) activate the tyrosine kinase domain. This can be inhibited by …

A

the tyrosine kinase inhibitor, Gleevec

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29
Q

only glioblastomas showing methylation of the MGMT gene are responsive to

A

Temozolamide

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30
Q

Malignant tumours of the oesophagus

A

Squamous carcinoma
Adenocarcinoma

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31
Q

Symptoms of oesophageal cancer and clinical features

A

Difficulting in swallowing solids and thick fluids

voice hoarseness
Weight loss
Occasional regurgitation after swallowing

supraclavicular lymphadenopathy, or any signs of metastatic disease (such as jaundice, hepatomegaly, or ascites)

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32
Q

Identify the morphological change in this oesophageal biopsy taken from an area of Barrett’s oesophagus

A

Glandular metaplasian in squamous epithelium of esophagus

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33
Q

This is an oesophageal biopsy from a structured area
Describe the type of cancer shown here

A

Moderately differentiated adenocarcinoma

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34
Q

What is Barrett’s oesophagus ? What causes it?

A

Barrett’s oesophagus is the term used for a potentially pre-cancerous condition
where the normal cells lining the oesophagus, also known as the gullet or food
pipe, have been replaced with abnormal cells.

Although the exact cause remains unknown, it is strongly associated with long-term Gastro-Oesophageal Reflux Disease (GORD), which can cause the symptom of heartburn.

GORD involves reflux of acidic and non-acidic stomach (gastric) contents into the oesophagus, which irritates (inflames) and injures the lining (epithelial cells).

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35
Q

Clinical features and symptoms of carcinoma of stomach

A

Mild jaundice - dry, earthy coloured skin
Liver enlarged ; tender in epigastrium
Gastroscopy - abnormal mucosa with loss of rural pattern ; stomach non-distensible

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36
Q

Poorly differentiated adenocarcinoma(stomach cancer) often have a ___ ___ ___ pattern

A

Signet ring cell

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37
Q

Carcinoma of colon/stomach is nearly always ____

A

Adenocarcinoma

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38
Q

Clinical presentation of colon cancer

A

change in bowel habit, rectal bleeding, weight loss, abdominal pain, and symptoms of iron-deficiency anaemia (fatigue, dyspnoea, heart palpitations, pale skin). Palpable mass in either side of iliac fossa

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39
Q

Describe the biopsy of this rectosigmoid tumour

A

Well differentiated colo-rectal adenocarcinoma

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40
Q

Give one example of neoplasi involving permanent activation of growth factor receptors

A

Mutation in the TK domain of c-Kit (receptor for Stem Cell Factor) in GISTs

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41
Q

2 main types of non small cell lung cancer

A

Squamous cell carcinoma, Adenocarcinoma

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42
Q

Describe this slide showing a lung cancer tumour

A

Moderately differentiated keratinising squamous cell carcinoma

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43
Q

A patient has moderately differentiated squamous cell carcinoma ; should radiotherapy be given ?

A

Yes

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44
Q

Symptoms of Pancoast tumour

A

Arm, shoulder and neck pain

may be weakening of hand muscle, droopy eyelid or blurred vision

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45
Q

Difference between non-small cell lung cancer and small-cell Lung cancer

A

Non-small cell lung cancer is the most common type of lung cancer. It grows and spreads more slowly than small cell lung cancer.

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46
Q

First place for breast cancer to metastasise

A

Axillary lymph nodes

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47
Q

features of a malignant breast lump

A

Irregular and hard

Fixed to the chest wall

Skin above is tethered

Palpable lymph nodes in axilla

Indrawn nipple/ nipple involvement

Bone tenderness/pain

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48
Q

Features of a benign breast tumour

A

feels Squishy, defined margins, mobile

Mammogram - uniforms, well defined , round or oval

MRI - slow to light up and doesn’t fade

Biopsy - well differentiated

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49
Q

Breast calcification

A

They may be caused by:

  • calcium deposits in a cyst or in milk ducts as women get older
  • previous injuries to the breast
  • inflammation.

often indicate a benign tumour

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50
Q

HER2 receptor and breast cancer

A

HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But in about 10% to 20% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (known as HER2 gene amplification).

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51
Q

Biology of tumour

A

Grade - how well differentiated

Receptor mutations

growth fraction - time taken for tumour to double

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52
Q

link between grade and prognosis

A

The higher the grade, the worse the prognosis

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53
Q

Breast Cancer Hormone Receptor Status

A

Breast cancer cells from biopsies are screened for oestrogen and progesterone receptors ; these hormones promote cell growth

better prognosis for hormone positive cancers as there are drugs available

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54
Q

Triple approach to breast cancer

A

Clinical exam

imaging

FNA cytology (small sample of lesion removed with needle) or biopsy

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55
Q

How do monoclonal antibodies treat cancer

A

block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful drugs to cancer cells.

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56
Q

breast carcinoma in situ

A

The normal breast is made of tiny tubes (ducts) that end in a group of sacs (lobules). Cancer starts in the cells lining the ducts or lobules, when a normal cell becomes a carcinoma cell. As long as the carcinoma cells are still confined to the breast ducts or lobules, without breaking out and growing into surrounding tissue

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57
Q

anaplasia definition and features

A

loss of differentiation of cells and their orientation to each other, a characteristic of most malignant tumor cells

Features of anaplastia

variation in nucleus size and shape (nuclear pleomorphism)

variation of cell shape and size ( cellular pleomorphism)

High nuclear-cytoplasmic ratio

presence of nucleoli

high mitotic index

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58
Q

Benign or malignant ?

A

Benign

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59
Q

Benign or malignant?

A

Malignant (invasive lobular carcinoma)

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60
Q

Benign or malignant?

A

Malignant (invasive lobular carcinoma)

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61
Q

Define these terms :

  • Carcinoma
  • Sarcoma
  • Lymphoma
  • Melanoma
  • Germ cell tumor
A
  • Adenoma: Benign neoplasm derived from glandular cells within epithelium. (Adrenal, thyroid, prostate or pituitary gland typically)
  • Carcinoma: Malignant neoplasm derived from epithelial cells
  • Sarcoma: Malignant neoplasm derived from mesenchymal cells (e.g., fat, muscle).
  • Lymphoma: Malignant neoplasm derived from lymphocytes.
  • Melanoma: Malignant neoplasm derived from melanocytes.
  • Germ cell tumor: Malignant neoplasm derived from germ cells.
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62
Q

Carcinoma-in-situ meaning

A

When dysplasia is found across the epithelial BM but is not invasive

63
Q

Main routes of metastcity spread

A

Lymphatic system

circuratory system to brain/lung/liver/bone

serosal surfaces

64
Q

Secondary deposits in bone often from primary tumours in the …

A

Breast

bronchus/lung

kidney

thyroid

prostate

65
Q

Metastases in the liver are often from the …

A

GI tract

pancreas

breast

lung

kidney

66
Q

Cachexia definition

A

progressice muscle weight loss due to chronic conditions such as cancer, COPD, CHF, AIDS

67
Q

What are the 5 features of cancer

A

Proliferation in absence of signals

immortality

avoiding apoptosis

angiogenesis

metastasis

68
Q

Stages of cancer progression

A

Continuing evolution by natural selection of cancer cells with accumulating mutations

69
Q

How does angiogenesis occur in cancer

A

Newly arisen tumours must promote angiogenesis in order to survive

newly arisen tumours are hypoxic due to their lack of blood vessels ; there is an intrinsic mechanism already in place that promotes angiogenesis in these conditions - via the action of hypoxia induced factor 1 alpha (HIF1A)

disregulation and overexpression of VEGF is also involved

tumour vascularisation will be disorganised and leaky

70
Q

Describe how tissue invasion and metastasis occur

A

Cells unstick from the basal lamina (delaminating) and break through (via action of metalloproteinases and loss of E-cadherin) of organ and invade the capillaries

1 cell out of the million tumour cells may adhere to the blood vessel in another organ, extravasation may occur and proliferation = metastasis

71
Q

What are the main infectious agents that can cause cancer and briefly describe their mechanism

A

H.pylori - excess Inflammation

Hep B - excess inflammation

HPV - oncogene activation

Epstein-Barr virus (EBV) - oncogene activation

HIV - immune suppression (immune system is involoved in killing cancer cells)

72
Q

Driver vs passenger mutations

A

Driver mutations occur in genes that regulate proliferation, apoptosis, immortality etc

passenger Mutations occur in other genes

73
Q

TS gene inheritance

A

It is highly unlikely that both copies of a gene will be inactivated by two successive random mutations

loss of function of TS genes occurs only when both allele become mutated

in reality, if you acquire the first mutant allele, the chance of the second becoming mutated is not not random; crossing over increases the chances of the second allele becoming mutated (loss of heterozygosity)

this explains the genetic component of cancer - if you inherit once copy of an oncogene, the chance of the second copy becoming cancerous is much higher , hence you have a higher chance of getting cancer

74
Q

Fucntion of tumour suppressor genes ; what goes wrong during cancer

A

TS proteins detect error in the cell cycle or DNA

error is spotted and repaired and cell goes back to proliferation/sensescence

or error is spotted and not repaired and cell undergoes apoptosis

in cancer, loss of fucntion of TS means errors are not repaired and cell continues to proliferate with the errors

75
Q

Inherited cancers are always due to what type of mutations and why?

A

Mutations in TS genes have a recessive action ; normal embryological development can occur as germ cells start off with only one mutant allele ; cancer develops when second allele develops mutation

mutations in oncogenes have dominant actions ; not conducive with embryological development

76
Q

Functions of oncogenes ; how do they become mutated in cancer ?

A

Oncogene promote proliferation

point mutations can activate receptors; translocations produce hybrid genes (such as pro-regulatory region added on to a growth factor gene); amplification

77
Q

Cancer of colon/stomach usually metastises to the …

A

Liver

78
Q

Carcinomas do the right side (caecum) commonly present with …

A

Bleeding in stool and anaemia

79
Q

Symptoms of rectal cancer

A
  • A change in bowel habits, such as diarrhea, constipation or more-frequent bowel movements.
  • Dark maroon or bright red blood in stool.
  • Narrow stool.
  • A feeling that your bowel doesn’t empty completely.
  • Abdominal pain.
  • Unexplained weight loss.
    • Weakness or fatigue
80
Q

Difference between dysplasia and metaplasia

A

Metaplasia:

when a cell transforms from one cell type to another; caused by external stimulus; can be reversible; less likely to lead to cancer.

Dysplasia:

when a cell turns into an abnormal version of itself; caused by internal stimulus; is not reversible; more likely to lead to cancer.

81
Q

clinical signs of metastasis

A

jaundice, hepatomegaly, or ascites

82
Q

Describe what ronchi sound like and the possible causes

A

Low pitched gurgling

causes : COPD,CF, pneumonia, bronchiectasis, lung cancer

83
Q

Squamous cell ccarcinoma presentation

A

Smoking related

cough

ulceration

and blood in sputum

84
Q

Presentation of adenocarcinoma of lung

A

Unrelated to smoking

pleural effusion is a typical presentation

85
Q

Indications and contraindications for operating on a lung tumour

A

If its small and constricted to one lobe ; no metastasis

contraindications - respirator comorbidities

86
Q

Describe stridor

A

High pitched whistling sound often heard in inspiration

often heard without stethoscope

causes : croup, epiglotitis, upper airway narrowing, foreign body aspiration, lung cancer, upper airway oedema due to allergic reaction, peritonsillar/retropharyngeal abscess

87
Q

presentation of small cell carcinoma derived from pulmonary neuroendocrine cells

A

Obstruction of SVC and bronchus = raised JVP and stridor

smoking related

poor prognosis

88
Q

Why does cancer lead to weakness and lethargy ?

A

Tumour is secreting may interleukins and interferons, causing alterations in the hormones affecting the hunger control systems

paracrine factors also released cause lethargy

89
Q

Paraneoplastic syndromes of lung cancer

A

Paraneoplastic syndromes are caused by the secondary effects of the growth factors, interleukins and interferons secreting by the lung tumour

cancer cachexia

stridor

clubbing (hypertrophic pulmonary osteo-arthropathy)

voice hoarseness (due to involvement of laryngeal nerve)

horners syndrome (involvement of cervical sympathetic chain)

wasted muscles of hand (brachial plexus involvement)

SIADH (inappropriate ADH secretion) leads to low Na+ and plasma osmolarity and high urine osmolarity

cushions syndrome

hypercalcaemia

cerebellar degenaration

90
Q

Which types of lung cancers are more likely to cause paraneoplastic syndromes?

A

Small cell lung cancer

91
Q

Features of benign tumour cells

A

resemble cells of origin

lower proliferation rate

normal/slightly Increased nucleus:cytoplasmic ratio

uniform cellular features

92
Q

Define menorah via and dysmenorrhea

A

Menorrhagia = heavy/prolonged menstruation

dysmenorrhea = painful menstruation due to uterine contraction

93
Q

What is menarche and IMB (what does it indicate)

A

Menarche = age menstruation began

IMB = intermenstrual blending - indicates malignancy

94
Q

What is a leiomyoma

A

Benign tumour of smooth muscles of my ome trim

well differentiated, no pleomorphism, no hyperchromicity, no increased mito tic activation

95
Q

Uncommon presentation of uterine benign tumours

A

Infertility

urinary complications

fibroids in pregnancy

95
Q

Uncommon presentation of uterine benign tumours

A

Infertility

urinary complications

fibroids in pregnancy

96
Q

Complications of uterine benign tumours *

A

Degeneration and complications common in fibroids

Hyaline degeneration and calcification

Red degeneration

Torsion

97
Q

Describe the characteristics and symptoms of benign colon tumours

A

lethargy

occasional diarrhoea

dark, nearly black faeces

no weight/appetite loss

iron deficiency anaemia

histological features - tubular adenoma with dysplasia

98
Q

Symptoms of pituitary gland benign tumour

A

Infertiity

progressively irregular and sparse periods

loss of libido

headaches, lethargy, depression

blurring of vision due to papilloedema and temporal hemianopia

high serum prolactin

99
Q

Symptoms of meningioma (benign tumour of frontal lobe)

A

Arise from arachnoidal epithelial cells

Positive grasp reflex (an infant reflex)

disinhibited social behaviour

anosmia

100
Q

How do benign tumours cause disease

A

Local pressure of surrounding structures, distorting local anatomy, fragility and bleeding, secreting hormones

101
Q

Which types of cancers have a high genetic component

A

Ovarian

stomach

breast

102
Q

Syndromes cause by mutations in proto-oncogenes

A

Mutated RET gene = multiple endocribe neoplasia type 2

mutation in MET gene - hereditary papillary renal carcinoma

103
Q

Syndromes caused by mutations in tumour suppressor gene [3]

A

Li-Fraumeni syndrome (TP53)- young onset cancers particularly sarcoma and breast

Cowden syndrome(PTEN) - breast or thyroid or endometrial cancer /benign skin tumour

Familial adenomatous polyposis (APC) - increased risk of colon cancer ; diagnosed by presence of >100 adenomatous polyps

104
Q

Syndromes caused by mutations in DNA repair genes

A

Hereditary non-polyposis colorectal cancer (also called lynch syndrome)

BRCA1 and BRCA2 mutations increase risk of breast and ovarian cancer in women and prostate/pancreatic cancer in men

105
Q

key features in identifying a genetic predisposition to Cancer syndrome

A

Early onset tumours

multiple tumours within an individual

same or related tumours in close relative

rare tumours

the chances of identifying the mutation will be low

106
Q

Whuch drugs reduce risk of colorectal cancer with genetic predisposition

which drug reduces risk of breast and ovarian cancers in people with BRCA1 or 2 mutation

A

aspirin

oral contraceptive

107
Q

lymphomas vs leukaemias

A

Lymophoma - lymphoid cell cancer

leukaemia - cancer of haemopoietic bone marrow

108
Q

What are the 2 types of lymphomas

A

Hodgkins diseasae

non-Hodgkin lymphoma - most common are lymphocytic lymphomas

diagnosis confirmed via histology

109
Q

Clinical features and behaviour of lymphomas

A

Lymphadenopathy - localised or generalised

hepatomegaly, splenomegaly

infiltration of bone marrow - bleeding disorders, immunodeficiency

110
Q

Define sclerosis

A

stiffening of a tissue or anatomical feature, usually caused by a replacement of the normal organ-specific tissue with connective tissue

111
Q

Name the neoplastic cell in classical Hodgkin disease

A

Reed-sternberg cel;s

other cells present include lymphocytes and some eosinophils/fibroblasts

the different types of Hodgkin disease based on differing proportions of reed0sternberg cells and lymphocytes

112
Q

what is myeloma and what are the symptoms/complications

A

tumour of mature plasma cells

arises in bone marrow causing bone tumours, bone breaks, increased infections, renal failure

monoclonal proteins in blood and protein

myeloma amyloid proteins

113
Q

describe the most common brain tumours

A

Glial cell derived - astrocytomas are most common (type of glial cell)

All astrocytomas behave in a malignant manner by local invasion but do not metastasize

114
Q

Embryonal tumours - describe them and name 2 most common examples

A

Highly malignant as all cells have the mutation

spreads very quickly via lymphatics and veins

responsive to chemotherapy

nephroblastoma and neuroblastoma are most common (occurs in primitive adrenal medullary precursors )

115
Q

Teratomas - describe the 2 most common examples

A

are tumours derived from primitive germ cells which retain the capacity to differentiate along all 3 primitive embryological lines

Malignant in nature

mainly occur in ovary and testes

teratoma of the ovary - found in young women , benign, many keratinous cysts; good prognosis

teratoma of testes - found in young men, painless swelling of testes, malignant, spreads early

116
Q

Name the 3 neoplasms involving white blood cells

A

Leukaemias

lymphomas

multiple myeloma

117
Q

Describe symptoms and clinical presentation of leukaemias

A

Leukaemia involves abnormal proliferation and differentiation of leucocytes or their precursor cells.

2 types; acute - lymphoblastic or myeloid and chronic

chronic leukaemias typically due to philadlohia chromosome

symptoms :

increased WBC count

increased susceptibility to infection due to bone marrow failure

anaemia

thrombocytopenia - bruising and increased bleeding

118
Q

Describe non-Hodgkin lymphoma

A

extranodal disease - gastrointestinal, CNS, endocrine, skin, pulmonary

associated with previous chemotherapy

immunosuppressant

EB virus

119
Q

What is GVHD

A

graft vs host disease

120
Q

Which one of the following would suggest a malignant e rather than benign

  1. Normal bone scan
  2. normal local draining
  3. fixation of the mass to deep tissue
  4. smooth contour on palpation
  5. clinical history of slow growth
A

3

121
Q

Pre-cancerous condition for oesophageal adenocarcinoma

  1. Reflux Oesophagitis
  2. eosinophilic oesoohagitis
  3. Herpes oesophagitis
  4. oesophageal candidiasis
  5. Barrett’s oesophagus
  6. all of the above
A

4

122
Q

Tumour grade helps determine the TNM staging ; true or fals

A

False

TNM tells us size and spread not differentiation

123
Q

foecal occult blood test positivity in the screening programme diagnoses a colorectal cancer

T or F

A

False - not always cancer ; just increases risk

124
Q

Which tumours harbour alterations in the MYC oncogene

mantle cell lymphoma

bursitis lymphoma

neuroblastoma

nephroblastoma

chronic myeloid leukaemia

retinoblastoma

A

burkitts lymphoma

neuroblastoma

125
Q
A
126
Q
A
127
Q
A
128
Q
A
129
Q
A
130
Q
A
131
Q

Advice on diet and lifestyle to prevent cancer

A

Maintenance of normal body weight

variety of fruit and veg - at least 400g per day

increased intake of plant foods rich in complex carbohydrates

limit intake of red meat, animal fat and processed food

limit alcohol consumption

132
Q

Patients with the highest weight loss have cancer of the … [3]

A

Oesophagus, stomach and larynx

133
Q

Patients with Stage III/IV cancer will have reduced energy and protein intakes; this presents as

A

Anorexia

taste changes

dysphagia

nausea

vomiting

diarrhoea

134
Q

Describe Cachexia

A

Chronic hypermetabolic state characterised by rapid weight loss and anorexia.

Seen in cancer patients and some infections such as malaria/TB/HIV/CF and chronic alcoholics

prevalent in GI/pancreatic/colorectal and lung cancer

135
Q

TNF, IL-1/6 indicate

A

Tumour induced inflammation

136
Q

descrieb the physiology of cancer Cachexia

A

Decreased protein synthesis/ Increased protein breakdown/Decreased energy intake (anorexia)/Increased resting metabolism/Insulin resistance/Increased lipolysis

Induction of hepatic APR (acute phase response) & synthesis of APP - positive acute-phase proteins

loss of muscle/fat

fatigue

impaired immunity and response to therapy

137
Q

How is cancer Cachexia different to starvation

A

Increased basal metabolic rate and total energy expenditure and inflammation in Cachexia but not starvation

138
Q

Nutrition therapy for cancer patients.

A

Sufficient protein should be provided (1-1.5 g/kg/day)

Carbohydrate should be the primary source of energy

Fat should represent ~25% of energy intake (including adequate intake of omega-3 fatty acids)

Adequate dietary fibre and fluid (including electrolytes)

139
Q

Parenteral and enteral nutrition

A

When patients have problems with eating or digestion = nutrition with specially formulated food

Enteral nutrition involves delivering the food to the gut via the nose.

Alternatively, the nutrition can be delivered into the blood stream through a drip to bypass the gut, which is known as Parenteral Nutrition.

140
Q

action of tamoxifen

A

In breast tissue , inhibits oestrogen action

in bones, mimics action of oestrogen, increases bone density

141
Q

Low level of oestrogen in pre-menopausal women with ER positive breast cancer results in …

A

negative feedback loop - body produces even more oestrogen - harmful in ER positive cancers

142
Q

Identify an example of a gene mutation that results in upregulation of a growth factor receptor

A

cErbB2 (member of the EGFR family) upregulated in breast cancer

143
Q

Identify an example of a gene mutation that results in the activation of GF receptors

A

Mutation in the TK domain of c-Kit (receptor for stem cell factor in gastrointestinal stroma tumours)

144
Q

Which of these will TSGs not be involved in ?

triggering apoptosis

mediating repair

inhibiting replication

producing growth factor receptors as gene product

A

Producing growth factor receptors as gene product

145
Q

Significance of TERT in cancerous transformation

A

Enzyme that adds to telomeres so chromosomes can replicate

146
Q

WhI h type of lung cancer is not related to smoking

A

Adenocarcinoma

147
Q

BRCA1 and BRCA2 gene mutations most commonly increase the risk of which cancers

A

Breast and ovarian cancer

148
Q

How are BRCA1 and BRCA2 mutations inherited ?

A

Autosomal dominant (although TSGs are recessive genes)

149
Q

Which of these are not a type of breast cancer

ductal carcinoma in situ

lobular carcinoma in situ

inflammatory ductal cancer

invasive ductal carcinoma

A

Inflammatory ductal cancer

150
Q

Which of these is not a risk factor for breast cancer

early menopause

late menopause

multiparity

obesity

A

Multiparity - having several children

nullparity (having no children is a risk factor)

151
Q

Which of these is not a change commonly associated with breast cancer

Peau d‘orange

nipple inversion

skin dimpling

paraesthesia

A

Paraesthesia

152
Q

West Point grading system

A

3 grades

153
Q

Give on example of a mutation causing down-regulation of pro-apoptotic factors and which type of cancer is this found in?

A

Caspase 3 is down-regulated in colorectal tumours

Medicine 2 (14 decks)

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