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DG1006 - HHD1&ANATOMY > Oncology > Flashcards

Oncology Flashcards

1
Q

What is the definition of cancer?

A

when abnormal cells divide in an uncontrolled way

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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
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3
Q

What are 4 oral manifestations of squamous cell carcinoma?

A
  • lateral border of tongue - solitary ulcer with rolled border
  • erythroplakia
  • leukoplakia
  • dysphagia
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4
Q

What are the 4 types of carcinoma cancer cells?

A
  1. squamous cell carcinoma
  2. adenocarcinoma
  3. transitional cell carcinoma
  4. basal cell carcinoma
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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

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6
Q

Which type of carcinoma cancer cell is the following?

  • glandular cells
  • function: produce fluids to keep tissues moist
  • adenomatous cells
A

adenocarcinoma

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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

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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

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9
Q

Which type of cancer cell originates in connective tissues eg. bone, cartilage, tendons and muscles?

A

sarcomas

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10
Q

What are bone sarcomas called?

A

osteosarcoma

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11
Q

What is cancer of the cartilage called?

A

chondrosarcoma

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12
Q

What is cancer of the muscle cells called?

A

rhabdomyosarcoma

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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

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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

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15
Q

Which type of cancer is the following?

  • cancers of the lymphatic system
  • plasma cells can become abnormal, multiply uncontrollable
A

myeloma

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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

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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

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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

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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

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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

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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

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22
Q

What are the 4 characteristics of a benign skin lesion?

A
  1. symmetrical
  2. even edge
  3. one shade
  4. <6mm
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23
Q

What are the 4 characteristics of a malignant skin lesion?

A
  1. asymmetrical
  2. irregular
  3. > 1 shades
  4. > 6mm
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24
Q

What are the 2 enabling hallmark characteristics of cancer?

A

genetic instability and mutation

and

tumour-promoting inflammation

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25
Q

What are the 2 emerging hallmarks characteristics of cancer?

A

avoiding immune destruction

and

deregulating cellular energetics

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26
Q

What are the 3 ways in which cancer cells deregulate cellular energetics?

A
  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
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27
Q

What are the 4 primary functions of chromatin?

A
  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
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28
Q

DNA methylation

In cancer typically, there is hypermethylation of…?

A

tumour supressor genes

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29
Q

DNA methylation

In cancer typically, there is hypomethylation of…?

A

oncogenes

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30
Q

Histone acetylation

In cancer typically, there is decrease in histone acetylation involved in…?

A

tumourogenesis, tumour evasion and metastasis

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31
Q

What is the function of oncogenes in cancer?

A

activation of proto-oncogenes to oncogenes, then become permanently switched on when not supposed to and cell grows out of control

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32
Q

What is the function of tumour suppressor genes in cancer?

A

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

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33
Q

What are the normal functions of oncogenes?

A

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.

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34
Q

What are the 3 normal functions of tumour suppressor genes? (SIR)

A
  1. slow down cell division
  2. repair DNA mistakes
  3. initiate apoptosis
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35
Q

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
A

two-hit hypothesis

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36
Q

What are the 2 HPV viruses that are high risk for cancers?

A

HPV16 - responsible for oral cancer
and
HPV18

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37
Q

Which phase of the cell cycle is responsible for?

  • growth of cell, no division
  • cells in this phase most of time except cancer cells
A

interphase

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38
Q

Which phase of the cell cycle is responsible for?

- cellular contents, excluding the chromosomes are duplicated

A

G1

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39
Q

Which phase of the cell cycle is responsible for?

- each of the 46 chromosomes is duplicated by the cell

A

S

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40
Q

Which phase of the cell cycle is responsible for the following?
- the cell double checks the duplicated chromosomes for error, making any needed repairs

A

G2

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41
Q

Which phase of the cell cycle is responsible for?

  • cell cycle arrest
  • no cell division
A

G0

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42
Q

Which phase of the cell cycle is responsible for?

- active cell division

A

mitosis

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43
Q

Which checkpoint of the cell cycle is responsible for regulation of cell size, nutrients, growth factors, DNA damage?

A

G1 checkpoint

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44
Q

Which checkpoint of the cell cycle is responsible for the regulation of DNA damage, DNA replication completeness?

A

G2 checkpoint

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45
Q

Which checkpoint of the cell cycle is responsible for regulating sister chromatids correctly attached to spindle microtubules?

A

M checkpoint

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46
Q

Which 2 genes are responsible for oncogenic HPV?

A

E6
and
E7

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47
Q

How does the HPV virus induce carcinogenesis?

A

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
Q

Mutations in which two genes are implicated in oral carcinogenesis?

A

p53
and
pRb

49
Q

What are 5 stages involved in the multistage model of carcinogenesis?

A
  1. normal
  2. dysplastic (morphology changes)
  3. benign
  4. pre-malignant
  5. malignant
50
Q

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

A

the theory of clonal expansion

51
Q

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

A

cancer stem cell theory

52
Q

Which 2 cells are markers of breast cancer stem cells?

A

CD44+
and
CD24-

53
Q

Which 3 monoclonal antibodies binds to growth factor receptors or neutralise growth factors to inhibit growth?

A
  • trastuzumab
  • cetuximab
  • bevacizumab
54
Q

Normal cells require growth signals before they can progress through the cell cycle, however in cancer cells they have?

A
  • 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
Q

What is responsible for preventing downstream signalling triggered by growth factors by inhibiting specific oncogenic kinases?

A

protein kinase inhibitors

56
Q

Inducing angiogenesis

VEGF (vascular endothelial growth factor) released to promote growth of?

A

new blood vessels

57
Q

Inducing angiogenesis

Which transcription factor is a major regulator of tumour cell adaptation to hypoxic stress?

A

HIF-1

58
Q

What is meant by the angiogenic switch?

A

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
Q

Achieving the metastatic state

Which 2 enzymes are involved in achieving the metastatic state?

A

PDPN - small membrane glycoprotein - increased cancer cell invasion into lymphatic and blood vessels

MMP1 - enzyme with breakdowns of extracellular matrix

60
Q

What is the difference between the clonal expansion theory and the cancer stem cell theory?

A

clonal expansion theory - every tumour cell has tumour initiating properties

cancer stem cell theory - only cancer stem cells have tumour initiating properties

61
Q

Immortilisation

Which cell is responsible for enabling replicative immortality?

A

hTERT - human telomerase

62
Q

Cell signalling
Which receptor protein is responsible for resisting cell death, sustaining proliferative signalling and evading growth suppressors?

A

EGFR - epidermal growth factor

63
Q

What are the 2 epithelial phenotypes involved in epithelial-mesenchymal transition (EMT)?

A

E-cadherin - cell adhesion molecule found in epithelial tissue
ZO-1 - tight junction protein binds actin cytoskeleton

64
Q

What are the 2 mesenchymal phenotypes involved in epithelial-mesenchymal transition (EMT)?

A

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
Q

How does the epithelial-mesenchymal transition enable metastasis?

A

the epithelial cells lose their polarity and cell adhesion

gain migratory and invasive properties to become mesenchymal stem cells

66
Q

What are the 5 sites by which oral cancers are classified?

A
  1. oral cavity
  2. pharynx
  3. larynx
  4. nasal cavity and the paranasal sinuses
  5. major salivary glands
67
Q

80% of parotid gland tumours are what? (rule of 80)

A

pleomorphic adenoma

68
Q

Which percentage of submandibular tumours are benign?

A

50%

69
Q

Which percentage of sublingual tumours are benign?

A

40%

70
Q

The 1… the salivary gland is the 2… the chances are of it being a malignancy

A
  1. smaller

2. bigger

71
Q

What are the 5 occupational risk factors for salivary gland tumours?

A
  • low dose radiation exposure
  • wood dust
  • chemicals (leather tanning industry)
  • rubber industry
  • nickel compound/alloy
72
Q

What are 5 benign salivary gland tumours?

A
  • pleomorphic adenoma
  • warthins tumour
  • oncocytoma
  • lymphangioma
  • haemangioma
73
Q

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
A

pleomorphic adenoma

74
Q

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
A

pleomorphic adenoma

75
Q

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
A

oncocytoma

76
Q

What is the name of the surgery for treatment of pleomorphic adenoma?

A

superficial parotidectomy

77
Q

What is the name of the surgery for treatment of an oncocytoma?

A

superficial parotidectomy

78
Q

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
A

warthins tumour (Adenolymphoma)

79
Q

What is the treatment for a warthins tumour?

A

wide local excision

80
Q

What are 6 malignant tumours in salivary glands?

A
  • mucoepidermoid carcinoma
  • adenoid cystic carcinoma
  • carcinoma ex-pleomorphic adenoma
  • adenocarcinoma
  • squamous cell carcinoma
  • non-hodgkins lymphoma
81
Q

Which type of malignant salivary tumour is the following?

  • most common salivary gland malignancy
  • not encapsulated
  • commonly in parotid gland
A

mucoepidermoid carcinoma

82
Q 
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
A

mucoepidermoid carcinoma

83
Q

What is the treatment for mucoepidermoid carcinoma?

A

total conservative parotidectomy

84
Q

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
A

adenoid cystic carcinoma

85
Q

What are the 3 treatment options for adenoid cystic carcinoma?

A
  • radical parotidectomy
  • post op radiotherapy
  • wide local excision of palate: for tumours of palate
86
Q

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
A

carcinoma ex-pleomorphic adenoma

87
Q

Which 2 malignant salivary gland tumours are the following?

  • rare
  • highly aggressive
  • rapidly growing tumours
  • local and distant metastasis
  • very poor prognosis
A

adenocarcinoma
and
squamous cell carcinoma

88
Q

What are 11 risk factors of head & neck cancers?

A
  • 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
Q

What two inherited genetic syndromes may greatly increase the risk of developing throat and mouth cancers at an early age?

A

fanconi anemia
and
dyskeratosis congenita

90
Q

What are the clinical presentations of oropharyngeal tumours?

A
  • pain
  • odynophagia (painful swallowing)
  • bleeding
  • neck mass
91
Q

What are the clinical presentations of a nasopharyngeal carcinoma?

A
  • neck mass
  • hearing loss due to the tumour
  • tinnitus
  • nasal obstruction and pain
  • impaired function of cranial nerves - optic nerve and abducens nerve
92
Q

What are the clinical presentations of hypopharyngeal tumours?

A
  • 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
Q

What are the clinical presentations of laryngeal cancer?

A
  • persistent horseness
  • difficulty swallowing
  • painful swallowing
  • referred earache
  • chronic cough
  • coughing blood
  • stridor (struggle to get air in)
94
Q

What are the clinical presentations of sinus tumours?

A
  • epistaxis (nose bleeds)
  • unilateral nasal obstruction
  • facial and/or head pain
95
Q

What is the name of the staging system for head and neck cancers?

A

TNM staging system

T - tumour size
N - nodal involvement
M - metastasis

96
Q

What are 3 types of skin cancers?

A
  • basal cell carcinoma
  • squamous cell carcinoma
  • malignant melanoma
97
Q

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
A

basal cell carcinoma

98
Q

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
A

squamous cell carcinoma

99
Q

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%
A

malignant melanoma

100
Q

What are the treatment options for skin cancers?

A
  • excision

- radiotherapy (for basal cell. carcinoma or squamous cell carcinoma)

101
Q

What are 9 risk factors for oral cancers?

A
  • 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
Q

What is the WHO classification for carcinogenesis?

A
  • hyperplasia
  • dysplasia (mild, mod, severe)
  • carcinoma in situ
103
Q

Where are sites of low risk oral malignancy?

A

buccal mucosa

104
Q

Where are sites of high risk of oral malignancy?

A
  • floor of mouth
  • sides of tongue
  • retromolar pad
105
Q

What is the term used for the following?

- white patch which will not rub off

A

leukoplakia

106
Q

What is the term used for the following?

- red patch not due to any other disease

A

erythroplakia

107
Q

Which groups of patients are at the highest risk factor for oral malignancy?

A
  • patients aged 65 and older with lifestyle risk factors

- patients with history of other cancer

108
Q

What percentage is the survival rate for stage 1 oral cancer at 5 years?

A

85%

109
Q

What percentage is the survival rate for stage 2 oral cancer at 5 years?

A

65%

110
Q

What percentage is the survival rate for stage 3 oral cancer at 5 years?

A

40%

111
Q

What percentage is the survival rate for stage 4 oral cancer at 5 years?

A

10%

112
Q

What are 5 methods of oral cancer screening?

A
  • HPV 16 screening
  • toluidine blue
  • VELscope
  • photodynamic diagnosis
  • clinical judgement
113
Q

What are 5 signs of epithelial dysplasia?

A
  • potentially malignant lesions
  • architectural changes
  • abnormal maturation and stratification
  • cytological abnormalities
  • cellular atypia
114
Q

Which type of oral cancer screening is the following?

  • false positive in inflammatory lesions
  • 50% false negatives?
A

toluidine blue

115
Q

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)
A

VELscope

116
Q

What are 5 things to be done when managing suspected oral cancer?

A
  • 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

DG1006 - HHD1&ANATOMY (12 decks)

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