Cancer Flashcards
(154 cards)
1
Q
Difference between hyperplasia and neoplasia
A
Hyperplasia stops when stimulus removed
Neoplasia continues even when stimulus removed
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.
3
Q
Define these terms :
Well differentiated tumour
Poorly differentiated tumour
Undifferentiated/anaplastic tumour
A
4
Q
What are the common metastatic sites of lung cancer?
A
Adrenal gland, bone, brain, liver, other lung
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
6
Q
Are all benign tumours harmless?
A
No - some can even be fatal due to compression of adjacent tumours
7
Q
What are the common metastatic sites of lung cancer?
A
Adrenal gland, bone, brain, liver, other lung
8
Q
Complete the table for the different naming of epithelial tumours
A
9
Q
Complete the table for the different naming of mesenchymal tumours
A
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
11
Q
How is the grade of tumour determined
A
Pleomorphism - variation in size and shape of tumour cells
Mitotic index
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).
13
Q
Tumours with excellent prognosis
A
Thyroid
14
Q
Tumours with moderate prognosis
A
Kidney
Prostate
Cervix
Breast
15
Q
Tumours with very poor prognosis
A
Pancreas
Brain
Oesophagus
16
Q
Grade vs stage of cancer
A
Stage looks at how far a tumour has grown
Grade looks at differentiation and proliferation
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
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
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
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
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
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.
23
Q
Benign tumours have the suffix
A
-oma
24
Q
Malignant epithelial tumours are usually known as
A
Carcinomas
25
Malignant mesenchymal tumours are usually known as
Sarcomas
26
What allows tumour cells to become self sufficient of growth signals (this means they do not rely on growth signals for proliferation to occur)
Through mutations that cause :
Increased secretion of growth factors
Upregulation of growth factor receptor
Activation of growth factor receptors
27
How can tumour cells evade apoptosis
Up-regulation of anti-apoptotic factors
Down-regulation of pro-apoptotic factors
Loss of function of pro-apoptotic factors
28
c-Kit mutations (GIST) activate the tyrosine kinase domain. This can be inhibited by …
the tyrosine kinase inhibitor, Gleevec
29
only glioblastomas showing methylation of the MGMT gene are responsive to
Temozolamide
30
Malignant tumours of the oesophagus
Squamous carcinoma
Adenocarcinoma
31
Symptoms of oesophageal cancer and clinical features
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)
32
Identify the morphological change in this oesophageal biopsy taken from an area of Barrett’s oesophagus
Glandular metaplasian in squamous epithelium of esophagus
33
This is an oesophageal biopsy from a structured area
Describe the type of cancer shown here
Moderately differentiated adenocarcinoma
34
What is Barrett’s oesophagus ? What causes it?
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).
35
Clinical features and symptoms of carcinoma of stomach
Mild jaundice - dry, earthy coloured skin
Liver enlarged ; tender in epigastrium
Gastroscopy - abnormal mucosa with loss of rural pattern ; stomach non-distensible
* [heartburn or acid reflux](https://www.nhs.uk/conditions/heartburn-and-acid-reflux/)
* having [problems swallowing (dysphagia)](https://www.nhs.uk/conditions/swallowing-problems-dysphagia/)
* [feeling or being sick](https://www.nhs.uk/conditions/feeling-sick-nausea/)
* symptoms of [indigestion](https://www.nhs.uk/conditions/indigestion/), such as burping a lot
* feeling full very quickly when eating
* loss of appetite or [losing weight without trying to](https://www.nhs.uk/conditions/unintentional-weight-loss/)
* a lump at the top of your tummy
* pain at the top of your tummy
* fluid filling stomach
36
Poorly differentiated adenocarcinoma(stomach cancer) often have a ___ \_\_\_ ___ pattern
Signet ring cell
37
Carcinoma of colon/stomach is nearly always \_\_\_\_
Adenocarcinoma
38
Clinical presentation of colon cancer
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
39
Describe the biopsy of this rectosigmoid tumour
Well differentiated colo-rectal adenocarcinoma
40
Give one example of neoplasi involving permanent activation of growth factor receptors
Mutation in the TK domain of c-Kit (receptor for Stem Cell Factor) in GISTs
41
2 main types of non small cell lung cancer
Squamous cell carcinoma, Adenocarcinoma
42
Describe this slide showing a lung cancer tumour
Moderately differentiated keratinising squamous cell carcinoma
43
A patient has moderately differentiated squamous cell carcinoma ; should radiotherapy be given ?
Yes
44
Symptoms of Pancoast tumour
Arm, shoulder and neck pain
may be weakening of hand muscle, droopy eyelid or blurred vision
45
Difference between non-small cell lung cancer and small-cell Lung cancer
**Non-small cell lung cancer** is the most common type of lung cancer. It grows and spreads more slowly than small cell lung cancer.
46
First place for breast cancer to metastasise
Axillary lymph nodes
47
features of a malignant breast lump
**Irregular and hard**
**Fixed to the chest wall**
**Skin above is tethered**
**Palpable lymph nodes in axilla**
**Indrawn nipple/ nipple involvement**
**Bone tenderness/pain**
48
Features of a benign breast tumour
feels Squishy, defined margins, mobile
## Footnote
**Mammogram - uniforms, well defined , round or oval**
**MRI - slow to light up and doesn't fade**
**Biopsy - well differentiated**
49
Breast calcification
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
50
HER2 receptor and breast cancer
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).
51
Biology of tumour
Grade - how well differentiated
Receptor mutations
growth fraction - time taken for tumour to double
52
link between grade and prognosis
The higher the grade, the worse the prognosis
53
**Breast Cancer Hormone Receptor Status**
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
54
Triple approach to breast cancer
Clinical exam
imaging
FNA cytology (small sample of lesion removed with needle) or biopsy
55
How do monoclonal antibodies treat cancer
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.
56
breast carcinoma in situ
The [normal breast](https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html) 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
57
anaplasia definition and features
_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
58
Benign or malignant ?
Benign
59
Benign or malignant?
Malignant (invasive lobular carcinoma)
60
Benign or malignant?
Malignant (invasive lobular carcinoma)
61
# Define these terms :
* **Carcinoma**
* **Sarcoma**
* **Lymphoma**
* **Melanoma**
* **Germ cell tumor**
* **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.
62
Carcinoma-in-situ meaning
When dysplasia is found across the epithelial BM but is not invasive
63
Main routes of metastcity spread
Lymphatic system
circuratory system to brain/lung/liver/bone
serosal surfaces
64
Secondary deposits in bone often from primary tumours in the …
Breast
bronchus/lung
kidney
thyroid
prostate
65
Metastases in the liver are often from the …
GI tract
pancreas
breast
lung
kidney
66
Cachexia definition
progressice muscle weight loss due to chronic conditions such as cancer, COPD, CHF, AIDS
67
What are the 5 features of cancer
Proliferation in absence of signals
immortality
avoiding apoptosis
angiogenesis
metastasis
68
Stages of cancer progression
Continuing evolution by natural selection of cancer cells with accumulating mutations
69
How does angiogenesis occur in cancer
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
Describe how tissue invasion and metastasis occur
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
What are the main infectious agents that can cause cancer and briefly describe their mechanism
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
Driver vs passenger mutations
Driver mutations occur in genes that regulate proliferation, apoptosis, immortality etc
passenger Mutations occur in other genes
73
TS gene inheritance
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
Fucntion of tumour suppressor genes ; what goes wrong during cancer
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
Inherited cancers are always due to what type of mutations and why?
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
Functions of oncogenes ; how do they become mutated in cancer ?
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
Cancer of colon/stomach usually metastises to the …
Liver
78
Carcinomas do the right side (caecum) commonly present with …
Bleeding in stool and anaemia
79
Symptoms of rectal cancer
* 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
Difference between dysplasia and metaplasia
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
clinical signs of metastasis
jaundice, hepatomegaly, or ascites
82
Describe what ronchi sound like and the possible causes
Low pitched gurgling
causes : COPD,CF, pneumonia, bronchiectasis, lung cancer
83
Squamous cell ccarcinoma presentation
Smoking related
cough
ulceration
and blood in sputum
84
Presentation of adenocarcinoma of lung
Unrelated to smoking
pleural effusion is a typical presentation
85
Indications and contraindications for operating on a lung tumour
If its small and constricted to one lobe ; no metastasis
contraindications - respirator comorbidities
86
Describe stridor
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
presentation of small cell carcinoma derived from pulmonary neuroendocrine cells
Obstruction of SVC and bronchus = raised JVP and stridor
smoking related
poor prognosis
88
Why does cancer lead to weakness and lethargy ?
Tumour is secreting may interleukins and interferons, causing alterations in the hormones affecting the hunger control systems
paracrine factors also released cause lethargy
89
Paraneoplastic syndromes of lung cancer
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
Which types of lung cancers are more likely to cause paraneoplastic syndromes?
Small cell lung cancer
91
Features of benign tumour cells
resemble cells of origin
lower proliferation rate
normal/slightly Increased nucleus:cytoplasmic ratio
uniform cellular features
92
Define menorah via and dysmenorrhea
Menorrhagia = heavy/prolonged menstruation
dysmenorrhea = painful menstruation due to uterine contraction
93
What is menarche and IMB (what does it indicate)
Menarche = age menstruation began
IMB = intermenstrual blending - indicates malignancy
94
What is a leiomyoma
Benign tumour of smooth muscles of my ome trim
well differentiated, no pleomorphism, no hyperchromicity, no increased mito tic activation
95
Uncommon presentation of uterine benign tumours
Infertility
urinary complications
fibroids in pregnancy
95
Uncommon presentation of uterine benign tumours
Infertility
urinary complications
fibroids in pregnancy
96
Complications of uterine benign tumours \*
**Degeneration and complications common in fibroids**
**Hyaline degeneration and calcification**
**Red degeneration**
**Torsion**
97
Describe the characteristics and symptoms of benign colon tumours
lethargy
occasional diarrhoea
dark, nearly black faeces
no weight/appetite loss
iron deficiency anaemia
histological features - tubular adenoma with dysplasia
98
Symptoms of pituitary gland benign tumour
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
Symptoms of meningioma (benign tumour of frontal lobe)
Arise from arachnoidal epithelial cells
Positive grasp reflex (an infant reflex)
disinhibited social behaviour
anosmia
100
How do benign tumours cause disease
Local pressure of surrounding structures, distorting local anatomy, fragility and bleeding, secreting hormones
101
Which types of cancers have a high genetic component
Ovarian
stomach
breast
102
Syndromes cause by mutations in proto-oncogenes
Mutated RET gene = multiple endocribe neoplasia type 2
mutation in MET gene - hereditary papillary renal carcinoma
103
Syndromes caused by mutations in tumour suppressor gene [3]
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
Syndromes caused by mutations in DNA repair genes
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
key features in identifying a genetic predisposition to Cancer syndrome
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
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
aspirin
oral contraceptive
107
lymphomas vs leukaemias
Lymophoma - lymphoid cell cancer
leukaemia - cancer of haemopoietic bone marrow
108
What are the 2 types of lymphomas
Hodgkins diseasae
non-Hodgkin lymphoma - most common are lymphocytic lymphomas
diagnosis confirmed via histology
109
Clinical features and behaviour of lymphomas
Lymphadenopathy - localised or generalised
hepatomegaly, splenomegaly
infiltration of bone marrow - bleeding disorders, immunodeficiency
110
Define sclerosis
stiffening of a tissue or anatomical feature, usually caused by a replacement of the normal organ-specific tissue with [connective](https://en.wikipedia.org/wiki/Connective_tissue) tissue
111
Name the neoplastic cell in classical Hodgkin disease
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
what is myeloma and what are the symptoms/complications
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
describe the most common brain tumours
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
Embryonal tumours - describe them and name 2 most common examples
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
Teratomas - describe the 2 most common examples
**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
Name the 3 neoplasms involving white blood cells
Leukaemias
lymphomas
multiple myeloma
117
Describe symptoms and clinical presentation of leukaemias
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
Describe non-Hodgkin lymphoma
extranodal disease - gastrointestinal, CNS, endocrine, skin, pulmonary
associated with previous chemotherapy
immunosuppressant
EB virus
119
What is GVHD
graft vs host disease
120
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
3
121
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
4
122
Tumour grade helps determine the TNM staging ; true or fals
False
TNM tells us size and spread not differentiation
123
foecal occult blood test positivity in the screening programme diagnoses a colorectal cancer
T or F
False - not always cancer ; just increases risk
124
Which tumours harbour alterations in the MYC oncogene
mantle cell lymphoma
bursitis lymphoma
neuroblastoma
nephroblastoma
chronic myeloid leukaemia
retinoblastoma
burkitts lymphoma
neuroblastoma
125
126
127
128
129
130
131
Advice on diet and lifestyle to prevent cancer
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
Patients with the highest weight loss have cancer of the … [3]
Oesophagus, stomach and larynx
133
Patients with Stage III/IV cancer will have reduced energy and protein intakes; this presents as
Anorexia
taste changes
dysphagia
nausea
vomiting
diarrhoea
134
Describe Cachexia
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
TNF, IL-1/6 indicate
Tumour induced inflammation
136
descrieb the physiology of cancer Cachexia
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
How is cancer Cachexia different to starvation
Increased basal metabolic rate and total energy expenditure and inflammation in Cachexia but not starvation
138
Nutrition therapy for cancer patients.
**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
Parenteral and enteral nutrition
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
action of tamoxifen
In breast tissue , inhibits oestrogen action
in bones, mimics action of oestrogen, increases bone density
141
Low level of oestrogen in pre-menopausal women with ER positive breast cancer results in …
negative feedback loop - body produces even more oestrogen - harmful in ER positive cancers
142
Identify an example of a gene mutation that results in upregulation of a growth factor receptor
*cErbB2 (member of the EGFR family) upregulated in breast cancer*
143
Identify an example of a gene mutation that results in the activation of GF receptors
Mutation in the TK domain of c-Kit (receptor for stem cell factor in gastrointestinal stroma tumours)
144
Which of these will TSGs not be involved in ?
triggering apoptosis
mediating repair
inhibiting replication
producing growth factor receptors as gene product
Producing growth factor receptors as gene product
145
Significance of TERT in cancerous transformation
Enzyme that adds to telomeres so chromosomes can replicate
146
WhI h type of lung cancer is not related to smoking
Adenocarcinoma
147
BRCA1 and BRCA2 gene mutations most commonly increase the risk of which cancers
Breast and ovarian cancer
148
How are BRCA1 and BRCA2 mutations inherited ?
Autosomal dominant (although TSGs are recessive genes)
149
Which of these are not a type of breast cancer
ductal carcinoma in situ
lobular carcinoma in situ
inflammatory ductal cancer
invasive ductal carcinoma
Inflammatory ductal cancer
150
Which of these is not a risk factor for breast cancer
early menopause
late menopause
multiparity
obesity
Multiparity - having several children
nullparity (having no children is a risk factor)
151
Which of these is not a change commonly associated with breast cancer
Peau d‘orange
nipple inversion
skin dimpling
paraesthesia
Paraesthesia
152
West Point grading system
3 grades
153
Give on example of a mutation causing down-regulation of pro-apoptotic factors and which type of cancer is this found in?
*Caspase 3 is down-regulated in colorectal tumours*
