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Boards II > Cancer > Flashcards

Cancer Flashcards

1
Q

Trusseau sign

  • what is it
  • location
  • associated w
  • LE
  • UE
A
  • superficial migratory thromboflibitis -> inflammation of blood vessel secondary to clot
  • superficial v
  • pancreatic CA
  • long (mid shin) and short saphenous v (on top calf)
  • Cephalic v and basilic v
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2
Q

Cachexia

  • what is it
  • sxs
  • caused by
  • how
  • when else can this occur, sxs
A
  • failure to thrive in adult
  • anorexia, muscle wasting, fatigue, malaise
  • TNF alpha -> from macrophages and neoplastic cells
  • stimulates hypothal to decrease appetite
  • septic shock -> tachycardia, hypotensive, fever
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3
Q

Resistance to chemo

  • caused by
  • codes for
  • presentation
A
  • human mutli-drug resistance gene
  • p -glycoprotein which is transmembrane ATP efflux pump protein to flush away chemo
  • tumor won’t shrink
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4
Q

Tumor lysis syndrome

  • what is it
  • when
  • labs
  • sxs
  • tx and MOA
A
  • lots of cancer cells killed at exact same time and lysing realing all intracellular ions at once
  • high grade lymphoma or high sensitvity to chemo
  • hyperkalemia, hyperphasphatemia, hypo Ca bc binding to phophorus, uric acid from DNA and RNA causing acidic env
  • cardiac arrythmia, muscle weakness, phophate crystals, calcium stones, tetany, seizure, myopathy
  • racburicase -> washes out excess uric acid
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5
Q

Most Common CA

  • men
  • men causing death
  • women
  • women causing death
A
  • prostes, lung, colon
  • lung, prostate, colon
  • lung, breast, colon
  • lung, breast, colon
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6
Q

Most Common CA overall

  • 1
  • 2
  • 3
  • 4
A
  • breast
  • lung
  • prostate
  • skin
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7
Q

Types of Cell changes

  • metaplasia: what is it, ex
  • dysplasia: what is it
A
  • one cell type replaced by different cell type -> barrets (strat squamous -> columnar -> adenocarcinoma)
  • abnormal cell growth that is conficed to epi -> does not violate basement membrane
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8
Q

Grade

  • low
  • high
  • invasive
A
  • not entire epithelium
  • entire epithelium but not into BM (carcinoma in situ)
  • invades into BM
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9
Q

Histo of Dysplasia

  • pleomorphic
  • staining
  • mitoses
A
  • cells and nuclei differ in shape and size
  • stain intensely because all nuc and little cytoplasm
  • increase significantly
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10
Q

how dysplastic cells violate BM to become invasive carcinoma

  • step 1
  • step 2
  • step 3
A
  • decrease in e-cadherin -> no longer attached to neighboring cells
  • increase in laminin -> so it can attach to BM
  • secretion proteolytic enzyme by tumor (metalloproteinase and cathepsin D protease) in order to break down BM and ECM
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11
Q

Why does CA met? Most common mets

  • breast
  • colon
  • lung
  • melanoma
  • prostate
A
  • bc it outgrows local blood supply
  • bone, brain, liver, lungs
  • liver, lung, bone, brain
  • bone, brain, liver, adrenal
  • bone, brain, liver lung
  • bone
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12
Q

Mech of CA

  • pre initiation
  • initiation
  • promotion
  • progression
  • malignancy
A
  • no CA
  • exposed to carcinogen which interacts with DNA
  • carcinogen causes mutation in DNA -> usually a transcription regulator -> will start replicating faster than cells around it
  • continue to have exposure to carcinogens -> mutations in DNA accumulate -> dysplasia is occurring so benign tumor is growing
  • cancer begins to violate BM
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13
Q

Tumor suppressor genes

  • what are they
  • mutations
  • ways
  • two hit hypothesis
  • kinds of mutations
A
  • anti-oncogene protecting cell from CA
  • loss or reduction of function allowing cell to progress to CA
  • gene repression, apoptosis, cell adhesion, block loss of contact inhibition, inhibit mets, DNA repair, stop cell cycle
  • both alleles have to be mutated in order to have increased susceptibility to CA
  • point mutation -> causing truncated protein OR large deletion -> loss of protein function
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14
Q

Oncogenes

  • what are they
  • proto; code for
  • activation
A
  • genes that can cause CA
  • normal gene that can become oncogene if mutated; cell growth and differentiation
  • mutation in proto oncogene or its regulatory region
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15
Q

Classifying Oncogenes

  • Growth Factors
  • Receptor Tyr Kinase
  • Reg GTPase
  • Transcription factors
  • cytoplasmic kinase
  • cytoplasmic tyrosine kinase
A
  • induce cell proliferation
  • transduce signal for cell growth and differentiation
  • signal pathway that leads to cell proliferation
  • reg transcription of genes that induce proliferation
  • cell cycle regulation, proliferation, differetiation, survival
  • mediates response to and activation of receptors for cell proliferation
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16
Q

Oncogenes Altered in CA

  • AKT1 *
  • BRAF *
  • FOS *
  • ERB2 *
  • C-MYC *
  • N- MYC *
  • HRAS
  • KRAS
  • NRAS *
  • RET *
  • WNT1 *
A
  • hepatoblastoma, wilms, lung, ovarian, colon, beckwidth weeman syndrome
  • breast CA, lung, colon, rectum, ovary, thyroid, Gastro-intestinal stromal tumors
  • osteosarcoma, endometrial, cervical
  • breast, lung, gastric, ovarian, glioma **
  • murkitts, ovarian, breast, colorectal, pancreas, uterus
  • neuroblastoma
  • neuroblastoma
  • MEN2a, 2b, medullary CA of thyroid
  • basal, colorectal, breast
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17
Q

Important translocation

  • 9:22
  • 8:14
  • 14:18
  • 11:22
  • 15:17
A
  • phil chromosome -> CML
  • burkitts
  • follicular
  • ewings osteosarcoma
  • AML -> promyeloblastic
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18
Q

Viruses and CA

  • how
  • HPV
  • EBV
  • Hep B, C
  • Retrovirus
A
  • activate growth promoting pathways or inhibit tumor suppressor
  • E6 -> p53, E7 -> RB; throat cancer, vulvar CA, penile CA, rectal CA
  • HCC
  • T cell leukemia
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19
Q

Staging

  • what is it
  • T
  • N
  • M
A
  • extent or severity of CA
  • extent of tumor; 0= only marker, TIS = in situ, 1-3: size or extenet of tumor
  • Lymph nodes; regional LN, n=0 none, N1-3: # LN or extenet of spread
  • Mets; 0= no mets, 1: distant mets
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20
Q

Grading

  • what is it
  • in situ
  • localized
  • regional
  • distant
  • unknown
  • 1
  • 2
  • 3
  • 4
A
  • classifies CA cells in terms of how abnormal the cells look microscopically and how quickly they are to grow and spread
  • abnrml cells present only in layer of cells in which they devleop
  • cancer limited to organ where it began
  • CA spread beyond primary sight to nearby LN or organs
  • CA spread from primary sight to distant organ of LN
  • not enough info to determine stage
  • well differentiated (low) -> similar to histo of tissue of origin
  • moderately diff (intermediate)
  • poorly diff (high) -> lack majority of characteristi features of normal cells
  • undiff (high) -> do not look anything like a normal cell
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21
Q

Benign

  • looks
  • mobile
  • encapsulated
  • mets
A
  • well circumcribed
  • freely
  • yes, and does not grow outside capsule
  • no, will not grow
22
Q

Malignant

  • looks
  • mobile
  • encapsulated
  • mets
A
  • not circumscribed
  • adehent to surrounding tissue
  • no, outgorwn
  • yes, outgrows blood supply
23
Q

Anaplastic tumors

  • architesture
  • mitoses
  • nuceli
  • look like
A
  • loss of cell polarity, variation in sixe and shape
  • lots
  • large, deep staining
  • giant, multi nucleated tumor cells
24
Q

2 factors for malignant neoplasia success

  • angiogenein
  • endostatin
A
  • help CA produce own vessels

- anti-angiogenic: interferes with activity of certain growth factors

25
Q

Tx for CA

  • target
  • chemo
  • radiation
  • normal cells affected
A
  • destroy rapid dividing cells
  • kill cancer cells
  • induce new mutations and cease cell division
  • RBC -> anemia, Hematopoetic stem cells -> WBC, GI tract -> ulcer, Hair follicles -> allopecia, Mucous membranes -> mucositis
26
Q

Cancer Meds that affect S

  • 5FU
  • 6MP
  • 6 thioguanine
  • MTX (oral ulcers and hepatotoxic)
  • azathioprine
  • cladribine
  • cytarabine
A
  • cant turn UMP to TMP to make thymine for DNA
  • purine analog -> PRPP aminotransferase -> no purine synthesis
  • gets turned into 6thio- GMP and provides negative feedback to rate limiting enzyme
  • dihyrdofolate reductase -> no tetra hydro folate -> prevents uracil from becoming thiamine
  • purine analog that will get turned into 6 mercaptopurine -> inhibits purine synthesis
  • purine analog works the same as azathioprine
  • damages DNA
27
Q

Cancer Meds that affect G2

  • Etoposide and doxarubicin (heart tox)
  • bleomycin (pulm fibrosis)
A
  • topoisomerase 2 inhibitor stops taking down of supercoil

- DNA strand breaker

28
Q

Cancer Meds that affect M

  • Paclitaxel
  • vincristine and vindlastine
  • Vinca Alkaloid
A
  • prevent MT disassembly; chromosomes will not separate
  • bind to tubulin and block spindle assembly
  • add alkyl group to guanine which forms DNA cross links
29
Q

Leukemia Nomenclature

  • acute
  • chronic
  • second letter
A
  • abnormal proliferation of precursor cells
  • abnormal proliferation of mature cells
  • tells you where its from, lymphoblasts (T or B cells) or myeloblast (PMNS, marco, eosinophil, basophil)
30
Q

Types

  • ALL
  • AML
  • CLL
  • CML
A
  • acute lymph
  • acute myelo
  • chronic lymph
  • chronic myelo
31
Q

ALL

  • what is it
  • effects on myeloid line
  • effects on RBC
  • mutation
  • diff B from T
  • stain w/
  • Common ALL antigen
  • physical sxs
  • tx
A
  • lymphoblasts proliferating and taking up all room in BM; greater than 20% lymphoblasts
  • myeloid cells will be squeezed out and can no longer be produced -> thrombocytopenia
  • RBCs can be made but will be pushed put quickly and pinched making teardrop cells
  • chromosomal abnormality leads to abnormal transcription factors affecting B and T cells
  • children
  • with immuno typing; B- 10, 19; T - 2, 3, 4, 5, 7, 8
  • TdT
  • marker w/ good prognosis bc indicates that CA will respond well to therapy and is seen in 80% pts
  • ant mediastinal mass -> can cause SVC syndrome, dyshpagia or dyspnea and stridor
  • MTX and prednisone (kills T cells)
32
Q

AML

  • what is it
  • effects on myeloid line
  • effects on RBC
  • caused by
  • cell morphology
  • sxs
  • epi
  • stain w/
  • acute promyeloblastic: translocation, causes
  • stain w/
  • why is it worse than ALL
  • tx
A
  • myeloblasts proliferating and taking up all room in BM; not maturing into normal cells -> so still no platelets
  • RBCs can be made but will be pushed put quickly and pinched making teardrop cells
  • oncogene mutation disrupting differentiation leading to accumulation of myeloid blasts
  • auer rods, myeloblasts
  • anemia, neutropenia, thrombocytopenia
  • adults, 67 yrs old
  • black w/ sudan black stain
  • cannot generate PMN or macrophages and since crowding out lymphoblasts you have no immune sxs
  • chemo and bone marrow transplant
33
Q

SXS of leukemia

A
  • weight loss, fever, SOB, weakness, LN swelling, night sweats, easy bleeding and bruising
34
Q

CLL

  • what is it
  • cell morphology
  • CBC
  • epi
  • tx
  • prognosis
A
  • abnormal proliferation of mature lymphocytes
  • smudge cells
  • lymphocytosis
  • male adults (avg age of dx is 70)
  • alkylating agents -> only when white count elevated
  • best
35
Q

CML

  • what is it
  • caused by
  • cell morph
  • sxs
  • epi
  • terminal phase
A
  • elevated levels of WBC
  • phili chromosome; 9:22
  • hypercellular marrow, elevated eosinophils and basophils
  • only have sxs when WBC greater than 200K
  • 20-50 yrs old
  • blast phase, final phase, nehaves similar to acute leukemia
36
Q

Hairy Cell Leukemia

  • what is it
  • sub-type of
  • look like
  • confirmed with
  • tx
A
  • T cell leukemia, 75% B cell and 25% t cell, whil most other lymphoblastic leukemias are 99% B cell
  • CLL
  • have hair like projections
  • tartrate resistant acid phosphatase
  • cladribine -> purine analog -> shuts down ribonuc reductase -> no purine synthesis
37
Q

Leukemia Age Group

  • ALL
  • CML
  • AML
  • CLL
A
  • 0 - 15 yr
  • 50 -60 yr
  • 67 yrs
  • 70 yrs
38
Q

Lymphoma

  • what is it
  • look for
  • then
A
  • CA in LN
  • enlarge LB
  • biopsy -> reed sternburg clles
39
Q

Nodes at Suspicious Site

  • suprcalvicular
  • inguinal
  • epitrochlear
  • what about cervical
A
  • lymphoma or gastric
  • no hx of STD then likely lymphoma
  • at elbow, very rare, need biopsy
  • usually viral infection, just watch, only biopsy after 4-6 weeks
40
Q

Reed sternburg

  • indicates
  • looks like
  • positive for
  • negative for
A
  • indicative of hodgkin lymphoma
  • multi nucleated
  • CD 15 and 30
  • CD 20 and 45
41
Q

Hodgkins

  • distribution
  • prognosis
  • nodular
  • lymph depleted
  • lymphocyte predominate
  • mixed
A
  • bimodal, 20-40 or elderly
  • relatively good, 70-90% survival
  • most common, female, least # RS, scarring LN, intermediate prognosis
  • least # lymphocytes, worst prognosis, rare, associated with HIV
  • rare, many lymph, best prognosis
  • many RS w/ inflamm cells, associated with EBV and HIV, intermediate prognosis, older pts
42
Q

Non- Hodgkins

  • seen in
  • present w
  • most common
  • follicular: sxs, architecture, translocation, prognosis
  • Burkitts: translocation, associated w/, variations, histo
A
  • immuno compromised -> get HIV test
  • abdominal or jaw mass
  • follicular
  • painless LN enlargement or abd discomfort; tumors arranged in follicles; 14;18 translocation w/ over expression BCL2 (anti-apoptosis); very slow growing tumor w/ avg survival being 10 yrs
  • 8:14(c-myc and ig H); associated with EBV; endemic (africa, kids w/ chronic malaria), sporadic( non- african, imapired immunity leaves susciptble to EBV, involves ileocecal region), immuno defficient (HIV); starry sky made up of macrophages that contain apoptotic tumor cells
43
Q

Staging Lymphoma

  • 1
  • 2
  • 3
  • 4
A
  • 1 group LN
  • 2 group LNs on same side diaphragm
  • 2 or more groups LN on both sides diaphragm
  • mets throughout body
44
Q

Lymphoma Tx Side effects

  • cyclophosphamide
  • adriamycin
  • bleomycin
A
  • hemm cysittis
  • cardiac fiboris
  • pulm fibrosis
45
Q

Polycythemia Rubra Vera

  • what is it
  • HCT
  • primary
  • secondary
  • sxs
  • tx
  • caused by
A
  • all cell lines from BM are increase, but RBC more increase
  • more than 60%
  • Bone marrow
  • chronic hypoxia
  • headahce, vertigo, itchy after hot shower (bs increase of mast cells and hot shower causes degranulation causing pruritis)
  • phlebotomy
  • mutation in jak 2 (tyr kinase) enabling cells sensitive to EPO -> increase RBC
46
Q

Essential Thrombocytopenia

  • what is it
  • sequelae
  • therapy
  • prognosis
A
  • increase in all cell lines but greatest is platelets
  • MI or stroke
  • anti- platelet and hydroxy urea to lower platelet count
  • slowl progressing, usually asymptomatic
47
Q

Aplastic Anemia

  • what is it
  • most common cause
  • tx
  • bone marrow
  • viruses
  • drugs
A
  • all cell lines depleted
  • viral or drug related, but check BM to identify if bone marrow is cause
  • remove cause
  • replaced by fatty tissue
  • parvo virus, hep E, hep C
  • AZT, vinblastine, chloramphenicol
48
Q

Myelo fibrosis

  • what is it
  • sxs
  • tx
  • sequalae
A
  • bone marrow cancer that burns out bone marrow and makes it scar up
  • bone pain, anemia, panyctopenia, petechial bleeding, tear drop cells
  • stem cell replacement
  • need transfusions bc panctopenia
49
Q

Multiple Myeloma

  • what is it
  • epi
  • histo
  • sxs
  • M protein
  • IL-6
  • kidneys
  • rouleau formation
A
  • plasma cell CA
  • 40-60 yrs old
  • basophilic cytoplasm, with wagon wheel distribution of chromatin, and plasma cell in BM
  • bone pain, pathologic fx w/ punched out lesions, anemia, hyper Ca
  • monoclonal Ig in serum; usually IgG
  • secreted by neopplastic cells causing osteoclastic activity
  • bence jones protein (light chain from antibody depositing), toxic to tubules
  • stacked RBC
50
Q

Cancer Antigen

  • what do they do
  • how
  • examples
A
  • only hows association
  • if pt has tumor, then measure them before, resect tumor, measure after to ensure decrease, then continue checking to look for reoccurence
  • PSA- prostate; HER2, BRCA- breast; Rb - retino blastoma or ewing

Boards II (20 decks)

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