11 Oncology Flashcards
1
Q
what cancer (with mets) are most successfully cured with surgery?
A
colon ca in liver and sarcoma to lung but survival will STILL be low overall
2
Q
which protein causes angiogenesis and is involved with tumor mets?
A
V-EGF (vascular epidermal growth factor)
3
Q
what cancer (with mets) are most successfully cured with surgery?
A
colon ca in liver and sarcoma to lung but survival will STILL be low overall
4
Q
which malignancies are HIV-related?
A
kaposi’s sarcoma and non-hodgkin’s lymphoma
5
Q
what are the cutaneous T-cell lymphomas?
A
HTLV-1 (skin lesions) and mycosis fungoides (sezary cells)
6
Q
which solid tumors are curable with chemotherapy only?
A
hodgkin’s and nonhodgkin’s lymphoma
7
Q
what are prognostic indicators for survival after resection of hepatic colorectal mets?
A
disease-free interval > 12 months tumor number < 3 CEA < 200 size < 5 cm negative nodes
8
Q
can en bloc multi-organ resection attempted?
A
for some tumors (colon into uterus, adrenal into liver, gastric into spleen) aggressive local invasiveness is different from metastatic disease
9
Q
what is 5 year survival for colon mets to liver if successfully resected?
A
35%
10
Q
when is palliative surgery considered?
A
for tumors of hollow viscus causing obstruction or bleeding (colon ca), or breast ca with skin or chest wall involvement
11
Q
how are lymph nodes good signs of probable mets?
A
they have poor barrier function
12
Q
when is salvage therapy given?
A
for tumors that fail to respond to initial chemotherapy
13
Q
what is adjuvant therapy?
A
combined with another modality; given after other therapy is used
14
Q
what is primary therapy, when is it used? what is another name?
A
neoadjuvant. chemo given 1st (usually), followed by another (secondary) therapy
15
Q
what is induction therapy, when is it used?
A
sole treatment; used for advanced disease or when no other tx exists
16
Q
what are the types of therapy?
A
induction, primary, adjuvant, salvage
17
Q
what question does a phase IV clinical trial answer?
A
implementation and marketing
18
Q
what question does a phase III clinical trial answer?
A
is it better than existing therapy?
19
Q
what question does a phase II clinical trial answer?
A
is it effective?
20
Q
what question does a phase I clinical trial answer?
A
is it safe and at what dose?
21
Q
which cancers cause small bowel mets?
A
melanoma (#1)
22
Q
which cancers cause skin mets?
A
breast, melanoma
23
Q
which cancers cause bone mets?
A
breast (31), prostate
24
Q
which cancers can cause ovarian mets?
A
stomach (krukenberg tumor), colon
25
which cancers are associated with a suspicious periumbilical node? what is that node called?
pancreas. Sister Mary Joseph's node
26
which cancers are associated with suspicious axillary node?
lymphoma (#1), breast, melanoma
27
what cancers can give you suspicious supraclavicular nodes?
neck, breast, lung, stomach (virchow's node), pancreas
28
what cancer does asbestos give you?
mesothelioma
29
what cancer does benzene give you?
leukemia
30
what cancer does beta-naphthylamine give you?
urinary tract ca (bladder ca)
31
what cancer does coal tar give you?
larynx, skin, bronchial ca
32
what are common carcinogens?
coal tar, beta-naphthylamine, benzene, asbestos
33
does colon ca met to bone?
not usually
34
which gene is the initial step in teh evolution of colorectal ca?
APC
35
which genes are involved in colon cancer?
APC, p53, DCC, K-ras
36
what is li-fraumeni syndrome?
defect in p53 gene. childhood sarcomas, breast ca, brain tumors, leukemia, adrenal ca
37
when mutated, which proto-oncogene is responsible for unregulated production of ranscription factors?
myc (c-myc, n-myc, l-myc)
38
when mutated, which proto-oncogene is responsible for an epidermal growth factor receptor defect?
erb B
39
when mutated, which proto-oncogene is responsible for a G protein defect?
ras
40
when mutated, which proto-oncogene is responsible for a platelet derived growth factor receptor defect?
sis
41
when mutated, which proto-oncogene is responsible for a tyrosine kinase defect?
src
42
what are the proto-oncogenes?
ras, src, sis, erb B, myc
43
what are the tumor suppressor genes?
Rb1, p53, APC, DCC, bcl, BRCA
44
which tumor suppressor gene is located on chromosome 18?
DCC.
45
what does APC gene do?
tumor suppressor gene involved with cell cycle regulation and movement
46
which tumor suppressor gene is located on chromosome 5?
APC
47
what does normal p53 gene do, and what happens when it is abnormal?
p53 normally induces cell arrest and apoptosis. abnormal p53 allows unrestrained cell growth
48
which tumor suppressor gene is located on chromosome 17?
p53
49
which tumor suppressor gene is located on chromosome 13?
Rb1
50
which tumor suppressor genes are involved in apoptosis?
bcl
51
which tumor suppressor genes are involved in cell adhesion?
DCC
52
which tumor suppresor genes are involved with cell cycle regulation?
retinoblastoma (Rb1), P53, APC
53
which organs can you resect to PREVENT cancer (resecting normal organs)?
Breast: BRCA I or II w strong family history
| Thyroid when pt has RET proto-oncogene with FH of thyroid ca
54
what is GCSF side effect?
sweet's syndrome (acute febrile neutropenic dermatitis)
55
what is GCSF used for?
neutrophil recovery after chemo
56
what is GCSF?
granulocyte colony-stimulating factor
57
which cancer drugs have the least myelosuppression?
bleomycin, vincristine, busulfan, cisplatin
58
what does topoisomerase do?
unwinds DNA
59
what is another name for etoposide?
VP-16
60
what does etoposide do?
inhibits topoisomerase.
61
what are teh toxicities of doxorubicin and at what doses?
heart toxicity 2/2 O2 radicals at doses >500mg/m^2
62
what does doxorubicin do?
DNA intercalator. creates O2 radicals
63
what cancer-related drug should you avoid with 5FU?
leucovorin (folinic acid). it increases toxicity of 5FU
64
what does thymidylate synthetase do?
inhibits purine and DNA synthesis
65
what does 5-fluorouracil do?
5FU inhibits thymidylate synthetase
66
how do you reverse effects of methotrexate?
leucovorin rescue (folinic acid): resupplyies folate
67
what are side effects of methotrexate?
renal toxicity, radiation recall
68
how does methotrexate work?
inhibits dihydrofolate reductase (DHFR), which inhibits purine and DNA synthesis.
69
what is levamisole?~ what does it do?
anthelminthic drug. thought to stimulate immune system against cancer
70
what drug can help with hemorrhagic cystitis that is given with cyclophosphamide?
Mesna
71
what are the side effects of cyclophosphamide?
gonadal dysfunction, SIADH, hemorrhagic cystitis
72
what is the active metabolite in cyclophosphamide?
acrolein
73
how do alkylating agents work?
transfer alkyl groups; form covalent bonds to DNA.
74
what are the toxicities of vinblastine?
bone (myelo) suppression. vinBlastine
75
how does vinblastine work?
microtubule inhibitor
76
what are the toxicities of vincristine?
peripheral neuropathy, neurotoxic
77
how does vincristine work?
microtubule inhibitor
78
what are the toxicities of carboplatin?
bone (myelo) suppression. carBoplatin
79
what is carboplatin?
platinum alkylating agent.
80
what are the toxicities of cisplatin?
nephrotoxic, neurotoxic, ototoxic
81
how does cisplatin work?
platinum alkylating agent
82
what are the risks of bleomycin and busulfan?
cause pulmonary fibrosis
83
how does taxol work?
promotes microtubule formation and stabilization that can't be broken down; cells are ruptured
84
what happens to the risk of blood clots and endometrial cancer when taking tamoxifen?
blood clot risk inc by 1%, endometrial ca risk by 0.1%
85
how much does tamoxifen decrease short term (5 year) risk of breast ca?
45%
86
how does tamoxifen work?
blocks estrogen receptor
87
what is the difference in response between cell cycle specific and nonspecific agents?
specific agents have a plateau in cell-killing ability. nonspecific agents have a linear response to cell killing
88
what are the cell-cycle specific agents?
5FU, methotrexate.
89
hwat is brachytherapy, what are the elements used?
source of radiation in or next to tumor (Au-198, I-128), delivers high, concentrated doses of radiation
90
why are large tumors less responsive to XRT?
they lack oxygen in the tumor
91
which tumors are very radioresistant?
epithelial, sarcomas
92
which tumors are very radiosensitive?
seminomas, lymphomas
93
what is fractionate XRT?
an xr dose that is distrubted over multiple courses
94
what are the benefits of fractionate XRT doses?
allows repair of normal cells (tumor cells can't repair as fast), allows re-oxygenation of tumor, allows redistribution of tumor cells in cell cycle
95
why is lower energy radiation worse than higher energy radiation?
high energy radiation has skin preserving effect (max ionizing potential isn't reached until deeper structures)
96
what is the main target for oxygen radicals and XRT?
DNA
97
what causes the most carcinogenic damage to cells/DNA and in what situation is can you get the max effect?
formation of oxygen radicals. maximal effect with high oxygen levels
98
when is the most vulnerable stage of the cell cycle for cancer when undergoing XRT?
M phase
99
what is the infectious agent for various lymphomas?
HIV
100
what is the infectious agent for burkitt's lymphoma?
EBV
101
what is the infectious agent for nasopharyngeal carcinoma?
EBV
102
what is the infectious agent for hepatocellular carcinoma?
hep B and hep C viruses
103
what is the infectious agent for gastric cancer?
H. pylori
104
what is the infectious agent for cervical cancer?
human papillomavirus (HPV)
105
what are proto-oncogenes?
human genes w malignant potential
106
what is an example of a retrovirus that contains oncogenes?
EBV, associated with burkitt's lymphoma (8:14) translocation) and nasopharyngeal CA (c-myc)
107
how do retroviruses give cancer?
they contain oncogene
108
how do neoplasms arise?
carcinogenesis (eg smoking), viruses (eg EBV), or immunodeficiency (eg HIV)
109
what are the steps of cancer within the latency period?
initiation: carcinogen acts with DNA
promotion of cancer cells then occurs
progression of cancer cells to clinically detectable tumor.
110
what is the definition of latency period?
time between exposure and formation of clinically detectable tumor
111
what is the definition of cancer transformation?
heritable alteration in genome AND loss of growth regulation
112
what is the half life of AFP?
5d
113
what is the half life of PSA?
18d
114
what is the half life of CEA?
18d
115
what is the tumor marker for thyroid medullary ca?
Ret oncogene
116
what is the tumor marker for carcinoid tumor?
chromogranin A
117
what is the tumor marker for breast ca?
BRCA I and II
118
what is the tumor marker for neuroblastoma?
NSE
119
what is the tumor marker for small cell lung cancer?
NSE
120
what is sensitivity and specificity of PSA?
high sensitivity, low specificity
121
what is the tumor marker for prostate ca?
PSA
122
what is the tumor marker for choriocarcinoma?
beta-hcg
123
what is the tumor marker for testicular cancer?
beta-hcg
124
what is the tumor marker for ovarian ca?
CA 125
125
what is the tumor marker for pancreatic ca?
CA19-9
126
what is the tumor marker for liver cancer?
AFP
127
what is the tumor marker for colon ca?
CEA
128
what is dysplasia?
altered size, shape, organization (eg Barrett's dysplasia)
129
what is an example of metaplasia?
GERD squamous epithelium in esophagus changed to columnar gastric tissue (eg Barrett's esophagus)
130
what is metaplasia?
replacement of one tissue with another
131
what is hyperplasia?
increased number of cells
132
how do you know if a cell is a tumor based on antigen?
you don't know. tumor antigens are random unless it's a viral-induced tumor
133
what do natural killer cells need to attack tumor cells?
they dont need anything. they can independently attack tumor cells
134
what do cytotoxic T cells need to attack a tumor?
the MHC complex
135
what type of molecules does PET detect?
fluorodeoxyglucose molecules
136
what is PET used for?
identify mets
137
what is the MC cancer in men?
prostate
138
what is the MC cause of cancer related death in women?
lung cancer
139
what is the MC Ca in women?
breast ca
140
what is the #2 cause of death in the US?
cancer
