Cancer Flashcards
(213 cards)
1
Q
Define Hypertrophy
A
Increase in cell size in response to a stimulus
2
Q
Give a physiological example of hypertrophy
A
Growth of skeletal muscle due to increased exercise
3
Q
Give a pathological example of hypertrophy
A
Left ventricular hypertrophy due to hypertension
4
Q
Define hyperplasia
A
Increase in cell number in response to a stimulus. Hyperplasia is reversible on withdrawal of the stimulus.
5
Q
Give a physiological example of hyperplasia
A
Increase in breast and uterus size during pregnancy
6
Q
Define atrophy
A
Decrease in cell size
7
Q
Define metaplasia
A
Change from one type of differentiated tissue to another
8
Q
What happens to the DNA of metaplastic cells?
A
All cells have the same DNA but metaplasia occurs due to different signals so different proteins etc are expressed
9
Q
Give 2 common examples of metaplasia in the body
A
- Barrett’s oesophagus- the squamous epithelium of the oesophagus changes to the columnar epithelium of the stomach in response to prolonged contact with stomach acid caused by GORD. This is intestinal metaplasia
- Change of respiratory epithelium to squamous epithelium which is more resistant to the harmful effects of smoking
10
Q
Define dysplasia
A
Disordered growth
11
Q
Define neoplasia
A
New growth not in response to a stimulus
12
Q
Define malignant
A
Means the tumour has metastatic potential. In epithelial malignancies this refers to invasion beyond the basement membrane.
13
Q
Neoplasia has five characteristics. Name them.
A
1) Progressive
2) Purposeless
3) Regardless of surrounding tissues (will continue to grow even when it is harming the tissue around it)
4) Not related to the needs of the body
5) Parasitic (uses the body’s resources providing no function in return)
14
Q
Define carcinoma in situ (CIS)
A
Dysplasia affecting the whole epithelium
15
Q
Name 4 characteristics of benign tumours
A
1) They resemble the cells of their tissue origin
2) They grow in uniformity
3) They have a normal nucleus to cytoplasm ratio
4) They have a normal mitotic index
16
Q
Name 5 characteristics of malignant tumours
A
1) They are poorly differentiated (they look unlike the cells they originated from)
2) They show hyperchromasia (they have very large nuclei which take up a lot of dye)
3) Pleomorphism (the cells are variable they are not uniform)
4) They have abnormal mitotic indices
5) Often they show evidence of necrosis and haemorrhage as they are growing too fast for their blood supply
17
Q
Name the 8 hallmarks of cancer
A
1) Sustained growth signalling
2) Loss of growth inhibition
3) Unlimited replicative potential
4) Avoiding apoptosis
5) Inducing angiogenesis
6) Evasion of the immune system
7) Disordered repair mechanisms
8) Activating invasion and metastases
18
Q
What are cellular proto-oncogenes?
A
Normal genes that stimulate cell division
19
Q
What are oncogenes?
A
Mutated/ activated proto-oncogenes that allow uncontrolled cell proliferation
20
Q
How many copies of a proto-oncogene need activated to allow uncontrolled proliferation?
A
One
21
Q
What are tumour suppressor genes?
A
Normal genes that inhibit cell division
22
Q
How many copies of tumour suppressor gene need to be lost to allow cancer to develop?
A
Both (two)
23
Q
Name 5 examples of tumour suppressor genes
A
1) p53
2) Retinoblastoma
3) APC
4) NF1
5) WT1
24
Q
For a cell to be cancerous it must have unlimited replicative potential, what mutation do cancer cells often have that allows this?
A
A mutation that reactivates telomerase that is present in stem cells
25
What is the most common type of malignancy?
Epithelial
26
What increases your risk of developing an epithelial malignancy?
Age
27
Characteristic pattern of spread for epithelial malignancies?
Local growth, haematogenous and lymphatic spread
28
What is the defining feature of mesenchymal tumours?
Local growth
29
Epithelial tumours are called?
Carcinomas
30
Mesenchymal tumours are called?
Sarcomas
31
How common is lymphatic spread in mesenchymal tumours?
Not at all. It is extremely rare.
32
What type of metastases are fairly common in sarcoma?
Blood borne to the lungs
33
Most sarcomas consist of what shape of cell?
Spindle shaped
34
How may you have to determine the type of sarcomas sometimes?
Using immunohistochemistry. Sometimes they are difficult to identify histologically.
35
Characteristics of a lymphoma?
Tumour like masses in the lymph nodes with swelling and classical features of tumour. Tends to be more lumps and bumps.
36
Characteristics of leukaemias?
Tend to be limited to the blood.
37
When should you consider haematological malignancy|?
When there are large lymph nodes that don't fit with the anatomical drainage of an epithelial malignancy
38
Histologically how do malignancies of the blood often appear?
They appear less pleomorphic in comparison to other malignancies and the cells often resemble their cell of origin
39
The name for malignant skin cancer?
Melanoma
40
Name for tumours of the brain?
Gliomas
41
Do Gliomas tend to spread anywhere?
No
42
What is a papilloma?
Benign tumour of an epithelial surface
43
What is an adenoma?
Benign tumour of glandular epithelium
44
What is a lipoma?
Benign tumour of the fat
45
What is a chondroma?
Benign tumour of the cartilage
46
What is an osteoma?
Benign tumour of the bone
47
What is a leiomyoma?
Benign tumour of the smooth muscle
48
What is a rhabdomyoma?
Benign tumour of the skeletal muscle
49
What is a squamous cell carcinoma?
Malignant tumour of surface epithelium
50
What is an adenocarcinoma?
Malignant glandular epithelium tumour
51
What is a liposarcoma?
Malignant tumour of the fat
52
What is a leiomyosarcoma?
Malignant tumour of the smooth muscle
53
What is a rhabdomyosarcoma?
Malignant tumour of the skeletal muscle
54
What is a haemangioma?
Benign tumour of the blood vessels
55
What risk factor is second highest after smoking in regards to developing cancer?
Obesity
56
Is physical inactivity an independent risk factor for cancer?
Yes- this basically means that even if you are of healthy weight but don't exercise and are sedentary for large parts of the day your risk of cancer is increasing
57
What cancer is particularly associated with a high salt diet?
Gastric
58
What two cancers are particularly associated with processed red meat?
Bowel and gastric cancer
59
What cancer is associated with a high calcium intake?
Prostate
60
Name five cancers associated with alcohol?
Breast, mouth and throat, oesophageal, gastric and liver
61
Why did the go for gold campaign come about?
Burned toast was shown to cause cancer so the campaign encourages the public to only have their bread lightly toasted ie. GOLD!
62
Acrylamide increases risk of cancer- what foods is it found in, name 5?
potatoes, crisps, coffee, cakes and fries
63
Acrylamide can cross the placenta in pregnancy, what cancer does it increase the risk of in the baby?
Leukaemia
64
Are high dose vitamin supplements protective against cancer?
No- they actually increase your risk
65
How does breast feeding affect your cancer risk?
For the mother it decreases the risk of them developing breast cancer
66
Beta carotene is found in vegetables such as carrots, what cancer is it meant to be protective of?
Lung cancer
67
Calcium supplements can decrease your risk of what cancer? Is it worth giving this advice? Why?
Decrease risk of colorectal cancer but not worth advising this as it also increases your risk of prostate cancer
68
What two cancers is coffee protective against?
Liver and endometrial
69
Does dairy affect your cancer risk?
No
70
Prostate specific antigen has good sensitivity... what does this mean?
It will detect those with cancer- not many people with cancer will get a negative result. Sensitivity= those detected with disease/ those with disease x 100
71
Prostate specific antigen has bad specificity... what does this mean?
It is bad at detecting those with out the disease- many people who are perfectly healthy will get a positive result. Specificity= no of normal results where disease is not detected/ no of people without the disease
72
Prostate specific antigen has a poor positive predictive value... what does this mean?
Getting a positive result doesn't mean you have prostate cancer. PPV= no of people with positive result and the disease/ no of people with positive result.
73
Prostate specific antigen is likely to have an okay negative predictive value... what does this mean?
Getting a negative result is indicative that you don't have the disease. NPV= no of people with negative result without disease/ no of people with negative result
74
Creatine kinase tells you there may be damage in two places what are they?
Heart and skeletal muscle
75
Where does troponin tell you there is damage?
The heart
76
AST tells you there may be damage in four places what are they?
RBCs
Skeletal muscle
Liver
Heart
77
Where does ALT tell you there is damage?
The liver- hepatitis marker
78
LDH tells you there may be damage in two places what are they?
The heart and RBCs
79
ALP tells you there may be damage in two places what are they?
The liver and bones
80
Skeletal muscle damage markers?
CK and AST
81
Heart damage markers?
Troponin, CK, AST and LDH
82
RBCs damage markers?
AST and LDH
83
Liver damage markers?
ALT, AST, ALP and GGT
84
Pancreas damage markers?
Amylase and Lipase
85
Bones damage markers?
ALP
86
Explain why ALP shows bone damage may be present?
If there is bone lysis/ loss then osteoblasts make new bone, this produces ALP. Osteoblast activity is always in response to bone damage by osteoclasts hence a raised ALP shows bone damage.
87
ALP is not specific to bone damage, how could you determine that it is bone damage causing the raise?
Test for GGT. If GGT is raised too there is damage in the liver. NOTE: there could be both bone and liver damage. You can only say for certain it is bone damage by doing a scan or if only ALP and note GGT is raised.
88
A transudate or an exudative pleural effusion is suggestive of a malignancy?
Exudative
89
The protein content of an exudative pleural effusion is?
More than 30 g/l
90
4 treatment intents?
Radical, palliative, adjuvant, and neo adjuvant
91
If a treatment has radical intent what does this mean?
It is curative
92
If a treatment has palliative intent what does this mean?
It is not curative but aims to improve symptoms and therefore quality of life
93
If a treatment has adjuvant intent what does this mean?
It is done after surgery to reduce the risk of recurrence
94
If a treatment has neo adjuvant intent what does this mean?
It is done before surgery to shrink the tumour for surgical removal
95
4 treatment endpoints?
Overall survival, disease free survival, progression free survival, local control
96
Overall survival refers too?
time alive
97
Disease free survival refers too?
time alive without symptoms or sign of cancer
98
Progression free survival refers to?
time living within cancer that is not getting worse
99
Local control refers to?
time without recurrence or progression at a specific tumour site
100
Surgery as a cancer treatment is usually done with what intent?
Radical
101
How does chemotherapy work?
It targets rapidly dividing cells and as cancer cells are often rapidly dividing these will be killed off.
102
What are common side effects of chemotherapy?
It helps to remember that chemotherapy targets rapidly dividing cells NOT cancer cells. Hence most of the side effects are due to this. For example hair is rapidly growing part of the body- hence one of the most infamous side effects is alopecia.
Others include malaise, fatigue, lethargy, diarrhoea, mucositis, altered tase, neutropenia, thrombocytopenia, renal and liver impairment.
103
Name 5 common agents for chemotherapy?
Alkylating agents, platinum salts, taxanes, antracyclines, topisomerase inhibitior
104
How does radiotherapy kill cells?
It ionises cell DNA and breaks the double strand
105
What are acute side effects of radiotherapy, name 3?
fatigue, skin peeling (erythema desquamation) and head and neck pain
106
What are chronic side effects of radiotherapy, name 8?
skin fibrosis, dysphagia, bowel dysfunction, incontinence and bladder instability, pneumonitis, menopause, infertility and secondary cancer
107
What does traztuzamab do?
Target the HER2 receptor in breast cancer
108
Signet rings on histology suggest?
A bad gastric cancer- the cells are dysplastic and all the mucin in the cells has pushed the nucleus to the front
109
What is linitus plastica? What is it a sign of?
A rigid stomach due to gastric cancer
110
In terms of genetics cancer is a disease of?
Mosaicism largely caused by post zygotic mutations
111
What do cells acquire every time they divide?
Mutations
112
Is cancer rarely or commonly inherited as a high penetrance mendelian disorder?
Rarely
113
Define driver mutations?
Those that drive carcinogenesis
114
Define passenger mutations?
Incidental mutations the cancer picks up because it is unstable
115
Why is it not always helpful to sequence a cancer?
You will pick up both driver and passenger mutations and can't necessarily tell which are which
116
What does Knudson's two hit hypothesis help explain?
The inactivation of tumour suppressor genes. You may inherit a fault in one copy of the gene but then you don't develop problems until you acquire a mutation in the other and both tumour suppressor genes are inactivated.
117
Is it more difficult to activate a gene or knock it out?
activate: activating a gene requires more specific mechanisms, literally any damage to a gene is enough to knock it out
118
What is the problem with target therapy?
Just because one pathway is knocked it that doesn't mean the cancer can't mutate and find another pathway to come back
119
What type of malignancy is more susceptible to targeted therapy? Why?
Haematological
| These are less genetically complex
120
What is lynch syndrome also known as?
Hereditary nonpolyposis colorectal cancer
121
Lynch syndrome is caused by mutations in what genes?
Mismatch repair genes
122
Mode of inheritance of lynch syndrome?
Autosomal dominant
123
What is loss of mismatch repair by cells in a tumour seen as?
Microsatellite instability
124
Two inherited conditions that predispose someone to colorectal cancer? Which is more common?
Lynch syndrome- most common (and can also predispose to other cancers)
FAP - less common
125
Mode of inheritance of FAP?
Autosomal dominant
126
What does FAP cause?
Causes numerous adenomatous polyps to develop in childhood in the colon. In untreated individuals carcinoma is inevitable by 40 years old.
127
Gene responsible for FAP?
APC
128
Why is FAP more easily recognised and picked up compared to Lynch syndrome?
You will see hundreds of polyps on endoscopy
129
BRCA 1 and 2 are implicated in what two cancers?
Breast and ovarian
130
What is HER2? What is it implicated in?
An epidermal growth factor that many breast carcinomas show changes in this gene
131
If someone is worried about their genetic risk of cancer who is it best to test?
It is better to test the person with cancer first. If there is a young and an old person test the young person first as the old person may be coincidence and not genetic
132
How are lung metastases described on imaging?
Multiple, rounded and basal predominant
133
How is primary lung cancer likely to look on imaging?
Apical, solitary and speculated
134
Cannon ball metastases in the lungs suggest?
Renal cell carcinoma
135
Renal cancer bone metastases usually result in?
Head of the humerus destruction
136
Pelvic bone metastases usually occur in what cancer?
Prostate cancer
137
What does a cancer's stage refer to?
Tumour size and whether it has spread beyond the area is firsted started growing in
138
What does a cancer's grade refer to?
How the tumour looks under the microscope compared to normal cells
139
T of TNM refers to the tumours ____
size
140
Explain the five T stages of Bowel cancer?
```
Tis= the tumour is only in the mucosa- carcinoma in situ
T1= tumour has invaded the submucosa
T2= tumour invades the muscular propriety
T3= tumour invades the serosa
T4= tumour invades into other organs or peritoneum
```
141
Explain the N of TNM staging?
Refers to lymph nodes involvement. Number= the amount involved.
142
Explain the M of TNM staging?
Refers to metastasis. Either 0 or 1. Metastasis present or absent.
143
What type of lung cancer is the most aggressive, metastasising widely and early?
Small cell lung cancer
144
What do most SCLC tumours express?
NCAM-1
145
What treatment does small cell lung cancer respond well to initially?
Chemo
146
What is the most common lung cancer?
Squamous cell
147
Where do squamous cell tumours tend to arise from?
Centrally from major bronchi
(think squamous cells are metaplastic as they have been in contact with smoke, smoke it most likely to concentrate in the central parts of the lung such as main bronchi)
148
What do squamous cell lung cancers often produce and express?
Often produce keratin
| Express p40, p63 and cytokeratin 5
149
What is the most common type of lung cancer in non-smokers?
Adenocarcinoma
150
Is adenocarcinoma more common in women or men?
Women
151
Where do adenocarcinomas of the lung often arise?
In the peripheries of the lung
| think not related to smoke damage so doesn't need to be near major airways
152
What do adenocarcinomas normally express?
TTF-1 or Napsin
| think TTF-1 stands for thyroid transcription factor, thyroid is a gland and adeno tumours arise from glands
153
Diagnosis of large cell carcinoma is a diagnosis of what?
Exclusion- the cells have no particular differentiation- you've excluded all other types- these diagnoses are less common as we get better at identifying tumours under the microscope
154
Someone with lung cancer and a hoarse voice suggests?
Invasion of the recurrent laryngeal nerve
155
Someone with lung cancer and pleuritic chest pain and effusion suggests?
Invasion of the pleura and chest wall
156
Someone with lung cancer and breathlessness, AF and pericardial effusion suggest?
Invasion of the pericardium
157
Someone with lung cancer and arm weakness suggests?
Invasion of the brachial plexus (usually caused by a pan coast tumour)
158
What is a pancoast tumour?
An apical lung tumour
159
What are the three features of horner's syndrome?
Ptosis (drooping of upper eye lid, think your eye lid is coming to your toe for TOEsis), mitosis (excessive pupil constriction) and anhydrosis (lack of sweating, think hydro is water, an usually means lack of)
THIS IS ALL ON ONE SIDE OF THE FACE
ie if someone says they have stopped sweating on only one side of the face think straight away lung cancer
160
What causes horner's syndrome?
Lung cancer invasion of the sympathetic chain, usually by a pan coast tumour
161
Lung cancer invasion of the phrenic nerve will cause what to become paralysed?
The diaphragm
162
Someone with lung cancer presents with puffy eye lids, headache, distended external jugular vein and clear anastomoses in the abdomen to the IVC what has been invaded?
The lung cancer has invaded the SVC.
Easier to understand the symptoms. The puffy eye lids and headache are cause blood can't drain due to obstruction same with the distended EJV. The anastomoses allow the upper body to try and drain bypassing the blocked SVC. This is an oncological emergency.
163
Name eight paraneoplastic effects of lung cancer?
1) Finger clubbing
2) Eaton Lambert Syndrome
3) Hypertrophic pulmonary osteoarthopathy
4) Hyponatraemia
5) Hypercalcaemia
6) Cushing's syndrome
7) Weight loss
8) Thrombophlebitis
164
Cushing syndrome is usually caused by what type of lung cancer?
Small cell
165
Explain how SCLC results in cushing syndrome?
The tumour secretes ACTH resulting in adrenal hyperplasia and raised blood cortisol.
166
Signs and symptoms of cushing syndrome?
Weight gain, increase in BP and glucose
167
Name two things small cell lung cancer can secrete?
ACTH
| ADH
168
Hyponatraemia is usually caused by what type of lung cancer?
Small cell
169
Explain how SCLC results in hyponatraemia?
The tumour secretes ADH so there's water retention reducing sodium concentration
170
What type of lung cancer can cause hypercalcaemia?
Squamous
171
Explain how squamous cell lung cancer can cause hypercalcaemia?
Secretes PTHrp which mimics the real parathyroid hormone so calcium is secreted when its not needed.
172
How can you infer someone has hypercalcaemia due to malignancy?
They have really high calcium levels but you can barely detect PTH (parathyroid hormone) in the blood
173
Explain what hypertrophic pulmonary osteoarthropathy is?
A paraneoplastic syndrome that causes the periosteum of the bone to lift off causing pain in the legs and down the shins in particular.
174
Explain what eaton lambert syndrome is?
This is weakness in the legs, arms and face due to the body attacking its own nerves. Causes aren't fully understood and there are several causes but it is mainly associated with lung cancer.
175
8 risk factors for colorectal cancer?
FAP, HNPCC, diet high in red meat, smoking, obesity, lack of exercise, IBDs and alcohol
176
Colorectal cancer is most commonly found where?
On the left side
177
5 symptoms of right sided colorectal cancer?
unexplained iron deficiency anaemia, change in bowel habit, persistent tiredness, colicky abdominal pain, lump in the abdomen
178
3 symptoms of left sided colorectal cancer?
rectal bleeding, tenesmus and worsening constipation
179
Why must you always investigate unexplained iron deficiency anaemia?
It may be caused by right sided colorectal cancer
180
What is a polyp?
A protrusion above an epithelial surface- it can be benign or malignant
181
Most colorectal cancers are?
Adenocarcinomas
182
Where do colorectal cancers often metastasise to?
The liver- late on.
183
Which type of mutation is most likely to directly activate an oncogene?
An amino acid change (missense)
184
What type of hepatitis is hepatocellular carcinoma most strongly associated with?
Hepatitis C
185
What virus increases your risk of getting nasopharyngeal cancers and lymphoma?
Epstein barr virus
186
What type of asbestos fibre is mesothelioma associated with?
chrysotile
187
Where does lung cancer commonly metastasise to?
* Liver
* Brain
* Bone
* Adrenal glands
* Lung
188
Primary sclerosing cholangitis is a risk factor for developing what type of cancer?
Cholangiocarcinoma
189
What does herceptin target?
Epidermal growth factor HER-2
190
The most common tumours of the liver are?
Metastases from elsewhere
191
Where can p53 cause cell cycle arrest?
Between G1 and S phase
192
What type of infection greatly increases your risk of gastric cancer?
H. pylori
193
Raised alfa feto protein could be a marker of?
Hepatocellular carcinoma
194
Asbestos is linked to what two cancers?
Mesothelioma and adenocarcinoma
195
Coeliac disease increases your risk of what type of cancer?
T cell lymphoma
| makes sense as coeliacs is a T cell mediated disease
196
Heptoma is the old and outdated name (yes I'm bitter about this) for what?
Hepatocellular carcinoma
197
Cancers caused by lynch syndrome tend to occur where?
in the ascending colon
198
How do smooth muscle grow physiologically?
by hyperplasia
199
A well circumscribed tumour protruding into the bronchus with a yellow cut surface is most likely to be a?
Carcinoid tumour
200
What is the most common heart tumour (bearing in mind they are all extremely rare)?
Atrial myxoma in the left atrium
201
Almost all cancers of the mouth are what?
Squamous cell carcinomas
202
Two types of malignant oesophageal tumours? Where are they found?
Squamous cell carcinoma= upper portion
| Adenocarcinoma= lower portion
203
What oesophageal cancer is associated with Barretts and GORD?
Adenocarcinoma (think it's lower down so its near the stomach where the acid is coming from, it also has glands like the stomach)
204
What two things do people with oesophageal cancer usually present with?
Progressive dysphagia and weight loss
205
Most common type of gastric cancer?
Gastric carcinomas
206
Most cases of carcinoma of the gall bladder are?
Adenocarcinomas
207
Gall bladder cancers are always associated with what and spread to where?
Gall stones and spread to the liver
208
Pancreatic cancers are usually?
Adenocarcinomas
209
Pancreatic cancers are usually found in what part of the pancreas?
The head
210
Symptoms of pancreatic cancer?
jaundice, steatorrhoea, dark urine, weight loss
211
Explain cerebellar ataxia as a paraneoplastic syndrome?
in some cancers e.g. gynae, breast, lung, hodgkins lymphoma you can get cerebellar degeneration as a paraneoplastic syndrome. it is believed to be immune mediated. symptoms will be of cerebellar degeneration i.e. DANISH
212
Explain the limbic encephalitis as a paraneoplastic syndrome?
not sure what causes it, thought to be immune mediated. observed in lung cancer patients. symptoms - personality changes, irritability, depression, seizures, memory loss and sometimes dementia.
213
What is dose of radiotherapy measured in?
Grays
