Cancer Week

Question 1

Define hypertrophy, atrophy, hyperplasia, metaplasia, dysplasia, and neoplasia.

Answer 1

HT - increase in size. AT - decrease in size/number. HP - increase in number. MP - change in cell type. DP - disordered growth. NP - growth without stimuli

Question 2

Name the tumour that is benign and non-glandular and non-secretory.

Answer 2

Squamous papilloma

Question 3

Name the type of tumour which is most common.

Answer 3

Epithelial (carcinoma)

Question 4

When a tumour is identified, which type of neoplasia should be assumed until proven otherwise?

Answer 4

Carcinoma

Question 5

What is the name of a tumour affecting the connective, lymphatic, or blood vessel tissue?

Answer 5

Sarcomas

Question 6

Name tumours of smooth and skeletal muscle.

Answer 6

Smooth - leiomyosarcoma. Skeletal - rhabdomyosarcoma

Question 7

Describe spread in sarcomas.

Answer 7

Usually only local (not really lymphatic) so can be big

Question 8

Which type of tumour is most common in children?

Answer 8

Sarcoma (carcinomas are very rare in children)

Question 9

Name the primary brain tumour.

Answer 9

Glioma

Question 10

Why do gliomas not metastasize?

Answer 10

Blood-brain barrier

Question 11

Name the four main categories of cancer treatment.

Answer 11

Palliative, radical, adjuvant, neo-adjuvant

Question 12

What is the difference between neo-adjuvant and adjuvant therapy?

Answer 12

Neo-adjuvant therapy is pre-operative to reduce size

Adjuvant therapy is post-operative to reduce recurrence

Question 13

What are the four endpoints of cancer treatment?

Answer 13

Overall-survival, disease free, progression-free, local control

Question 14

Describe how radiotherapy works and how it is prescribed.

Answer 14

Breaks DNA during replication. Prescribed in Grays (Gy) in fractions

Question 15

Name the chemotherapy agent types.

Answer 15

Alkylating agents, platinum salts, anti-metabolites, taxanes, arithrocyclines, topoisomerase inhibitors

Question 16

Describe the mechanism of the drug herceptin.

Answer 16

Blocks HER2 receptors (EGFR)

Question 17

Name the three main features of genetics in cancer.

Answer 17

Autosomal dominant, somatic mosaicism, proliferative/invasive phenotype

Question 18

Describe the two-hit hypothesis.

Answer 18

Both chromosomes (i.e. both mother and father) must be ‘hit’ with a mutation. Therefore one germline mutation increases risk of cancer developing

Question 19

Name the mechanism and drug inhibiting melanoma.

Answer 19

BRAF -> KRAS (verurafenib - BRAF inhibitor)

Question 20

Name the mechanism and drug inhibiting the Philidelphia chromosome mutation metastasis.

Answer 20

ACL (imatinib, Glivec)

Question 21

Name the main treatments of BRCA1/BRCA2.

Answer 21

PARP inhibitors, platinum salts, immunotherapy

Question 22

An accumulation of which type of mutation increases risk of breast cancer?

Answer 22

SNIP - single nucleotide polymorphisms

Question 23

Describe the markers which indicate high, medium, and low risk of breast cancer in families.

Answer 23

High - identified BRCA1 mutation. Medium - young family members with breast/ovary cancer. Low - older members of a family with cancer

Question 24

Name the histological layers of the GI tract.

Answer 24

Mucosa (with lamina propria and muscularis mucosa), submucosa, muscularis externa (with inner circular and outer longitudinal layer)

Question 25

What is the difference between serosa and adventitia tissue?

Answer 25

Serosa - outer shiny layer | Adventitia - connects to other tissues

Question 26

What is GALT? How does it appear on histology?

Answer 26

Gut associated lymphoid tissue - purple dots (these are lymphocytes)

Question 27

Describe the TNM classification system.

Answer 27

T1 - breach of muscularis mucosa, T2 - breach of submucosa, T3 - breach of muscularis externa, T4 - escape to other tissues N1 - 1-3 nodes affected, N2 - 4+ affected M1 - distant metastasis identified

Question 28

Name some factors which may increase cancer risk.

Answer 28

Obesity, processed/red meat, alcohol, acrylamide (burned food), smoking, beta-carotene

Question 29

Name some factors which may decrease cancer ris.

Answer 29

Vitamin D, dairy and calcium, physical activity, breastfeeding, coffee

Question 30

Name the biochemical marker which can be used to differentiate the two main prostate conditions.

Answer 30

Prostate specific antigen (PSA) | Benign prostate hypertrophy (BPH) & cancer

Question 31

Describe the role of osteoblasts and osteoclasts.

Answer 31

'blasts lay down bone tissue (using calcium and releasing ASP) and 'clasts break it down.

Question 32

Name the three biochemical markers which may differentiate between bone and liver metastasis.

Answer 32

ALP, GGT, and AFP (for hepatocellular carcinoma)

Question 33

Describe how biochemistry may be used to identify risk of ascites fluid.

Answer 33

Albumin gradient (serum level minus fluid tap level)

Question 34

Define an exudate.

Answer 34

Fluid with a protein of > 30g/L or LDH that is above 2/3 the upper limit of normal (164 units/L)

Question 35

What are the suggestive differences between transudate and exudate?

Answer 35

Exudate - local | Transudate - systemic

Question 36

Describe the role of hypercalcaemia in biochemical cancer assessment.

Answer 36

Ca2+ is high in most cancers. It blocks parathyroid hormone (PTH) so if both are high, malignancy is indicated

Question 37

Name the three main paraneoplastic syndromes associated (in particular) with small cell lung cancer.

Answer 37

Lambert-Eaton, Cushing's, SIADH

Question 38

Name the screening tests for breast and colon cancer.

Answer 38

Mammography and FOB/FIT kits

Question 39

What is the purpose of CT and MRI scans in cancer assessment?

Answer 39

Assesses the relation to multiple sites. IV contrast assesses multiple sites at once

Question 40

What are the four main sites of metastasis?

Answer 40

Brain, bone, liver, lung

Question 41

What is palliative care?

Answer 41

Intends to alleviate symptoms without treating the underlying cause. Improves QoL

Question 42

What are the treatment options for palliative care?

Answer 42

Drug therapy, surgery, drainage, vertebroplasty

Question 43

Describe the pain management model in palliative care.

Answer 43

Non-opioids -> opioids -> somatic fibre interruption

Question 44

Name the five main oncogenes and describe their associated malignancies.

Answer 44

``` ABL -> chronic myeloid leukamia c-MYC -> Burkitt lymphoma n-MYC -> neuroblastoma BCL-2 -> follicular lymphoma RAS -> many cancers, particularly pancreatic ```

Question 45

Name the six main tumour supressors and their associated malignancies.

Answer 45

``` p16 (multiple tumour suppressor) -> melanoma p53 -> many cancers APC -> colorectal cancer BRCA1/2 -> breast/endometrial NF1 -> neurofibramotisis Rb -> Retinoblastoma ```

Question 46

Which oncogene is associated with Burkitt lymphoma?

Answer 46

c-myc

Question 47

Which oncogene is associated with follicular lymphoma?

Answer 47

BCL-2

Question 48

Which tumour suppressor is associated with colorectal cancer?

Answer 48

APC

Question 49

Which tumour suppressor is associated with chronic myeloid leukemia?

Answer 49

ABL