Chapter 15

Question 1

What is the second most common cause of death?

What is first?

Answer 1

Malignant CA

Heart dz

Question 2

What are the top three common causes of CA for men?

Answer 2

Prostate
Lung
Colorectal

Question 3

What are the top three common causes of CA for women?

Answer 3

Breast
Lung
Colorectal

Question 4

Oncogenes

Answer 4

Mutated forms of normal cellular genes generally conferring uninhibited cell growth

Question 5

Mechanisms of oncogenes

Answer 5

Point mutation (Ras family), chromosomal translocation (CML 9 and 22), gene amplification (N-myc oncogene in neuroblastoma)

Question 6

Tumor suppressor gene

Answer 6

Result in loss of function (TSG p53)

Question 7

Physical carcionogens

Answer 7

Radiation is carcinogen
Ionizing radiation- leukemia
UV light- nonmelanocytic skin cancers

Question 8

Chemical carcinogens

Answer 8

Tobacco (lung cancer)
Asbestos
Benzene
Aromatic amines

Question 9

Dietary carcinogens

Answer 9

Alcohol (oropharynx, esophagus, liver)
Salt (Nasopharyngeal, gastric)
Animal fats (breast, colon)

Question 10

Viral carcinogens

Answer 10

HCV (hepatocellular carcinoma)

Question 11

Growth characteristics of tumor phenotype

Answer 11

Typically not seen until ~1 cm (30 doubling from a single cell)
Only 10 additional doublings are required to reach a lethal size of 1 kg
Depends on 3 factors:
-Tumor growth fraction
-Duration of the cell cycle
-Balance between cell proliferation and death

Question 12

Angiogenesis

Answer 12

Delivery of nutrients and growth factors is required to sustain tumor growth
Without neovascularization, tumors fail to grow beyond a few milimeters

Question 13

What occurs during tumor development in angiogenesis

Answer 13

An angiogenic switch occurs, favoring proangiogenic factors
This may result from an increase in proangiogenic factors such as VEGF or basic fibroblast growth factor (BFGF) or from a decrease in anti-angiogenic factors such as thrombospondin-1 (TSP-1)
Leads to neovascularization
Leads to tumor growth and metastasis

Question 14

How is angiogenesis treated?

Answer 14

Treated with angiogenesis inhibitor- bevacizumab (binds to VGEF)

Question 15

Invasion and metastasis

Answer 15

Ability to cross the basement membrane

Question 16

Carcinoma in situ

Answer 16

The whole layer is bad

Question 17

Associated cancer with cryptorchidism

Prophylactic sugery

Answer 17

Testicular

Ochiopexy

Question 18

Associated cancer with FAP

Prophylactic surgery

Answer 18

Colon

Colectomy

Question 19

Associated cancer with HNPCC/Lynch syndrome

Prophylactic surgery

Answer 19

Colon

Colectomy

Question 20

Associated cancer with ulcerative colitis

Prophylactic surgery

Answer 20

Colon

Colectomy

Question 21

Associated cancer with MEN type 2 and 3

Prophylactic surgery

Answer 21

Medullary cancer of the thyroid

Thyroidectomy

Question 22

Associated cancer with familial breast cancer

Prophylactic surgery

Answer 22

Breast

Mastectomy

Question 23

Associated cancer with familial ovarian cancer

Prophylactic surgery

Answer 23

Ovary

Oophrectomy

Question 24

Neoadjuvant therapy

Answer 24

Systemic or radiation therapy prior to definitive surgery

Question 25

Principles of chemo

Answer 25

Induction or primary chemo- administered as primary tx for metastatic dz Adjuvant chemo- given after another tx modality (surgical resection)

Question 26

Principles of radiation therapy

Answer 26

``` Direct and indirect toxic effects on tumor cells (breaks DNA) Internal radiotherapy (brachytherapy)- source is placed within or adjacent to target tissue External beam radiotherapy (teletherapy)- high energy electomagnetic beam ```

Question 27

Indications for busulfan

Answer 27

CML | Myeloproliferative d/o

Question 28

Toxicities for busulfan

Answer 28

Myelosuppression Pulmonary fibrosis Gonadal dysfunction Marrow failue

Question 29

Indications for cisplatin

Answer 29

``` Carcinomas of: Ovaries Testis Cervix Head an neck Bladder Lung (small and NSCLC) Esophagus Lymphomas ```

Question 30

Indications for 5-FU

Answer 30

``` Carcinomas of: Breast Cervix Head and neck GI tract Nonmelanoma skin cancer ```

Question 31

Toxicities for 5-FU

Answer 31

``` Mucositis Diarrhea Myelosuppression Dermatitis Hepatotoxicity (intra-arterial therapy) Nausea and vomiting ```

Question 32

Indications for methotrexate

Answer 32

``` Carcinomas of: Breast Head and neck Esophagus Choriocarcinoma Leptomeningeal Carcinomatosis Osteogenic sarcoma ```

Question 33

Toxicities for methotrexate

Answer 33

``` Myelosuppression Stomatitis Diarrhea Intestinal bleeding and perf Arachnoiditis Hepatic dysfunction Cirrhosis Radiating recall Pneumotitis Renal dysfunction ```

Question 34

Indication for fludarabine

Answer 34

B0 cell chronic lymphocytic leukemia

Question 35

Toxicities for fludarabine

Answer 35

``` Myelosuppression Tumor lysis syndrome Weakness Neurotoxicity Edema Pneumonitis N/V Anorexia Bleeding Stomatitis Diarrhea ```