Chapter 15 Flashcards
What is the second most common cause of death?
What is first?
Malignant CA
Heart dz
What are the top three common causes of CA for men?
Prostate
Lung
Colorectal
What are the top three common causes of CA for women?
Breast
Lung
Colorectal
Oncogenes
Mutated forms of normal cellular genes generally conferring uninhibited cell growth
Mechanisms of oncogenes
Point mutation (Ras family), chromosomal translocation (CML 9 and 22), gene amplification (N-myc oncogene in neuroblastoma)
Tumor suppressor gene
Result in loss of function (TSG p53)
Physical carcionogens
Radiation is carcinogen
Ionizing radiation- leukemia
UV light- nonmelanocytic skin cancers
Chemical carcinogens
Tobacco (lung cancer)
Asbestos
Benzene
Aromatic amines
Dietary carcinogens
Alcohol (oropharynx, esophagus, liver)
Salt (Nasopharyngeal, gastric)
Animal fats (breast, colon)
Viral carcinogens
HCV (hepatocellular carcinoma)
Growth characteristics of tumor phenotype
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
Angiogenesis
Delivery of nutrients and growth factors is required to sustain tumor growth
Without neovascularization, tumors fail to grow beyond a few milimeters
What occurs during tumor development in angiogenesis
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
How is angiogenesis treated?
Treated with angiogenesis inhibitor- bevacizumab (binds to VGEF)
Invasion and metastasis
Ability to cross the basement membrane
Carcinoma in situ
The whole layer is bad
Associated cancer with cryptorchidism
Prophylactic sugery
Testicular
Ochiopexy
Associated cancer with FAP
Prophylactic surgery
Colon
Colectomy
Associated cancer with HNPCC/Lynch syndrome
Prophylactic surgery
Colon
Colectomy
Associated cancer with ulcerative colitis
Prophylactic surgery
Colon
Colectomy
Associated cancer with MEN type 2 and 3
Prophylactic surgery
Medullary cancer of the thyroid
Thyroidectomy
Associated cancer with familial breast cancer
Prophylactic surgery
Breast
Mastectomy
Associated cancer with familial ovarian cancer
Prophylactic surgery
Ovary
Oophrectomy
Neoadjuvant therapy
Systemic or radiation therapy prior to definitive surgery
Principles of chemo
Induction or primary chemo- administered as primary tx for metastatic dz
Adjuvant chemo- given after another tx modality (surgical resection)
Principles of radiation therapy
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
Indications for busulfan
CML
Myeloproliferative d/o
Toxicities for busulfan
Myelosuppression
Pulmonary fibrosis
Gonadal dysfunction
Marrow failue
Indications for cisplatin
Carcinomas of: Ovaries Testis Cervix Head an neck Bladder Lung (small and NSCLC) Esophagus Lymphomas
Indications for 5-FU
Carcinomas of: Breast Cervix Head and neck GI tract Nonmelanoma skin cancer
Toxicities for 5-FU
Mucositis Diarrhea Myelosuppression Dermatitis Hepatotoxicity (intra-arterial therapy) Nausea and vomiting
Indications for methotrexate
Carcinomas of: Breast Head and neck Esophagus Choriocarcinoma Leptomeningeal Carcinomatosis Osteogenic sarcoma
Toxicities for methotrexate
Myelosuppression Stomatitis Diarrhea Intestinal bleeding and perf Arachnoiditis Hepatic dysfunction Cirrhosis Radiating recall Pneumotitis Renal dysfunction
Indication for fludarabine
B0 cell chronic lymphocytic leukemia
Toxicities for fludarabine
Myelosuppression Tumor lysis syndrome Weakness Neurotoxicity Edema Pneumonitis N/V Anorexia Bleeding Stomatitis Diarrhea
