Summary study book Kumar and Clark's Clinical Medicine of Adam Feather, Randall (-) - ISBN: 9780702078682, Edition: 10th Revised edition, Year of publication: - (checklist 2.1.3.)
Checklist theme 2.1.3 Neoplasms 1 – week 9 General principles of oncology
1. What changes has a cell to undergo to become a cancer cell and to metastasize?
A cell has to go several changes
Hallmarks of cancer
To invade: loss of cell cohesion due to
much E-cadherin expression.
2. What role do these processes have
in normal cells?
1) evade growth suppression
normally to prevent
uncontrolled growth
2) Sustain proliferative signaling
normally prevent uncontrolled
growth
3) Avoid immune destruction
get rid of ‘sick cells’
4) enable replicative immortality
normally cells go in
senescence to prevent
mutations
5) tumor promoting inflammation
6) genomic instability
normally prevent mutations
7) resistant to cell death
normally cells die to prevent mutations
8) induce angiogenesis
normally not that many blood supply needed
9) invasion and metastasis
normal cells don’t do this, they stay in place with the right properties
10) deregulating cellular metabolism
normally cells need ATP, not the products to grow
3. What is the difference between dysplasia and an invasive tumour?
Dysplasia: disordered growth. Loss of uniformity of cells.
Invasive tumor: invaded into other tissues, not only disordered growth.
4. What are the differences between lymph node metastases and distant metastases?
Lymph node metastases are the first place to spread to. Distant metastases are often
placed in other tissues, they invest in organs.
5. What imaging modality is first choice for analysing a breast lump an why?
a. In a woman 50 years old?
Mammogram: women over 50 year old have less glandular tissue, so it is sensitive for older
people but not for younger people, because they have more glandular tissue.
b. in a 25 year ol women?
Ultrasound: this is more sensitive in younger women than a mammography due to the
glandular tissue.
6. What does sensitivity mean when evaluating a diagnostic test?
Sensitivity is about the affected people, so the sensitivity of a test says how many people
who have the disease will be diagnosed positively. Imagine a group with all affected people,
and a part of that group is diagnosed by the test.
7. What does specificity mean when evaluating a diagnostic test?
, 8. What are differences between mammography, ultrasound and MRI In the diagnostic
process for breast cancer?
Mammography: more sensitive in older women.
Ultrasound: more sensitive in younger women
MRI: very accurate for soft tissues. Used for postoperative planning, decide if neoadjuvant
chemotherapy is needed. And also for screening for women with high risk.
also used to evaluate therapy response.
9. What is the difference between Fine Needle Aspiration Cytology (FNAC) and core
needle biopsy?
Fine needle aspiration cytology core needle biopsy
- only soft tissue - in soft tissue tumours
- negative result has uncertain meaning - tumour spill occurs, so site of insertion
- only determines presence or absence determined by later treatment. This parts are
of tumour, so still core, incisional or than also treated with i.e. radiotherapy
incisional biopsy needed!
10. What is CT thorax and abdomen, FDG-PET and MRI/CT brain used for in the
diagnostic process for breast cancer?
They are used to detect metastases. PET is also used for staging.
11. What is the aim of taking a tissue biopsy of malignant lesion and what is being looked
at in a biopsy in different stages of treatment?
By taking a biopsy you can determine if the tissue is benign or malignant. And also if the
tumour is very aggressive or not. It can also be used to see where the tumour is derived
from, so in case of distant metastases.
12. What is the role of tumour markers in oncological diagnostics?
Markers can determine where the tumour is derived from, i.c.o. metastases. Furthermore, it
can determine treatment.
13. What is the definition of a curative treatment?
Aim is to cure the patient.
14. What is the definition of a palliative treatment?
Not aimed at cure, but to relieve symptoms by attacking a tumor.
15. What is the definition of palliative care?
Aim is to relieve the patient from symptoms/improve quality of life and to prolong life.
It is also directed at the family of the patient.
16. What is the surprise question? What can it be used for?
Would you be surprised if this patient would die within a year? yes? Treat with
palliative care.
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