Cancer EOYS2 Flashcards
What are the different types of biopsy? [6]
- Transcutaneous
- Endoscopic Biopsy
- Laparoscopic Biopsy
-
Image-directed (with fine-needle aspiration or
cutting needle)
–Ultrasonography
–Computerized tomography
–Magnetic resonance imaging - Open incisional ( portion of the tumor)
- Open excisional (all tumor mass removed)
What are the 5 types of surgical treatment? [5]
- Local resection
-
Radical resection with en-bloc resection of
lymph nodes - Supra-radical resections = LN+Organs
- Surgery for metastasis/recurrence
- Surgical management of complications
Name a classification type for bowel cancer [1]
Dukes Classification
Curative Resection
The complete removal of tumour is termed []
The complete removal of tumour is termed R0
When is radical surgery utilised as treatment? [1]
What tissue is removed? [2]
When area/organ-confined & it is likely that all of the tumour can be removed with clear margins.
Lymph Nodes which drain the affected area are sometimes removed along with the primary tumour
What are the 3 categories of surgery? [3]
1. Open Surgery
2. Minimally Invasive Surgery (MIS)
Hand Assisted (MIS)
Laparoscopic Surgery
Robot Assisted Surgery
Surgery thru natural orifice (NOTES)
3. Image Guided Surgery
What are the 4 types of minimally invasive surgery? [4]
2. Minimally Invasive Surgery (MIS)
Hand Assisted (MIS)
Laparoscopic Surgery
Robot Assisted Surgery
Surgery thru natural orifice (NOTES)
What is this type of surgery?
Hand Assisted (MIS)
Laparoscopic Surgery
Robot Assisted Surgery
Surgery thru natural orifice (NOTES)
What is this type of surgery?
Hand Assisted (MIS)
Laparoscopic Surgery
Robot Assisted Surgery
Surgery thru natural orifice (NOTES)
Define palliative surgery [1]
Name some examples
‘surgery performed for relief of symptoms caused by advanced cancer not amenable for cure’
- Adequate control of pain
- Relief gastrointestinal and biliary obstruction
- Stop haemorrhage
- Supplement poor nutrition
- Airway obstruction
- Renal failure
- Rectal or urinary incontinence
Which types of urological cancer are now treted robotically? [4]
- Prostate cancer – robotic prostatectomy
-
Bladder cancer – robotic cystectomy with
urinary diversion - Renal cancer – robotic partial nephrectomy
-
Testis cancer - robotic retroperitoneal lymph
node dissection
Why may curative resection not be successful? [3]
– Invasion of a vital, unresectable structure (e.g. SMA)
– Undetectable micrometastasis in distal organ
– Distal metastasis which cannot be safely removed
Name 7 types of AEs that arise from anaesthesia for surgery? [7]
1. Local trauma– teeth, throat from intubation
2. Drug related – reaction/allergy
3. Aspiration of oesophageal/gastric contents
4. Anaesthetic line complication
– Arterial line
– bleeding
– Central venous line complication
– Epidural catheter complication
5. Lung injury from high pressure ventilation
6. Iontropes
7. Electrolyte imbalance
Name two potential future cancer surgery treatments
- Pre-emptive surgery in at risk populations (e.g. BRCA)
- Tissue and function-preserving improvements
Future potential cancer treatments
What are 4 types of tissue and function-preserving improvements surgery that may be possible in the future? [4]
- Ablative, minimally-invasive, image guided surgery
- Tissue-engineered, implantable “spare parts”
- Implantable monitors
- Treatment sensitizers
Name three cancers that often diagnosed late [3]
Ovarian
Pancreatic
Myeloma
The majority of humanised monoclonal antibodies use which Ig as a backbone?
IgA
IgD
IgE
IgG
IgM
IgG
Which of the following is targeted by Pembrolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
PD-1
Which cascade is perhaps the most important oncogenic driver of human cancers?
PI3 Kinase
MAP Kinase
KRAS
AKT
Which cascade is perhaps the most important oncogenic driver of human cancers?
PI3 Kinase
MAP Kinase
KRAS
AKT
Which of the following is targeted by Rituximab
CD10
CD12
CD15
CD19
CD20
Which of the following is targeted by Rituximab
CD10
CD12
CD15
CD19
CD20
Which of the following is targeted by Atezolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
Which of the following is targeted by Atezolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
Which of the following is an example of a CAR-T drug?
Tisagenlecleucel (Kymriah)
Atezolizumab
Ipililumbab
Nivolumab
Which of the following is an example of a CAR-T drug?
Tisagenlecleucel (Kymriah)
Which of the following binds to CD20 in its mechansim of action?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which of the following binds to CD20 in its mechansim of action?
Rituximab
Which of the following binds to CTLA4?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which of the following binds to CTLA4?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Describe what checkpoint inhibition is [1]
State two key molecules influential in checkpoint inhibition [2]
Checkpoint inhibitors: take the brakes off the immune system; checkpoints inhibits the stop sign that a cancer cell usually presents to immune cells
Checkpoints (caused by)
PD1 Programmed Death Receptor 1
CTLA-4 Cytotoxic T-Lymphocyte Associated protein 4
Explain the role of the PD1 checkpoint [2]
PD1 regulates T cell activation through binding with the ligands programmed death-ligand 1 (PDL1) and programmed cell death 1 ligand 2 (PDL2)
Under physiological conditions this inhibits T cell proliferation and survival: helps prevent the immune system from attacking itself
Cancer cells can hijack this pathway to escape immune detection
Explain the influence of cancer cells on PD1 checkpoint
Cancer cell can turn off the PD-1 pathway:
.
If PDL1 or PDL2 are expressed within the tumour microenvironment (TME), the ligands can bind to PD1, terminating TCR signalling and reducing the activation of T cells.
Which drugs bind to PD-L1? [3]
Atezolizumab
Durvalumab
Avelumab
Which drugs bind to PD-1? [2]
Pembrolizumab
Nivolumab
Explain the role of CTLA-4 [1]
What happens if CTLA-4 is inhibited? [1]
CTLA-4 suppressed T cell activation and inhibits cell function; plays a role in T-cell priming
Inhibiting CTLA-4 ”takes the breaks off” the immune system
Name two drugs that inhibit CTLA-4
Ipilimubab
Tremelimubab
What is the difference between chimeric and humanised monoclonal antibodies? [2]
- chimeric: Monoclonal antibody with a large stretch of non-human proteins
- humanized: Monoclonal antibody coupled with a human Ig backbone
What are the three ways that monoclonal antibodies are broadly used? [3]
Complement mediated lysis: unconjugated
Immunotoxins: Coupled to toxin
Radioimmunoconjugates: Coupled to radioisotopes
Give an example that is a chimeric monoclonal antibody used for treating B-Lymphomas [1]
What is the target? [2]
Rituximab: targets CD20 on malignant B-cells and CD3 on normal T cells
Together enhance cytotoxicity
What are Chimeric antigen receptors? [1]
Chimeric antigen receptors (CARs): are recombinant receptors for antigens which redirect the specificity and function of T lymphocytes and/or other immune cells in a single molecule.
(Chimeric antigen receptors: on the surface we have the antibody components so the T cells are recognised by the antigen on the tumour cells, and 2nd and 3rd generation CARs have additional costimulatory molecules to enhance the immune response)
Give an example of CAR-T drug for targetting large B-cell lymphoma? [1]
What is the drug target? [1]
Tisagenlecleucel (Kymriah)
CAR-T Cell targeting CD19
What is the point of using immunotherapy biomarkers? [1]
Name 3 key biomarkers for immunotherapy
All cancer treatment comes with AES. If can ID patients who will likely have least AEs then best cost / benefit: using biomarkers can try and ID.
General immune status (how many T cells are in the tumour)
Absence of checkpoints
Tumour insensitivty to immune effectors
(listen over quickly)
Name 5 future immunotherapy treatments
Microbiome: faecal microbiota transplant treated checkpoint inhibition
ECM: cancerous cells can manipulate the immune system so they can change what type of collagen is in the matrix (and make it an easier place for them to live). Can change the type of collagen or structure in our immune system to combat the cancer
Adaptive T cell therapy: Priming - generation a new immune response; Boosting of immune memory
Adpotive cell transfer:
Dendritic Cell Vaccination
Explain the mechanism of how chimeric antigen receptor treatment occurs [3]
Take T cells
Retrovirally transfect them to be able to express the chimeric antigen whereby you have the antibody on the surface linked into the molecule that activates the T cell
(T cells are removed from a cancer patient and modified so they express receptor specific to the patient’s cancer, then are reintroduced to patient)
T cell then recognises the tumour cell and that activated tumour cell kills off these cells
The majority of humanised monoclonal antibodies use which Ig as a backbone?
IgA
IgD
IgE
IgG
IgM
IgG
Which of the following is targeted by Pembrolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
PD-1
Which cascade is perhaps the most important oncogenic driver of human cancers?
PI3 Kinase
MAP Kinase
KRAS
AKT
Which cascade is perhaps the most important oncogenic driver of human cancers?
PI3 Kinase
MAP Kinase
KRAS
AKT
Which of the following is targeted by Rituximab
CD10
CD12
CD15
CD19
CD20
Which of the following is targeted by Rituximab
CD10
CD12
CD15
CD19
CD20
Which of the following is targeted by Atezolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
Which of the following is targeted by Atezolizumab
PD-1
CTLA-4
PD1-Ligand
LAG-3
PD2-Ligand
Which of the following is an example of a CAR-T drug?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which of the following is an example of a CAR-T drug?
Tisagenlecleucel (Kymriah)
Which of the following binds uses this as its mechanism of action
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which of the following binds to CD19 in its mechansim of action?
Tisagenlecleucel (Kymriah)
Which of the following binds to CTLA4?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which of the following binds to CTLA4?
Tisagenlecleucel (Kymriah)
Atezolizumab
Rituximab
Ipililumbab
Nivolumab
Which drug prevents the HER2/HER3 dimer from forming?
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug prevents the HER2/HER3 dimer from forming?
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Herceptin is also known as
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Herceptin is also known as
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug stops HER2 binding to another HER2
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug stops HER2 binding to another HER2
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Tarceva
(Erlotinib) targets which of the following
HER2
HER2/HER3
EGFR
VEGF
Tarceva
(Erlotinib) targets which of the following
HER2
HER2/HER3
EGFR
VEGF
Which drug has a side effect of a rash?
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug has a side effect of a rash?
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug causesa decline in left ventricular function AND congestive heart failure
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug causesa decline in left ventricular function AND congestive heart failure
Trastuzumab
Pertuzumab
Cetuximab
Kadcycla
Which drug blocks ATP binding to tyrosine kinase receptor
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Which drug blocks ATP binding to tyrosine kinase receptor
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Which of the following drug binds to B
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Which of the following drug binds to B
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Which of the following drug binds to C
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Pertuzumab
Which drug acts according to this image as a first line drug used for non-small cell lung cancer
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
Which drug acts according to this image as a first line drug used for non-small cell lung cancer
Trastuzumab
Pertuzumab
Osimertinib
Erlotinib
Kadcycla
