Cancer Flashcards
(80 cards)
1
Q
what are the hallmarks of cancer
A
resisting cell death sustaining proliferative signalling evading growth suppressors activating invasion and metastasis enabling replicative immortality inducing angiogenesis
2
Q
what is a major carinogen related to skin cancer
A
ultraviolet radiation (UVR)
3
Q
what effects does UV have
A
damages DNA and causes mutations
4
Q
which UV light is more dangerous
A
UVB
5
Q
which UV light is more prevalent
A
UVA
6
Q
what is the UV signature mutation
A
pyrimidine dimer
7
Q
what is the principle carcinogen of UV
A
UVB 290-320nm
8
Q
how does the different UV lights cause damage
A
UVB causes direct DNA damage
UVA causes indirect oxidative damage
9
Q
UVR is immunosuppressive - true or false
A
true
10
Q
why has there been an increase in non-melanoma skin cancer
A
cheap air travel
sun seeking behaviour
ageing population
11
Q
what are cutaneous precursors for SCC
A
actinic keratoses
12
Q
what are risk factors for skin cancer
A
sunlight sunburn in childhood sun exposure genetic susceptibility chemicals age immunosuppression HPV
13
Q
who are skin type 1
A
Very fair skin/redheads/blondes
14
Q
what is different about those with skin type 1
A
Pheomelanin instead of eumelanin
Pheomelanin absorbs UV less efficiently
Unable to “tan” in a protective way
15
Q
what are signs that you cannot tan
A
freckles solar lentigines (freckles across the shoulders)
16
Q
what can increase melanoma risk by 4-fold
A
childhood sunburn
17
Q
- genetic disease
- defect in enzyme
- causes increased photosensitivity
A
Xeroderma Pigmentosum
18
Q
what skin cancers are suffers of Xeroderma Pigmentosum susceptible to
A
AKs BCC SCC Melanoma Fibrosarcoma
19
Q
what is Oculocutaneous albinism
A
form of albinism involving the eyes, skin and hair
20
Q
what are the major features of Gorlin’s syndrome/Naevoid basal cell carcinoma
A
early onset/multiple BCCs
palmar pits
jaw cysts
skeletal abnormality
21
Q
what is Gorlin’s syndrome due to
A
germline mutation in PTCH gene - leads to hedgehog signalling
22
Q
molecular drivers of BCC
A
Genetically homogenous tumour; aberrant hedgehog signalling, involvement PTCH
23
Q
what mutations are common early on in skin cancer
A
TP52 mutations
24
Q
what is a hereditary type IV collagen deficiency
A
Recessive Dystrophic Epidermolysis Nullosa
25
examples of phytotoxic drugs
```
Voriconazole
Thiazide diuretics
NSAIDs
Anti-TNF
Azathioprine
```
26
what are precancerous skin conditions
actinic keratoses
| viral warts
27
what skin cancer does HPV associate with
SCC
28
what is the treatment for premalignant structures
cryotherapy
surgery
topical agents
photodynamic therapy
29
what is the most common cancer in 15-24 year olds
melanoma
30
what does melanoma survival depends on
tumour depth
31
thin melanomas have the worst prognosis - t or f
false
thin melanomas are cured
the deeper the tumour the worst the prognosis
32
what is the rule for melanomas
```
A – Asymmetry
B – Border (regular or irregular)
C – Colour (darker, unsafer)
D – Diameter (increasing in size?)
E – Evolution (has it changed)
```
33
melanoma sign
ugly duckling sign
34
what is the typical history of Basal cell carcinoma
```
slow growing lump or non-healing ulcer
painless
well defined border
pearly/translucent
visible blood vessels
central ulceration
can by locally invasive but rarely metastasise
```
35
typical history of SSC
hyperkeratonic (crusted) lump or ulcer
fleshy
grow relatively fast
can be painful or bleed
36
what is the general rule for the borders of SSC
majority - well differentiated low risk SCC
| minority - poorly differentiated high risk SCC
37
what are precursor lesions for SSC
actinic keratoses and Bowen’s disease (erythematous plaque)
38
what are cutaneous horns
hard conical projections from the skin, made of compact keratin
arise from benign, premalignant or malignant skin lesions (commonly SSC)
39
where are high risk sites for SSC
the ear, lip and scalp
40
where do SSC's metastasise to
Lymph nodes and Bone
41
what type of immunosuppressed patients often get skin cancers
people receiving organ transplants
42
what is RDEB
Recessive dystrophic epidermolysis bullosa
presents with severe blistering
Blisters heal but with scarring and deformity causing limited movement as fingers and toes may be fused together
43
where are melanocytes derived from
Neural Crest
44
what determines the balance of pigment in skin and hair
MC1R - Melanocortin 1 receptor gene
45
what causes red hair
phaeomelanin
46
what causes any hair colour bar red
eumelanin
47
what does MC1R do
turns phaeomelanin into eumelanin
48
what does a defective MC1R cause
One defective copy of MC1R causes freckling
| Two defective copies-red hair and freckles
49
what is the correct name for liver spots
actinic lentigines
50
where do you get AL and why
face, forearms and dorsal hands
| related to UV exposure
51
correct name for baby born with mole
congenital melanocytic naevi
52
what is the pathology of usual type acquired naevi
During infancy the melanocytes : keratinocyte ratio breaks down at a number of cutaneous sites
Allows formation of simple naevi
53
what are the 3 stages of naevus development
```
Junctional naevus (childhood)
Compound naevus (early adulthood)
Intradermal naevus (adulthoos)
```
54
what are the characteristics of dysplastic naevi
Generally >6mm diameter
Variegated pigment
Border asymmetry
55
what are halo naevi
peripheral halo of depigmentation. inflammatory regression and are overrun by lymphocytes
56
what are blue naevi
entirely dermal and consist of pigment rich dendritic spindle cells
57
when is a melanoma suspected
```
Ulceration
Development of satellite nodules
Bleeding
Irregular pigmentation
Change in shape
New pigmented lesions develops in adulthood
```
58
what are the 4 types of malignant melanoma
superficial spreading (commonest)
Acral/mucosal lentiginous
Lentigo maligna
Nodular
59
what are characteristics of SSM, A/MLM and LMM
grow as macules or with dermal micro invasion
| invade the dermis forming an expansile mass with mitosis
60
what melanomas can metastasis
in vertical growing phase
61
NM characteristics
a nodule of VGP tumour
| has metastatic potential from beginning
62
what are adverse prognostic indicators for melanomas
tumour depth
| ulceration
63
what are ulcers called
suffix b
64
what areas do melanomas commonly metastasis to
local dermal lymphatics
regional lymph nodes
blood spread - to any where
65
melanoma treatment
primary excision with clear margins
sentinel node biopsy - if positive then regional lymphadenectomy
if cancer far along - chemo, radio
66
what is the medical term for freckles
ephilides
67
characteristics of SSM
young-middle-aged adults
Usually trunk of men or legs of women
Usually macule with irregular border and colour which may have been increasing in size for years (slow horizontal growth phase) before developing a nodule (rapid vertical growth phase)
68
characteristics of NM
```
any body site
Usually in older patients
Blue-black or red-skin-coloured nodule
may be ulcerated or bleeding
developed rapidly over preceding months
Aggressive growth pattern (vertical from outset)
```
69
what are seborrheic keratoses
harmless warty spot that appears during adult life as a common sign of skin agin
stuck on appearance
regular border
70
what can Eruptive appearance of many seborrheic keratoses may indicate
internal malignancy
| Leser-Trelat Sign
71
what are the 3 types of BCC
nodular
superficial
infiltrative (most important as it may infiltrate tissues widely)
72
where are viral precursors often dysplastic
genital lesions
73
what are viral genital lesions associated with
HPV type 16
74
how to dermtofibroma appear
firm to touch
| often increased pigment around rim
75
what are topical treatments for skin cancer
5% imiquimod cream
76
how does a snip excision work
1 - grasp lesion with skin hook
| 2 - cut across base of lesion
77
advantages of snip excision
minimally invasive procedure
78
what the surgical options for getting out a skin cancer
snip excision
shave excision
punch biopsy
elliptical excision
79
what are the advantages and disadvantages of punch biopsy
adv - quick, good wound edges
| disadv - difficult to judge depth round holes do not always heal well, pathology sample may be too small
80
what is the ratio for margin of normal skin in elliptical excision
3mm length to 1mm height
| need relaxed skin tension lines
