Oncology Flashcards
(116 cards)
1
Q
What is the definition of cancer?
A
when abnormal cells divide in an uncontrolled way
2
Q
What are 10 oral cancer signs and symptoms?
A
- sore mouth ulcers that do not heal within weeks
- persistent lumps and swollen lymph nodes
- persistent oral discomfort or pain
- unusual bleeding or numbness in the mouth
- difficulty when swallowing
- feeling that something is caught in the throat
- changes in voice or speech problems
- persistent red or white patches on the lining of mouth
- unexplained weight loss
- loose teeth for no apparent reason or a tooth socket that does not heal
3
Q
What are 4 oral manifestations of squamous cell carcinoma?
A
- lateral border of tongue - solitary ulcer with rolled border
- erythroplakia
- leukoplakia
- dysphagia
4
Q
What are the 4 types of carcinoma cancer cells?
A
- squamous cell carcinoma
- adenocarcinoma
- transitional cell carcinoma
- basal cell carcinoma
5
Q
Which type of carcinoma cancer cell is the following?
- flat, surface covering cells
- function: protection
- oral cavity, oesophagus, throat, skin
A
squamous cell carcinoma
6
Q
Which type of carcinoma cancer cell is the following?
- glandular cells
- function: produce fluids to keep tissues moist
- adenomatous cells
A
adenocarcinoma
7
Q
Which type of carcinoma cancer cell is the following?
- transitional epithelium
- function: can stretch as an organ expands
- lining of the bladder
A
transitional cell carcinoma
8
Q
Which type of carcinoma cancer cell is the following?
- line the deepest layer of skin cells
- most common type of skin cancer
A
basal cell carcinoma
9
Q
Which type of cancer cell originates in connective tissues eg. bone, cartilage, tendons and muscles?
A
sarcomas
10
Q
What are bone sarcomas called?
A
osteosarcoma
11
Q
What is cancer of the cartilage called?
A
chondrosarcoma
12
Q
What is cancer of the muscle cells called?
A
rhabdomyosarcoma
13
Q
Which type of cancer is the following?
- originate in blood forming tissue, bone marrow
- over-production of abnormal white blood cells
A
leukaemia
14
Q
Which type of cancer is the following?
- cancers of the lymphatic system
- abnormal lymphocytes collect in the lymph nodes, the bone marrow or spleen, they can then grow into tumours
A
lymphoma
15
Q
Which type of cancer is the following?
- cancers of the lymphatic system
- plasma cells can become abnormal, multiply uncontrollable
A
myeloma
16
Q
Which type of cancer is the following?
- originate in the cells of the brain or spinal card
- the most common type of brain tumour develops from glial cells (provide support and protection for neurones)
A
glioma
17
Q
Which type of cancer is the following?
- epithelial and connective tissue components
- malignant tumours that consist of a mixture:
- carcinoma (epithelial carcinoma)
- sarcoma (mesenchymal or connective tissue cancer)
- common in uterus
A
carcinosarcoma
18
Q
Which type of cancer is the following?
- common benign salivary gland tumour:
- epithelial or myoepithelial cells
- mesenchymal or connective cells
- most common, parotid gland
- malignant, transformation to carcinoma ex-pleomorphic adenoma
A
pleomorphic adenoma
19
Q
Which type of cancer is the following?
- originates in the germ cell
- type of germ cell tumour:
- different types of tissue, such as hair, muscle or bone
- typically form in the ovaries, testicles
- often benign if mature and malignant if immature
A
teratoma
20
Q
Which type of tumour is the following?
- enclosed in connective tissue
- confined to site of origin
- may grow but do not spread to other parts of body
- may turn malignant, best to remove when noticed
A
benign
21
Q
Which type of tumour is the following?
- not enclosed in any tissue
- not confined to site of origin
- grow rapidly and spread to other body parts via blood or lymph (metastasis) causing secondary tumours
A
malignant
22
Q
What are the 4 characteristics of a benign skin lesion?
A
- symmetrical
- even edge
- one shade
- <6mm
23
Q
What are the 4 characteristics of a malignant skin lesion?
A
- asymmetrical
- irregular
- > 1 shades
- > 6mm
24
Q
What are the 2 enabling hallmark characteristics of cancer?
A
genetic instability and mutation
and
tumour-promoting inflammation
25
What are the 2 emerging hallmarks characteristics of cancer?
avoiding immune destruction
and
deregulating cellular energetics
26
What are the 3 ways in which cancer cells deregulate cellular energetics?
1. produce a lot less ATP per glucose but they make it much faster
2. increase glucose transporters take in more glucose
3. produce intermediate precursors for building proteins & DNA needed by rapidly dividing cells
27
What are the 4 primary functions of chromatin?
1. to package DNA into a more compact, denser shape
2. to reinforce the DNA macromolecules to allow mitosis
3. to prevent DNA damage
4. to control gene expression and DNA replication
28
DNA methylation
| In cancer typically, there is hypermethylation of...?
tumour supressor genes
29
DNA methylation
| In cancer typically, there is hypomethylation of...?
oncogenes
30
Histone acetylation
| In cancer typically, there is decrease in histone acetylation involved in...?
tumourogenesis, tumour evasion and metastasis
31
What is the function of oncogenes in cancer?
activation of proto-oncogenes to oncogenes, then become permanently switched on when not supposed to and cell grows out of control
32
What is the function of tumour suppressor genes in cancer?
regulates a cell during cell division and replication. If the cell grows uncontrollably, it will result in cancer. When a tumor suppressor gene is mutated, it results in a loss or reduction in its function
33
What are the normal functions of oncogenes?
Your cells contain many important genes that regulate cell growth and division. The healthy forms of these genes are called proto-oncogenes. The mutated forms are called oncogenes. Oncogenes cause cells to replicate out of control and can lead to cancer.
34
What are the 3 normal functions of tumour suppressor genes? (SIR)
1. slow down cell division
2. repair DNA mistakes
3. initiate apoptosis
35
What is the term used for the following hypothesis?
- unlike oncogenes, tumour suppressor genes generally follow this hypothesis
- implies that both alleles that code for a particular proteins must be affected to promote malignancy
- this is because if only one allele for the gene is damaged, the second can still produce the correct protein
two-hit hypothesis
36
What are the 2 HPV viruses that are high risk for cancers?
HPV16 - responsible for oral cancer
and
HPV18
37
Which phase of the cell cycle is responsible for?
- growth of cell, no division
- cells in this phase most of time except cancer cells
interphase
38
Which phase of the cell cycle is responsible for?
| - cellular contents, excluding the chromosomes are duplicated
G1
39
Which phase of the cell cycle is responsible for?
| - each of the 46 chromosomes is duplicated by the cell
S
40
Which phase of the cell cycle is responsible for the following?
- the cell double checks the duplicated chromosomes for error, making any needed repairs
G2
41
Which phase of the cell cycle is responsible for?
- cell cycle arrest
- no cell division
G0
42
Which phase of the cell cycle is responsible for?
| - active cell division
mitosis
43
Which checkpoint of the cell cycle is responsible for regulation of cell size, nutrients, growth factors, DNA damage?
G1 checkpoint
44
Which checkpoint of the cell cycle is responsible for the regulation of DNA damage, DNA replication completeness?
G2 checkpoint
45
Which checkpoint of the cell cycle is responsible for regulating sister chromatids correctly attached to spindle microtubules?
M checkpoint
46
Which 2 genes are responsible for oncogenic HPV?
E6
and
E7
47
How does the HPV virus induce carcinogenesis?
E6 binds to p53 and induces its degradation
E7 binds the pRb and causes E2F transcription factor to become unbound and free to induce the cell cycle activation/proliferation
48
Mutations in which two genes are implicated in oral carcinogenesis?
p53
and
pRb
49
What are 5 stages involved in the multistage model of carcinogenesis?
1. normal
2. dysplastic (morphology changes)
3. benign
4. pre-malignant
5. malignant
50
Which theory of carcinogenesis is the following?
- follows on from the multistage model, also assumes that the accumulation causes cancer but it does not assume that all the mutations happen in the same cell
the theory of clonal expansion
51
Which theory of carcinogenesis is the following?
-this hypothesis suggests that there is a small subset of cancer cells that are responsible for tumour initiation and growth, possessing properties such as indefinite self-renewal, slow replication, intrinsic resistance to chemotherapy and radiotherapy, and an ability to give rise to differentiated progeny
cancer stem cell theory
52
Which 2 cells are markers of breast cancer stem cells?
CD44+
and
CD24-
53
Which 3 monoclonal antibodies binds to growth factor receptors or neutralise growth factors to inhibit growth?
- trastuzumab
- cetuximab
- bevacizumab
54
Normal cells require growth signals before they can progress through the cell cycle, however in cancer cells they have?
- increased production of EGF (epidermal growth factor)
- mutation in EGFR (epidermal growth factor receptor) results in consecutively active receptor
- abnormal cell signalling and growth
55
What is responsible for preventing downstream signalling triggered by growth factors by inhibiting specific oncogenic kinases?
protein kinase inhibitors
56
Inducing angiogenesis
| VEGF (vascular endothelial growth factor) released to promote growth of?
new blood vessels
57
Inducing angiogenesis
| Which transcription factor is a major regulator of tumour cell adaptation to hypoxic stress?
HIF-1
58
What is meant by the angiogenic switch?
when a tumour recognises there is not enough oxygen to grow, so switches on HIF-1 that bind to the DNA and increase expression of VEGF which then supply oxygen and nutrients to the tumour and remove waste products
59
Achieving the metastatic state
| Which 2 enzymes are involved in achieving the metastatic state?
PDPN - small membrane glycoprotein - increased cancer cell invasion into lymphatic and blood vessels
MMP1 - enzyme with breakdowns of extracellular matrix
60
What is the difference between the clonal expansion theory and the cancer stem cell theory?
clonal expansion theory - every tumour cell has tumour initiating properties
cancer stem cell theory - only cancer stem cells have tumour initiating properties
61
Immortilisation
| Which cell is responsible for enabling replicative immortality?
hTERT - human telomerase
62
Cell signalling
Which receptor protein is responsible for resisting cell death, sustaining proliferative signalling and evading growth suppressors?
EGFR - epidermal growth factor
63
What are the 2 epithelial phenotypes involved in epithelial-mesenchymal transition (EMT)?
E-cadherin - cell adhesion molecule found in epithelial tissue
ZO-1 - tight junction protein binds actin cytoskeleton
64
What are the 2 mesenchymal phenotypes involved in epithelial-mesenchymal transition (EMT)?
N-cadherin - cell adhesion molecule found in migrating neurone and mesenchymal cells during organogenesis
B-catenin - binding to N cadherin and in turn interacts with the actin cytoskeleton
65
How does the epithelial-mesenchymal transition enable metastasis?
the epithelial cells lose their polarity and cell adhesion
gain migratory and invasive properties to become mesenchymal stem cells
66
What are the 5 sites by which oral cancers are classified?
1. oral cavity
2. pharynx
3. larynx
4. nasal cavity and the paranasal sinuses
5. major salivary glands
67
80% of parotid gland tumours are what? (rule of 80)
pleomorphic adenoma
68
Which percentage of submandibular tumours are benign?
50%
69
Which percentage of sublingual tumours are benign?
40%
70
The 1... the salivary gland is the 2... the chances are of it being a malignancy
1. smaller
| 2. bigger
71
What are the 5 occupational risk factors for salivary gland tumours?
- low dose radiation exposure
- wood dust
- chemicals (leather tanning industry)
- rubber industry
- nickel compound/alloy
72
What are 5 benign salivary gland tumours?
- pleomorphic adenoma
- warthins tumour
- oncocytoma
- lymphangioma
- haemangioma
73
Which type of benign salivary tumour is the following?
- mixed tumour: contains both epithelial and mesenchymal elements
- most common benign tumour of salivary glands
- can arise from parotid, submandibular
- parotid: usually arises from its tail
- encapsulated
- slow growing tumour
pleomorphic adenoma
74
The following signs are of which benign salivary tumour?
- swelling in front, below and behind ear
- raises ear lobe
- retromandibular groove is obliterated
- any swelling which raises ear lobe is due to parotid gland tumour until proved otherwise
pleomorphic adenoma
75
Which type of benign salivary tumour is the following?
- rare: 2.3% of benign salivary tumours
- associated with people in their 50s or above
- usually benign - malignant less common
- major salivary glands: parotid, submandibular
- minor salivary glands: palate, buccal mucosa, tongue
oncocytoma
76
What is the name of the surgery for treatment of pleomorphic adenoma?
superficial parotidectomy
77
What is the name of the surgery for treatment of an oncocytoma?
superficial parotidectomy
78
Which type of benign salivary gland tumour is the following?
- never malignant
- 40-60 age group
- encapsulated
- usually in parotid gland
- usually fluctuant, slow growing
- 10% bilateral
warthins tumour (Adenolymphoma)
79
What is the treatment for a warthins tumour?
wide local excision
80
What are 6 malignant tumours in salivary glands?
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
- carcinoma ex-pleomorphic adenoma
- adenocarcinoma
- squamous cell carcinoma
- non-hodgkins lymphoma
81
Which type of malignant salivary tumour is the following?
- most common salivary gland malignancy
- not encapsulated
- commonly in parotid gland
mucoepidermoid carcinoma
82
```
The following clinical features are of which malignant salivary gland tumour?
- slow growing
- facial nerve palsy
- presentation:
low grade - slow growing, painless mass
high grade - rapidly enlarging, +/- pain
```
mucoepidermoid carcinoma
83
What is the treatment for mucoepidermoid carcinoma?
total conservative parotidectomy
84
Which type of malignant salivary gland tumour is the following?
- 2nd most common salivary gland malignancy
- slow growing
- infiltrates widely into the tissue and muscles
- commonly in submandibular gland, sublingual or minor salivary glands, less common in parotid gland
- perineurial spread (spread across nerves)
- occasionally lymph node metastasis
- local recurrent after surgical excision
adenoid cystic carcinoma
85
What are the 3 treatment options for adenoid cystic carcinoma?
- radical parotidectomy
- post op radiotherapy
- wide local excision of palate: for tumours of palate
86
Which type of malignant salivary gland tumour is the following?
- usually from pre-existing pleomorphic adenoma
- malignancy takes about 10 years to develop in an adenoma
carcinoma ex-pleomorphic adenoma
87
Which 2 malignant salivary gland tumours are the following?
- rare
- highly aggressive
- rapidly growing tumours
- local and distant metastasis
- very poor prognosis
adenocarcinoma
and
squamous cell carcinoma
88
What are 11 risk factors of head & neck cancers?
- smoking
- alcohol
- viral infection (epstein-barr virus)
- HPV
- HIV
- betel nut chewing
- occupational exposure
- field cancerization (results from chronic exposure to carcinogens)
- genetic factors
- radiation
- diet
89
What two inherited genetic syndromes may greatly increase the risk of developing throat and mouth cancers at an early age?
fanconi anemia
and
dyskeratosis congenita
90
What are the clinical presentations of oropharyngeal tumours?
- pain
- odynophagia (painful swallowing)
- bleeding
- neck mass
91
What are the clinical presentations of a nasopharyngeal carcinoma?
- neck mass
- hearing loss due to the tumour
- tinnitus
- nasal obstruction and pain
- impaired function of cranial nerves - optic nerve and abducens nerve
92
What are the clinical presentations of hypopharyngeal tumours?
- asymptomatic for a longer period and therefore more likely to be seen in the later stages of the disease
- difficulty swallowing
- painful swallowing
- earache
- weight loss
- neck mass
93
What are the clinical presentations of laryngeal cancer?
- persistent horseness
- difficulty swallowing
- painful swallowing
- referred earache
- chronic cough
- coughing blood
- stridor (struggle to get air in)
94
What are the clinical presentations of sinus tumours?
- epistaxis (nose bleeds)
- unilateral nasal obstruction
- facial and/or head pain
95
What is the name of the staging system for head and neck cancers?
TNM staging system
T - tumour size
N - nodal involvement
M - metastasis
96
What are 3 types of skin cancers?
- basal cell carcinoma
- squamous cell carcinoma
- malignant melanoma
97
Which type of skin cancer is the following?
- a cancer that develops in the basal cells - skin cells located in the lowest layer of the epidermis
- can take several forms - can appear as shiny translucent or pearly nodule, a sore that continuously heals and re-opens, a slightly pink elevated growth, reddish patches of skin or a wavy scar
- have a history of sun exposure such as the face, ears, scalp and upper trunk
- very rarely metastasise
basal cell carcinoma
98
Which type of skin cancer is the following?
- begins in the squamous cells which are found in the upper layer of the epidermis
- tends to develop in fair-skinned middle aged and elderly people who have had long term sun exposure
- crusted or scaly area of skin with a red inflamed base, non-healing ulcer, or created over patch
- commonly found in sun exposed area, requires early treatment to prevent metastasis
squamous cell carcinoma
99
Which type of skin cancer is the following?
- begins in melanocytes, cells within epidermis that give skin its colour
- often develops in a pre-existing mole or looks like a new mole
- with early detection, cure rate is 95%
malignant melanoma
100
What are the treatment options for skin cancers?
- excision
| - radiotherapy (for basal cell. carcinoma or squamous cell carcinoma)
101
What are 9 risk factors for oral cancers?
- elderly, male
- tobacco
- alcohol
- sun exposure
- syphilis
- chronic candidosis
- viruses HPV16 and HPV18
- genetic disorders
- mucosal diseases, dysplastic lesions, lichen planus, oral submucous fibrosis
102
What is the WHO classification for carcinogenesis?
- hyperplasia
- dysplasia (mild, mod, severe)
- carcinoma in situ
103
Where are sites of low risk oral malignancy?
buccal mucosa
104
Where are sites of high risk of oral malignancy?
- floor of mouth
- sides of tongue
- retromolar pad
105
What is the term used for the following?
| - white patch which will not rub off
leukoplakia
106
What is the term used for the following?
| - red patch not due to any other disease
erythroplakia
107
Which groups of patients are at the highest risk factor for oral malignancy?
- patients aged 65 and older with lifestyle risk factors
| - patients with history of other cancer
108
What percentage is the survival rate for stage 1 oral cancer at 5 years?
85%
109
What percentage is the survival rate for stage 2 oral cancer at 5 years?
65%
110
What percentage is the survival rate for stage 3 oral cancer at 5 years?
40%
111
What percentage is the survival rate for stage 4 oral cancer at 5 years?
10%
112
What are 5 methods of oral cancer screening?
- HPV 16 screening
- toluidine blue
- VELscope
- photodynamic diagnosis
- clinical judgement
113
What are 5 signs of epithelial dysplasia?
- potentially malignant lesions
- architectural changes
- abnormal maturation and stratification
- cytological abnormalities
- cellular atypia
114
Which type of oral cancer screening is the following?
- false positive in inflammatory lesions
- 50% false negatives?
toluidine blue
115
Which type of oral cancer screening is the following?
- auto fluorescence of tissues with blue light - loss of fluorescence equates to change
- published work 'non convincing' yet
- 2 studies in cancer journals (same author)
VELscope
116
What are 5 things to be done when managing suspected oral cancer?
- refer - rapid access/ 2 week/red flag
- make telephone contact with the department
- fax/email telephone contact with the department
- check the patient has an appointment
- make sure patient attends the appointment
