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BIOM 4150 Cancer Biology- Final > 12- Clinical Oncology > Flashcards

12- Clinical Oncology Flashcards

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1
Q

What techniques are used to determine the “what”?

A

Cytology > examination of cell types from bodily fluids
- obtained by fine needle aspiration (FNA)
- important to rule out benign lesions (most are)

Histopathology > microscopic examination of tissue
- the gold standard
- requires tissue biopsy
- provides architecture information

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2
Q

What lymph nodes are usually palpable in a normal healthy dog?

A
  • Mandibular/ Prescapular/ Popliteal
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3
Q

Why is FNA (fine needle aspiration) for cytology done in lymph nodes?

A
  • drainage of tumor > often 1st site of metastasis
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4
Q

What are the most common cancers in vet med vs humans?

A

Humans- carcinomas (epithelial)
Vet med- sarcomas (mesenchymal)/ hematopoietic)

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5
Q

What is a very common tumor in vet med (dogs)?

A

Mast cell tumor
- C-kit is a marker for canine mast cell tumors

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6
Q

What are the 5 criteria of malignancy?

A
  • Anisocytosis (cell size differences)
  • Anisokaryosis (nucleus size differences)
  • Lack of cell-cell contact (epithelial tumors)
  • Abundant mitotic figures
  • General reversion to a less mature phenotype
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7
Q

What are some specialized staining techniques?

A

ICC = Immunocytochemistry
IHC = Immunohistochemistry

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8
Q

Why are specialized staining techniques used?

A
  • to more definitively identify cell of origin > cancer type
  • to identify cell subtypes within a type of cancer (T vs B cell lymphoma)
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9
Q

What is done if cytology is inconclusive?

A
  • Histology (histopathology)
  • Immunohistochemistry (IHC)
  • Flow Cytometry > test multiple markers
  • PCR of antigen receptor rearrangements of lymphocytes
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10
Q

What is the difference between grading/ staging?

A

Grading- classify cancer cells by appearance (how undifferentiated)
Staging- classify cancer cells by extent in body/ spread

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11
Q

What is the WHO criteria for cancer staging?

A

TNM (tumor, node, metastasis)/ 0,1,2
T- depends on of mass
N- (0-no LN/ 1-few regional LN/ 2-many regional LN)
M- 0-no metastasis/ 1-yes metastasis

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12
Q

How is cancer staging obtained?

A
  • physical examination
  • laboratory analysis
  • imaging (CT is more sensitive/ definitive than x-ray)
  • abdominal ultrasound
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13
Q

How does a PET scan work? (imaging for staging)

A
  • glucose metabolize measured (fluorescent dye)
  • Warburg effect > tumor take up glucose at higher rate
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14
Q

What is paraneoplastic syndrome?

A
  • cancer cells secrete substances with distant effects (symptoms)
    ex) mast cell degranulation > release of mast cell mediators
  • can lead to difficulty closing wounds/ anaphylaxis
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15
Q

Why are biomarkers important for clinical oncology?

A
  • identification of potential responders to treatment
  • monitoring treatment response
  • pharmacologic biomarkers for drug optimization
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16
Q

What is the WHO classification for canine MCT?

A

Stage 1 > 1 tumor confined to dermis/ no lymph node involvement
Stage 2 > 1 tumor confined to dermis/ regional lymph node involvment
Stage 3 > multiple tumors or 1 large infiltrating/ lymph node
Stage 4 > distant metastasis

Substage > a/b > based on outlook of patient (a = good/ b = problems)

17
Q

How does staging impact treatment?

A
  • local disease > local therapy > surgery/ radiation
  • systemic disease > systemic therapy > chemo
    = Oncology Dogma
18
Q

What are important considerations for surgery?

A
  • Margins
  • Fascial planes (may need to remove)
  • separate surgical teams > surgeon removes tumor, trauma/ plastics close and repair
  • not all wounds are closed > heal by scarring/ second intention
19
Q

What is a pre-surgery treatment?

A
  • Neoadjuvant therapy > to ↓ surgical field
  • assess response of primary tumor to chemotherapy
  • early treatment of micrometastasis
20
Q

What is adjuvant therapy?

A
  • follow up after treatment
  • surgical complication (dirty margins)/ metastatic disease
21
Q

What are the types of radiation therapy?

A
  • Orthovoltage/ Megavoltage/ Brachytherapy/ Systemic
22
Q

What is the mechanism of radiation therapy?

A
  • double-stranded DNA damage
  • direct action > DNA damage > cell death
  • indirect action > free radicals > DNA damage > cell death
23
Q

What is an important protocol of radiation therapy?

A

Fractionation- smaller doses over time
- palliative, coarse-fractioned

24
Q

What are the 4 R’s of radiation therapy?

A

Repair- allow normal cells to repair between treatments
Reoxygenation- more O2 > more sensitive to radiation > target
Redistribution- at any one time, cells in different stages of cell cycle (DNA damage best in G2-M phase of cell cycle)
Repopulation- working against you > proliferation between cycles

25
Q

What are the side effects of radiation therapy?

A

Early > within days/ weeks/ completely repairable/ harsh
Late > months-years/ irreversible damage
- VRTOG scoring system used to assess extent of side effects in tissues

26
Q

What is the general mechanism of chemotherapy?

A
  • targets rapidly dividing cells > therapeutic index
27
Q

What are the side effects of chemotherapy?

A
  • generalized side effect profile since target rapidly proliferating cells (GIT/ hair/ bone marrow)
  • neutropenia (↓ neutrophils)/ thrombocytopenia (↓ platelets)
  • HSC lineage affected > susceptible to infections
28
Q

What are some chemotherapies?

A

Alkylating agents > covalently bonding alkyl groups ex)nitrogen mustard
- induce dsDNA breaks

Antimetabolites > interfere with DNA synthesis (purine/ pyrimidine analogs)

Anthracyclines > Topoisomerase II inhibitors/ generate free radicals

29
Q

What are chemotherapy principles?

A

MTD = max tolerated dose (without killing patient)
Metronomic Chemotherapy > smaller doses more often/ for longer

30
Q

What are the 3 rules of combination chemotherapy protocols?

A
  1. Different mechanisms of action
  2. No overlapping side effect profiles
  3. Drugs do not impact each other
31
Q

What are the therapeutic considerations of targeted drugs?
- monoclonal antibodies VS small molecule RTK inhibitors

A
  • target specificity (↑ MAb/ ↓ RTKI)
  • target trafficking > MAb extracellular/ RTKI intracellular
  • administration > IV (MAb) vs oral (RTKI)
  • frequency > MAb less often/ RTKI more often
  • mechanism of action
32
Q

What is the goal of personalized medicine?

A
  • knowledge of molecular composition > specific therapies
  • prognostic information
  • predictive information

BIOM 4150 Cancer Biology- Final (6 decks)

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