From Oncology for Medical Students

Objective 2.3

At graduation, the student should be able to:

a) describe the concept of carcinogenesis
b) for the common cancers, demonstrate an understanding of microscopic and macroscopic findings, including pathological features from pre-malignant to malignant stages of cancer
c) describe patterns of spread of common cancers
d) demonstrate an understanding of the role and purpose of molecular pathology particularly the prognostic and/or predictive values of receptors and other targets.

Prerequisite knowledge

  • Cell biology

Representative questions that suggest the required depth of knowledge

1. Explain the patho-physiological mechanism(s) whereby a tumour may grow in lines of diverse differentiation (“tumour heterogeneity”).

Essential in answer:

  • Knowledge of mutation/genetic instability

2. What are the roles of Tumour Angiogenesis Factor and Tumour Necrosis Factor in neoplasia?

Essential in answer:

  • Knowledge of new blood vessel formation.
  • Knowledge of abnormal cytokine production

3. A 65 year-old man has been diagnosed with rectal cancer. Describe possible methods of cancer spread.

Essential in answer:

  • Vascular and lymphatic systems
  • Direct spread
  • Trans-coelomic spread
  • Implantation

4. Describe how knowledge of ER PR and HER2 status in breast cancer will dictate prognosis and treatment?

Essential in answer:

  • Hormone responsiveness
  • Role of hormonal treatment
  • Role of Herceptin

5. With respect to cancer spread, the most common site of extralymphatic dissemination is from (select the best answer):

(a) colon to lung

(b) breast to contralateral breast

(c) prostate to liver

(d) lung to brain

Answer: (d)