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TIN > WK 12- BREAST, LUNG, AND COLON CANCER > Flashcards

WK 12- BREAST, LUNG, AND COLON CANCER Flashcards

(54 cards)

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1
Q

What are the 3 types of neoplasia of the breast

A
  • Benign neoplasia
  • non invasive carcinoma
  • invasive carcinoma
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2
Q

What are the 2 types of non invasive carcinoma

A

Lobular and ductal

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3
Q

Where is the most common location of tumours within the breast

A

Upper outer quadrant

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4
Q

What are the risk factors for breast cancer

A

age and female gender, estrogen exposure (early menarche, nullparity, late menopause, oral contraceptive pill, HRT), high calorie intake during childhood and adolescence, obesity, excessive alcohol during adolescence

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5
Q

what are the protective factors against breast cancer

A

parity (having had children) and breast feeding

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6
Q

What genes are involved in inherited breast cancer

A

BRCA 1/2 mutations

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7
Q

What genes are involved in sporadic breast cancer

A

HER2 over expression

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8
Q

What are the 4 molecular subtypes of breast cancer

A

ER positive, HER2 negative, HER2 positive and ER pos/neg, Triple neg ( ER neg, HER2 neg and progesterone negative)

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9
Q

What is meant by triple negative breast cancer

A
  • triple negative cancer cells lack receptors for estrogen, progesterone and HER2
  • these have a poor prognosis for treatment with hormone treatments (receptor targeted treatments) but a good response to chemotherapy
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10
Q

What does median survival mean

A

measure of central tendency (most common outcome/prognosis)

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11
Q

What is the 5 year survival

A

percentage based on population of patients who have cancer

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12
Q

What are the clinical features that a pt with breast cancer presents with

A

Present with screen detected cancers and other features such as a palpable mass, skin tethering, nipple discharge

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13
Q

What factors influence the prognosis of breast cancer

A

Dependent on both the biologic type of cancer (molecular or histologic type) and the extent of cancer at the time of diagnosis
-large tumour size, higher grade, lymph node metastases, ER and PR -ve are poor prognostic factors (eg triple negative)

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14
Q

How is early breast cancer management

A
  1. Surgery- wide local excision and sentinel node biopsy
  2. Adjuvant radiotherapy after breast conservation to prevent local recurrence (radio after surgery to treat micrometastasis)
  3. Hormone receptor blockers: if a tumour has receptors to oestrogen/progesterone (ER+, HER2+, Progesterone+) it will feed off these hormones and grow- blocking these receptors can prevent tumour growth
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15
Q

What medicates are used in HER2+ patients

A

Trastuzamab/herceptin- monocloncal antibody that binds to and blocks the HER2 gene to prevent over expression and EGFR

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16
Q

How are locally advanced breast cancers treated

A

cancers that are fixed to the pec muscle or skin they are considered inoperable so are treated with neoadjuvant approach to make them operable (treat with chemo/radiotherapy to make them operable) and control micrometastatic disease

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17
Q

How is metastatic breast cancer treated

A

Cannot be cured, but symptomatic relief through anti-estrogen and radiotherapy can be provided

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18
Q

What are the 2 morphological subgroups that invasive carcinomas can be put in

A
  • 2/3 are grouped together and called “ductal” or no special type
  • 1/3 can be classified morphologically into special histologic types, some of which are strongly associated with clinically relevant biologic characteristics
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19
Q

What is the most common malignant tumour in the lung

A

metastasis from another primary cancer- most commonly breast, kidney, uterus, melanoma, colorectal, testes and thyroid

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20
Q

What are the risk factors for lung cancer, apart from smoking

A

Exposure to arsenic, radiation, iron oxide, coal mining

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21
Q

What genetic mutations occur to cause lung cancer

A
  • activation of oncogenes EGFR, K-Ras, Myc, EML4-ALK

- inactivation of tumour suppressor genes→ 3p, 9p, p16, 13q, 17P and TP53 (bolded are most common)

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22
Q

What are the 2 broad categories of lung cancer

Study These Flashcards
A

Small cell lung cancer and non-small lung cancer

23
Q

What are the 3 sub types of non-small lung cancer

Study These Flashcards
A

Adenocarcinoma, squamous cell carcinoma and large cell carcinoma

24
Q

Which of the non-small cell lung cancers has the poorest diagnosis

Study These Flashcards
A

Large cell carcinoma–> more undifferentiated, metastisize early and have poor prognosis

25
What cells do small cell lung cancers arise from
Arise from neuroendocrine cells (neoplastic tumour due to parathyroid)-> very aggressive and considered a systemic disease at diagnosis due to the endocrine effects
26
What do adenocarcinoma cells arise from
- arise from mucous cells in bronchial epithelium - non-smokers most often have adenocarcinoma - slow growing and progresses to mediastinal lymph nodes and pleura and spreads to bone and brain - often present late with distant metastases at time of diagnosis
27
What is the most common form of NSCLC
adenocarcinoma
28
What are the clinical presentations associated with lung cancer
- respiratory symptoms of persistent dry cough, haemoptysis, wheezing, “recurrent” pneumonia or dyspnea - physical examination is often normal
29
What tools are used to form a diagnosis of lung cancer
-chest X-ray, CT scan. abdo CT for nodal spread and metastases→ TNM system used
30
Which has a better prognosis- NSCLC or SCLC
SCLC has a poorer prognosis with median survival at 12 months for metastatic SCLC
31
What combination combination of treatment is used to treat SCLC
platinum and etoposide (combo used in lung cancer) with radiation to the primary tumour also highly recommended
32
What treatment is recommended for NSCLC
1. for curative small tumours= surgery 2. for operable tumours with spread to the lymph nodes= chemotherapy plus surgery 3, for widespread disease= chemotherapy doublets such as cisplatin with vinorelbine, or gemcitabine or paclitaxel with carboplatin -in some lung cancers, agents targeted at the EGFR can be beneficial
33
What is the MOA for chemotherapy doublets used in treatment of NSCLC (cisplatin-intercalating agent, gemcitabine- antimetabolite agent)
Cisplatin- acts to wedge between base pairs and stops the DNA strands coming apart during transcription Gemcitabine- interfere with the incorportation of nucleic acid bases into the DNA during DNA synthesis and inhibits ribonucleotide reductase
34
What is the most common benign neoplasia of the colon
Colonic adenomas
35
What 2 genetic syndroms are associated with colonic polyps and increased rates of colon cancer
FAP (APC mutation) and Lynch syndrome (MSH2, MLH1)
36
What are the risk factors for colon cancer
- highest frequency in Western societies - diet high in red meat, fat, high caloric intake; tobacco and alcohol use, sedentary lifestyle - inflammatory bowel disease - family history - familial syndromes eg FAP and Lynch Syndrome
37
What genes are involved somatic colon cancer
APC, KRAS, TP53, B-cantenin
38
What are the clinical signs of colon cancer
variable presentation - change in bowel habits - non-obstructing tumours may cause anaemia, rectal bleeding - large bowel obstruction requires emergency surgery
39
What tools are used for diagnosis of colon cancer
colonoscopy / biopsy for histological diagnosis - CT scan of abdomen for detection of nodal and liver metastases - staging is performed using the TNM system or historical Dukes system
40
What was the 5 year survival from colorectal cancer
69%
41
How is early stage (Stage 1) colon cancer managed
surgery
42
How is locally advances (Stage 2-3) colon cancer managed
surgery plus adjuvant chemotherapy combination for those with nodal involvement
43
How is metastatic colon cancer manage
usually considered incurable → systemic chemotherapy combination regimens → targeted therapies eg bevacizumab show further improvement -anti-EGFR antibodies and cetuximab effective in KRAS wild type metastatic colorectal cancers → tyrosine kinase inhibitors of benefit in patients with refractory metastatic colorectal cancer → some patients with solitary metastases in the liver or lung may be cured with surgical resection
44
What are the 3 types of skin cancer
NMSC; squamous cell carcinoma and basal cell carcinoma | Melanoma
45
What is the most fatal (poorest prognosis) type of skin cancer
melanoma
46
Out of the NMSC, which has low potential for metastasis and which rarely ever metastasises
SCC has ability to metastasize, BCC will barely ever
47
What is the commonest type of NMSC
BCC
48
What are the risk factors for skin cancer
- environmental exposure -UV intensity and duration - previous diagnosis of melanoma - family history - skin type, eye colour, hair colour (fair skin, blonde hair) - less melanin pigmentation - smoking- particularly for BCC
49
Which genetic components may play a role in skin cancer
B-raf, Mek and C-kit
50
What are the clinical presentations of SCC, BCC and melanoma
- BCC: pink, nodular, raised lesion with 'pearly' edges; or flat pink - SCC: whitish-pink, scaly, crusted, raised lesion; or pink flat lesion - Melanoma: many clinical forms, typically a pigmented, variegated (multicolour) skin lesion with recent changes in size, shape, colour→ may involve the keratinised skin of the sun-exposed, as well as occasionally the non-exposed regions of the body
51
What are the diagnostic tools for staging
diagnosis by pathology using excision biopsy for primary lesions and fine /core needle biopsy for secondaries, CT scan / MRI for metastases - LDH may be a useful bio-marker in melanoma for metastatic disease or recurrence - TNM classification usually used; other systems
52
What are the management options for skin cancer
1. Surgery 2. -dacarbazine and fotemustine chemotherapy, but low rates of response and cure 3. kinase inhibitors (MEK, BRAF) checkpoint inhibitors (CTLA, PD1) have improved response rates and survival (immune checkpoint inhibs→ drugs that overcome immune response) 4. adjuvant radiotherapy for symptom control, especially for bone metastases
53
What is triple negative breast cancer
triple negative cancer cells lack receptors for estrogen, progesterone and HER2 - these have a poor prognosis for treatment with hormone treatments (receptor targeted treatments) - on a positive note, this type of breast cancer is typically responsive to chemotherapy
54
What is tumour marker for colon cancer
CEA

TIN (14 decks)

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