Chapter 11: Oncology Flashcards
1
Q
2 cause of death in the United States
A
Cancer
2
Q
MC Ca in women
A
Breast cancer
3
Q
MCC cancer related death in women
A
Lung cancer
4
Q
MC Cancer in men
A
Prostate cancer
5
Q
Used to identify metastases; defects fluorodeoxyglucose molecules
A
PET (positron emission tomography)
6
Q
Need MHC complex to attack tumor
A
Cytotoxic T cells
7
Q
Can independently attack tumor cells
A
Natural killer cells
8
Q
Are random unless viral-induced tumor
A
Tumor antigens
9
Q
Tumor marker: colon ca
A
CEA
10
Q
Tumor marker: liver CA
A
AFP
11
Q
Tumor marker: pancreatic CA
A
CA 19-9
12
Q
Tumor marker: Ovarian ca
A
CA 125
13
Q
Tumor marker: testicular Ca, choriocarcinoma
A
Beta-HCG
14
Q
Tumor marker: prostate CA
A
PSA
15
Q
Prostate CA: thought to be tumor marker with the highest sensitivity, although specificity is low
A
PSA
16
Q
Tumor marker: small cell lung CA, neuroblastoma
A
NSE
17
Q
Tumor marker: breast CA
A
BRCA I and II
18
Q
Tumor marker: carcinoid tumor
A
Chromogranin A
19
Q
Tumor marker: thyroid medullary CA
A
Ret oncogene
20
Q
Half life: CEA
A
18 days
21
Q
Half life: PSA
A
18 days
22
Q
Half life: AFP
A
5 days
23
Q
Two components of cancer transformation
A
- Heritable alteration in genome and;
2. Loss of growth regulation
24
Q
Oncogenesis: time between exposure and formation of clinically detectable tumor
A
Latency period
25
Three phases of latency period
1. Initiation (carcinogen acts with DNA)
2. Promotion (then occurs)
3. Progression (cancers cells to clinically detectable tumor)
26
What can neoplasms arise from?
Carcinogenesis (e.g. smoking)
Viruses (eg, EBV)
Immunodeficiency (eg HIV)
27
What do retroviruses contain?
Oncogenes
28
Associated with Burkitt's lymphoma (8:14 translocation) and nasopharyngeal CA (c-myc)
Ebstein-Barr Virus
29
Human genes with malignant potential
Proto-oncogenes
30
Infectious agent: cervical cancer
Human papillomavirus
31
Infectious agent: gastric cancer
Helicobacter pylori
32
Infectious agent: hepatocellular carcinoma
Hepatitis B and hepatitis C viruse
33
Infectious agent: nasopharyngeal carcinoma
EBV
34
Infectious agent: Burkitt's lymphoma
EBV
35
Infectious agent: various lymphomas
HIV
36
Most vulnerable stage of cell cycle for XRT
M phase
37
Radiation therapy: what causes most of the damage?
Most damage done by formation of oxygen radicals -> maximal effect with high oxygen levels
38
Main target of radiation therapy
DNA: oxygen radicals and XRT itself damage DNA and other molecules
39
How does high-eneregy radiation have a skin--preserving effect?
Maximal ionizing potential not reached until deeper structures
40
What do fractionate XRT doses allow?
- Repair of normal cells
- Re-oxygenation of tumor
- Redistribution of tumor cells in the cell cycle
41
Very radiosensitive tumors
Seminomas, lymphomas
42
Very radio resistant tumors
Epithelial, sarcomas
43
Less responsive to XRT due to lack of oxygen in the tumor
Large tumors
44
Source of radiation in or next to tumor (Au-198, I-128); delivers high, concentrated doses of radiation
Brachytherapy
45
Chemo Agent: exhibit plateau in cell-killing ability
Cell cycle-specific agents (5FU, methotrexate)
46
Chemo Agent: Linear response to cell killing
Cell cycle-nonspecific agents
47
Chemo Agent: Decreases short-term (5 year) risk of breast CA 45%
Tamoxifen (blocks estrogen receptor)
48
Complications: tamoxifen therapy
1% risk of blood clots
| 0.1 % risk of endometrial cancer
49
Chemo Agent: promotes microtubule formation and stabilization that cannot be broken down; cells are ruptures
Taxol
50
Chemo Agent: can cause pulmonary fibrosis
Bleomycin
| Busulfan
51
Chemo Agent: nephrotoxic, neurotoxic, ototoxic
Cisplatin (platinum alkylating agent)
52
Chemo Agent: bone (myelo) suppression
Carboplatin (platinum alkylating agent) *and*
| Vinblastine (microtubule inhibitor)
53
Chemo Agent: peripheral neuropathy, neurotoxic
Vincristine (microtubule inhibitor)
54
Chemo Agent: transfer alkyl groups; forms covalent bonds to DNA
Alkylating agents
55
Chemo Agent: Acrolein is the active metabolite.
| - Side effects: gonadal dysfunction, SIADH, hemorrhagic cystitis
Cyclophosphamide
56
Tx: hemorrhagic cystitis s/t cyclophosphamide
Mesna
57
Chemo Agent: antihelminthic drug though to stimulate immune system against cancer
Levamisole
58
Chemo Agent: inhibits dihydrofolate reductase (DHFR), which inhibits purine and DNA synthesis
- Side effects: renal toxicity, radiation recall
Methotrexate
59
Reverses effects of methotrexate by re-supplying folate
Leucovorin rescue (folinic acid)
60
Chemo Agent: inhibits thymidylate synthetase, which inhibits purine and DNA syntehsis
5-fluorouracil (5FU)
61
Increases toxicity of 5-fluorouracil
Leucovorin (folinic acid)
62
Chemo Agent: DNA intercalator, oxygen radical formation
Doxorubicin
63
Side effects: doxorubicin
Heart toxicity secondary to oxygen radicals at total doses > 500 mg/m^2.
64
Chemo Agent: inhibits topoisomerase (which normally unwinds DNA)
Etoposide (VP-16)
65
Chemo Agents: least myelosuppression
Bleomycin, vincristine, busulfan, cisplatin
66
Used for neutrophil recovery after chemo; side effects - Sweet's syndrome (acute febrile neutropenic dermatitis)
GCSF (granulocyte colony-stimulating factor
67
Acute febrile neutropenic dermatitis
Sweet's syndrome
68
When to consider resection of a normal organ to prevent cancer -> breast
BRCA I or II with strong family history
69
When to consider resection of a normal organ to prevent cancer -> thyroid
RET proto-oncogene with family history thyroid cancer
70
Tumor suppressor gene: chromosome 13; involved in cell cycle regulation
Retinoblastoma
71
Tumor suppressor gene: chromosome 17; involved in cell cycle
p53
72
Normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth
p53
73
Tumor suppressor gene: chromosome 5, involved with cell cycle regulation and movement
APC
74
Tumor suppressor gene: chromosome 18; involved in cell adhesion
DCC
75
Tumor suppressor gene: involved in apoptosis (programmed cell death)
bcl
76
Chromosome: p53
17
77
Chromosome: APC
5
78
Chromosome: DCC
18
79
Proto-oncogene: G protein defect
ras proto-oncogene
80
Proto-oncogene: tyrosine kinase defect
src proto-oncogene
81
Proto-oncogene: platelet-derived growth factor receptor defect
sis proto-oncogene
82
Proto-oncogene: epidermal growth factor receptor defect
erb B proto-oncogene
83
Proto-oncogene: proto-oncogenes - transcription factors
myc (c-myc, n-myc, l-myc)
84
Defect in p53 gene -> patients get childhood sarcomas, breast CA, brain tumors, leukemia, adrenal CA
Li-Fraumeni syndrom
85
- Gene involved in development include APC, p53, DCC, and K-ras
- APC though to be initial step in evolution
- Does not usually go to bone
Colon cancer
86
Carcinogens: coal tar
Larynx, skin, bronchial CA
87
Carcinogens: beta-naphthylamine
Urinary tract CA (bladder CA)
88
Carcinogens: benzene
Leukemia
89
Carcinogens: asbestos
Mesothelioma
90
DDX: suspicious supraclavicular node
Neck, breast, lung, stomach (Virchow's node), pancreas
91
DDX: suspicious axillary node
Lymphoma (#1), breast, melanoma
92
DDX: suspicious periumbilical node
Pancreas (Sister Mary Joseph's node)
93
DDx: ovarian metastases
Breast (#1), prostate
94
DDx: skin metastases
Breast, melanoma
95
DDx: small bowel metastases
Melanoma (#1)
96
Clinical trials:
- Phase 1
- Phase 2
- Phase 3
- Phase 4
- Phase 1: Is it safe and at what dose?
- Phase 2: Is it effective?
- Phase 3: Is it better than existing therapy?
- Phase 4: implementation and marketing
97
What is induction therapy?
Sole treatment; use for advanced disease or when no other treatment exists
98
What is primary therapy?
(Neoadjuvant) - chemo give 1st (usually), followed by another (secondary) therapy
99
What is adjuvant therapy?
Combined with another modality; given after other therapy is used
100
What is salvage therapy?
For tumors that final to respond to initial chemotherapy
101
Have poor barrier function -> better to view them as signs of probably metastasis
Lymph nodes
102
Can be attempted for some tumors (colon into uterus, adrenal into liver, gastric into spleen); aggressive local invasiveness is different from metastatic disease
En bloc multiorgan resection
103
Tx: tumors of hollow visit causing obstruction or bleeding (colon Ca), breast CA with skin or chest wall involvement
Palliative surgery
104
No role in patients with clinically palpable nodes; you need to get after and sample these nodes
Sentinel lymph node biopsy
105
35% 5-year survival rate if successfully resected
Colon metastases to the liver
106
Prognostic indictors for survival after resection of hepatic colorectal metastases
Disease-free interval > 12 months, tumor number
107
Most successfully cured metastases with surgery
Colon CA in liver, sarcoma to the lung, but survival still low overall for these
108
One of the few tumors for which surgical debunking improves chemotherapy (not seen in other tumors)
Ovarian CA
109
Curable solid tumors with chemotherapy only
Hodgkin's and non-Hodgkin's lymphoma
110
T cell lymphomas
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HTLV-1 (skin lesions)
Mycosis fubgoides (Sezary cells)
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111
HIV related malignancies
Kaposi's sarcoma, non-Hodgkin's lymphoma
112
Causes angiogenesis; involved in tumor metastasis
V-EGF (Vascular epidermal growth factor)
