Cancer Flashcards
(38 cards)
1
Q
Name the three types of non-neoplastic lesions
A
- Metaplasia
- Dysplasia
- Hamartoma
2
Q
Define metaplasia, list its characteristics.
A
- Metaplasia = a reversible change in which one adult cell type changes to another cell type
- Non-cancerous (because changes are reversible)
- Metaplasia can lead to cancer
- Change in morphology but not increased proliferation
3
Q
Define dysplasia, list its characteristics.
A
- Dysplasia = an abnormal pattern of growth in which s_ome of the histological features of malignancy are present_
- **Non-cancerous **
- Loss of architectural orientation (the cells “forget” where they are)
- Loss in uniformity of individual cells
- Variability in size and shape
- Nuclei hyperchromatic (enlarged)
- Mitotic figures abundant
4
Q
List the common sites of dysplasia and their causes.
A
- Cervix – HPV infection
- Bronchus – smoking is an irritant (causes the turnover of cells to increase)
- Colon – uc (ulcerative colitis à increase risk of colon cancer)
- Larynx - smoking
- Stomach -pernicious anaemia
- Oesophagus- barrett’s metaplasia
5
Q
Define hamartoma, list its characteristics.
A
- Hamartoma = relative overgrowth of part of a tissue with disorderly structural arrangement
- Restrained overgrowth
- Tumour-like malformations
- Vascular origin – haemangioma
- Naevus of skin – mole/birth mark cf skin cancer (type of hamartoma)
6
Q
What is a neoplastic lesion?
A
Neoplastic lesions = tumours
They can either be benign or malignant
7
Q
What is a benign neoplastic lesions? List its characteristics.
A
- Benign tumours are caused by loss of growth control & feedback regulation
- Normal regulation of motility (i.e. benign tumours stay where they are – key differentiation between benign and malignant)
- Mostly slow growth
- Growth = expansive, non-destructive & non-invasive
- Well differentiated; normal cells, r_esembles architecture_ of host tissue
- Non-metastatic
- Rarely fatal
8
Q
List the conditions which would render a benign tumour fatal
A
Benign tumours are rarely fatal, unless:
- They are in a dangerous place [eg: brain/meninges]
- The s_ecreting dangerous products_ [eg: insulinoma]
- They get infected [common in the bladder]
- They bleed [eg: gastric tumours] or rupture
9
Q
What is a malignant neoplastic lesions? List its characteristics.
A
- Malignant tumours = loss of growth control, feedback regulation & loss of regulation of motility
- Loss of regulation of motility (i.e. malignant tumour cells can escape from the lesion)
- Frequently rapid growth (this is not all or nothing – but generally, carcinomas will grow faster than adenomas)
- Growth invasive and destructive
- Many mitoses
- Poorly differentiated (i.e. “forgotten” originating tissue)
- Pleomorphic (variation in morphology), abnormal cells
- Metastatic (will grow in a different tissue - often, but not always)
- Invariably fatal if untreated
10
Q
Concerning nomenclature, what to the following suffixes mean:
(a) tissue type + oma
(b) tissue type + carcinoma
(c) tissue type + sarcoma
A
(a) oma = benign
(b) carcinoma = malignant epithelial
(c) sarcoma = malignant connective tissue
11
Q
What are leukaemias and lymphomas?
A
Both are tumours of white blood cells
- Leukaemia is a malignant tumour of primitive bone marrow derived cells which circulate in blood stream.
- Lymphoma is a malignant tumour of lymphocytes
12
Q
What is a teratoma? List its characteristics
A
- Teratoma = **enbryonic tumour derived from germ cells **
- Has the potential to develop into tumours of all three germ cell layers
- Sites of development - nests of germ cells (i.e. not differentiated correctly and have jdeveloped into the three cell layers, almost like miniature embryos)
- Common in the gonads, but occur in midline situations.
- Gonadal teratomas - in males, all malignant, in females, most are benign
13
Q
Invaision is a characteristic of what type of tumour?
A
Invasion distinguishes malignant tumours from benign & can make a difference in treatment of the patient
14
Q
Define: carcinoma in situ & invasive carcinoma
A
- Carcinoma in situ - malignant epithelial cells are still separated from the adjacent tissue by the basement membrane and do not invade the underlying tissue
- Invasive carcinoma - invasion of underlying tissue by cells which have penetrated the basement membrane
15
Q
What are the 4 signs of invasion?
A
- Cells lose adherence
- Cells become motile
- Penetrate the basement membrane
- Produce proteolytic enzymes that dissolve the ground substance in the adjacent tissues
16
Q
What are the two types of invasion?
A
Direct & Metastasis
- Direct = invasion of surrounding tissue
- Metastasis = “breaking off” of tumour cells and embedding in completely different locations
17
Q
Define metastasis
A
Metastasis is the development of secondary tumours at sites remote from the primary
18
Q
What are the 4 mechanisms of metastasis?
A
- Associated with genetic changes
- Ability to penetrate vessels and to exit vessels
- Ability to survive in the circulation
- Ability to **colonise **
19
Q
List the major mechanisms of transport of metastases throughout hte body
A
- Via blood vessels to organs
- Via lymphatics to lymph nodes
- Transcoelomic - across body cavities
- **Iatrogenic - **when tumours are cut into they can be spread – therefore when they are removed, it is best for the whole tumour to be removed with a margin around it
20
Q
Define grading and staging
A
Grading = how bad is the primary tumour
- Architectural pattern of the tumour
- Nuclear size and nuclear :cytoplasmic ratio
- Number and type of mitoses
- Similarity to the cell type from which they have arisen
Staging = how far has the tumour spread
- Clinical assessment of how much and far the tumour has spread
21
Q
What are the 6 major risk factors for breast cancer? Briefly explain them
A
- Age - breast cancer is a disease of > 50 (in general)
- Hormonal Factors - there is an increased risk to women that: menarch < 12, later menopause, first child over 30, don’t breast feed.
- Dense Breast Tissue - larger proportion of glandular/connective tissue, less proportion of fat
- Radiation - Radiotherapy to chest under 35 yo
- Lifestyle - lack of exercise, alcohol, overweight (more of a risk to post-menopausal women)
- Genetics - 5-10% of cancers are linked to mutations in teh BRCA1/2 genes
22
Q
Name and describe the two major biological markers for breast cancer
A
ER (oestrogen receptor)
- ER is over expressed in around 75% of breast cancers.
- Presence is indicative of a better prognosis.
- More common in older women
- Oestrogen withdrawal or competition for binding to the ER using anti-oestrogens results in a response in about 70% of ER-positive cancers
HER2
- HER2 is over-expressed in cancer cells (multiple copies on chromosome 17 – i.e. point mutation resulting in amplification)
- Amplification must be presence for the drug to be given as an appropriate treatment
23
Q
Outline the four major sub-types of breast cancer and which biochemical markers they are positive for
A
- Luminal A = ER+, PR+ and HER2 -
- Luminal B = ER+, PR + and HER2 +
- HER2 = ER-, PR- and HER2 +
- _Basal-like = ER-, PR- and HER2 - _
24
Q
What are the five major treatment options available for breast cancer?
A
- Surgery - removing the tumour with good margins is usually the best treatment
- Radiotherapy
- Chemotherapy - neoadjuvant [before surgery – purpose is to shrink the tumour] and adjuvant [after surgery – purpose is if the whole tumour could not be removed]. Can have negative fertility effects in younger women
- Endocrine therapy - neoadjuvant and adjuvant
- Targeted agents (e.g. herceptin) - this is the future of breast cancer therapy
25
Which type of breast cancers are treated with endocrine therapy?
Endocrine (or hormone) therapy is only indicated for **_ER+ breast cancers_**
26
What is the purpose of endocrine therapy (as a treatment for ER+ cancers)?
Purpose is to interfere with oestrogen receptor signalling
27
What are the 6 types of chemotherapeutic agents?
* **Alkylating agents **
* **Antimetabolites**
* **Anti-tumour antibiotics **
* **Topoisomerase inhibitors **
* **Mitotic inhibitors **
* **Corticosteroids**
28
How does age affect tumour growth?
the environment affects the growth of the tumour, and age affects the environment
29
List the 8 major risk factors associated with skin cancer
* **Intermittent exposure to high-intensity sunlight**
* **History of sunburn**
* **Long-term occupational exposure to sunlight.**
* **Skin type**
* **Hair & eye colour**
* **Large number or unusually shaped moles **
* **Family history of melanoma**
* **History of dysplastic moles **
30
Which type of UV light is more important for skin cancer
UV**B**
31
Name the three categories of skin cancer
* **Basel cell carcinoma**
* **Squamous cell carcinoma**
* **Melanoma**
32
List the characteristics of **basal cell carcinoma**
* Generally a _tumour of the elderly_
* _Commonest in certain sun exposed areas_ – face, ears, neck and are frequently seen on the back, chest and legs
* _Tumours arise from pluripotent stem cells within the epidermis_
* _Locally destructive_ but generally _not metastatic_
33
List the characteristics of **squamous cell carcinoma**
* Tumours of the _elderly_
* These tumours _develop from basal keratinocytes_
* Tumours are _commonest in sun exposed areas_
* Tumours are _metastatic_ spreading to regional lymph nodes then to solid organs particularly the lung
* May arise from _precursor lesions_ – solar keratoses and Bowen’s disease
34
What are the four clinical sub-types of **melanoma**?
* **Superficial spreading melanoma** (spreads along the skin) - 30% arise from pre-existing melanocytic naevus. Horizontal growth phase through the epidermis is followed by vertical growth
* **Nodular** - no horizontal growth phase
* **Lentigo maligna melanoma** - mainly elderly developing in a lentigo maligna (non-invasive melanoma, surface)
* **Acrolentigenous** - starting on feet or hands (palms), commonest in Afrocarribbeans
35
What are teh potential pre-cursor lesions for melanoma?
* Junctional or compound **acquired melanocytic naevae**
* **Dermal naevae**
* **Giant bathing trunk naevae **
* **Dysplastic naevae**
36
What are the risk factors of melanoma
* **Presence of dysplastic naevae** (when they look rough around the edges)
* **Family history**
* Higher socioeconomic groups (due to sun exposure, multiple times a year)
* Arsenic exposure in farmers
* Airline pilots have 3X risk (due to ionising radiation)
* Airline cabin crew have 1.5X risk (sun with stop-overs)
37
What is breslow thickness?
* This is a method of staging melanomas
* It invovles the spread the tumour into the skin (i.e. the _depth_)
* Generally speaking, the deeper it is in the skin the further stage it is
* Affects survival rates
38
What are the four major treatment possibilities for skin cancer?
* **Surgery**
* **Radiotherapy** (if surgery not an option or to reduce possibility of relapse – this is rare)
* **Immunotherapy** (melanoma)
* Patients with cancer do not mount a good immune response, you want to stop the tumour from turning this off (i.e. maintain this response – the immune response to the tumour)
* This is a risky response as you can end up with autoimmune issues (particularly within the kidneys) (autoimmunity because you have essentially upregulated the system à over-expression à autoimmunity if unregulated)
* **Targeted agents** for melanomas - anti-BRAF/VEGFR etc (this is an active area of research)
