Cancer Pathophysiology

Question 1

Is cancer overall more prevalent in men or women

Answer 1

More prevalent in men

Question 1

T/F Cancer is the leading cause of death in Canada

Answer 1

True

Question 2

What type of cancer is most common in males and females

Answer 2

Males
- prostate cancer

Female
- Breast cancer

Question 3

What is the most common cancer based on age
<14
15-29
30-49
50-69
70-84
85+

Answer 3

<14
- #1 Leukemia
- CNS lymphoma

15-29
- Thyroid
- Testis, hodgkin lymphoma

30-49
- breast cancer

50-69
- breast

70-84
- lungs and bronchus

85+
- colorectal

Question 4

Which gender has a slightly higher risk of death

Answer 4

Males

Question 5

Which cancer is the deadliest cancer? Why?

Answer 5

Lung cancer
- No good way of screening for it
- Presentation is very generalized
- Not symptomatic until stage 4

Question 6

Which cancer has the highest mortality in
0-14
30-49
50+

Answer 6

0-14
- Brain/CNS (many inoperable)

30-49
- Breast cancer (more aggressive in this age group)

50+
- lung/bronchus

Question 7

How do we screen for breast cancer? What age? Frequency?
High risk?

Answer 7

Mammograms q2years for women between 45-74

High risk screen at 30 (family history)

Question 8

How do we screen for colorectal cancer? What age? Frequency?

Answer 8

Fecal occult blood test q2years for everyone 50+

Question 9

How do we screen for prostate cancer?

Answer 9

Digital rectal exam (DRE)
Prostate-specific antigen (PSA)

Question 10

How do we screen for high risk lung cancer?

Answer 10

Low dose spiral CT for smokers

Question 11

How do we screen for cervical cancer? Who?

Answer 11

PAP in sexually active people ages 25-70

Question 12

What are the general cancer MODIFIABLE risk factors (7)

Answer 12

• Tobacco
• Poor diet
• Lack of physical activity
• Solar radiation (tanning beds)
• Exposure to environmental carcinogens
• Infection (eg. HPV)
• Alcohol use

Question 13

What are the general cancer NON-MODIFIABLE risk factors (4)

Answer 13

• Genetics
• Gender at birth
• Age (older)
• Race

Question 14

What is the leading cause of preventable illness and death including cancer

Answer 14

Tobacco

Question 15

T/F does quitting smoker reduce cancer risk

Answer 15

True
- Reduce 30-50% after 10 years

Question 16

What kind of food are considered carcinogens
What is the recommendation for these?

Answer 16

Red meat and processed meats are carcinogens

Recommend
- no more than 3 servings of red meat/week
- Processed meat should be avoided (can eat in moderation)

Question 17

What BMI is considered a risk factor for developing cancer

Answer 17

BMI >30

Question 18

What infections are linked to cancer (6)

Answer 18

• HPV (most common)
• Hep B & C
• Epstein-Barr virus (lymphoma)
• Kaposi’s sarcoma associated herpesvirus
• Merkel cell polyomavirus
• H. pylori

Question 19

What is the recommendation of alcohol intake in cancer patients

Answer 19

No more than 2 standard drinks/week
- Alcohol is a carcinogen

Question 20

How does genetic play a role in cancer? How is it passed on?

Answer 20

Can be a new mutation or a heritable mutation
- new mutations cannot be passed on

Question 21

Define proto-oncogenes. Give examples (4)

Answer 21

(normal genes that can become oncogenic when mutated or increased expression)
- RAS, Raf, MEK, ERK

Question 22

What type of mutations are in cancer? Which genes (2)

Answer 22

Tumour suppressor genes
- BRCA 1 and 2, p53

Question 23

What do malignant cells do pathophysiologically

Answer 23

• Replicate out of control
• Don’t die when they’re supposed to
• Metastasize to and invade other areas of the anatomy (main reason for cancer death)
• Do not require growth signals
• Able to recruit a constant blood supply

Question 24

Define a benign tumour (2) When can they cause problems (3)

Answer 24

Benign tumours - do not grow in a unlimited, aggressive manner - Lack the ability to metastasize and invade Cause health problems when: - compresses other anatomic structures - overproduction of hormones if grown on endocrine tissue - Have potential to be malignant

Question 25

How are suspected malignancies discovered?

Answer 25

Through screening or appearance of symptoms (cough, weight loss, hemoptysis (coughing blood))

Question 26

What do tissue diagnosis tell us? (3)

Answer 26

Tumour origin Histology Grade - these factors are important in guiding treatment

Question 27

What are the categories of histology and where are they derived from i.e their origin (5)

Answer 27

- Carcinoma (epithelial cells) - Sarcoma (connective tissue) - Hematologic (hematopoetic cells) - Germ-cell (totipotent cells) - Blastoma (immature precursor cells)

Question 28

How is the histologic grade given i.e grading

Answer 28

Well-differentiated cells are given low grades as they are easier to identify - ex. skin cells, muscle cells, gilal cells Poorly differentiated cells are given high grades as they do not look like the parent tissue (difficult to identify) and carry a poorer prognosis

Question 29

Symptoms of metastasis in the.. Liver (4)

Answer 29

- May be asymptomatic - jaundice - RUQ pain - Nausea

Question 30

Symptoms of metastasis in the.. Brain (4)

Answer 30

- Headache - altered mental status - Cushing's triad (severe, bradycardia, hypertension, abnormal breathing) - Focal Neurological signs (hemiparesis, aphasia, seizures, parasthesias)

Question 31

Symptoms of metastasis in the.. Bone (3)

Answer 31

- Pain - Fracture - Hypercalcemia

Question 32

Symptoms of metastasis in the.. Spinal cord (4)

Answer 32

- Back pain - Parasthesias (tingling in skin) - Cauda equina syndrome (compressed nerves at the end of spinal cord) - Cord compression

Question 33

Symptoms of metastasis in the.. Lung (3)

Answer 33

- Dysnea - Hemoptysis - Cough

Question 34

Describe the TNM staging in solid tumours and their scores

Answer 34

T = size of tumour and whether it has spread - 0-4 N = regional lymph nodes involved - 0-2 M = distant metastasis (either yes or no) - 0-1

Question 35

Describe stage 1-4 cancer

Answer 35

Stage 1 and 2: Early stage (curative intent) Stage 3: Locally advanced Stage 4: Metastatic (widespread)

Question 36

Differentiate between grading and staging of cancer

Answer 36

Grading - how aggressive patient's tumour is BY APPEARANCE under a microscope - (well/poorly differentiated from parent tissue) Staging - how advanced a patient's disease is according to how WIDESPREAD - i.e TNM staging (size, lymph nodes, metastasis)

Question 37

What are the types of biomarkers we use in cancer (5)

Answer 37

- Diagnostic (whether they have it or not) - Prognostic (independent of treatment) - Predictive (how well they will respond) - Resistance (predict for resistance) - Surrogate (can correlate with real clinical endpoint)

Question 38

Why are predictive biomarkers the most important (3)

Answer 38

- Can make treatment more effective - Can reduce cost (right drug, right patient) - Can minimize risk of clinical trial failure

Question 39

What are some common symptoms of cancer

Answer 39

- Pain - Weight loss (rapid) - Cachexia (weakness) - Fatigue - Loss of appetite - Night sweats (bad in heme malignancies) - Anemia - Thrombosis - Paraneoplastic syndromes (overproduction of hormones) (hypercalcemia, cushing's triad, dermatomyositis)