Lecture 11 - Neoplasia IV

Question 1

define staging

Answer 1

the extent of spread of tumour

Question 2

what is the tnm staging system?

Answer 2

t = primary tumour
n = regional lymph node involvement
m = metastasis

Question 3

how does T progress?

Answer 3

increasing size in primary lesion, T1 -> T4

Question 4

how does N progress?

Answer 4

N0 = no nodal involvement

increasing involvement, N1 -> N3

Question 5

how does M progress?

Answer 5

M0 = no distant metastases
M1 = presence of blood borne metastases

Question 6

what is the T staging for breast cancer?

Answer 6

TIS - carcinoma in situ
T1 - 5cm across
T4 - spread to chest wall and/or skin

Question 7

what is the N staging for breast cancer?

Answer 7

N0 - no nodal
N1 -axillary
N2 - mammary
N3 - supraclavicular

Question 8

what is the M staging for breast cancer?

Answer 8

M0 - no metastasis

M1 - metastasis

Question 9

what is the dukes staging for colorectal carcinomas?

Answer 9

a, b, c1/2

Question 10

what is the A of the dukes staging?

Answer 10

confined to bowel wall
not extending through muscularis propria
>90% 5 year survival

Question 11

what is the B of the dukes staging?

Answer 11

through bowel wall (muscularis propria)

70% 5 year survival

Question 12

what is the C1/2 of the dukes staging?

Answer 12

lymph nodes involved
30% 5 year survival
C1 = regional lymph nodes involved
C2 = apical node (furthest away) involved

Question 13

what is the ann arbor classification of hodgkins disease?

Answer 13

I = one lymph node involved
II = two lymph nodes on one side of diaphragm
III = > two lymph nodes on both sides of diaphragm
IV = multiple foci

Question 14

define grading

Answer 14

based on the degree of differentation of tumour cells; attempts to judge the extent to which tumour cells resemble or fail to resemble their normal counterparts

Question 15

what is the scarff-bloom-richardson grading system?

Answer 15

degree of tubule formation
extent of nuclear variation
number of mitoses

Question 16

what is the survival rates of breast carcinoma based on scarff-bloom-richardson?

Answer 16

grade 1 = 85% 10 year survival
grade 2 = 60% 10 year survival
grade 3 = 15% 10 year survival

Question 17

what grading system is used for prostate carcinoma?

Answer 17

gleason

Question 18

explain radiotherapy

Answer 18

external radiation to tumour at fractionated doses with shielding of adjacent normal tissues
causes damage to dna of rapidly dividing cells
if dna damage is extensive - apoptosis

Question 19

what has a high sensitivity to radiotherapy?

Answer 19

lymphoma
leukaemia
seminoma

Question 20

what has a fairly high sensitivity to radiotherapy?

Answer 20

squamous carcinomas

Question 21

what has a moderate sensitivity to radiotherapy?

Answer 21

GI

breast

Question 22

what has a low sensitivity to radiotherapy?

Answer 22

sarcoma

Question 23

name 3 chemotherapy drugs

Answer 23

cyclophosphamide
vincristine
methotrexate

Question 24

what is the action of cyclophosphamide?

Answer 24

acts on cells in g1/s and mitosis

Question 25

what is the action of vincristine?

Answer 25

block cells entering cell cycle | act on mitosis

Question 26

what is the action of methotrexate?

Answer 26

acts on cells in s phase

Question 27

name 2 hormone therapy drugs

Answer 27

tamoxifen | herceptin

Question 28

what is the action of tamoxifen?

Answer 28

competes for binding to oestrogen receptor | 50-80% of breast cancers express oestrogen receptors

Question 29

what is the action of herceptin?

Answer 29

her-2 growth factor receptor | overexpressed in 20-30% of breast carcinomas

Question 30

name 3 tumour markers in diagnosis and monitoring of disease

Answer 30

carcinoembryonic antigen human chorionic gonadotrophin alpha-fetoprotein

Question 31

what is the use of carcinoembryonic antigen?

Answer 31

normally only in embryonic tissue | useful to see if there is any residual disease after removal of tumours

Question 32

what are 5 uses of human chorionic gonadotrophin?

Answer 32

1) evaluation of testicular masses 2) indicate residual disease after orchidectomy 3) monitoring response to therapy and prediction of recurrence 4) raised in nonseminomatous testicular tumours 5) seminomas with syncytiotrophoblastic giant cells

Question 33

what is the use of alpha-fetoprotein?

Answer 33

normally synthesised in early foetal life | raised plasma levels associated with cancer of liver and yolk sac tumour of testis

Question 34

what is the value of screening?

Answer 34

detect premalignant, non invasive and early invasive cancers to improve prognosis

Question 35

when is the first invitation to cervix screening?

Answer 35

age 25

Question 36

how often is cervical screening age 25-49?

Answer 36

3 yearly

Question 37

how often is cervical screening age 50-64?

Answer 37

5 yearly

Question 38

how often is cervical screening age 65+?

Answer 38

only if not been screened since 50 or have had recent abnormalities

Question 39

what is the value of cervical screening?

Answer 39

cytological smears to detect early precancerous changes

Question 40

what is the value of breast screenig?

Answer 40

identify invasive cancers before they can be felt relies on mammography 50-69 years every 3 years