Lesson 13 Cancer

Question 1

Progression to neoplasm

Answer 1

Normal
Dusplasia
In-situ neoplasm
Invasive neoplasm

Question 2

Characteristics of tumors

Answer 2

Benign tumor
1. Well differenciated
2. Do not spread

Malignant tumors
1. More rapid growth rate
2.specific microscopic alternation( loss of differentiation)
3. Absence of normal tissue organisation, no capsule
4. Invade into blood vessel and lymphatics and have distant spread

Question 3

Pathophysiology of cancer tumor

Answer 3

1.Altered cell membrane including surface antigen
2. Expanding mass compressing vessel and strucutr around -> necrosis
3. Normal organisation, growth control, cell cell communication absent

Question 4

Angiogenesis is what?

Answer 4

Development of new capillaries in the tumor-) promote tumor development

Question 5

Carcinogenesis and tumorigenesis definition

Answer 5

Carcinogenesis
The transformation of normal cell into cancer cell

Tumorigenesis
The process of cancer cells transforming into production of tumor

Question 6

Gene-environment interaction
Gene related problem

Answer 6

Lack of tumor suppressant hence promotes neoplasia

Leukemia
Breast cancer

Question 7

Risk factors of cancer

Answer 7

Diet, nutrition, smoking, tobacco use, sexual behaviour, uv radiation, oral contraceptives

Question 8

Diet risk factors

Answer 8

Increase when women gain weight
(Endometrical cancer, breast cancer
Prostatic and renal cancer)

Use of preservation(nitrite)
Fish and meat preservation
-) gastric cancer

Question 9

Nutrition and disease risk factors

Answer 9

To avoid cancer:
Low fat, high in fiber
More fruit and vitamine A, C, E
Soy provduct
Avoid food with high amount of preservation
Less alcohol intake

Question 10

Smoking risk factor:

Answer 10

Smoking is carcinogenesis
Passive smoker have greatest chance of lung cancer

Question 11

Alcohol risk factors

Answer 11

Alcohol interact with smokes, increase risk of malignant tumor formation.
Alcohol act as solvent of carcinogenic chemicals
Links to breast cancer

Question 12

Sexual risk factors

Answer 12

Sex-)HPV-) cervix cancer

early age of first sex
Multiple partners

Question 13

Occupational risk factors to cancer?

Answer 13

Miners and shipyard workers
Asbestos inhalation—>lung cancer

Question 14

Ultraviolet radiation risk factors to cancer

Answer 14

Risk of forming malignant melanoma

Affect tissue antioxidants—> tissue and DNA damage
Outdoor worker, fisherman, living in high sunlight exposure area

On area of head, neck, upper extremities

Question 15

Oral contraceptives

Answer 15

Endometrium, ovary, breast cancer risk reduced

Question 16

Cancer in Hong Kong

Answer 16

Is 2nd cause of death
1961 72 in 100k
1990 150 in 100k
(Lifestyle changed)

Question 17

Ranking of cancer

Answer 17

1st lung cancer
2nd colorectal cancer
3rd breast cancer

Question 18

Benign tumor

Answer 18

Tumor which closely resemble to tissue of origin

Grow locally

Grow slowly

Not fetal

Question 19

Malignant tumor

Answer 19

Able to spread invasion
Can move to different part of body
Grow separately

Question 20

How malignant neoplasm spread

Answer 20

Local invasion
Direct growth to adjacent tissue

Lymphatic spread
Through lymphatic node

Vascular spread
Spread via veins

Transfer by implantation
Graft donation, surgery

Question 21

Degree of differentiation and grading (1-4)

Answer 21

Grade 1
Well differenciated
Tumor closely resemble to tissue

Grade 2
Moderately differentiated
Tumor is slightly less resemblance to tissue of origin
More various in size

Grade 3
Poorly differentiated
Not closely resembled tissue to origin

Grade 4
Very poorly differenciated
No resemblance to tissue of origin
Grreat variation in size and shape

Question 22

Site of tumor

Answer 22

Carcinomas -）epithelial tissue
Liposarcoma-) adipose
Sarcomas-) connective tissue
Lymphomas-) lymphatic tissue
Leukemias-) blood forming organs, mainly bone marrow
Osteosarcoma-) bone

癌症——上皮組織
• 脂肪肉瘤－脂肪
• 肉瘤－結締組織
• 淋巴瘤－淋巴組織
• 白血病－造血器官，主要是骨髓
• 骨肉瘤－骨

Question 23

Tumor staging-system
Tumor 0-3
Node (involvement) 0-2
Metastasis (轉移）0-2

Answer 23

T0= no tumor
T1= lesion <2cm
T2= lesion 2-5cm
T3= skin/ chest wall involved by invasion

N0=no nodes involved
N1= mobile nodes involved
N2= fixed node involved

M0= no metastasis
M1= demonstrable metastasis 可證明的
M2= suspected metastasis

Question 24

Staging
1-4

Answer 24

Stage 1: T1 N0 M0
Stage 2: T0-2 N0 M0
Stage 3: T3 N1 M0
Stage 4: T4 N3 M3

Question 25

Both benign/ malignant neoplasm causing death Loss of appetite , progressive weakness -) pneumonia Obstruction to vital organ is fatal E.g. benign tumor in brain is fatal.

Question 26

Clinical manifestations-pain

Answer 26

No pain in early stage But occurs in 60-80% in late stage Mechanism- pressure, obstruction, invasion, sensitive structure, stretching of visceral surface, tissue destruction

Question 27

Cancer-type of pain

Answer 27

Bone metastasis- fucking pain Referred pain- back pain Hepatic malignancies-) stretch liver-) dull pain, feeling full Tumor compression of nerve ending Little space to grow, compressing blood vessels

Question 28

Fatigue Decreased muscle contractility/ lose of muscle function to perform activities Patient is: exhausted, depression, sleepiness Not able to concentrate

Question 29

Anorexia, 0 hungry , weight loss, anemia Cachexia- fucking malnutrition

Question 30

Anemia 貧血

Answer 30

Hemoglobin<9g/dl Related to chemotherapy Reason: malignance in blood forming organ E.g. chronic lymphocytic leukemia E.g. GI chronic bleeding

Question 31

Leukopenia, thrombocytopenia (少） why？

Answer 31

When tumor invasion to bone marrow Chemotherapeutic drugs are toxic to bone marrow Causing: leukopenia- decreasing number of platelet.

Question 32

Infection

Answer 32

Prone to infection& death Decrease in lumpocyte count Reduce immunologic function Because: surgery, Hospital related infection, bad wound care

Question 33

Diagnosis of neoplasia

Answer 33

1. Imaging test MRI, CT scan can see staging 2. Laboratory testing Alpha fetoprotein (AFP)= liver cancer

Question 34

5 year surviving rate Pancreas cancer, liver cancer, oesophagus <10% Lung cancer, stomach 10-20% Colon, rectum cancer 50% Cervix cancer 65%

Question 35

Cancer treatment

Answer 35

1. Surgery Tumor removal-) colon, breast, ovary, lung 2.chemotherapy-eradicate tumor cell Treatment to help stop or slow down cancer growth Side effects: bone marrow depression, hair loss 3. Radiotherapy Damage to target cell without causing toxicity to normal cell 4. Immunotherapy Encourage killer T cell to attack cancer cells For cancer not effective with chemotherapy( bone marrow) Palliative When the cancer is advanced, tend to reloef the manifestation

Question 36

Primary/ secondary prevention

Answer 36

Primary prevention： avoid known carcinogens Lifestyle, diary change, reduce cancer risk Secondary prevention: screening to achieve early diagnosis: Self breast exam Self testicular exam Screening colonscopy

Question 37

Nasalpharynegeal carcinoma

Answer 37

All carcinomas arising in nasalpharynx Clustering diseases reported in families Chromosomes 6 Consumption in salted fish in infancy

Question 38

Prevention of nasalpharynegeal carcinoma

Answer 38

EBV screening test Serological test Biopsy(鼻咽黏膜切片) of nasalpharynegeal mucosa