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HEM/ONC > EXAM 2 - Stevich-Heemer > Flashcards

EXAM 2 - Stevich-Heemer Flashcards

1
Q

What cancer is the second most common and the most common cause of cancer-related deaths?

A

Lung cancer

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2
Q

What is the #1 risk factor for lung cancer?

A

Tobacco

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3
Q

What are the molecular abnormalities in the pathogenesis of lung cancer?

A

KRAS
EGFR
ALK

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4
Q

What are mutations in lung cancer?

A

activation of proto-oncogenes
inhibition of tumor suppressor genes
production of autocrine growth factors

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5
Q

What the 2 types of lung cancer?

A

Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)

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6
Q

small cell lung cancer expresses?

A

C-KIT (tyrosine kinase receptor)

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7
Q

non-small cell lung cancer expresses?

A

EGFR
ALK

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8
Q

Which mutations are less common in lung cancer?

A

BRAF
NTRK
ROS1

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9
Q

what is the use of prophylactic medications to prevent cancer development?

A

chemoprevention

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10
Q

what are chemo-preventive agents?

A

NSAIDs
retinoids
inhaled glucocorticoids
vitamin E
selenium

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11
Q

Which type of lung cancer is more common?

A

non-small cell lung cancer (NSCLC)

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12
Q

What type of lung cancer grows slower?

A

non-small cell lung cancer

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13
Q

what are the s/sx of lung cancer?

A

cough
SOB
chest pain
anorexia
weight loss
fatigue

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14
Q

what are the s/sx of paraneoplastic syndrome?

A

weight loss
cushing’s syndrome
hypercalcemia
SIADH
pulmonary hypertrophic osteoarthropathy
anemia

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15
Q

what are extrapulmonary s/sx?

A

bone pain / fractures
liver dysfunction
neurologic deficits
spinal cord compression

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16
Q

which type of lung cancer uses TNM staging?

A

non-small cell lung cancer

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17
Q

what are the common histologic types of non-small cell lung cancer?

A

adenocarcinoma
squamous cell
large cell carcinoma

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18
Q

What is the regimen for stage II lung cancer?

A

platinum-based regimens

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19
Q

stage IIIA lung cancer is treated with?

A

platinum-containing regimen and concurrent radiotherapy

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20
Q

what is consolidation therapy in lung cancer?

A

given to stage IIIB and IIIC
PD-L1 inhibitor - durvalumab
*** durvalumab is not used is patient has surgical resection

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21
Q

what are the 3 pathways for advanced NSCLC

A
  1. immune sensitive (PD-L1+)
  2. genetic mutation driven
  3. nonbiomarker-driven therapy
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22
Q

bevacizumab is for which type of histology in lung cancer?

A

nonsquamous

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23
Q

what are the 2 stages of SCLC

A

limited
extensive

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24
Q

what is primary treatment for extensive stage SCLC?

A

platinum with etoposide

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25
Q

what is the main side effect of cisplatin

A

nephrotoxicity

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26
Q

what is the main side effect of etoposide?

A

hypotension

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27
Q

Bevacizumab. What class and side effects?

A

class: VEGF inhibitor
side effects: bleeding, impaired wound healing, HTN, proteinuria

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28
Q

what are the side effects for PD-L1 inhibitors?

A

immune reactions

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29
Q

What ENDOCRINE factors cause an increased risk of breast cancer? decreased?

A

increased: early menarche, late age of natural menopause, nulliparity or late age of first birth
decreased: oophorectomy before 45 YO

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30
Q

What gene mutations are associated with breast cancer?

A

BRCA1
BRCA2

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31
Q

s/sx of metastases in breast cancer

A

bone pain, difficulty breathing, abdominal pain, jaundice, mental status change

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32
Q

What labs will be elevated in breast cancer?

A

tumor markers (CA 15-3, CEA)
Alk Phos
LFTs

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33
Q

breast cancer cells spread through

A

lymph channels
blood vessels

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34
Q

what cytotoxic chemotherapy is used in breast cancer?

A

doxorubicin
epirubicin
cyclophosphamide
methotrexate
fluorouracil
carboplatin
paclitaxel

35
Q

breast cancer: curative (stage I-III) systemic therapy is which classes?

A

anthracyclines (doxorubicin / epirubicin)
taxanes (paclitaxel / docetaxel)

36
Q

what is the ADR of anthracyclines

A

red urine
cardiotoxicity

37
Q

what is the ADR of taxanes

A

neuropathies

38
Q

breast cancer: stage I-III biologic therapy uses what class?

A

HER2 therapy (trastuzumab / pertuzumab)

39
Q

breast cancer: stage I-III endocrine therapy uses what classes?

A

aromatase inhibitors (anastrozole / letrozole)
tamoxifen gold standard

40
Q

breast cancer with bone metastases are treated with?

A

bone modifying agent (pamidronate / zoledronic acid / denosumab)

41
Q

what is mTOR and what drug is an mTOR inhibitor?

A

important mediator for cell proliferation and regulation of apoptosis, angiogenesis, and cellular metabolism
everolimus

42
Q

What is PI3K and what drug is a Pi3K inhibitor?

A

PI3Ks play a critical role in regulating many biological functions
Alpelisib

43
Q

what drugs are PARP inhibitors?

A

olaparib and talazoparib

44
Q

What tumor suppressor gene mutations are associated with ovarian cancer?

A

BRCA1 (more prevalent)
BRCA2

45
Q

if exposed to what hormone will you be at an increased risk of ovarian cancer?

A

estrogen

45
Q

and increase/decrease in the total number of ovulations increases the risk of ovarian cancer?

A

increase

46
Q

what is the incessant ovulation hypothesis

A

risk of mutations and cancer increase each time the ovarian epithelium undergoes cell repair

47
Q

a diet high in ______ increases the risk of ovarian cancer? a diet high in _____ decreases the risk of ovarian cancer

A

increases: galactose, animal fat, meat
decreases: vegetables

48
Q

what are the 3 cell/tumor types of ovarian cancer?

A

epithelial carcinoma (most common)
germ cell tumors
stromal carcinomas

49
Q

What are some preventative ways for ovarian cancer?

A

decrease the # of ovulations (multiparity, oral contraceptives)

50
Q

ovarian cancer is often asymptomatic, so known as the ?

A

silent killer

51
Q

What are some s/sx and labs for ovarian cancer?

A

symptoms: abdominal discomfort, nausea, dyspepsia, flatulence, bloating, eating/digestive issues, urinary issues, bowel issues, weight change
signs: abdominal or pelvic mass, irregular vaginal bleeding, ascites
labs: elevated CA-125, LFTs and renal function abnormalities

52
Q

goal of ovarian cancer depends on the ______ stage at diagnosis

A

FIGO

53
Q

What is the primary treatment for ovarian cancer?

A

surgery

54
Q

what is needed for accurate diagnosis and staging of ovarian cancer?

A

comprehensive exploratory laparotomy

55
Q

cannot readily biopsy a ovarian cancer tumor because of risk of ____?

A

tumor seeding (increases the risk of recurrence)

56
Q

Radiation therapy in ovarian cancer is used for what type of care?

A

palliative

57
Q

what is the first-line chemotherapy for ovarian cancer?

A

taxane and platinum regimen (following surgery)

58
Q

chemotherapy regimens for ovarian cancer are typically how many days?

A

21 or 28

59
Q

neoadjuvant chemotherapy for ovarian cancer is which classes?

A

taxane with platinum

60
Q

Consolidation therapy is given to patients WITH or WITHOUT measurable disease (ovarian cancer)

A

WITHOUT

61
Q

what medications are used for consolidation therapy in ovarian cancer?

A

bevacizumab and PARP inhibitors (olaparib / niraparib)

62
Q

maintenance therapy is given to patient WITH or WITHOUT measurable disease (ovarian cancer)

A

WITH

63
Q

what is the length of time that has lapsed since the completion of chemotherapy?

A

disease-free interval

64
Q

a patient is considered platinum-resistant if their cancer recurs in how much time?

A

< 6 months

65
Q

a patient is considered platinum-sensitive if their cancer recurs in how much time?

A

> 6 months

66
Q

platinum-sensitive patients are given what drugs for recurrent ovarian cancer?

A

platinum in combo with gemcitabine, doxorubicin, or paclitaxel

67
Q

platinum-resistant patients are given what agents for recurrent ovarian cancer?

A

Paclitaxel + bevacizumab
Topotecan + bevacizumab
cyclophosphamide + bevacizumab
gemcitabine
docetaxel
etoposide

68
Q

What are some risk factors for colorectal cancer?

A

age
adenomatous polyps
IBD
DM
family history

69
Q

what lifestyle factors are associated with REDUCED risk of colorectal cancer?

A

NSAIDs and aspirin
postmenopausal hormone replacement therapy

70
Q

what lifestyle factors are associated with INCREASED risk of colorectal cancer?

A

obesity and physical inactivity
alcohol consumption
cigarette smoking
antimicrobials
antacids
PPIs
a diet high in red and processed meat, fat, and refined grains

71
Q

what test is done to detect occult blood in the stool?

A

fecal occult blood testing

72
Q

what are the 2 methods of FOBT?

A

Guaiac-based FOBT (gFOBT)
immunochemical (iFOBT)

73
Q

which FOBT do we need to counsel patients to avoid NSAIDs, red meat, vit. C, citrus before testing?

A

gFOBT

74
Q

what is the gold standard for colorectal cancer screening?

A

colonoscopy

75
Q

what are some clinical s/sx of colorectal cancer?

A

signs: blood in stool, jaundice, leg edema (widespread)
symptoms: change in bowel habits, constipation, N/V, fatigue

76
Q

what lab tests are done to diagnose colorectal cancer?

A

positive guaiac stool test
anemia
elevated CEA, and liver enzymes

77
Q

what stage of colorectal cancer is curable? not curable?

A

curable: stage I-III
not curable: stage IV

78
Q

Standard adjuvant chemotherapy for colorectal cancer stages II involve what drugs?

A

fluoropyrimidine
- fluorouracil with leucovorin in combo with oxaliplatin (FOLFOX)
- capecitabine in combo with oxaliplatin (CapeOx)
- capecitabine alone

79
Q

in stage III colorectal cancer you can add on _______ for better treatment?

A

oxaliplatin better than fluoropyrimidines alone

80
Q

stage IV colorectal cancer (resectable or potentially resectable) get what chemo regimen?

A

FOLFOX (fluorouracil, leucovorin, oxaliplatin)
CAPEFOX (capecitabine, leucovorin, oxaliplatin)
FOLFIRI (fluorouracil, leucovorin, ininotecan)

81
Q

in stage IV colorectal cancer if it has metastasized to the liver what is done?

A

a permanent access catheter is implanted into the heaptic artery for direct administration of chemo into the liver
floxuridine with dex
fluoruracil w/ or w/out leucovorin

82
Q

stage IV unresectable colorectal cancer is given?

A

FOLFOX, FOLFIRI, or CAPEOX
add on bevacizumab

HEM/ONC (4 decks)

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