EXAM 2 - Stevich-Heemer Flashcards
What cancer is the second most common and the most common cause of cancer-related deaths?
Lung cancer
What is the #1 risk factor for lung cancer?
Tobacco
What are the molecular abnormalities in the pathogenesis of lung cancer?
KRAS
EGFR
ALK
What are mutations in lung cancer?
activation of proto-oncogenes
inhibition of tumor suppressor genes
production of autocrine growth factors
What the 2 types of lung cancer?
Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)
small cell lung cancer expresses?
C-KIT (tyrosine kinase receptor)
non-small cell lung cancer expresses?
EGFR
ALK
Which mutations are less common in lung cancer?
BRAF
NTRK
ROS1
what is the use of prophylactic medications to prevent cancer development?
chemoprevention
what are chemo-preventive agents?
NSAIDs
retinoids
inhaled glucocorticoids
vitamin E
selenium
Which type of lung cancer is more common?
non-small cell lung cancer (NSCLC)
What type of lung cancer grows slower?
non-small cell lung cancer
what are the s/sx of lung cancer?
cough
SOB
chest pain
anorexia
weight loss
fatigue
what are the s/sx of paraneoplastic syndrome?
weight loss
cushing’s syndrome
hypercalcemia
SIADH
pulmonary hypertrophic osteoarthropathy
anemia
what are extrapulmonary s/sx?
bone pain / fractures
liver dysfunction
neurologic deficits
spinal cord compression
which type of lung cancer uses TNM staging?
non-small cell lung cancer
what are the common histologic types of non-small cell lung cancer?
adenocarcinoma
squamous cell
large cell carcinoma
What is the regimen for stage II lung cancer?
platinum-based regimens
stage IIIA lung cancer is treated with?
platinum-containing regimen and concurrent radiotherapy
what is consolidation therapy in lung cancer?
given to stage IIIB and IIIC
PD-L1 inhibitor - durvalumab
*** durvalumab is not used is patient has surgical resection
what are the 3 pathways for advanced NSCLC
- immune sensitive (PD-L1+)
- genetic mutation driven
- nonbiomarker-driven therapy
bevacizumab is for which type of histology in lung cancer?
nonsquamous
what are the 2 stages of SCLC
limited
extensive
what is primary treatment for extensive stage SCLC?
platinum with etoposide
what is the main side effect of cisplatin
nephrotoxicity
what is the main side effect of etoposide?
hypotension
Bevacizumab. What class and side effects?
class: VEGF inhibitor
side effects: bleeding, impaired wound healing, HTN, proteinuria
what are the side effects for PD-L1 inhibitors?
immune reactions
What ENDOCRINE factors cause an increased risk of breast cancer? decreased?
increased: early menarche, late age of natural menopause, nulliparity or late age of first birth
decreased: oophorectomy before 45 YO
What gene mutations are associated with breast cancer?
BRCA1
BRCA2
s/sx of metastases in breast cancer
bone pain, difficulty breathing, abdominal pain, jaundice, mental status change
What labs will be elevated in breast cancer?
tumor markers (CA 15-3, CEA)
Alk Phos
LFTs
breast cancer cells spread through
lymph channels
blood vessels
what cytotoxic chemotherapy is used in breast cancer?
doxorubicin
epirubicin
cyclophosphamide
methotrexate
fluorouracil
carboplatin
paclitaxel
breast cancer: curative (stage I-III) systemic therapy is which classes?
anthracyclines (doxorubicin / epirubicin)
taxanes (paclitaxel / docetaxel)
what is the ADR of anthracyclines
red urine
cardiotoxicity
what is the ADR of taxanes
neuropathies
breast cancer: stage I-III biologic therapy uses what class?
HER2 therapy (trastuzumab / pertuzumab)
breast cancer: stage I-III endocrine therapy uses what classes?
aromatase inhibitors (anastrozole / letrozole)
tamoxifen gold standard
breast cancer with bone metastases are treated with?
bone modifying agent (pamidronate / zoledronic acid / denosumab)
what is mTOR and what drug is an mTOR inhibitor?
important mediator for cell proliferation and regulation of apoptosis, angiogenesis, and cellular metabolism
everolimus
What is PI3K and what drug is a Pi3K inhibitor?
PI3Ks play a critical role in regulating many biological functions
Alpelisib
what drugs are PARP inhibitors?
olaparib and talazoparib
What tumor suppressor gene mutations are associated with ovarian cancer?
BRCA1 (more prevalent)
BRCA2
if exposed to what hormone will you be at an increased risk of ovarian cancer?
estrogen
and increase/decrease in the total number of ovulations increases the risk of ovarian cancer?
increase
what is the incessant ovulation hypothesis
risk of mutations and cancer increase each time the ovarian epithelium undergoes cell repair
a diet high in ______ increases the risk of ovarian cancer? a diet high in _____ decreases the risk of ovarian cancer
increases: galactose, animal fat, meat
decreases: vegetables
what are the 3 cell/tumor types of ovarian cancer?
epithelial carcinoma (most common)
germ cell tumors
stromal carcinomas
What are some preventative ways for ovarian cancer?
decrease the # of ovulations (multiparity, oral contraceptives)
ovarian cancer is often asymptomatic, so known as the ?
silent killer
What are some s/sx and labs for ovarian cancer?
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
goal of ovarian cancer depends on the ______ stage at diagnosis
FIGO
What is the primary treatment for ovarian cancer?
surgery
what is needed for accurate diagnosis and staging of ovarian cancer?
comprehensive exploratory laparotomy
cannot readily biopsy a ovarian cancer tumor because of risk of ____?
tumor seeding (increases the risk of recurrence)
Radiation therapy in ovarian cancer is used for what type of care?
palliative
what is the first-line chemotherapy for ovarian cancer?
taxane and platinum regimen (following surgery)
chemotherapy regimens for ovarian cancer are typically how many days?
21 or 28
neoadjuvant chemotherapy for ovarian cancer is which classes?
taxane with platinum
Consolidation therapy is given to patients WITH or WITHOUT measurable disease (ovarian cancer)
WITHOUT
what medications are used for consolidation therapy in ovarian cancer?
bevacizumab and PARP inhibitors (olaparib / niraparib)
maintenance therapy is given to patient WITH or WITHOUT measurable disease (ovarian cancer)
WITH
what is the length of time that has lapsed since the completion of chemotherapy?
disease-free interval
a patient is considered platinum-resistant if their cancer recurs in how much time?
< 6 months
a patient is considered platinum-sensitive if their cancer recurs in how much time?
> 6 months
platinum-sensitive patients are given what drugs for recurrent ovarian cancer?
platinum in combo with gemcitabine, doxorubicin, or paclitaxel
platinum-resistant patients are given what agents for recurrent ovarian cancer?
Paclitaxel + bevacizumab
Topotecan + bevacizumab
cyclophosphamide + bevacizumab
gemcitabine
docetaxel
etoposide
What are some risk factors for colorectal cancer?
age
adenomatous polyps
IBD
DM
family history
what lifestyle factors are associated with REDUCED risk of colorectal cancer?
NSAIDs and aspirin
postmenopausal hormone replacement therapy
what lifestyle factors are associated with INCREASED risk of colorectal cancer?
obesity and physical inactivity
alcohol consumption
cigarette smoking
antimicrobials
antacids
PPIs
a diet high in red and processed meat, fat, and refined grains
what test is done to detect occult blood in the stool?
fecal occult blood testing
what are the 2 methods of FOBT?
Guaiac-based FOBT (gFOBT)
immunochemical (iFOBT)
which FOBT do we need to counsel patients to avoid NSAIDs, red meat, vit. C, citrus before testing?
gFOBT
what is the gold standard for colorectal cancer screening?
colonoscopy
what are some clinical s/sx of colorectal cancer?
signs: blood in stool, jaundice, leg edema (widespread)
symptoms: change in bowel habits, constipation, N/V, fatigue
what lab tests are done to diagnose colorectal cancer?
positive guaiac stool test
anemia
elevated CEA, and liver enzymes
what stage of colorectal cancer is curable? not curable?
curable: stage I-III
not curable: stage IV
Standard adjuvant chemotherapy for colorectal cancer stages II involve what drugs?
fluoropyrimidine
- fluorouracil with leucovorin in combo with oxaliplatin (FOLFOX)
- capecitabine in combo with oxaliplatin (CapeOx)
- capecitabine alone
in stage III colorectal cancer you can add on _______ for better treatment?
oxaliplatin better than fluoropyrimidines alone
stage IV colorectal cancer (resectable or potentially resectable) get what chemo regimen?
FOLFOX (fluorouracil, leucovorin, oxaliplatin)
CAPEFOX (capecitabine, leucovorin, oxaliplatin)
FOLFIRI (fluorouracil, leucovorin, ininotecan)
in stage IV colorectal cancer if it has metastasized to the liver what is done?
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
stage IV unresectable colorectal cancer is given?
FOLFOX, FOLFIRI, or CAPEOX
add on bevacizumab
