MoD S12 - Neoplasm IV Flashcards Preview

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Flashcards in MoD S12 - Neoplasm IV Deck (29):

What was the incident rate for cancer and cancer death in 2008 worldwide?

13 million new cases
7.6 million deaths


In 2010 what was the incidence rate for cancer and cancer death in the UK



What are the most common cancers in the UK?

What proportion of cancer in the UK do these represent?


(All carcinomas)

Make up over 50% of all cancers combined (In the UK)


Give the proportion of new cancer cases diagnosed in:
- Over 65s
- Under 24s

60% in over 65s
1% in under 24s


What are the common cancers in children under 14?

CNS tumours


Give statistics that show the broad range of 5 year survival rates between tumour types

Separate statistics for men and women please!

Testicular - 93%
Hodgkin's lymphoma - 84%
Melanoma - 78%
Oesophageal - 7%
Lung - 6%
Pancreatic - 3%

Melanoma - 90%
Hodgkin's lymphoma - 83%
Breast cancer - 79%
Oesophageal - 8%
Lung - 6%
Pancreatic - 2%


Overall, what types of cancer accounted for the greatest proportions of death?

Lung - 22%
Colorectal - 10%
Breast - 7%
Prostate - 7%


What factors might influence the prediction of favourable outcome in someone with cancer?

General health status
The tumour site
Tumour grade (i.e. differentiation)
Tumour stage
Effective treatment availability


Describe the TNM staging system

3 factors T, N and M

- Primary tumour size
- T1 to T4

- Regional node metastasis
- N0 to N3

- M denotes distant metastatic spread
- M0 or M1

These ratings then converted to 'stage' (I to IV)


Briefly describe the TNM stages, giving TNM values for each stage

Stage 1:
- Early local disease
- Low T, N0, M0

Stage 2:
- Advanced local disease
- Higher T, N0, M0

Stage 3,
- Regional metastases present
- Any T, N>1, M0

Stage 4:
- Advanced disease with distant metastases
- Any T, Any N, M1


What is the Ann Arbor staging system?

Give an example of a cancer type that uses this rating

Used for lymphomas (E.g. Hodgkin's lymphoma)

Stage 1:
- Lymphoma in single nodal region OR one body organ

Stage 2:
- Two separate nodal regions OR an organ and 1 group of nodes on one side of the diaphragm

Stage 3:
- Spread to both sides of diaphragm

Stage 4:
- Disseminated involvement of one or more extra-lymphatic organs (E.g. Lungs, Bone marrow)


Describe Duke's staging

Used for colorectal cancers

Stage A:
- Cancer present in the mucosa, may be projecting into lumen

Stage B:
- Cancer growth through to the muscle layers

Stage C:
- Cancer has spread to at least 1 lymph node close to the bowel
- C2 = Apical node involvment

Stage D:
- Cancer has spread to a distant site (E.g. Lung)


Describe the staging of breast cancer

TNM staging used

T stages:
Tis - Carcinoma in situ
T1 - 2cm or less
T2 - 2-5cm
T3 - >5cm
T4 - Spread to chest wall or overlying skin

N stages:
N0 - No cancer in nearby nodes
N1 - Upper lymph nodes on same side as breast show cancer cells
N2- Cells in armpit or retrosternal nodes
N3 - Cells in lymph nodes surrounding just the collarbone, or collarbone and armpit

M stages:
M0 - No distant metastases
M1 - Cancer has spread to distant site


Describe the staging of prostate cancer

TNM staging used

T stages:
T1 - too small to be seen
T2 - Tumour is contained within prostate, one or both lobes
T3 - Broken through prostate capsule but no spread
T4 - Spread to nearby body organs (rectum, bladder)

N stages:
NX - Lymph nodes cant be checked
N0 - No cancer cells in lymph nodes
N1 - Cancer cells in lymph nodes

M stages:
M0 - No cancer spread outside pelvis
M1a - Cancer spread to nodes outside pelvis
M1b - Cancer in bone
M1c - Cancer in other organs


Describe the staging of bladder cancer

TNM staging used

T stages:
Ta - Cancer in urothelium
T1 - Cancer in lamina propria
T2 - Cancer in muscle layer
T3 - Cancer has grown into fat layer
T4 - Cancer growth through muscle into adjacent organs (E.g. Prostate, uterus, abdominal wall)

N stages:
N0 - No nodal cancer
N1 - Cancer in one node in the pelvis
N2 - Cancer in >1 node in the pelvis
N3 - Cancer in 1 or more nodes in the groin (other areas)

M stages:
M0 - No spread to distant site
M1 - Spread to distant site


Describe the standard form of cancer grading

Give examples of cancer types that use this system

G1 - Well differentiated
G2 - Moderately differentiated
G3 - Poorly differentiated
G4 - Undifferentiated or anaplastic

Squamous cell carcinoma
Colorectal carcinoma


Give another example of a cancer grading system and include an example of a cancer type it is used for

Include 10 year survival rate at each stage

Bloom-Richardson grading

Used for breast carcinoma

- Tubule formation
- Nuclear variation
- Number of mitoses

I - 85% 10yr survival
II - 60% 10yr survival
III - 15% 10yr survival


In what situations is tumour grade an important factor?

In certain cancers:
- Soft tissue sarcoma
- Primary brain tumours
- Lymphoma
- Breast cancer
- Prostate cancer

Important for:
- Planning treatment
- Determining prognoses


What are the common methods of cancer treatment?

Hormone therapy
Treatment targeting specific molecular alterations


What treatments commonly accompany surgical treatment of cancer?

- Given post-op to eliminate subclinical disease

- Given to reduce primary tumour size pre-op


Describe how radiotherapy is useful and how it's performed

Radiotherapy gives fractionated doses of X rays or other ionising radiation to kill rapidly dividing cells (especially in G2)

High dosage causes free radical induced DNA damage that promotes apoptosis at cell cycle checkpoints

Double stranded DNA breakages also occur which prevents M phase completing properly

Surrounding cells are shielded to minimise damage to healthy tissue


Describe method of action(s) involved in the different drug classes used for chemotherapy

Give examples for each mechanism

Several drug classes exist

- Mimic normal substates involved in DNA replication
- E.g. Fluorourocil

Alkylating and platinum based drugs:
- Cross link the two strands of the DNA double helix
- E.g. Cyclophosphamide, Cisplatin

- Doxorubicin inhibits DNA topoisomerase, which is needed for DNA synthesis
- Bleomycin causes DNA double strand breaks

Plant derived drugs:
- Vincristine blocks microtubule assembly and interferes with mitotic spindle formation


Give examples of hormone therapy used for the treatment of cancers

Selective oestrogen receptor modulators (SERMS):
- Bind to oestrogen receptors, preventing oestrogen binding
- Used to treat hormone receptor positive breast cancer

Androgen blockage:
- Used in the treatment of prostate cancer


Give 2 drugs that target cancer specific molecular alterations and explain how they work

- 1/4 of breast cancers grossly over express HER-2
- Can block HER-2 signalling

- Chronic myeloid leukaemia shows a t9-22 chromosome re-arrangement creating a 'Philadelphia chromosome' on which an oncogenic fusion protein (BCR-ABL) is encoded
- Inhibits fusion protein


What are tumour markers?

What are some of the general classes of tumour markers?

Substances release by cancer cells into circulation

They can be used by the clinician to monitor tumour burden or contribute to diagnoses

- Hormones
- Oncofetal antigens
- Specific proteins
- Mucins/glycoproteins


Give 3 examples of tumour marks for 3 types of cancer and give their most common use as markers

Carcinoembryonic antigen (CEA):
- Related to colorectal cancers and breast cancer
- Used to check for colorectal cancer spread and breast cancer recurrence

Beta- Human chorionic gonadotrophin (B-hCG):
- Related to choriocarcinoma and testicular cancer
- Used to assess stage, prognosis and treatment response of cancer

Alpha fetoprotein (AFP):
- Related to liver and germ cell tumours
- Used to diagnose and determine response to treatment of liver cancer
- Used to assess stage, prognosis and response to treatment of germ cell tumours


What is cancer screening and what are some of the associated problems with screening?

What cancers are screened for in the UK?

Screening attempts to detect cancer signs as early as possible when the chance of a cure is highest

Screening can have problems such as lead time bias, length bias and over diagnoses

In the UK, cervical, breast and bowel cancer are screened for


Describe the process of cervical cancer screening

Give the schedule for invitation to screening

Cytological smears to look for cervical intraepithelial neoplasia (pre-cancerous)

Curative treatment can be given if positive and before invasion

- 25yrs at first invitation
- 25 to 49 is every 3 years
- 50 to 64 is every 5 years
- 65+ is in those who haven't been screened since 50 or those who have had recent abnormality


Describe the process of breast cancer screening

What is the screening schedule?

Mammogram taken to identify invasive cancer before they can be felt, identifies densities and calcification

Generally 10 - 15mm in size

Saves 1 in 500 women screened

Screened every 3 years from 50 - 69