Session 10 Neoplasia

Question 1

What does grade mean in relation to a neoplasm?

Answer 1

The level of the malignancy

Question 2

What factors should you consider when deciding the outcomes of malignant neoplasms?

Answer 2

Age
Health
Status
Site
Type
Grade
Stage 
Treatment

Question 3

What’s the TNM naming system?

Answer 3

Method for assessing the extent of a tumour

T= the size of the primary tumour, T1-T4, t4 being the biggest.
N describes the extend of regional node metastasis via lymphatic N0-N3
M means extent of distant metastatic spread via the blood M0-M1.

Each cancer has its own specific TNM and this is only for solid tumours (so not leukaemia)

Question 4

How does the TNM system relate to cancer grading?

Answer 4

Stage 1 = early local disease so T1/2, N0 and M0

Stage 2 = advanced local disease, T2/4, N0 and M0

Stage 3 = regional metastasis any T, N1+, M0

Stage 4 = advanced disease with distant metastasis, any T any N M1.

Question 5

How does tumour grading work?

Answer 5

G1 = well differentiated
G2 = moderately differentiated 
G3 = poorly differentiated
G4 = undifferentiated or anaplastic

Question 6

Why is tumour grading important?

Answer 6

For planing treatment and estimating prognosis in certain types of malignancies e.g soft tissue sarcomas

Question 7

What’s the different between adjuvant and neoadjuvant treatment?

Answer 7

Adjuvant = treatment given after surgical removal of primary tumour to eliminate sub clinical diseases

Neoadjuvant = given to reduce the size of a primary tumour prior to surgical excision

Question 8

How does radiotherapy work?

Answer 8

Focused on the tumour
Given in fractional doses to minimise normal tissue damage
Radiation is used to kill rapidly dividing cells, especially in g2 of the cell cycle by creating free radicals that trigger apoptosis.

Question 9

How does chemotheraphy work?

Answer 9

Several classes exists

Antimetabolites = mimic normal substrates involved in DNA replication

Alkylating and platinum based drugs = cyclophosphamide and cisplatin cross link two strands of the DNA helix

Antibiotics = can influence DNA structure.

Plant derived drugs = can influence with cell proliferation e.g spindle fibres formation in mitosis.

Question 10

How can chemotherapy cause immunosuppression?

Answer 10

Marrow suppression = are immunosuppressed

Question 11

What can hormone therapy be Used for?

Answer 11

Used to treat hormone receptor positive cancers.

Question 12

What do tumour markers do?

Answer 12

Allow monitoring of cancer burden

Markers include hormones, oncofetal antigens, specific proteins and mucins/glycoproteins.