Neoplasia IV: Incidence & Treatment Overview

Neoplasia IV: Incidence, Prognosis & Treatment

• This session discusses the incidence, prognosis, and treatment of neoplasia IV.
• Objectives include: understanding malignant tumor staging (rectum, breast, prostate, bladder, Hodgkin's disease), grading (squamous cell carcinoma, breast cancer, colon cancer), and the biological basis of cancer treatments (radiotherapy, chemotherapy, hormone therapy, newer agents like Herceptin).
• The use of tumor markers in diagnosis and monitoring is also covered. This includes carcinoembryonic antigen (CEA), human chorionic gonadotropin (hCG), and alpha-fetoprotein (AFP).
• Screening methods are discussed, including cervical cancer, and breast cancer screening.
• Different staging systems and examples are presented.
  • TNM staging (tumor size, lymph node status, metastasis).
  • Dukes staging for rectal neoplasia (A, B, C).
  • Ann Arbor staging for Hodgkin's disease (I-IV).
• Tumor grading, differentiating between types of tumors, is covered.
  • Degree of tubule formation, extent of nuclear variation, and number of mitoses are used to grade breast cancer.
  • Prostate cancer grading uses the Gleason scale (1-5).
• Treatment options for cancer are summarized: surgery, radiotherapy, chemotherapy, and hormone therapy.
• The effectiveness of therapy depends on the tumor type and stage.
• The use of tumor markers is discussed as a way of monitoring disease.
• The role of screening in improving prognosis is covered, for cervical, breast, large intestine and prostate cancers.
• Screening methods, clinical features and tumor markers as support in stage assessment and treatment are covered.
• Small group questions on testicular teratoma and Hodgkin's disease are presented.
  • Specific cells and features in histology are noted.
  • Staging assessment from scans is discussed.

Cancer Incidence & Mortality

• 2008 data shows the different incidence and mortality rates for various cancer types and sexes.
• The most common cancers, by incidence and mortality, as determined by site, are detailed.

Commonest Ten Cancers by Primary Site (2009)

• Data from 2009 demonstrates the number of cancer cases per site.
• Breast, Bronchus, and Lung, Brain and other CNS, Urinary bladder, Leukemia, Colorectal Cancer, Non-Hodgkin Lymphoma, Skin, Stomach, and Larynx are noted as the most common cancer sites.

Incidence Rate of Commonest Ten Cancer Deaths (2009)

• Incidence rates for specific cancer sites are detailed.
• Sites like Bronchus & Lung, Brain, Breast, Hodgkin Disease, Liver, Bladder, Stomach, Colorectal, Pancreas, and Leukemia are presented.

Radiotherapy: Factors and Sensitivity

• Factors influencing Radiotherapy include: radiation type, cumulative dose, delivery rate, and target tissues.
• Sensitivity varies by the type of cancer.

Chemotherapy: Drug Use and Effects

• Chemotherapy drugs target specific cell cycle stages and rapidly dividing cells (e.g. bone marrow).
• Specific details are presented on the effects of particular chemotherapy drugs (Cyclophosphamide, Vincretin, Methotrexate) on cell cycles.

Hormone Therapy: Predicting Response

• Hormone therapy effectiveness depends on hormone receptior and HER-2 status.
• Herceptin® is used in treatment.
• Determining receptor and HER-2 status can help predict therapy effectiveness.

Tumor Markers

• Tumor markers are products released from tumors into the bloodstream.
• Tumor markers are used to help with monitoring, diagnosis and measuring treatment response.
• Key examples of tumor markers along with the cancer type they may be associated with are included (alpha-fetoprotein (liver cancer, germ cell tumors), human chorionic gonadotropin (trophoblastic tumors), acid phosphatase, prostate-specific antigen (Prostate cancer), carcinoembryonic antigen (GI tract).

Screening

• Screening aims to detect precancerous, non-invasive, and early invasive cancers to improve prognosis.
  • Key types of screening are discussed, including cervical, breast, large intestine, and prostate screening.
  • Details about cervical, breast, cancer screening techniques methods are given using methods like cytology and mammography respectively.

Improving Prognosis

• Identifying "at-risk" groups (familial, occupational) and detecting cancer at an earlier stage for breast and cervical cancers is important to improve prognosis.

Small Group Questions

• Questions regarding the diagnosis, treatment, and monitoring of tumors are provided in the text.
• Relevant cases and questions are presented.