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Blood, Cancer and Palliation > BCP Week 3 > Flashcards

BCP Week 3 Flashcards

1
Q

3 categories of cancer:

A
  • carcinomas (epithelial cells: 80% of cancers)
  • sarcomas (muscle and connective tissue cells)
  • lymphoma and leukemia (blood and lymphatic tissues)
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2
Q

What’s the basic process of metastasis?

A

Cancer cells enter bloodstream and extravasate out of capillary beds to colonize other organs

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3
Q

Explain how autocrine signaling enables cancer cells to grow unregulated:

A

Cancer cells make and secrete their own growth factor, which binds to receptor tyrosine kinases, causing them to initiate a signal cascade stimulating growth.

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4
Q

Intracellular signaling protein mutated in ~30% of cancers:

A

RAS

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5
Q

RNA tumor viruses:

A

Viruses carrying oncogenes that direct a cell to become a cancer cell.

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6
Q

DNA tumor viruses:

A

Viruses that do not carry oncogenes but which induce cancer by activity of viral gene products on the cell.

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7
Q

Basic role of estrogens and androgens in cancer:

A

Non-mutagenic tumor promoters

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8
Q

True or false: mutation in one oncogene (gene on the other chromosome still normal) is sufficient to induce cancer.

A

True

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9
Q

True or false: mutation in one tumor suppressor gene (gene on other chromosome still normal) is sufficient to induce cancer.

A

False

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10
Q

Protein that is a key cellular stress sensor and that is mutated in ~50% of all tumors:

A

P53

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11
Q

Apoptosis, cell cycle arrest, and senescence (in response to hyper proliferative signals, hypoxia, telomere shortening and DNA damage) is mediated by what protein?

A

P53

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12
Q

One example of a DNA tumor virus:

A

HPV

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13
Q

How do anti-PD1 therapies work?

A
  • PD1 inhibits T cell mediated cell death

- Antibodies to PD1 block its inhibitory function, resulting in enhanced T cell activity against cancer cells

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14
Q

What are the possible T scores for tumor assessment?

A

Tis (tumor in situ)
T1 - T4 (based on size, invasion of adjacent structures)
Tx (primary tumor can’t be assessed)

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15
Q

Which class of herpes virus is associated with oncogenicity?

A

gamma herpesviruses (EBV, KSHV, HVS)

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16
Q

Most common cancer seen in HIV patients, very often associated with EBV:

A

Non Hodgkin’s Lymphoma

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17
Q

What is the most important factor associated with epidemic (HIV-associated) Kaposi Sarcoma?

A

CD4 count

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18
Q

Most common high and low risk HPV strains:

A

High risk: 16, 18

Low risk: 6, 11

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19
Q

Most likely quadrant for breast malignancy to develop:

A

Upper outer (50% of breast cancers develop here)

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20
Q

True or false: Most breast tumors are painful or tender

A

False

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21
Q

Views to order for screening mammogram:

A
  • 2 craniocaudal (CC) views

- 2 mediolateral oblique (MLO) views

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22
Q

Views to order for diagnostic mammogram:

A

CC, MLO + other views as necessary

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23
Q

When is an MRI indicated for breast cancer workup?

A
  • Screening in high risk women
  • Staging in women with breast cancer
  • Not recommended for evaluation of a mass
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24
Q
  1. Name two types of breast cancer in situ:

2. Which one has the potential to develop into invasive cancer?

A
  1. Lobular carcinoma in situ (LCIS)
    Ductal carcinoma in situ (DCIS)
  2. DCIS
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25
Q

What is the biggest concern with “mastitis” that doesn’t resolve with antibiotics?

A

Inflammatory breast cancer (IBC)

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26
Q

Selective estrogen receptor modulator used as supplemental treatment for breast cancer:

A

Tamoxifen x 5 yrs (new evidence that x 10 yrs is more effective but more side effects)

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27
Q

Supplemental breast cancer treatment that targets the Her2 protein, effective in early stage cancers and metastatic disease:

A

Herceptin

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28
Q

Complications of tamoxifen as chemoprophylaxis for breast cancer:

A
  • Increased risk of thrombotic events

- Increased risk of endometrial cancer

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29
Q

Other prophylactic medications used to reduce risk of breast cancer:

A
  • Arimidex

- Raloxifene

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30
Q

3 purposes of radiation therapy:

A
  • Kill cancer cells
  • Shrink tumors
  • Alleviate pain
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31
Q

How does radiation work to treat cancer?

A

Double stranded DNA breaks result in chromosomal aberrations that prevent the cancer cells from dividing normally.

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32
Q

Typical course of radiation therapy:

A

M - F once a day for 1 - 9 weeks

Usually lasts 20 - 30 min

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33
Q

3 reasons why tumor markers are imperfect indicators:

A
  • Levels of the same marker can be present in different cancers
  • Markers have not been identified in all cancers
  • Not always elevated in a person with cancer
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34
Q

Autosomal dominant mutation that results in increased risk of breast and ovarian cancer in women, and prostate and colorectal cancer in men:

A

BRCA 1 and 2

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35
Q

True or false: chemotherapy works better on cells that are not actively proliferating.

A

False. It works better on cells that are rapidly dividing.

36
Q

Explain how tumor reduction (either through surgery or radiation) and chemotherapy work synergistically:

A

As tumors get larger their growth rate decreases due to lack of oxygen and nutrients. Reducing the tumor size promotes tumor cell division, which makes the chemo more effective.

37
Q

Side effects of fluorouracil:

A

Stomatitis, GI ulcer, Hand-foot syndrome, cardiotoxicity (angina), photosensitivity, myelosuppresion

38
Q

Drug class, indications, and MOA of Fluorouracil:

A
  • Class: cell cycle specific antimetabolite
  • MOA: pyrimidine analogue, interferes with DNA/RNA synthesis
  • Indications: Breast, colon, gastric CA
39
Q

Drug class, indications, and MOA of doxorubicin:

A
  • Class: cell cycle specific anthracycline
  • MOA: Topoisomerase II inhibitor
  • Indications: Breast, metastatic solid tumors, leukemia and lymphoma
40
Q

Definition of adjuvant chemotherapy:

A

Chemo used to treat micrometastases given after surgery or radiation

41
Q

Definition of neo-adjuvant chemotherapy:

A

Chemo done before surgery or radiation in an attempt to shrink the tumor and make resection easier.

42
Q

Most common type of bone cancer:

A

Osteosarcoma

43
Q

Classic presentation of osteosarcoma:

A
  • Sunburst pattern on x-ray
  • Metaphyseal region of long bones (distal femur, proximal tibia, proximal humerus: 55% around knee)
  • Most common symptoms are pain, swelling
  • Bimodal incidence (adolescents and elderly)
44
Q

Classic presentation of Giant Cell Tumor

A
  • Most common in young adults 25 - 40
  • Pathologic fracture
  • F > M
  • Benign but aggressive
  • Epiphyseal location
  • Radiolucent center
45
Q

Classic presentation of Ewing sarcoma:

A
  • Diaphysis of long bones
  • Age 10 - 20, M > F, white > minorities
  • Lower extremity
  • Onion skin appearance
46
Q

USPSTF recommendation for prostate cancer screening:

A

Recommends against PSA testing due to risk of harm.

47
Q

USPSTF recommendation for colon cancer screening:

A
  • FOBT, sigmoidoscopy or colonoscopy in adults starting at age 50 and continuing until age 75.
  • Sigmoidoscopy and colonoscopy are recommended every 10 years.
48
Q

USPSTF recommendation for lung cancer screening:

A

Annual low dose CT in adults age 55 – 80 with a 30 pack-year Hx, who currently smoke or have quit within last 15 years.

49
Q

USPSTF recommendation for breast cancer screening:

A

Recommends biennial screening mammography for women 50 – 74 y/o. B recommendation.

50
Q

USPSTF recommendation for cervical cancer screening:

A

Every 3 years for women age 21 – 65 who have been sexually active and have a cervix. Or, every 5 years with HPV testing for women 30 – 65. A recommendation.

51
Q

USPSTF recommendation for testicular cancer screening:

A

Recommends against screening for testicular cancer in adolescent or adult men. D recommendation.

52
Q

Classic presentation of osteochondroma:

A
  • Age F
  • Sessile or pedunculated
  • Trumpet shaped deformity
  • Benign
53
Q

Classic presentation of enchondroma:

A
  • Lucent defect with endosteal scalloping
  • Age 20 - 30
  • M = F
  • Asymptomatic, incidental finding on x-ray
54
Q

What are the indications for use of methotrexate?

A
  • ALL
  • Breast CA
  • Head and neck CA
  • Osteosarcoma
55
Q

What does R-CHOP stand for?

A
  • Rituximab
  • Cyclophosphamide
  • Doxorubicin
  • Vincristine
  • Prednisone
56
Q

What is R-CHOP used to treat?

A

Non-Hodgkin’s Lymphoma

57
Q

Side effects of methotrexate:

A

Acute: N/V, mucositis
Delayed: myelosuppression, nephro-, hepato- and pulmonary-toxicity, photosensitivity

58
Q

Mnemonic for general chemo toxicities:

A 
HOAGIE
H = hematologic
O = organ dysfunction
A = alopecia
GI = gastrointestinal
E = endocrine
59
Q

Drug class, indications, and MOA of etoposide:

A
  • Class: Cell cycle specific
  • MOA: Topoisomerase II inhibitor
  • Indications: small cell lung cancer, NHL
60
Q

Name two topoisomerase I inhibitors:

A
  • topotecan

- irinotecan

61
Q

Drug class, indications, and MOA of paclitaxel:

A
  • Class: antimicrotubule taxane
  • MOA: promotes formation and prevents disassembly of microtubules
  • Indications: ALL, CNS tumors, lymphomas
62
Q

Drug class, indications, and MOA of vincristine:

A
  • Class: vinka alkyloids
  • MOA: antimicrotubule; binds tubulin and inhibit MT assembly
  • Indications: ALL, CNS, lymphomas
63
Q

Which class of drugs are cell cycle non-specific?

A

Alkylating agents: e.g., cyclophosphamide, cisplatin

64
Q

MOA for alkylating agents:

A

Alkylates and crosslinks DNA to inhibit cell division. Non-specific.

65
Q

Alkylating agent that can cause ototoxicity:

A

Cisplatin

66
Q

Alkylating agent that can cause hemorrhagic cystitis:

A

Cyclophosphamide

67
Q

Vinka alkaloid drug that frequently causes constipation:

A

Vincristine

68
Q

Notable side effects of doxorubicin:

A

Cardiotoxicity, extravasation potential, 2-ary malignancies

69
Q

Type of drug used to treat post-menopausal breast cancer:

A

Aromatase inhibitor

70
Q

Hormonal therapy indicated for the treatment of prostate cancer as well as breast cancer:

A

Leuprolide

71
Q

What kind of therapy would be used to treat myelodysplastic syndrome?

A

An epigenetic modifying agent such as azacitidine.

72
Q

Drug class, indications, and MOA of bevacizumab:

A

Class: monoclonal antibody
MOA: anti-B cell antibody
Indications: Colorectal, lung, breast, renal, brain cancers.

73
Q

Drug class, indications, and MOA of imatinib:

A

Class: targeted therapies
MOA: tyrosine kinase inhibitor
Indications: CML, GIST

74
Q

most common sites for metastasis of cervical cancer:

A
  • liver
  • lung
  • bone
75
Q

most common sites for metastasis of breast cancer:

A
  • brain
  • bone
  • liver
  • lung
76
Q

most common sites for metastasis of colon cancer:

A
  • liver
  • lung
  • peritoneum
77
Q

most common sites for metastasis of lung cancer:

A
  • vertebrae
  • ribs
  • pelvis
  • adrenal glands
  • brain
  • liver
  • other lung
78
Q

most common sites for metastasis of prostate cancer:

A
  • axial skeleton
  • liver
  • lung
  • adrenal glands
79
Q

most common sites for metastasis of testicular cancer:

A
  • retroperitoneal lymph nodes
  • lung
  • liver
80
Q

Stage IIIA breast tumor:

A
  • Tumor can be any size but not tethered to skin or chest wall
  • Axillary LN matted or tethered unless tumor > 5 cm
81
Q

Stage IIIb breast tumor:

A
  • Tumor tethered to skin or chest wall, regardless of axillary LN involvement
82
Q

Stage IIIc breast tumor:

A

All that matters is if supra/infraclavicular LN’s are involved

83
Q

Stage IIa breast tumor:

A
  • Tumor
84
Q

Stage IIb breast tumor:

A
  • Tumor between 2 and 5 cm and moveable axillary LN

- Tumor > 5 cm but no LN

85
Q

HER2 targeted therapies:

A
  • Trastuzumab

- Herceptin

Blood, Cancer and Palliation (3 decks)

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