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What are the commonest cancers in Men and Women

Men: Lung, Bowel, Prostate

Women: Lung, Bowel, Breast


What are the commonest cancers in Children (below 14)

CNS tumours


State the survival rates for;

- Testicular cancer
- Melanoma
- Breast cancer
- Pancreatic cancer
- Lung cancer
- Oesophageal cancer

- Testicular: 98%
- Melanoma: 90%
- Breast: 87%
- Pancreatic: 3%
- Lung: 10%
- Oesophageal: 15%


Which cancer is the biggest cause of deaths in the UK?

Lung cancer


What are 7 factors that influence the outcome of a malignant neoplasm?

- Age
- General health status
- Tumour site
- Tumour type
- Grade (differentiation)
- Tumour stage
- Availability of effective treatments


Tumour stage is a measure of the malignant neoplasm’s overall burden.

The most common system used to measure this is the TNM system. Explain this system

T: Refers to size of primary tumour (T1-T4)

N: Describes the extent of regional lymph node involvement (N0-N3)

M: Denotes the extent of metastatic spread via blood (M0 or M1)


For a given cancer the T,N and M status are usually converted to stages 1-4. The staging varies for each cancer.

Give broad descriptions of each stage

Stage I: Early local disease

Stage II: Advanced local disease (N0, M0)

Stage III: Regional metastasis (M0 with N1 or more)

Stage IV: Advanced disease with distant metastasis (M1)


Name and describe the staging system used for Lymphoma (Has its own staging system)

Ann Arbor Staging System

Stage I: Lymphoma in a single node region

Stage II: Lymphoma in 2 separate regions on same side of diaphragm

Stage III: Spread of lymphoma to both sides of diaphragm

Stage IV: Indicates diffuse/ disseminated involvement of 1/ more extra-lymphatic organs (Such as lungs, bone marrow)


Dukes’ Staging System used to be used specifically for one kind of cancer.

It is now incorporated into the TNM system.

Which cancer was it, and is still used for?

Colorectal carcinoma (bowel cancer)


Describe the Stages in Dukes’ Staging System (Colorectal carcinoma)

Dukes’ A: Invasion into, but not through bowel

Dukes’ B: Invasion through bowel wall

Dukes’ C: Involvement of lymph nodes (outside bowel wall)

Dukes’ D: Distant metastases (such as in liver)


Tumour grade describes the degree of differentiation of a neoplasm

What do the 4 grades mean?

G1: Well-differentiated

G2: Moderately differentiated

G3: Poorly differentiated

G4: Undifferentiated or Anaplastic


For what 2 cancers, is the Tumour Grading system used?

Squamous cell carcinoma
Colorectal carcinoma


Name the grading system used for Breast Carcinoma

What 3 things does it asses?

Bloom-Richardson System

- Tubule formation
- Nuclear variation
- Number of mitoses/ mitotic figures


Tumour grade is more important than tumour stage, for planning treatment and estimating prognosis in certain types of malignancy.

Name 4 of these malignancies

- Soft tissue sarcoma
- Primary brain tumours
- Lymphomas
- Breast and prostate cancer


List 6 types of Cancer Treatment

- Surgey
- Radiotherapy
- Chemotherapy
- Hormone therapy
- Targeted molecular therapies
- Immunotherapy


In reference to cancer, when is Adjuvant Treatment given? What is its purpose?

- Given after surgical removal of a primary tumour
- To eliminate subclinical disease (micrometastases)


In reference to cancer, when is Neoadjuvant Treatment given? What is its purpose?

- Given before surgical removal of a primary tumour
- To reduce size of the primary tumour


Radiotherapy kills proliferating cells by triggering apoptosis or interfering with mitosis.

What are 2 ways it minimises damage to normal tissues

- Focused on tumour (with shielding of surrounding healthy tissue)
- Given in fractionated doses


How does Radiotherapy kill rapidly dividing cancer cells (especially in G2 of cell cycle)?

High dosage causes either Direct or Free-radical Induced DNA damage.

This is detected by cell cycle check points triggering apoptosis


How does Radiotherapy interfere with mitosis in cancer cells?

Causes double strand DNA breaks, leading to damaged chromosomes

Thus, M phase is prevented from completing correctly


List 4 classes of Chemotherapy agents

- Antimetabolites
- Antibiotics
- Plant derived drugs
- Alkylating and Platinum based drugs


Antimetabolites are a class of chemotherapy agents.

How do they work?
Give 1 example

- Mimic normal substrates involved in DNA replication
- Fluorouracil


Antibiotics are a class of chemotherapy agents.

Give 2 examples
How does each one work?

- Inhibits DNA topoisomerase (needed to make DNA)

- Causes double strand DNA breaks


Plant derived drugs are a class of chemotherapy agents.

Give 1 example
How does it work?

Vincristine (from Periwinkles);
- Blocks microtubule assembly and interferes with mitotic spindle formation


Alkylating and Platinum based drugs are a class of chemotherapy agents.

How do they work?
Give 2 examples

Cross link the 2 strands of the DNA helix

- Cyclophosphamide
- Cisplatin


List 4 side effects of Chemotherapy, other than Pain, Vomiting and Hair loss

- Mouth sores
- Weakened immune system
- Rashes
- Nausea/ vomiting
- Constipation/ diarrhoea
- Bruising/ bleeding


Hormone therapy is a relatively non-toxic treatment for certain malignant tumours

What kind of drugs do use to treat hormone receptor positive breast cancer?
Give an example?

Selective Oestrogen Receptor Modulators (SERMs)



How do Selective Oestrogen Receptor Modulators (SERMs) work?

(One example is Tamoxifen)

Bind to oestrogen receptors, preventing oestrogen from binding


Give an example of using Selective Oestrogen Receptor Modulators (SERMs) to treat prostate cancer

Androgen blockade


Identifying cancer specific alterations (such as oncogene mutations) allows us to create drugs targeted specifically at cancers cells

Give 2 examples of such drugs

Herceptin (trastuzumab)
Gleevec (imatinib)

(These are oncogene targeting drugs)