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Flashcards in MOD 11 Deck (78)
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Which 4 cancers account for over half the incidence of all malignant neoplasms?

Lung, prostate, breast and bowel carcinomas.


In which age group are the majority of malignant neoplasms diagnosed?

Over 65s (only a small proportion in people up to 24).


In children younger than 14 which cancers are most common?

Leukaemias, central nervous system tumours and lymphomas.


Which cancers have a high (87% and over) 5 year survival rate?

testicular, malignant melanoma and breast cancer.


Which cancers have a low (15% and under) 5 year survival rate?

Oesophagus, lung and pancreas (only 3%)/


What cancer causes the most death in the UK (over double the amount than the second most common leading cause of cancer deaths)?

Lung cancer.


What factors need to be taken into consideration when predicting the outcome of a malignant neoplasm?

1. Age
2. General health status
3. Tumour site
4. Tumour type
5. Grade (e.g. differentiation)
6. Tumour stage (e.g. tumour burden)
7. Availability of effective treatments


What does tumour staging measure?

The maligant neoplasm's overall burden.


What is the commonest method for assessing the extent of a tumour?

The TNM staging system - standardised across the world.


In the TNM staging system, what does T stand for? How many subdivision to T are there?

T refers to the size of the primary tumour. It is typically expressed as T1-T4.


In the TNM staging system, what does N stand for? How many subdivision to N are there?

N describes the extent of regional node involvement e.g. N0-N2.


In the TNM staging system, what does M stand for? How many subdivision to M are there?

M denotes the extent of distant metastatic spread. E.g. M0-M1.


How does the TNM staging system assess different types of cancer?

Each cancer has its own specific TNM criteria.


How is the TNM staging system used to come up with an ultimate stage (I-IV)? What does each Stage (I-IV) roughly describe the cancer?

The details of this conversion vary for each cancer type but in general:
Stage I: early local disease
Stage II: advanced local disesae
Stage III: regional metastasis (i.e. any T, and N and M1).


What special staging system is used for lymphoma? What does each stage (I-IV) represent?

Ann Arbor staging.
stage I: lymphoma in a single node region
Stage II: two separate regions on one side of the diaphragm
Stage III: spread to both sides of the diaphragm
Stage IV: indicates diffuse or diseminated involvement of one or more extra-lymphatic organs such as bone marrow or lungs.


Duke's staging system is a historical staging system that was used for which type of cancer?

Colorectal carcinoma.


In Duke's staging system what does A mean?

Invasion into but not through the bowel wall.


In Duke's staging system what does B mean?

Invasion through the bowel wall.


In Duke's staging system what does C mean?

Involvement of lymph nodes.


In Duke's staging system what does D mean?

Distant metastases.


What is the importance of cancer staging?

It measures the tumour's overall burden and therefore is a powerful predictor of survival.


List some features of cells with worsening differentation:

1. Increased nuclear size
2. Increased nuclear: cytoplasmic ratio
3. Increased nuclear staining (hyperchromasia)
4. More mitotic figures
5. Pleomorphism: increased variation in size and shape of cells and nuclei.


What features of cells are used to grade tumours in the Bloom Richardson grading for breast cancer (G1-G3)?

1. Number of tubules
2. Number of mitotic figures
3. Nuclear polymorphism (variation in size and shape of nuclei).


In grading of squamous cell carcinoma and colorectal carcinoma, what do G1-G4 typically describe?

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


What is meant by anaplastic?

When cells have lost so much differentiation that thy no longer morphologically resemble any tissue.


What is the importance of tumour grade?

It is more important for planning treatment and estimating prognosis in certain types of malignancy, such as soft tissue sarcoma, primary brain tumours, lymphomas and breast and prostate cancer.


What types of cancer treatment are available?

1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Hormone therapy
5. Treatment targeted to specific molecular alterations
6. (Immune system targets have recently shown promise)


What is the mainstay treatment for most cancers?



What determines the treatment used for a cancer?

1. The type of cancer
2. The cancer stage.


What is adjuvant treatment?

Treatment given AFTER the surgical removal of a primary tumour, to eliminate subclinical disease.