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Fiser's ABSITE Ryan > Chapter 11 - Oncology > Flashcards

Chapter 11 - Oncology Flashcards

1
Q

Most common cancer in women?

A

Breast

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2
Q

Most common cause of CA related death in women?

A

Lung

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3
Q

Most common cancer in men?

A

Prostate

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4
Q

Most common CA related death in men?

A

Lung

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5
Q

What is a PET scan?

A

positron emission tomography scan. Identifies fluorodeoxyglucose molecules.

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6
Q

What do T-cells require to attack tumor cells?

A

MHC complex

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7
Q

Do natural killer cells require MHC to attack tumor cells?

A

no

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8
Q

Hyperplasia means what?

A

increased number of cells

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9
Q

Metaplasia means what?

A

replacement of one tissue with another (GERD - squamous esophagus changed to columnar gastric tissue)

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10
Q

Dysplasia means what?

A

altered size, shape, and organization of cells (Barrett’s esophagus)

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11
Q

Colon marker?

A

CEA

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12
Q

Liver marker?

A

AFP

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13
Q

Pancreatic marker?

A

CA 19-9

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14
Q

Ovarian marker?

A

CA 125

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15
Q

Testicular marker?

A

Beta-HCG

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16
Q

Choriocarcinoma marker?

A

Beta-HCG

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17
Q

Prostate marker?

A

PSA (highest sensitivity of markers)

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18
Q

Small cell lung marker?

A

NSE

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19
Q

Neuroblastoma marker?

A

NSE

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20
Q

CEA, PSA, AFP marker half lives?

A

CEA 18; PSA 18; AFP 5

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21
Q

What is cancer transformation?

A

heritable alteration in genome- loss of growth regulation

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22
Q

What is the latency period of oncogenesis?

A

time between exposure and formation of clinically detectable tumor

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23
Q

What is the steps of oncogenesis?

A

initiation- carcinogen interacts with DNA; Promotion of cancer cells; Progression of cancer cells to clinically detectable tumor

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24
Q

What are three ways neoplasms can arise?

A

carcinogenesis (smoking), viruses (EBV), Immunodeficiency (HIV)

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25
Q

How do viruses cause cancer?

A

Contain oncogenes

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26
Q

What is translocation that occurs with EBV?

A

8:14- causes Burkitt’s; c-myc causes nasopharyngeal

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27
Q

Cervical caused by?

A

HPV

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28
Q

Gastric caused by?

A

H. Pylori

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29
Q

Hepatocellular caused by?

A

Hep B and Hep C

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30
Q

Kaposi’s caused by?

A

HHV-8

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31
Q

Primary effusion lymphoma caused by?

A

HHV-8

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32
Q

Splenic lymphoma caused by?

A

Hep C

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33
Q

Nasopharyngeal caused by?

A

EBV

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34
Q

Burkitt’s caused by?

A

EBV

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35
Q

Adult T-cell leukemia/lymphoma caused by?

A

Human T-cell leukemia virus-1

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36
Q

What cell phase is the most vulnerable for radiation?

A

M phase

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37
Q

How does radiation therapy cause damage?

A

formation of oxygen radicals- damage DNA and other molecules. XRT can also cause small breaks in DNA primarily

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38
Q

How does higher energy radiation have a skin preserving effect?

A

maximal energy not reached until it gets to deeper structures

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39
Q

Why are fractionated doses of radiation helpfule?

A
  • allows for repair of normal cells
  • allows reoxygenation of tumor cells
  • Allows for redistribution of tumor cells in cell cycle
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40
Q

What tumor types are very radiosensitive?

A

seminomas and lymphomas

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41
Q

What tumor types are very radioresistant?

A

epithelial, sarcomas

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42
Q

Why are large tumors less responsive to XRT?

A

lack of oxygen in the tumor

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43
Q

What is brachytherapy?

A

source of radiation in or next to tumor (Au-198, I-128)

44
Q

What are cell cycle specific agents?

A

5FU, methotrexate- exhibit plateau in cell killing ability

45
Q

What does tamoxifen do?

A

blocks estrogen receptor- decreases short term (5 year) risk of breast Ca by 45%. 1% risk of blood clots, 0.1% risk of endometrial ca

46
Q

What does taxol do?

A

promotes microtubule formation and stabilization that cannot be broken down- cell ruptures

47
Q

What are side effects of bleomycin and busulfan?

A

pulmonary fibrosis

48
Q

What is cisplatin and what are the side effects?

A

platinum alkylating agent. Nephrotoxic, neurotoxic, ototoxic.

49
Q

What is carBoplatin and what is a side effect?

A

platinum alklating agent; Bone myelo suppresion

50
Q

What is vincristine and what are side effects?

A

microtubule inhibitor; periperal neuropathy, nephrotoxic

51
Q

What is vinBlastine and what is a side effect?

A

microtubule inhibitor; Bone myelo suppression

52
Q

How do alkylating agents work?

A

transfer alkyl groups; form covalent bonds

53
Q

What is the active metabolite of cyclophosphamide and what are the side effects?

A

Acrolein; gonadal dysfunction, SIADH, hemorrhagic cystitis

54
Q

What can help with hemorrhagic cystitis from cyclophosphamide?

A

Mesna

55
Q

What is levamisole, what is its role in CA tx?

A

Anti-helminthic drug- can stimulate immune system against CA

56
Q

How does methotrexate work, what are its side effects?

A

inhibits dihydrofolate reductase which inhibits purine and DNA synthesis; renal toxicity

57
Q

What is leucovorin rescue?

A

decreases folate, reverses effects of methotrexate

58
Q

How does 5-fluorouracil work?

A

inhibits thymidylate synthesis which inhibits purine and DNA synthesis

59
Q

What does leucovorin do in combination with 5-FU?

A

increases toxicity

60
Q

What is Doxyrubicin and what is its toxicity?

A

DNA intercalator, O2 radical formation; Heart toxicity

61
Q

how does etoposide work?

A

inhibits topoisomerase which normally unwinds DNA

62
Q

Which agents have the least myelosuppressive effects?

A
  • bleomycin
  • vincristine
  • busulfan
  • cisplatin
63
Q

What is GCSF used for? what is the side effect?

A

Neutrophil recovery after chemo; Sweet’s syndrome- acute febrile neutropenic dermatitis

64
Q

In what syndromes are normal organs resected to prevent cancer?

A
  • FAP colon
  • BRCA I, II- breast
  • RET or MENIN - thyroid
65
Q

Rb1 is found where and is involved in what?

A

Chromosome 13; involved in cell cycle

66
Q

p53 is found where and does what in normal cell cycle?

A

Chromosome 17; normal gene induces cell cycle arrest and apoptosis

67
Q

APC is found where and does what?

A

chromosome 5; cell adhesion and cytoskeletal function

68
Q

DCC is found where and does what?

A

chromosome 18; cell adhesion

69
Q

ras proto oncogene has a defect where?

A

G-proten

70
Q

src proto oncogene has a defect where?

A

tyrosine kinase defect

71
Q

sis oncogene has a defect where?

A

platelet derived growth factor receptor defect

72
Q

erb B oncogene has a defect where?

A

epidermal growth factor receptor defect

73
Q

myc oncogene has a defect where?

A

transcription factor defect

74
Q

what is Li Fraumeni syndrome?

A

defect in p53 gene- pts get childhood sarcomas, breast ca, brain tumors, leukemia, adrenal CA

75
Q

Medullary ca of the thyroid is associated with what oncogene?

A

Ret proto oncogene on chromosome 10. (defect + family hx = 90% chance of medullary thyroid CA- prophylactic total thyroidectomy

76
Q

Genes involved in development of Colon Ca includes?

A
  • APC (cell adhesion/cytoskeletal fxn; 1st mutation in development of ca)
  • p53
  • DCC
  • K-ras
77
Q

Where does colon cancer not metastasize to?

A

Bone

78
Q

Coal tar is carcinogenic to what?

A

larynx, skin, bronchial Ca

79
Q

Beta-naphtylamine is carcinogenic to what?

A

Urinary tract

80
Q

Benzene causes?

A

leukemia

81
Q

Asbestos causes?

A

mesothelioma

82
Q

Supraclavicular node suspicious for what?

A
  • neck
  • breast
  • lung
  • Stomach (virchow’s node)
83
Q

Axillary node suspicious for what?

A
  • Lymphoma (#1)
  • breast
  • melanoma
84
Q

Ovarian metastases from what primary?

A
  • Stomach (krukenberg tumor)

- colon

85
Q

Periumbilical node suspicious for what?

A

-pancreatic ca (Sr. Mary Joseph’s node)

86
Q

Bone metastases from what primary?

A
  • breast (#1)

- prostate

87
Q

Skin metastases from what primary?

A

breast, melanoma

88
Q

Small bowel metastases from what primary?

A

Melanoma (#1)

89
Q

Phase I trial determines what?

A

is it safe and at what dose

90
Q

Phase II determines what?

A

is it effective

91
Q

Phase III determines what?

A

is it better than existing therapy

92
Q

Phase IV determines what?

A

implementation and marketing

93
Q

What is induction therapy?

A

sole treatment- for advanced disease or when no other tx exists

94
Q

What is primary neoadjuvant therapy?

A

chemo given first followed by another therapy

95
Q

What is adjuvent therapy?

A

combined with another modality; given after another therapy

96
Q

What is salvage therapy?

A

used when tumors fail to respond to initial therapy

97
Q

What is en bloc multiorgan resection used for?

A

locally invasive tumors (colon into uterus, adrenal into liver, gastric into diaphragm)

98
Q

What is palliative surgery?

A

not curative - hollow viscus obstructing tumors, pancreatic with biliary obstruction, breast with skin or chest wall involvement

99
Q

Does sentinal lymph node biopsy have a role in patients with clinically palpable nodes?

A

No. palpable nodes need to be sampled.

100
Q

Liver mets from colon have what percentage 5 year survival if successfully resected?

A

25%

101
Q

What are the most successfully cured metastases with surgery?

A
  • Colon to liver

- Sarcoma to the lung

102
Q

What is one tumor that has improved outcome with debulking?

A

ovarian

103
Q

What solid tumors are curable with chemo alone?

A
  • hodgkins

- non-hodgkins lymphoma

104
Q

What are the T-cell lymphomas caused by?

A
  • HTLV-1 (skin lesions)

- Mycosis fungoides (Sezary cells)

105
Q

What are HIV related malignancies?

A
  • Kaposi’s sarcoma

- non-hodgkin’s lymphoma

Fiser's ABSITE Ryan (50 decks)

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