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Year 2 > Cancer > Flashcards

Cancer Flashcards

1
Q

What happens to proto-oncogenes to make them oncogenes?

A

They get a gain of function - enhanced kinase activity, uncontrolled signalling for example

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2
Q

What is HER2?

A

Receptor tyrosine-protein kinase

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3
Q

How does retinoblastoma protein normally prevent cell cycle progression?

A

pRb normally stops the cells ability to progress from G1 to S stage. When cell ready to divide pRb is phosphorylated, inactivating it, allowing cell cycle to progress

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4
Q

What does p21 do?

A

it becomes activated when p53 is phosphorylated.
When active it inhibits CDK which leads to cell cycle arrest

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5
Q

What does loss of BRCA1/2 result in?

A

Results in strand breaks and aneeuploidy

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6
Q

What is the main role of BRCA2?

A

Regulating the function of RAD51 in repair by homologous recombination at G2/M checkpoint
(BRCA1 has broader role upstream)

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7
Q

How can Bcl-2 play a role in leukaemia/lymphoma?

A

Overexpression of BCL2 may prevent cell death in cancer cells

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8
Q

What does imatinib work on?

A

The bcr-abl part of the phildedelphia chromosome (due to the 9,22 translocation)

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9
Q

What is the BRAF-V6OOE mutation common in?

A

Melanoma

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10
Q

When would EGFR inhibitors not work?

A

When KRAS is also mutated

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11
Q

What is a drug for breast cancer that can be directed into the lysosome?

A

Trastuzumab emtansine

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12
Q

What cancer does trastuzumab target ?

A

Breast and stomah cancer that is HER2 positive

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13
Q

What payload is carried by trastuzumab emtansine and what does it do?

A

DM1 - microtubule inhibitor. It is directed into lysosome

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14
Q

what is a dangerous side effect of Trastuzumab?

A

Cardiotoxicity (As the HER2 surivival pathways seem to be cardiac protective)

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15
Q

What are the two most common mutations in pancreatic cancer?

A

K-ras (90%)
P53 (50%)

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16
Q

Where do pancreatic cancers tend to arise?

A

exocrine pancreas - ductal adenocarcinomas

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17
Q

What is a common pancreatic cancer presentation>

A

Obstructive weight loss associated with weight loss,
epigastric pain radiating through to back

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18
Q

What blood biomarker is often raised in ovarian cancer?

A

CA-125

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19
Q

What chemo is often used in ovarian cancer?

A

Platinum + a taxane

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20
Q

What happens in myeloma?

A

You get unregulated proliferation of monoclonal plasma cells in the bone marrow

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21
Q

How does myeloma present?

A

CRAB
Calcium high
Renal failure
Anaemia
Bone pain due to lytic bone lesions

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22
Q

What can gamma knife treat?

A

Things in the brain needing radiotherapy

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23
Q

What are some acute side effects of radiotherapy?

A

Skin reaction, fatigue, pain, pruritus

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24
Q

What are the most common breast cancer genes?

A

BRCA1
BRCA2
TP53
CHEK2

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25
Q

What type of cancers do breast cancers tend to be?

A

Adenocarcinomas

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26
Q

What receptor in breast cancer often has a better prognosis?

A

oestrogen receptor

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27
Q

What is a smooth lump in the breast that moves easily likely to be?

A

Fibroadenoma - benign breast condition

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28
Q

What cells do acute lymphocytic leukemia arise from?

A

Lymphoid progenitor cells

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29
Q

What cells do chronic lymphocytic leukemia arise from?

A

B cells

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30
Q

What cells does acute myelogenous leukemia arise from?

A

Myeloid progenitor cells

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31
Q

What does polatuzumab vedotin treat?

A

B cell lymphoma
It is a CD79b directed antibody drug conjugate
(lara polat loves CDs from 1979)

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32
Q

What germline mutations get regular colorectal cancer screening from a young age?

A

APC or MLH1/MSH2

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33
Q

What appearance do small cell carcinomas have on a biopsy?

A

Salt and pepper chromatin appearance under H&E

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34
Q

Name the non-small cell carcinomas?

A

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma

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35
Q

In what lung carcinoma do you see keratin pearls?

A

Squamous cell carcinoma

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36
Q

What gene can be mutated in squamous cell carcinoma?

A

FGFR1 (Fibroblast growth factor receptor 1)

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37
Q

How do the adenocarcinomas (lung cancer) arise?

A

Gain of function mutations in growth factor signalling pathways (eg receptor tyrosine kinases)

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38
Q

What lung cancer is the most common in non smokers?

A

Adenocarcinoma

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39
Q

How do platinum agents work?

A

Through the development of covalent adducts preventing replication
(all end in platin carboplatin, cisplatin etc)

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40
Q

How do the anti-metabolites work?

A

They are all structural analogs of molecules normally involved in cell growth eg methotrexate is a deriv of folic acid. (S phase)

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41
Q

How do the vinca alkaloids work? (vinblastine, vincristine)

A

They prevent the assembly of microtubules and inhibit spindle formation

42
Q

How does actinomycin-D work?

A

Cytotoxic effects by intercalation between guanine-cytosine base bairs with inhibition of synthesis of RNA

43
Q

How does L-asparaginase work as a chemo agent?

A

It depletes asparagine in blood stream which deprives tumour cells of required amino acids and inhibits protein synthesis (from E Coli)

44
Q

How does Trabectedin work?

A

Binds to the minor groove of DNA bending helix towards major groove?

45
Q

What is a common side effect of bleomycin?

A

Flagellate erythema (rash) and pulmonary fibrosis

46
Q

What is a side effect of doxorubicin?

A

Raspberry urine

47
Q

What is a side effect of capecitabine?

A

Palmar-planter erythrodysesthesia (hand foot syndrome)

48
Q

What is a side effect of Imantinib? (tyrosine kinase inhibitor)

A

peri-orbital oedema

49
Q

Whereabouts do the majority of prostate cancers arise from?

A

peripheral zone (less likely to cause urinary symptoms)

50
Q

What medication can be used to treat prostate cancer?

A

LHRH antagonist (causes testicles to stop making testosterone)

51
Q

What does TMN system refer to?

A

T= size of cancer 1-4
N= lymph node status 0-3
M= metastasis M0 = no distant spread, M1 has spread to distant organs

52
Q

What do the prefixes to the TMN staging mean?

A

p=pathological stage
c=clinal stage
y=restaged after therapy
r = restaged after recurrence

53
Q

What is Duke’s classification a staging for?

A

Colorectal cancer

54
Q

Where does breast cancer often metastise to?

A

Brain

55
Q

What is downregulated in metastatic breast cancer?

A

E-cadherin and BRCA1

56
Q

What is the difference between carcinoma and sarcoma?

A

Carcinoma = epithelial
Sarcoma = mesenchymal

57
Q

What is the name for a benign and malignant tumour of neuroectoderm origin?

A

Naevus = benign
Melanoma = malignant

58
Q

Where are myoxomas and myxosarcomas from?

A

Embryonic fibrous tissue

59
Q

What’s the benign and malignant name of tumours of nerve cells?

A

Benign = ganglioneuroma, malignant = neuroblastoma

60
Q

At what age is red reflex checked in babies?

A

newborn and 6 weeks

61
Q

When does breast cancer screening take place and how long for?

A

50-70 every 3 years

62
Q

When is bowel screening done?

A

50-74 every 2 years

63
Q

What is one of the most common side effects of radiotherapy?

A

Skin reaction and itching

64
Q

What are the three occult cancers?

A

Myeloma, ovarian and panceatic

65
Q

What epigenetic modification in tumour suppressor genes results in a loss of gene expression?

A

Hypermethylation

66
Q

When is cervical cancer screened for?

A

25-49 every 3 years. 50-64 5 yearly

67
Q

What does cancer grading take into account?

A

1) degree of anaplasia
2) rate of growth

eg grade 1 is less than 25% anaplastic cells
grade 4 is more than 75%

68
Q

What does intravastation refer to?

A

invasion of cancer cells through basement membrane to blood vessles

69
Q

What is often upregulated in metastatic breast cancer?

A

VEGF

70
Q

What does R0 refer to?

A

the complete removal of all tissue containing tumour with a margin of intact unaffected tissue

71
Q

What are the only identified gene mutations linked to prostate cancer?

A

BRCA1 and BRCA2

72
Q

Would a Gleason score of 6 be good or bad?

A

it means low grade, small and slow-growing

73
Q

What is the name for radiation that comes in of seeds, ribbons, or wires?

A

Brachytherapy

74
Q

What is a mechanism of treating metastatic prostate cancer?

A

medical castration through a LHRH agonist/antagonist

75
Q

Difference between adjuvant and neo adjuvant?

A

neo-adjuvant given prior to surgery
adjuvant given after surgery

76
Q

What chemo agents work on S phase?

A

methotrexate, 6-mercaptopurine and 5-flurouricil

77
Q

What drugs work on the M phase?

A

The tubulin-active agents-
vinblastine, vincristine
and the taxanes - paclitaxel, docetaxel

78
Q

How do cyclophosphamide, ifosfamide and busulfan work?

A

they are alkylating agents - add an alkyl group to DNA

79
Q

What are irinotecan, topotecan and doxorubicin examples of?

A

Topoisomerase inhibitors. They block Topoisomerase which normally plays important roles in cellular reproduction and DNA organization

80
Q

What type of cancer is small cell carcinoma?

A

neuroendocrine

81
Q

What genes are involved in small cell lung cancer?

A

loss of tp53 and RB
amplification of MYC

82
Q

What cancer would you use prophylactic cranial irradiation in?

A

small cell lung cancer

83
Q

What is the inheritance patterns of the mutations in familial adenomatous polyposis and lynch syndrome?

A

autosomal dominant

84
Q

What type of cancer are most colorectal cancers?

A

adenocarcinoma

85
Q

Which type of stage 4 colorectal cancers respond well to immunotherapy with PD1 inhibitors?

A

MSI tumours - microsatelite instable

86
Q

How do bispecific t-cell engagers work?

A

They bind to cancer cell antigen (cd20) and the cytotoxic t cells to get them to engage (cd3), then release cytotoxic granules

87
Q

What are pembrolizumab, ipilumumab and retalimab examples of?

A

checkpoint inhibitors

88
Q

What do HPV viral proteins E6 and E7 have high affinity for?

A

p53 and RB, inhibiting them

89
Q

What receptors in breast cancer affect prognosis and how?

A

Estrogen receptor positive - better prognosis
Her2 positive - more aggressive

90
Q

When is it most common to be triple negative in breast cancer?

A

more common in pre-menopause and BRCA1 (sensitive to early relapse

91
Q

What is one gray?

A

one gray is the deposit of one joule of energy in one kg of matter

92
Q

What does Whipples procedure treat?

A

pancreatic cancer

93
Q

What translocation is common in myeloma?

A

IgVH

94
Q

How can myeloma be screened for?

A

through serum protein electrophoresis - will see a monoclonal band

95
Q

What is a benefit of small molecule kinase inhibitors over antibodies?

A

small molecule kinase inhibitors can be taken orally and also bind to a wider range of targets

96
Q

What is trastuzumab dereuxtecan used to treat?

A

HER2 positive unresectable breast cancer. It is a third line therapy after trying trastuzumab- emantansine

97
Q

What payload does trastuzumab deruxtecan carry?

A

topoisomerase I inhibitor (DXd payload)

98
Q

What is Tarceva and what is it used for?

A

It is a small molecule tyrosine kinase inhibitor that works by steric hinderance of ATP binding pocket and it is used for metastatic non small cell lung cancer

99
Q

What are side effects of therapies targeting EGFR?

A

slow wound healing and skin rashes

100
Q

What does p53 do?

A

Its a transcription factor which increases expression of p21 (cyclin dependent kinase inhibitors)

101
Q

Why can TERT upregulation lead to cancer?

A

Bc it maintains telomeres so allows cells that would otherwise undergo cell death to become immortal

102
Q

How does pertuzumab work?

A

It inhibits ligand dependent HER2-HER3 dimerization and reduce signalling via intracellular pathways

Year 2 (10 decks)

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