Neoplasia III: Epidemiology and Principles of Management

• How have male cancer incidence rates in the UK changed over the past 20 years?

  Lung & stomach cancer incidence rate has decreased but head & neck cancer has increased by 20% and liver by 80%
• How have female cancer incidence rates in the UK changed over the past 20 years?

  Bladder and stomach cancer had decreased incidence rates but head & neck cancer was up by 26% (melanoma, liver, & kidney cancer had all also increased)
• What are the trends with HPV-associated cancers over the years?

  They are rising e.g. incidence of oropharynx cancer excluding soft palate rose from ~1 in 100,000 in 1990 to ~2.5 in 100,000 in 2006
• What are the 2 cancers with the highest worldwide incidence?

  Breast cancer

  Prostate cancer

  
• Where is the global incidence of lip & oral cancer the highest?

  Europe, North America, Australia, India subcontinent and parts of south-east Asia
• What 2 cancers are associated with Epstein-Barr Virus (EBV)?

  Burkitt lymphoma (prevalent in central & southeast Africa)

  
  

  Nasopharyngeal carcinoma (prevalent in southeast Asia)

  
• What cancer is human herpesvirus-8 associated with?

  Kaposi sarcoma (prevalent in central & southeast Africa)
• How can you diagnose cancer?

  Incisional biopsy- histopathological diagnosis

  
  

  Fine needle aspiration- cytological diagnosis

  
• What is an example of screening and what is it used for?

  Example- mammography

  
  

  It's used to look for early lesions in patients who don't have obvious symptoms of cancer

  
  

  Types of scans used: CT, MRI, PET and US

  
• Why is cross-section imaging important in patients with cancer diagnoses?


  Because you need to determine exact location, metastasis, how large it is, if it's growing so you know what viable treatment options there are to go for
• What kind of tumours is surgery a good option for?

  Solid tumours i.e. carcinomas, sarcomas, melanomasNot lymphomas.

  Surgically remove entirely

  Is the patient well enough?

  Is the surgery safe? Will it damage any other area e.g artery, spinal cord
• What is radiotherapy?


  Treatment of disease using radiation

  
  

  Use of ionising radiation to kill tumour cells
• How does radiotherapy work?

  External beam fires ionising radiation (usually X rays & gamma rays) directed onto a patient & it's proton beam therapy so it has a high precision.

  
  

  You rely on the ionising radiation to damage the DNA- with the intention of sending targeted cells down the apoptosis pathway.

  
  

  This also relies on the apoptotic mechanisms working & not being mutated.

  
• What are the limitations of radiotherapy?

  It relies on apoptotic mechanisms working and not mutated.

  
  

  If apoptotic pathways aren't working, the cell cannot be killed off.

  
  

  You can cause more damage to the DNA leaving the cell more damaged than it was before.
• What are a couple of other ways you can deliver radiotherapy?

  Brachytherapy- radioactive sources placed within body e.g. Cs-137 for cervical cancer

  Radionuclides- certain radioisotopes are taken up by a particular tumour cell type e.g. Iodine-131 for thyroid cancer

  
• What are the different types of radiotherapy and what are they commonly used for?

  Radical radiotherapy- small cancers that can be treated with radiotherapy.

  Neoadjuvant radiotherapy- making large cancers smaller before surgery. If surgeons try take out large cancers during surgery, this can be damaging.

  Adjuvant radiotherapy -post-operative treatment in case there may be some suspicion.

  Palliative radiotherapy -radiotherapy for metastatic disease, not to cure patient but to help with symptoms. Enhancing QOL

  
• What are the early side effects of radiotherapy?

  AnorexiaMalaise

  Damage to highly proliferating tissue:

  Mouth & GI- mucositis, ulcersHair follicle- alopeciaBone marrow- myelosuppression
• What are the late side effects of radiotherapy?

  Fibrosis

  Bowel stenosis

  Infertility

  Xerostomia

  Endarteritis obliterans - blood supply in area of radiation is affected

  Osteonecrosis - jaw bones can die off/fall apart

  Second malignancies
• What is chemotherapy?


  Use of chemical substances to treat disease and it's usually for disseminated/systemic disease

  In cancer this includes:

  cytotoxic drugs; hormonal therapies; biologicals or targeted therapies
• What are the different types of chemotherapy and what are they commonly used for?

  
• Describe cytotoxic chemotherapy in more detail.

  -It's systemically administered through a vein

  
  

  -It has many different modes of action depending on the drugs used

  
  

  -Some damage DNA promoting apoptosis and necrosis like -radiation treatment

  
  

  -However, tumours develop resistance to single agents so drugs are combined

  
  

  -This chemotherapy is not cancer specific and damage normal tissue as well

  
  

  -There is also a narrow window between therapeutic and toxic doses
• What is an example of a DNA-damaging agent used in chemotherapy and how does it work?

  Cisplatin- platinumcompound that causes DNA cross links so the cell should recognise the cross links and send itself into apoptosis

  Common head and neck cancer dru
• What are some examples of other types of drugs used in chemotherapy and how do they work?

  Antimetabolites- interfere with normal synthesis of nucleic acids e.g. 5-fluorouracil blocks synthesis of thymine

  DNA repair inhibitors-inhibit topoisomerase II so DNA breaks are caused e.g. doxorubicin

  
• What are the side effects of cytotoxic chemotherapy?

  Malaise

  Fatigue

  Vomiting

  Myelosupression

  Mucositis

  Alopecia

  Organ toxicity

  Infertility
• Why is hormonal chemotherapy used sometimes?

  Because some cancers are hormone sensitive e.g.

  
  

  tamoxifen binds and blocks oestrogen receptor- slows/stops growth of breast cancer
• What is an example of a monoclonal antibody used in cancer treatment?

  Cetuximab: Anti-EGFR

  
  

  Used with radiotherapy to treat advanced head and neck cancers
• What are some new developments in oncological treatments (1)?

  
• What are some new developments in oncological treatments (2)?