Chapter 11 - Oncology+ Flashcards
1
Q
Most common cancer in women?
A
Breast
2
Q
Most common cause of CA related death in women?
A
Lung
3
Q
Most common cancer in men?
A
Prostate
4
Q
Most common CA related death in men?
A
Lung
5
Q
What is a PET scan?
A
positron emission tomography scan. Identifies fluorodeoxyglucose molecules to help find metastases.
6
Q
What do T-cells require to attack tumor cells?
A
MHC complex
7
Q
Do natural killer cells require MHC to attack tumor cells?
A
no
8
Q
Hyperplasia means what?
A
increased number of cells
9
Q
Metaplasia means what?
A
replacement of one tissue with another (GERD - squamous esophagus changed to columnar gastric tissue)
10
Q
Dysplasia means what?
A
altered size, shape, and organization of cells (Barrett’s esophagus)
11
Q
Colon cancer marker?
A
CEA
12
Q
Liver cancer marker?
A
AFP
13
Q
Pancreatic cancer marker?
A
CA 19-9
14
Q
Ovarian cancer marker?
A
CA 125
15
Q
Testicular cancer marker?
A
Beta-HCG
16
Q
Choriocarcinoma marker?
A
Beta-HCG
17
Q
Prostate cancer marker?
A
PSA
18
Q
Small cell lung cancer marker?
A
NSE
19
Q
Neuroblastoma marker?
A
NSE
20
Q
What happens in cancer transformation?
A
heritable alteration in genome - loss of growth regulation
21
Q
What is the latency period of oncogenesis?
A
time between exposure and formation of clinically detectable tumor
22
Q
What are the steps of oncogenesis?
A
Initiation - carcinogen interacts with DNA
Promotion of cancer cells
Progression to clinically detectable tumor
23
Q
What are three mechanisms neoplasms can arise?
A
- carcinogenesis (smoking)
- viruses (EBV)
- immunodeficiency (HIV)
24
Q
How do viruses cause cancer?
A
Contain oncogenes
25
What is translocation that occurs with EBV?
8:14 causes Burkitt's lymphoma
c-myc causes nasopharyngeal carcinoma
26
Cervical cancer can be caused by what virus?
HPV
27
Gastric cancer can be caused by what organism?
H. Pylori
28
Hepatocellular can be caused by what virus?
Hep C (also causes splenic lymphoma), Hep B
29
Kaposi's sarcoma can be caused by what virus?
HHV-8 (also causes primary effusion lymphoma)
30
Primary effusion lymphoma can be caused by what virus?
HHV-8 (also causes Kaposi's sarcoma)
31
Splenic lymphoma can be caused by what virus?
Hep C (also causes HCC)
32
Nasopharyngeal carcinoma can be caused by what virus?
EBV (also causes Burkitt's lymphoma) c-myc association
33
Burkitt's lymphoma can be caused by what virus?
EBV (also causes nasopharyngeal carcinoma)
34
Adult T-cell leukemia/lymphoma can be caused by what virus?
Human T-cell leukemia virus-1
35
What cell phase is the most vulnerable for radiation?
M phase
36
How does radiation therapy cause damage?
formation of oxygen radicals - damage DNA and other molecules. XRT can also cause small breaks in DNA primarily
37
How does higher energy radiation have a skin preserving effect?
maximal energy not reached until it gets to deeper structures
38
Why are fractionated doses of radiation helpful?
* allows for repair of normal cells
* allows reoxygenation of tumor cells
* allows for redistribution of tumor cells in cell cycle
39
What tumor types are very radiosensitive?
seminomas, lymphomas, head and neck cancers
40
What tumor types are very radioresistant?
epithelial, sarcomas
41
Why are large tumors less responsive to XRT?
lack of oxygen in the tumor
42
What is brachytherapy?
source of radiation in or next to tumor (Au-198, I-128)
uses: localized prostate cancer, advanced cervical cancer
43
What are cell-cycle specific agents?
5FU, methotrexate
44
What does tamoxifen do?
blocks estrogen receptor - decreases short-term (5 yr) risk of breast Ca by 45%
1% risk of blood clots, 0.1% risk of endometrial ca
uses: metastatic breast ca, adjuvant as well
45
What does taxol (paclitaxel) do?
What is it used for?
promotes microtubule formation and stabilization that cannot be broken down - cell ruptures
uses: adjuvant for node-positive/metastatic breast cancer, second-line for Kaposi sarcoma, first-line for NSCLC, subsequent and first-line for advanced ovarian cancer
46
What are side effects of bleomycin and busulfan?
pulmonary fibrosis
47
What is the mechanism of **cisplatin**?
What are the side effects?
What are its uses?
* Platinum alkylating agent
* Nephrotoxic, neurotoxic, ototoxic
* Advanced bladder cancer - not candidates for local therapy (surg/radx)
* Metastatic ovarian cancer - adjuvant after surgery and/or radx
* Metastatic testicular cancer - adjuvant after surgery and/or radx
48
What is carboplatin and what is a side effect?
* platinum alkylating agent
* bone myelosuppression
* uses: initial in advanced ovarian cancer
49
What is vincristine and what are side effects?
* microtubule inhibitor
* periperal neuropathy, nephrotoxic
* uses: ALL, HL, NHL, neuroblastoma, rhabdomyosarcoma, Wilms tumor
50
What is vinBlastine and what is a side effect?
* microtubule inhibitor
* bone myelosuppression
* HL, Kaposi sarcoma, Langerhans cell histiocytosis, NHL, testicular cancer
51
How do alkylating agents work?
transfer alkyl groups; form covalent bonds
52
What is the active metabolite of cyclophosphamide and what are the side effects?
Acrolein; gonadal dysfunction, SIADH, hemorrhagic cystitis
53
What can help with hemorrhagic cystitis from cyclophosphamide?
Mesna
54
What is levamisole, what is its role in CA tx?
Anti-helminthic drug - can stimulate the immune system against CA
55
How does methotrexate work, what are its side effects?
What are its uses?
* inhibits dihydrofolate reductase, which inhibits purine and DNA synthesis
* renal toxicity, hematologic sfx
* careful in patients w/ alcoholism, liver dz, immunodeficiency, blood dyscrasias
* Many uses: ALL, BRCA, ENT cancer, T-cell lymphoma, lung cancer, NHL, osteosarcoma, psoriasis, RA, pJIA
56
What is leucovorin rescue?
reverses toxic effects of methotrexate by increasing folate
57
How does 5-fluorouracil work?
What is it used for?
* inhibits thymidylate synthesis which inhibits purine and DNA synthesis
* Uses: breast cancer, CRC, gastric cancer, pancreatic cancer
58
What does leucovorin do in combination with 5-FU?
increases toxicity
59
What is Doxyrubicin and what is its toxicity?
* DNA intercalator, O2 radical formation
* Heart toxicity
* Uses: breast cancer, metastatic solid tumors, leukemia, lymphoma
60
How does etoposide work?
* inhibits topoisomerase which normally unwinds DNA
* SCLC, testicular cancer
61
Which chemo agents have the least myelosuppressive effects?
* bleomycin
* vincristine
* busulfan
* cisplatin
62
What is GCSF used for in chemo? What is the side effect?
Neutrophil recovery after chemo
Sweet's syndrome - acute febrile neutropenic dermatitis
63
In what cancer syndromes are normal organs resected to prevent cancer?
* FAP - colon
* BRCA I, II - breast
* RET or MENIN - thyroid
64
Rb1 is found on what chromosome and is involved in what?
* Chromosome 13
* Cell cycle
* Bladder cancer
65
p53 is found on what chromosome and does what in normal cell-cycle?
* Chromosome 17
* normal gene induces cell cycle arrest and apoptosis
* Li Fraumeni
66
APC is found on what chromosome and does what?
* chromosome 5
* cell adhesion and cytoskeletal function
* colorectal cancer
67
DCC (deleted in colorectal carcinoma) is found on what chromosome and does what?
* chromosome 18
* cell adhesion
* CRC
68
Ras proto-oncogene has a defect on what protein?
* G-protein
* pancreatic ductal adenocarcinoma
69
Src proto-oncogene has a defect on what enzyme?
tyrosine kinase defect
70
Sis oncogene has a defect on what receptor?
platelet-derived growth factor receptor defect
71
Erb B oncogene has a defect on what receptor?
epidermal growth factor receptor defect
72
Myc oncogene has a defect where?
* transcription factor defect
* nasopharyngeal carcinoma
73
what is Li Fraumeni syndrome?
defect in p53 gene - pts get childhood sarcomas, breast ca, brain tumors, leukemia, adrenal CA
74
Medullary ca of the thyroid is associated with what oncogene?
Ret proto oncogene on chromosome 10. (defect + family hx = 90% chance of medullary thyroid CA- prophylactic total thyroidectomy
75
Genes involved in development of Colon cancer include?
* APC (cell adhesion/cytoskeletal fxn; 1st mutation in development of ca)
* p53
* DCC
* K-ras
76
Coal tar is carcinogenic to what?
larynx, skin, bronchial Ca
77
Beta-naphtylamine is carcinogenic to what?
Urinary tract
78
Benzene causes what cancer?
leukemia
79
Asbestos causes what cancer?
mesothelioma
80
Supraclavicular node suspicious for what types of cancer?
* neck
* breast
* lung
* stomach (virchow's node)
81
Axillary node suspicious for what types of cancer?
* lymphoma (#1)
* breast
* melanoma
82
Ovarian metastases from what primary cancer?
* stomach (Krukenberg tumor)
* colon
83
Periumbilical node suspicious for what cancer?
-pancreatic ca (Sr. Mary Joseph's node)
84
Bone metastases usually from what primary?
* breast (#1)
* prostate
\*almost never colon cancer
85
Skin metastases from what primary cancer?
* breast
* melanoma
86
Small bowel metastases from what primary cancer?
Melanoma (#1)
87
Phase I trial determines what?
is it safe and at what dose?
88
Phase II determines what?
is it effective?
89
Phase III determines what?
is it better than existing therapy?
90
Phase IV determines what?
implementation and marketing
91
What is induction therapy?
sole treatment - for advanced disease or when no other tx exists
92
What is primary neoadjuvant therapy?
chemo given first followed by another therapy
93
What is adjuvent therapy?
combined with another modality; given after another therapy
94
What is salvage therapy?
used when tumors fail to respond to initial therapy
95
What is en bloc multiorgan resection used for?
locally invasive tumors (colon into uterus, adrenal into liver, gastric into diaphragm)
96
What is palliative surgery?
not curative - hollow viscus obstructing tumors, pancreatic with biliary obstruction, breast with skin or chest wall involvement
97
Does sentinal lymph node biopsy have a role in patients with clinically palpable nodes?
No. Palpable nodes need to be sampled.
98
Liver mets from colon have what percentage 5 year survival if successfully resected?
25%
99
What are the most successfully cured metastases with surgery?
* Colon to liver
* Sarcoma to lung
100
What is one tumor that has improved outcome with debulking?
ovarian
101
What solid tumors are curable with chemo alone?
* Hodgkins
* non-Hodgkins lymphoma
102
What are the T-cell lymphomas caused by?
- HTLV-1 (skin lesions)
- Mycosis fungoides (Sezary cells)
103
What are HIV related malignancies?
- Kaposi's sarcoma
- non-Hodgkin's lymphoma
104
For gallbladder cancer, what is the role for adjuvant therapy?
* \> or = to T2, node positive, margin positive
* gemcitibine and cisplatin
* follow CEA and CA 19-9
105
What is the role for risk-reducing BSO in patients with BRCA1?
Lynch syndrome?
* The lifetime risk of ovarian cancer is 35 to 46 percent in women with BRCA1 gene mutations, 13 to 23 percent in those with BRCA2 mutations, and 3 to 20 percent in those with Lynch syndrome.
* Pts w/ BRCA who have completed childbearing: rrBSO is recommended over screening or chemoprevention
* Premenopausal pts w/ Lynch syndrome who have completed childbearing: rrBSO over cancer screening or chemoprevention
106
What prognostic factor does HER2 positivity represent?
Negative prognostic factor - correlation between HER2 overexpression and shorter disease-free and overall survival. Tx w/ trastuzumab.
Encodes a 185-kDa transmembrane glycoprotein with tyrosine kinase activity that is a member of the EGFR family
107
Hepatoblastoma marker?
AFP
It is found in the developing fetus in the liver and yolk sac cells and not found in normal adults.
108
HCC marker?
AFP
109
What is recommended as adjuvant therapy for cutaneous melanoma that is stage III or IV, or with a BRAF mutation?
nivolumab
110
S/p total thyroidectomy for differentiated cancer, what can be used as a biomarker for disease recurrence?
thyroglobulin
111
The most common mutation in pancreatic cancer occurs in which gene?
K-ras
Also: CA 19-9, p53
