The Case Of The Man Who Wanted To Know The Future

Question 1

cancer staging

Answer 1

a classification system that describes how far a cancer has spread

Question 2

colorectal cancer stage 1

Answer 2

confined to mucosa

Question 3

colorectal cancer stage 2

Answer 3

penetrates muscularis of colon wall

Question 4

colorectal cancer stage 3

Answer 4

tumour penetrates serosa

Question 5

colorectal cancer stage 4

Answer 5

tumour invades other structures, distant metastasis

Question 6

TNM

Answer 6

T = size of T umor N = N ode involvement M = M etastases

Question 7

how do you look for distant metastasis?

Answer 7

CT, occasionally PET

Question 8

what imaging modalities can assist biopsy?

Answer 8

ultrasound or CT

Question 9

types of new tumour therapies in interventional radiology

Answer 9

trans-arterial chemoembolisation
selective internal radiotherapy
particle embolisation
tumour ablation

Question 10

radiofrequency ablation

Answer 10

An interventional radiologic technique in which tumors are removed from tissues by heating

Question 11

limitation of RFA currently

Answer 11

only good for tumours about 2-3cm big, heating zone not wide

Question 12

cryoablation

Answer 12

destroying tumours with liquid nitrogen

Question 13

what cancer is US ablation promising for?

Answer 13

breast cancer

Question 14

4 subdivisions of colorectal cancer

Answer 14

colon cancer
rectal cancer
oligo-metastatic
widespread metastatic

Question 15

symptoms of colorectal cancer (4)

Answer 15

anaemia
rectal bleeding
change in bowel habit
tenesmus

Question 16

tenesmus

Answer 16

The feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.

Question 17

Hallmarks of Cancer

Answer 17

Sustaining proliferative signaling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis
Resisting cell death

Question 18

cancer enabling characteristics

Answer 18

tumour promoting inflammation

genome instability

Question 19

key 1st gene affected in colorectal cancer

Answer 19

APC gene - a tumour suppressor

Question 20

how do polyps progress to cancer?

Answer 20

APC loss causes initial polyp
KRAS mutation causes bigger polyp
more mutations in p53 and Chr 18 then get cancer

Question 21

KRAS

Answer 21

Oncogene associated with colorectal cancer

Question 22

how does mismatch repair lead to cancer?

Answer 22

epigenetic loss of one of the mismatch repair genes, get multiple point mutations by accident, eventually switch off a tumour suppressor

Question 23

how much colorectal cancer is hereditary?

Answer 23

how much colorectal cancer is hereditary?

3-5%

Question 24

Familial Adenomatous Polyposis (FAP)

Answer 24

Autosomal dominant disorder characterized by 100s to 1000s of adenomatous colonic polyps, get inevitable subsequent mutations leading to colorectal cancer

Question 25

Hereditary Nonpolyposis Colon Cancer/Lynch Syndrome

Answer 25

An autosomal dominant disorder associated with faulty mismatch repair gene so get multiple point mutations

Question 26

which cancers are you at increased risk of if you have Lynch syndrome?

Answer 26

colorectal endometrial pancreatic small bowel

Question 27

treating FAP

Answer 27

prophylactic pan-colectomy by aged 40

Question 28

treating HNPCC

Answer 28

regular screening colonoscopy and preventative aspirin 600mg

Question 29

screening for bowel cancer

Answer 29

faecal immunochemical test offered to over 60s, if positive go for a colonoscopy

Question 30

adjuvant chemotherapy

Answer 30

the use of chemotherapy after or in combination with another form of cancer treatment such as administering chemotherapy after surgery or with radiation therapy

Question 31

How does colorectal cancer spread?

Answer 31

direct extension via portal circulation to liver via venous circulation to lung

Question 32

common mutations in colorectal cancer

Answer 32

RAS RAF MEK ERK

Question 33

which is the key mutation in CRC which renders EGFR inhibitors useless?

Answer 33

RAS mutation

Question 34

Sotorasib

Answer 34

a potential upcoming cancer drug for CRC with KRAS mutations

Question 35

prevalence of KRAS mutation in CRC

Answer 35

about 40%

Question 36

Cetuximab

Answer 36

EGFR inhibitor used in colorectal cancer

Question 37

how can you discover patients at risk of metastatic disease?

Answer 37

do blood tests and PCR for circulating tumour cells or DNA, these people can then have adjuvant chemo as well as surgical resection

Question 38

Immune checkpoint inhibitors

Answer 38

Take the "brakes" off the immune system, which helps it recognize and attack cancer cells, potential use in CRC that are mismatch repair gene deficient

Question 39

Immune checkpoint inhibitors

Answer 39

lots of mutations makes cells more 'foreign' so more easily targeted by native immune system