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.
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 marker?
A
CEA
12
Q
Liver marker?
A
AFP
13
Q
Pancreatic marker?
A
CA 19-9
14
Q
Ovarian marker?
A
CA 125
15
Q
Testicular marker?
A
Beta-HCG
16
Q
Choriocarcinoma marker?
A
Beta-HCG
17
Q
Prostate marker?
A
PSA (highest sensitivity of markers)
18
Q
Small cell lung marker?
A
NSE
19
Q
Neuroblastoma marker?
A
NSE
20
Q
CEA, PSA, AFP marker half lives?
A
CEA 18; PSA 18; AFP 5
21
Q
What is cancer transformation?
A
heritable alteration in genome- loss of growth regulation
22
Q
What is the latency period of oncogenesis?
A
time between exposure and formation of clinically detectable tumor
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
24
Q
What are three ways neoplasms can arise?
A
carcinogenesis (smoking), viruses (EBV), Immunodeficiency (HIV)
25
How do viruses cause cancer?
Contain oncogenes
26
What is translocation that occurs with EBV?
8:14- causes Burkitt's; c-myc causes nasopharyngeal
27
Cervical caused by?
HPV
28
Gastric caused by?
H. Pylori
29
Hepatocellular caused by?
Hep B and Hep C
30
Kaposi's caused by?
HHV-8
31
Primary effusion lymphoma caused by?
HHV-8
32
Splenic lymphoma caused by?
Hep C
33
Nasopharyngeal caused by?
EBV
34
Burkitt's caused by?
EBV
35
Adult T-cell leukemia/lymphoma caused by?
Human T-cell leukemia virus-1
36
What cell phase is the most vulnerable for radiation?
M phase
37
How does radiation therapy cause damage?
formation of oxygen radicals- damage DNA and other molecules. XRT can also cause small breaks in DNA primarily
38
How does higher energy radiation have a skin preserving effect?
maximal energy not reached until it gets to deeper structures
39
Why are fractionated doses of radiation helpfule?
- allows for repair of normal cells
- allows reoxygenation of tumor cells
- Allows for redistribution of tumor cells in cell cycle
40
What tumor types are very radiosensitive?
seminomas and lymphomas
41
What tumor types are very radioresistant?
epithelial, sarcomas
42
Why are large tumors less responsive to XRT?
lack of oxygen in the tumor
43
What is brachytherapy?
source of radiation in or next to tumor (Au-198, I-128)
44
What are cell cycle specific agents?
5FU, methotrexate- exhibit plateau in cell killing ability
45
What does tamoxifen do?
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
What does taxol do?
promotes microtubule formation and stabilization that cannot be broken down- cell ruptures
47
What are side effects of bleomycin and busulfan?
pulmonary fibrosis
48
What is cisplatin and what are the side effects?
platinum alkylating agent. Nephrotoxic, neurotoxic, ototoxic.
49
What is carBoplatin and what is a side effect?
platinum alklating agent; Bone myelo suppresion
50
What is vincristine and what are side effects?
microtubule inhibitor; periperal neuropathy, nephrotoxic
51
What is vinBlastine and what is a side effect?
microtubule inhibitor; Bone myelo suppression
52
How do alkylating agents work?
transfer alkyl groups; form covalent bonds
53
What is the active metabolite of cyclophosphamide and what are the side effects?
Acrolein; gonadal dysfunction, SIADH, hemorrhagic cystitis
54
What can help with hemorrhagic cystitis from cyclophosphamide?
Mesna
55
What is levamisole, what is its role in CA tx?
Anti-helminthic drug- can stimulate immune system against CA
56
How does methotrexate work, what are its side effects?
inhibits dihydrofolate reductase which inhibits purine and DNA synthesis; renal toxicity
57
What is leucovorin rescue?
decreases folate, reverses effects of methotrexate
58
How does 5-fluorouracil work?
inhibits thymidylate synthesis which inhibits purine and DNA synthesis
59
What does leucovorin do in combination with 5-FU?
increases toxicity
60
What is Doxyrubicin and what is its toxicity?
DNA intercalator, O2 radical formation; Heart toxicity
61
how does etoposide work?
inhibits topoisomerase which normally unwinds DNA
62
Which agents have the least myelosuppressive effects?
- bleomycin
- vincristine
- busulfan
- cisplatin
63
What is GCSF used for? what is the side effect?
Neutrophil recovery after chemo; Sweet's syndrome- acute febrile neutropenic dermatitis
64
In what syndromes are normal organs resected to prevent cancer?
- FAP colon
- BRCA I, II- breast
- RET or MENIN - thyroid
65
Rb1 is found where and is involved in what?
Chromosome 13; involved in cell cycle
66
p53 is found where and does what in normal cell cycle?
Chromosome 17; normal gene induces cell cycle arrest and apoptosis
67
APC is found where and does what?
chromosome 5; cell adhesion and cytoskeletal function
68
DCC is found where and does what?
chromosome 18; cell adhesion
69
ras proto oncogene has a defect where?
G-proten
70
src proto oncogene has a defect where?
tyrosine kinase defect
71
sis oncogene has a defect where?
platelet derived growth factor receptor defect
72
erb B oncogene has a defect where?
epidermal growth factor receptor defect
73
myc oncogene has a defect where?
transcription factor defect
74
what is Li Fraumeni syndrome?
defect in p53 gene- pts get childhood sarcomas, breast ca, brain tumors, leukemia, adrenal CA
75
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
76
Genes involved in development of Colon Ca includes?
- APC (cell adhesion/cytoskeletal fxn; 1st mutation in development of ca)
- p53
- DCC
- K-ras
77
Where does colon cancer not metastasize to?
Bone
78
Coal tar is carcinogenic to what?
larynx, skin, bronchial Ca
79
Beta-naphtylamine is carcinogenic to what?
Urinary tract
80
Benzene causes?
leukemia
81
Asbestos causes?
mesothelioma
82
Supraclavicular node suspicious for what?
- neck
- breast
- lung
- Stomach (virchow's node)
83
Axillary node suspicious for what?
- Lymphoma (#1)
- breast
- melanoma
84
Ovarian metastases from what primary?
- Stomach (krukenberg tumor)
| - colon
85
Periumbilical node suspicious for what?
-pancreatic ca (Sr. Mary Joseph's node)
86
Bone metastases from what primary?
- breast (#1)
| - prostate
87
Skin metastases from what primary?
breast, melanoma
88
Small bowel metastases from what primary?
Melanoma (#1)
89
Phase I trial determines what?
is it safe and at what dose
90
Phase II determines what?
is it effective
91
Phase III determines what?
is it better than existing therapy
92
Phase IV determines what?
implementation and marketing
93
What is induction therapy?
sole treatment- for advanced disease or when no other tx exists
94
What is primary neoadjuvant therapy?
chemo given first followed by another therapy
95
What is adjuvent therapy?
combined with another modality; given after another therapy
96
What is salvage therapy?
used when tumors fail to respond to initial therapy
97
What is en bloc multiorgan resection used for?
locally invasive tumors (colon into uterus, adrenal into liver, gastric into diaphragm)
98
What is palliative surgery?
not curative - hollow viscus obstructing tumors, pancreatic with biliary obstruction, breast with skin or chest wall involvement
99
Does sentinal lymph node biopsy have a role in patients with clinically palpable nodes?
No. palpable nodes need to be sampled.
100
Liver mets from colon have what percentage 5 year survival if successfully resected?
25%
101
What are the most successfully cured metastases with surgery?
- Colon to liver
| - Sarcoma to the lung
102
What is one tumor that has improved outcome with debulking?
ovarian
103
What solid tumors are curable with chemo alone?
- hodgkins
| - non-hodgkins lymphoma
104
What are the T-cell lymphomas caused by?
- HTLV-1 (skin lesions)
| - Mycosis fungoides (Sezary cells)
105
What are HIV related malignancies?
- Kaposi's sarcoma
| - non-hodgkin's lymphoma
