Tumour Classification Flashcards
Clear Diagnosis is important for what?
Prognosis and treatment of the individual, as well as understanding causation and prevention
What do patients want to know about a cancer?
Their chance of cure.
Prognosis.
Treatment options.
Risk to family.
Risk of progression of something benign
What do clinicians want to know about a cancer from classification?
To weight the risks and benefits of treatment.
To know prognosis.
Treatment options.
The likelihood and impact of identifying an actionable driver.
What are the different types of classification?
Benign Vs Malign.
Tissue/Organ of origin.
Depth of invasion, spread. TNM (Tumour Node Metastasis).
Tumour Grade - how aggressive and differentiated.
Molecular identification using DNA/RNA.
What are some benign lesions?
Fibroma. Naevus. Metaplastic lesions (cell type has changed to another).
What are some malignant lesions?
Leiomyosarcoma, colorectal adenocarcinomas, melanomas.
Is it just a matter of benign vs malignant? Why?
No, because some benign lesions have a propensity to become malign in the future.
What feature of a benign lesion should make us more worried, and why?
Metaplastic (external stimuli cell turns cell to different type) -> Dysplastic (internal signal turns cell to abnormal version of itself). Because then the curative window before they become carcinomas is small.
To better identify malignant and benign lesions we need to better identify what else?
Normal tissue
What will clear biomarkers enable?
Identify drivers of transition, predict progression, detect early, prevent over diagnosis.
What are aspects of dysplastic tissue?
Crowding of cells, multilayer growth, nuclear atypia, disruption of normal architecture.
Why is looking for dysplasia not good enough to identify cancers early?
A tumour can transition too quick through dysplasia?
Which organs get the most cancers? (not specific organs)
Those exposed to the most carcinogens. Those affected by hormonal changes. Those with a high cell turn over.
Organ of origin may impact aggressiveness which is:
Rate of growth and metastasis. Impacts survival.
Organ of organ may cause local issues such as:
Glioblastoma - little space in brain, can cause significant symptoms.
Pancreatic cancer - Damages digestion ability, leads to muscle wasting
Organ of origin can largely impact therapy response, be it sarcoma, carcinoma, etc. Tell me about this with respect to CRC, gastric, esophageal and breast cancers.
CRC has a poor response to Taxol.
Anthracyclines have little benefit in gastric or esophageal cancer, but is the cornerstone of breast cancer treatment.
Knowing the tissue of origin can guide genetic tests, how and why?
Certain tissues are exposed to certain mutagens, which tend to produce particular changes in specific oncogenes. So we know which tests to be running.
Why is BRAF V600E often in melanomas?
UV causes C>T mutations at CT dinucleotides.
What specific mutations do the carcinogens in smoking often cause?
KRAS G12C.
How many different cell types might be in the lung?
50
Sarcomas are rare tumours from what type of cells?
Connective Tissue cells
Neuroendocrine cells in the lung are what type of cell?
Epithelial sub type.
What are 3 types of tumour from neuroendocrine cells of the lung, each with a very different prognosis?
Carcinoid, Large Cell NEC, and Small Cell NEC.
SCC oesophageal cancers respond much better with neoadjuvant chemoradiotherapy than AC oesophageal cancers. What are these two types in full?
Squamous Cell Carcinoma respond better than Adenocarcinomas.
