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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
What is the biggest concern with "mastitis" that doesn't resolve with antibiotics?
Inflammatory breast cancer (IBC)
26
Selective estrogen receptor modulator used as supplemental treatment for breast cancer:
Tamoxifen x 5 yrs (new evidence that x 10 yrs is more effective but more side effects)
27
Supplemental breast cancer treatment that targets the Her2 protein, effective in early stage cancers and metastatic disease:
Herceptin
28
Complications of tamoxifen as chemoprophylaxis for breast cancer:
- Increased risk of thrombotic events | - Increased risk of endometrial cancer
29
Other prophylactic medications used to reduce risk of breast cancer:
- Arimidex | - Raloxifene
30
3 purposes of radiation therapy:
- Kill cancer cells - Shrink tumors - Alleviate pain
31
How does radiation work to treat cancer?
Double stranded DNA breaks result in chromosomal aberrations that prevent the cancer cells from dividing normally.
32
Typical course of radiation therapy:
M - F once a day for 1 - 9 weeks | Usually lasts 20 - 30 min
33
3 reasons why tumor markers are imperfect indicators:
- 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
34
Autosomal dominant mutation that results in increased risk of breast and ovarian cancer in women, and prostate and colorectal cancer in men:
BRCA 1 and 2
35
True or false: chemotherapy works better on cells that are not actively proliferating.
False. It works better on cells that are rapidly dividing.
36
Explain how tumor reduction (either through surgery or radiation) and chemotherapy work synergistically:
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
Side effects of fluorouracil:
Stomatitis, GI ulcer, Hand-foot syndrome, cardiotoxicity (angina), photosensitivity, myelosuppresion
38
Drug class, indications, and MOA of Fluorouracil:
- Class: cell cycle specific antimetabolite - MOA: pyrimidine analogue, interferes with DNA/RNA synthesis - Indications: Breast, colon, gastric CA
39
Drug class, indications, and MOA of doxorubicin:
- Class: cell cycle specific anthracycline - MOA: Topoisomerase II inhibitor - Indications: Breast, metastatic solid tumors, leukemia and lymphoma
40
Definition of adjuvant chemotherapy:
Chemo used to treat micrometastases given after surgery or radiation
41
Definition of neo-adjuvant chemotherapy:
Chemo done before surgery or radiation in an attempt to shrink the tumor and make resection easier.
42
Most common type of bone cancer:
Osteosarcoma
43
Classic presentation of osteosarcoma:
- 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
Classic presentation of Giant Cell Tumor
- Most common in young adults 25 - 40 - Pathologic fracture - F > M - Benign but aggressive - Epiphyseal location - Radiolucent center
45
Classic presentation of Ewing sarcoma:
- Diaphysis of long bones - Age 10 - 20, M > F, white > minorities - Lower extremity - Onion skin appearance
46
USPSTF recommendation for prostate cancer screening:
Recommends against PSA testing due to risk of harm.
47
USPSTF recommendation for colon cancer screening:
- FOBT, sigmoidoscopy or colonoscopy in adults starting at age 50 and continuing until age 75. - Sigmoidoscopy and colonoscopy are recommended every 10 years.
48
USPSTF recommendation for lung cancer screening:
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
USPSTF recommendation for breast cancer screening:
Recommends biennial screening mammography for women 50 – 74 y/o. B recommendation.
50
USPSTF recommendation for cervical cancer screening:
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
USPSTF recommendation for testicular cancer screening:
Recommends against screening for testicular cancer in adolescent or adult men. D recommendation.
52
Classic presentation of osteochondroma:
- Age F - Sessile or pedunculated - Trumpet shaped deformity - Benign
53
Classic presentation of enchondroma:
- Lucent defect with endosteal scalloping - Age 20 - 30 - M = F - Asymptomatic, incidental finding on x-ray
54
What are the indications for use of methotrexate?
- ALL - Breast CA - Head and neck CA - Osteosarcoma
55
What does R-CHOP stand for?
- Rituximab - Cyclophosphamide - Doxorubicin - Vincristine - Prednisone
56
What is R-CHOP used to treat?
Non-Hodgkin's Lymphoma
57
Side effects of methotrexate:
Acute: N/V, mucositis Delayed: myelosuppression, nephro-, hepato- and pulmonary-toxicity, photosensitivity
58
Mnemonic for general chemo toxicities:
``` HOAGIE H = hematologic O = organ dysfunction A = alopecia GI = gastrointestinal E = endocrine ```
59
Drug class, indications, and MOA of etoposide:
- Class: Cell cycle specific - MOA: Topoisomerase II inhibitor - Indications: small cell lung cancer, NHL
60
Name two topoisomerase I inhibitors:
- topotecan | - irinotecan
61
Drug class, indications, and MOA of paclitaxel:
- Class: antimicrotubule taxane - MOA: promotes formation and prevents disassembly of microtubules - Indications: ALL, CNS tumors, lymphomas
62
Drug class, indications, and MOA of vincristine:
- Class: vinka alkyloids - MOA: antimicrotubule; binds tubulin and inhibit MT assembly - Indications: ALL, CNS, lymphomas
63
Which class of drugs are cell cycle non-specific?
Alkylating agents: e.g., cyclophosphamide, cisplatin
64
MOA for alkylating agents:
Alkylates and crosslinks DNA to inhibit cell division. Non-specific.
65
Alkylating agent that can cause ototoxicity:
Cisplatin
66
Alkylating agent that can cause hemorrhagic cystitis:
Cyclophosphamide
67
Vinka alkaloid drug that frequently causes constipation:
Vincristine
68
Notable side effects of doxorubicin:
Cardiotoxicity, extravasation potential, 2-ary malignancies
69
Type of drug used to treat post-menopausal breast cancer:
Aromatase inhibitor
70
Hormonal therapy indicated for the treatment of prostate cancer as well as breast cancer:
Leuprolide
71
What kind of therapy would be used to treat myelodysplastic syndrome?
An epigenetic modifying agent such as azacitidine.
72
Drug class, indications, and MOA of bevacizumab:
Class: monoclonal antibody MOA: anti-B cell antibody Indications: Colorectal, lung, breast, renal, brain cancers.
73
Drug class, indications, and MOA of imatinib:
Class: targeted therapies MOA: tyrosine kinase inhibitor Indications: CML, GIST
74
most common sites for metastasis of cervical cancer:
- liver - lung - bone
75
most common sites for metastasis of breast cancer:
- brain - bone - liver - lung
76
most common sites for metastasis of colon cancer:
- liver - lung - peritoneum
77
most common sites for metastasis of lung cancer:
- vertebrae - ribs - pelvis - adrenal glands - brain - liver - other lung
78
most common sites for metastasis of prostate cancer:
- axial skeleton - liver - lung - adrenal glands
79
most common sites for metastasis of testicular cancer:
- retroperitoneal lymph nodes - lung - liver
80
Stage IIIA breast tumor:
- Tumor can be any size but not tethered to skin or chest wall - Axillary LN matted or tethered unless tumor > 5 cm
81
Stage IIIb breast tumor:
- Tumor tethered to skin or chest wall, regardless of axillary LN involvement
82
Stage IIIc breast tumor:
All that matters is if supra/infraclavicular LN's are involved
83
Stage IIa breast tumor:
- Tumor
84
Stage IIb breast tumor:
- Tumor between 2 and 5 cm and moveable axillary LN | - Tumor > 5 cm but no LN
85
HER2 targeted therapies:
- Trastuzumab | - Herceptin

Blood, Cancer and Palliation (3 decks)

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