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What are the two main types of genes involved with cancer?
- Tumor suppressor genes
What are oncogenes and what do they do?
They are mutated versions of normal cellular genes (proto-oncogenes) which control cell proliferation, survival and spread. Oncogenes cause uncontrolled cell division, enhance survival and dissemination of the cancer cells.
What are tumour suppressor genes and what do they do?
They normally act by inhibition of proliferation and survival. They stop abnormal cells from dividing through apoptosis, if theses genes are abnormal they are allowed to proliferate. p53 is the most significant tumour suppressor which is inactivated or mutated in 50% of malignant disease.
What is cancer?
Disease caused by the abnormal and unrestricted growth of cells which can then invade other tissues.
Name ten risk factors for cancer.
- environment or occupation,
- previous cancer,
- infectious agents,
- geographical distribution,
- iatrogenic (drugs and radiation)
What age group of women are invited for breast screening?
50 - 70
What age group of women are invited for a 'smear test' for cervical cancer?
25 to 64
How often are women in the age range called for a mammogram?
Every three years
How often are women in the age range called for a smear test?
3 to 5 years depending on age.
When did HPV vaccines start? What age group receive the injection routinely?
- 2008 -12 to 13 year olds
- (catch up programme was run for 3 years for girls 14-18)
Bowel cancer screening is available for all men and women of what age? How often?
60 to 75. Every two years.
What are the main limitations of bowel cancer screening?
The test looks for blood in stools. However, abnormalities of the bowel, other than cancer, such as polyps can bleed giving a false positive. A positive result requires investigation (such as endoscopy) which may be an unnecessary spend of money.
What are the symptoms of cancer, for men and women, according to cancer research UK that should make a patient go to see their doctor?
- An unusual lump or swelling
- change in size, shape or colour of a mole
- a sore that doesn't heal after several weeks
- mouth or tongue ulcer that lasts longer than three weeks
- cough or croaky voice for 3+ weeks
- persistent difficulty swallowing/indigestion
- problems passing urine
- blood in urine or bowel motions
- more frequent bowel movements for 3+ weeks
- Unexplained weight loss or heavy night sweats
- pain or ache for 4 weeks (unexplained)
- coughing up blood
What does the TNM classification stand for?
- Tumour size (0-4)
- lymph Node involvement (0-3)
- presence of Metastases (0-1)
What are the classifications for performance status?
Grade 0, 1, 2, 3, 4, 5
- 0-fully active, able to carry on all pre-disease performance without restriction
- 1-restricted in physically strenuous activity
- 2-Selfcare, but no work activites. Up and about 50% of waking hours.
- 3-limited selfcare, confined to bed/chair over 50% of waking hours
- 4-completely disabled. Total confined
What is ECOG used for?
To assess performance status, predicts how well treatment and survival rates are. (eastern cooperative oncology group) Score higher than 2 suggests treatment and survival will be reduced for most tumours. Sccale 0-5
What are the four aims of treatment in cancer?
- Cure - eradication of the cancer
- Adjuvant therapy - to prevent return of cancer
- Palliation - to control cancer and prolong life
What is the difference between adjuvant and neoadjuvant therapy?
Adjuvant - given after a first treatment which aimed to eradicate the tumour (usually surgery or radiotherapy). To occult micro-metastases.
What factors need to be considered when deciding on treatment for breast cancer?
- Prognostic factors
- Predictive factors (HER2) (ER status)
- Potential benefits / side effects
- Other factors (age, menopause status)
What types of surgery are available?
Local excision, segmental mastectomy or full mastectomy (with or without reconstruction)
What types or adjunct therapy is available for breast cancer?
Radiotherapy, chemotherapy, hormonal therapy or biological therapy
What is the NPI score and what is the formula?
- Nottingham prognostic index score
- NPI=(tumour size cm x0.2) + grade + lymph node status
Adjuvant chemotherapy for breast cancer is given for a NPI score above what? What is normally a constituent?
3.4. Most regimes will include an anthracycline eg epirubicin unless contra...
Hormonal therapy is given when a breast tumour expresses what?
Express receptors for oestrogen / progesterone. (ER+ or PR+) Are less progressive tumours.
What are the two methods of hormonal therapy?
Oestrogen antagonists block the proliferative effect of oestrogen (Tamoxifen) or reducing circulating oestrogen (aromatase inhibitors(AI))
What are the side effects associated with tamoxifen?
- Hot flushes
- GI disturbances
- Vaginal bleeding and discharge
- Changes to menstruation
- Weight gain
- Mood changes
What are the side effects associated with aromatase inhibitors?
- Hot flushes
- GI disturbances
- Vaginal dryness
- Skin rash
- Osteoporosis (reduced BMD)
What is the biological therapy agent available for breast cancer tumours?
- Trastuzumab (Herceptin) monoclonal antibody.
- Targets human epidermal growth factor receptor-2 (HER2) used id HER2 is over expressed.
How is Trastuzumab given?
Given at 3-weekly intervals for a year or until disease recurs (whichever is shortest)
What are the main side effects of Trastuzumab? What impact does this have?
- Cardiotoxicity due to toxic effect on the myocardium
- Cardiac function needs to be monitored (before and during tx, 12 weeks) If ejection fraction is reduced by more than 10% from baseline or 50% overall, stop immediately. Concomitant use with anthrocycline increases risk so should be avoided and 25 weeks after course is complete.
What are the risk factors for lung cancer?
- Smoking (some cases passive smoking)
- Asbestos or Radon exposure
- Industrial carcinogens
- Air pollution
- Family history
- Pervious cancer history
What symptoms should be followed up with a chest x-ray?
- or the following for 3+ weeks
- cough or change in a long standing cough
- chest/shoulder pain
- chest infection that doesn't resolve
- finger clubbing
- signs suggesting metastases
- weight loss
- chest signs
- cervical/supraclavicular lymphadenopathy
What are the two main types of lung cancer? What are the incidence rates and what are they made up of?
- Small cell lung cancer (SCLC) ~ 20% of cases
- Non-small cell lung cancer (NSCLC) ~ 80% of cases
- - squamous cell carcinoma
- - adenocarcinomas
- - Large cell carcinomas
How is SCLC staged? How is it treated?
- Limited stage (if confined to a single anatomical area or affects lymph nodes that can be treated by radiotherapy) or extensive stage disease.
- Systemic therapy is indicated due to disseminated nature of the cancer. Chemo or radio. Responds well to both but has poor prognosis.
How is NSCLC staged?
Using the TNM system. For treatment the stage of cancer s broadly divided into local, locally advanced and advanced stages.
Lung cancer surgical treatment. What is it predominately used for?
- NSCLC, best chance of cure.
- As patients are old/co-mobidities, may be a dangerous procedure or not suitable
Pt's with stage I-III NSCLC may have radio therapy if surgery isn't suitable, what are the two regimens?
- Radical therapy treatments:
- Radiotherapy fractions given as
- Inpatient: 3tx daily for 3 week (CHART)
- Outpatient: 1tx daily for 4-7 weeks
- Dose is about the same
What chemotherapy should be given first line for SCLC?
Platinum-based combination chemotherapy for 4-6 cycles.
When is chemotherapy used in NSCLC? What drugs should be used first line?
- Adjuvant therapy, if surgery isn't an option, palliative care in advanced disease.
- Pemetrexed is recommended first line, combination regime with cisplatin.
How does targeted therapy work in the treatment of NSCLC?
Erlotinib and gefitinib inhibits epidermal growth factor receptor (EGFR) tyrosine kinase. Overexpression in EGFR is common in NSCLC, it's associated with aggressive tumours, resistance to chemotherapy and reduced survival. Don't cause suppression but have other s/e (erlotinib 75% develop rash, 54% diarrohea.