Question 1
Question
What is cancer ?
Cancer is a [blank_start]malignant[blank_end] tumor, a mass of cell in which cell division/cell cycle is no longer regulated. The tumor is [blank_start]benign[blank_end] if it does not spread (but may still cause tissue damage). The spread of a cancer to a secondary site is called [blank_start]metastasis[blank_end].
Some common carcinomas(a type of cancer that starts in cells that make up the skin or the tissue lining organs):
- [blank_start]Lung, breast, colon, prostate, bladder[blank_end]
Leukemias:
- Blood stream
Lymphomas:
- Lymph nodes
Some common sarcomas(a type of cancer that can occur in various locations in your body):
-[blank_start]Fat, bone, muscle[blank_end]
Answer
-
malignant
-
benign
-
metastasis
-
Lung, breast, colon, prostate, bladder
-
Fat, bone, muscle
Question 2
Question
Epidemiology:
- Leading cause of [blank_start]death[blank_end] in NZ – 30.6%.
- 70% of cases & deaths in [blank_start]>[blank_end]60
- [blank_start]Prostate[blank_end] most common in men, [blank_start]breasts[blank_end] most common in women
- [blank_start]Lung[blank_end] cancer most lethal
- Rates higher for those residing in [blank_start]more[blank_end] deprivedareas
Answer
-
death
-
over
-
under
-
Prostate
-
breast
-
Lung
-
more
-
less
Question 3
Question
Screening:
Detects the possibility of cancer, is not [blank_start]definitive[blank_end]. Are often population based tests. Can be done at [blank_start]home[blank_end] or in clinics.
Has [blank_start]variable[blank_end] sensitivity & specificity. E.g.: Prostate-specific antigen ([blank_start]PSA[blank_end]) testing, mammography, Pap smears, breast self examination, blood in stools, mole checks
Diagnosis:
[blank_start]confirmation[blank_end] of cancer. Can be done: with imaging - [blank_start]X-ray, CT, PET or MRI[blank_end], biochemical tests - tumor [blank_start]biomarkers[blank_end] in the blood e.g. carcinoembryonic antigen (CEA), or by [blank_start]biopsy[blank_end]. To grade the cancer, [blank_start]microscopy[blank_end].
Answer
-
definitive
-
home
-
variable
-
PSA
-
Confirmation
-
X-ray, CT, PET or MRI
-
biomarkers
-
biopsy
-
microscopy
Question 4
Question
Cancer Grading
• grading system depends on that [blank_start]type[blank_end] of cancer
• 4 [blank_start]or[blank_end] 10 point scale, higher number = [blank_start]worse[blank_end]
• Low grade - normal tissue [blank_start]structure[blank_end], cells well differentiated
• High grade – [blank_start]un[blank_end]differentiated, [blank_start]disorganized[blank_end] mass
Answer
-
type
-
or
-
worse
-
structure
-
disorganized
-
un
Question 5
Question
Cancer Staging:
Extent of tumor – how large, has it spread.
Different methods
• TNM:
- Tumour – size, [blank_start]0 to 4[blank_end]
- Nodes – local [blank_start]metastases[blank_end] to [blank_start]lymph[blank_end] node, number/location 0-4
- Metastases – 0 ([blank_start]no[blank_end] spread) or 1 (distant metastases)
• Stage & grade used by oncologist, along with information on the patient age & health, to determine [blank_start]treatment options & prognosis[blank_end]
Question 6
Question
(Healthy) Cell cycle:
• cell numbers are [blank_start]maintained[blank_end] at homeostasis in the body
• cell turnover is different for different tissue types - most cells are [blank_start]terminally differentiated[blank_end] and are [blank_start]long[blank_end] lived.
Exceptions - [blank_start]bone[blank_end] marrow, [blank_start]mucosal[blank_end] surfaces, skin.
• cell is formed by [blank_start]division[blank_end] (by mitosis), functions, wears out, [blank_start]dies[blank_end] (apoptosis)
• in homeostasis division is [blank_start]equal to[blank_end] apoptosis
In a tumour division is [blank_start]greater than[blank_end] apoptosis.
Question 7
Question
The cell cycle is carefully regulated and there are a number of checkpoints. The cell must check that all necessary [blank_start]enzymes[blank_end] etc, are present, and also for DNA integrity and [blank_start]damage[blank_end] (mutations). If DNA damage is present, the cell should [blank_start]not[blank_end] enter cell cycle ([blank_start]G1 arrest[blank_end]) or mitosis is delayed until damage is repaired ([blank_start]G2/Marrest[blank_end]).
If DNA damage is not repaired [blank_start]apoptosis[blank_end] is initiated - this is a [blank_start]key[blank_end] regulatory pathway . Genes/proteins involved include
p53, Bax, and Rb. If these genes are mutated, the checkpoints are removed and damaged cells can [blank_start]proliferate[blank_end]…. and a tumour can develop.
• [blank_start]p53[blank_end] is mutated in > 70% of tumours
Answer
-
enzymes
-
damage
-
not
-
G1 arrest
-
G2/M arrest
-
apoptosis
-
key
-
proliferate
-
p53
Question 8
Question
Telomeres
• Are an internal divisional [blank_start]clock[blank_end] that regulates the replicative lifespan of a cell
• They are non-[blank_start]coding[blank_end] repetitive DNA located at the [blank_start]ends[blank_end] of all chromosomes, with each division telomeres [blank_start]shorten[blank_end] & when they reach a threshold - cell is targeted for [blank_start]apoptosis[blank_end]
• Tumours prevent this by [blank_start]stabilising[blank_end] telomere length by activating [blank_start]telomerase[blank_end] (80-95% of tumours)
Answer
-
clock
-
coding
-
ends
-
shorten
-
apoptosis
-
stabilising
-
telomerase
Question 9
Question
Uncontrolled cell [blank_start]division[blank_end] differentiates cancerous cells from healthy cells and so it is a good drug [blank_start]target[blank_end].
• Some drugs act in:
- specific [blank_start]phases[blank_end] of cell cycle ([blank_start]time[blank_end] dependent mechanism of action)
Others not cycle–specific ([blank_start]concentration[blank_end] dependent).
Answer
-
division
-
target
-
phases
-
time
-
concentration
Question 10
Question
Label the process of metastasis from start (1) to finish (8)
1. [blank_start]tumor cells proliferate[blank_end] (cell cycle unregulated)
2. avoid [blank_start]immune system recognition[blank_end] (ON02)
3. [blank_start]tumor must vascularise[blank_end] (angiogenesis)
4. [blank_start]local[blank_end] invasion
5. penetration of [blank_start]blood[blank_end] vessel
6. spread - accumulation of cells in [blank_start]small vessels[blank_end]
7. [blank_start]exit[blank_end] from the vessels
8. [blank_start]invasion and proliferation[blank_end]
Question 11
Question
Vascularisation/Angiogenesis is necessary to supply [blank_start]oxygen[blank_end] and nutrients for [blank_start]growth[blank_end] of the tumour.
• Multiple factors used/pathways means [blank_start]low efficacy[blank_end]/short term nature of anti-angiogenic therapies
• Also get development of new [blank_start]lymphatic[blank_end] vessels (lymphangiogenesis)
• New vessels (blood & lymphatic) that develop are [blank_start]leaky & inefficient[blank_end]
Answer
-
oxygen
-
growth
-
low efficacy
-
lymphatic
-
leaky & inefficient
Question 12
Question
Spread:
• Cells move towards vessels in response to [blank_start]oxygen & nutrients[blank_end]
• Enter into [blank_start]leaky[blank_end] new vessels, or acquire [blank_start]mutations[blank_end] (mostly unknown) to breach intact vessels
• Once in vessel they need to survive factors such as physical [blank_start]shear[blank_end] stress & [blank_start]platelet[blank_end] adhesion
• Getting out – adhesion [blank_start]receptors[blank_end]
• Local lymph nodes (new lymphatic
vessels)
Spread can be distant.
- Mechanical lodging – platelet + tumour cell [blank_start]aggregates[blank_end] get lodged in small [blank_start]capillaries[blank_end]
Answer
-
oxygen & nutrients
-
leaky
-
mutations
-
shear
-
platelet
-
receptors
-
aggregates
-
capillaries
Question 13
Question
Growth of Metastasis"
• After extravasation many tumours can not grow/thrive (are [blank_start]dormant[blank_end])
Why?
• No [blank_start]angiogenesis[blank_end]
• Some can’t enter back into cell [blank_start]cycle[blank_end]
Knowledge of these angiogenic [blank_start]pathways[blank_end] allows for development of new molecular [blank_start]target[blank_end] therapies. However – drug [blank_start]resistance[blank_end] is an issue.
Metastatic cells are less [blank_start]genetically[blank_end] stable. Not all primary tumours, or cells in the primary tumour, can [blank_start]metastasize[blank_end] (will be benign). Some cancers can be [blank_start]cured[blank_end], others are treatable.
Answer
-
dormant
-
angiogenesis
-
cycle
-
pathways
-
target
-
resistance
-
genetically
-
metastasize
-
cured