Fiser.11.Oncology Flashcards
1
Q
What is the #2 cause of death in the US?
A
cancer
2
Q
what is the MC CA in women?
A
breast
3
Q
what is the MCC of CA-related death in women?
A
lung ca
4
Q
what is the MC CA in men?
A
prostate
5
Q
what is the MCC of CA-related death in men?
A
lung CA
6
Q
what does the acronym PET scan stand for?
A
positron emission tomography
7
Q
what does a PET scan detect and what is it used to identify?
A
PET scans detect fluorodeoxyglucose molecules and are used to identify metastases
8
Q
what receptors to cytotoxic T cells require to attack cancer cells?
A
cytotoxic T cells require MHC to attack tumor cells
9
Q
what receptors to NK (natural killer) cells require to attack cancer cells
A
they don’t! they can independently attack tumor cells
10
Q
How are tumor antigens determined?
A
they aren’t! they’re random
11
Q
in what case are tumor antigens not random?
A
in viral-induced tumors
12
Q
define hyperplasia
A
an increased number of cells
13
Q
define metaplasia
A
replacement of one tissue/cell type with another
14
Q
give an example of how metaplasia can occur with GERD
A
GERD squamous epithelium in the distal esophagus is changed to columnar gastric tissue (Barret’s esophagus)
15
Q
define dysplasia
A
altered size, shape, and organization of cells
16
Q
what is CEA a tumor marker for?
A
colon CA
17
Q
what is AFP a tumor marker for?
A
liver CA
18
Q
what is CA 19-9 a tumor marker for?
A
pancreatic CA
19
Q
what is CA-125 a tumor marker for?
A
ovarian CA
20
Q
what is beta-HCG a tumor marker for? (2)
A
testicular CA, choriocarcinoma
21
Q
what is PSA a tumor marker for?
A
prostate CA
22
Q
what is the sensitivity and specificity of PSA for prostate CA?
A
tumor marker with the highest sensitivity but low specificity
23
Q
what is NSE (neuron-specific enolase) a tumor marker for?
A
small cell lung CA, neuroblastoma
24
Q
what is BRCA I a tumor marker for?
A
breast CA
25
what is BRCA II a tumor marker for?
breast CA
26
what is chromogranin A a tumor marker for?
carcinoid tumor
27
what is Ret oncogene a tumor marker for?
thyroid medullary CA
28
what is the half life of CEA?
18 days
29
what is the half life of PSA?
18 days
30
what is the half life of AFP?
5 days
31
What are the two steps in cancer transformation of a cell?
heritable alteration in genome AND loss of growth regulation
32
define "latency period" in oncogenesis
time between exposure and formation of clinically detectable tumor
33
what is the "initiation" phase of oncogenesis?
carcinogen acts with DNA
34
what is the "promotion" phase of oncogenesis?
after carcinogen interacts with DNA, you get the increased growth (promotion) of cancerous cells
35
what is the "progression" phase of oncogenesis?
progression of cancer cells to a clinically detectable tumor
36
name three potential mechanisms of oncogenesis
carcinogenesis (smoking); viruses (EBV); or immunodeficiency (HIV)
37
what type of genetic material are in retroviruses that can cause cancer?
oncogenes
38
what two types of CA are a/w EBV infection?
Burkitt's lymphoma and nasopharyngeal CA
39
what is the genetic defect a/w Burkitt's lymphoma?
8:14 translocation
40
What is the genetic defect a/w nasopharyngeal CA?
increased c-myc expression
41
define proto-oncogenes
human genes with malignant potential
42
which infectious agent is a/w cervical ca?
human papillomavirus
43
which infectious agent is a/w gastric CA?
H. pylori
44
which infectious agent is a/w hepatocellular carcinoma?
Hep B and HepC
45
which infectious agent is a/w nasopharyngeal CA
Epstein-Barr Virus
46
which infectious agent is a/w Burkitt's lymphoma?
Epstein-Barr Virus
47
which infectious agent is a/w various/lotso lymphomas?
HIV
48
What is the most vulnerable stage of the cell cycle for radiation therapy?
M phase
49
what is the MOA of the most damage caused by radiation therapy in CA treatment? how can this be optimized?
formation of oxygen radicals --\> maximal effect with high O2 levels
50
What is the target of radiation therapy?
main target is DNA, oxygen radicals and XRT damage DNA and other molecules
51
what type of radiation therapy has a skin-preserving effect and why?
higher-energy radiation has a skin-preserving effect because the maximum ionizing potential is not reached until it gets to deeper structures
52
what does it mean to fractionate XRT?
to spread the XRT out over several days rather than one large dose
53
what are three reasons to fractionate XRT doses?
allows repair of normal cells; allows reoxygenation of tumor; allows redistribution of tumor cells in the cell sycle
54
is a seminoma radiosensitive or radioresistant?
radiosensitive
55
is a lymphoma radiosensitive or radioresistant?
radiosensitive
56
is a epithelial tumor radiosensitive or radioresistant?
radioresistant
57
is a sarcoma radiosensitive or radioresistant?
radioresistant
58
why are large tumors less responsive to XRT?
lack of oxygen in the tumor
59
define brachytherapy and why its useful for treatment
source of radiation in or next to the tumor, delivers high, concentrated doses of radiation
60
What two elements are used for brachytherapy
Au-198, I-128
61
is 5FU cell cycle-specific or nonspecific chemotherapy?
cell cycle-specific
62
is methotrexate cell cycle-specific or nonspecific chemotherapy?
cell cycle specific
63
what happens to cell killing ability in cell cycle-specific chemotherapy
it plateaus
64
what happens to cell killing ability in cell cycle nonspecific chemotherapy
linear response to cell killing
65
what is the MOA of tamoxifen?
blocks estrogen receptor
66
what are two adverse effects of tamoxifen and their incidence?
1% risk of blood clots; 0.1% risk of endometrial CA
67
which cancer risk is reduced by tamoxifen and by how much at 5 years?
reduces 5 year risk of breast cancer by 45%
68
what is the MOA of taxol?
promotes microtubule formation and stabilization that cannot be broken down --\> cells are ruptured
69
what is an AE of bleomycin?
pulmonary fibrosis
70
what is an AE of busulfan?
pulmonary fibrosis
71
what is the MOA of cisplatin?
platinum alkylating agent
72
name 3 AEs of cisplatin
nephrotoxic, neurotoxic, ototoxic
73
what is the MOA of carboplatin?
platinum alkylating agent
74
what is the AE of carboplatin?
bone marrow (myelo) suppression
75
what is the MOA of alkylating agents as chemo?
transfer alkyl groups and form covalent bonds to DNA
76
what is the active metabolite in cyclophosphamide?
cyclophosphamide is an alkylating agent for chemo, acrolein is the active metabolite
77
what are four side effects of cyclophosphamide?
gonadal dysfunction, SIADH, hemorrhagic cystitis
78
what drug can help treat hemorrhagic cystitis a/w cyclophosphamide?
mesna
79
what does levamisole treat?
an anthelminthic drug
80
how does levamisole treat cancer?
thought to stimulate the immune system against cancer
81
what is the MOA of methotrexate
chemotherapy, inhibits dihydrofolate reductase, which inhibits purine DNA syntehsis
82
name two AEs of methotrexate
renal toxicity, radiation recall
83
what is radiation recall?
Radiation recall is a severe skin reaction that occurs when certain chemotherapy drugs are administered during or soon after radiation treatment. The rash appears like a severe sun burn
84
what is leucovorin rescue?
leucovorin = folinic acid, reverses effects of methotrexate by resupplying folate
85
what is the MOA of 5-fluorouracil?
chemotherapy, inhibits thymidyl synthetase, which inhibits purine and DNA synthesis
86
how does lecovorin affect 5-FU
leucovorin increases toxicity of 5FU
87
what is the MOA of doxorubicin (2)
chemotherapy, DNA intercalator, O2 radical formation
88
what is one AE of doxorubicin?
heart toxicity
89
at which doses does cardiotoxicity occur 2/2 doxorubicin and what is the MOA?
heart toxicity 2/2 O2 radicals at total doses \> 500 mg/m2
90
what is the MOA of etoposide?
chemotherapeutic agent, inhibits topoisomerase (unwinds DNA)
91
what are the four chemotherapeutic agents that have the least myelosuppression
bleomycin, vincristine, busulfan, cisplatin
92
what does GCSF stand for?
granulocyte colony stimulating factor
93
what does GCSF treat?
used for neutrophil recovery after chemo
94
name 1 AE of GCSF
Sweet's syndrome: acute febrile neutropenic dermatitis
95
When is breast surgery indicated in the absence of cancer?
if BRCA I or II with strong family history
96
When is thyroid surgery indicated in the absence of cancer?
RET protooncogene with family history of thyroid cancer
97
what type of cancer gene is Rb1?
tumor suppressor gene
98
which chromosome is Rb1 located on?
chromosome 13
99
what does Rb1 regulate?
cell cycle regulation
100
what type of cancer gene is p53?
tumor suppressor gene
101
which chromosome is p53 located on?
chromosome 17
102
what does p53 regulate? what is its normal and abnormal function
involved in cell cycle, normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth
103
what type of cancer gene is APC?
tumor suppressor gene
104
which chromosome is APC located on?
chromosome 5
105
what does APC regulate?
involved in cell cycle regulation & movement
106
what type of cancer gene is DCC?
tumor suppressor gene
107
which chromosome is DCC located on?
chromosome 18
108
what does DCC regulate?
involved in cell adhesion
109
what type of cancer gene is bcl
involved in apoptosis
110
what type of cancer gene is BRCA
tumor suppressor gene
111
what type of cancer gene is ras?
protooncogene
112
what defect is a/w ras mutation?
G-protein deficit
113
what type of cancer gene is src?
proto-oncogene
114
what defect is a/w src mutation?
tyrosine kinase defect
115
what type of cancer gene is erb B?
proto-oncogene
116
what defect is a/w erb mutationB?
epidermal growth factor defect
117
what type of cancer gene is sis?
proto oncogene
118
what defect is a/w sis mutation?
platelet-derived growth factor defect
119
what type of cancer gene is myc and its three subtypes?
protooncogene, l-myc; n-myc; c-myc
120
what defect is a/w myc mutation?
transcription factors
121
what is the underlying defect a/w Li-Fraumeni syndrome?
p53 gene defect
122
What are the 5 cancers a/w Li-Fraumeni syndrome?
breats CA, brain tumors, leukemia, adrenal CA, and childhood sarcomas
123
Name four gene mutations a/w colon CA?
APC, p53, DCC, and K-ras
124
what gene is thought to be the initial step in the evolution of colorectal CA?
APC
125
does colon CA metastasize to bone?
does not usually metastasize to bone
126
what types of cancers are caused by coal tar (3)
larynx, skin, bronchial CA
127
what type of CA is caused by beta-naphthylamine (2)
urinary CA, bladder CA
128
what type of CA is caused by benzene
leukemia
129
what type of CA is caused by asbestos?
mesothelioma
130
name five cancers you should suspect with suspicious supraclavicular nodes
neck, breast, lung, stomach, pancreas
131
where is Virchow's node and what cancer is it a/w with?
stomach
132
what is the #1 cancer you should suspect with a suspicious axillary LN? Name two others as well
#1: lymphoma; breast; melanoma
133
what cancer should you suspect with a suspicious periumbilical node? What is the eponym for this node?
Sister Mary Joseph's node a/w pancreatic CA
134
What two cancers can spread to the ovaries? Include eponyms
stomach (Krukenberg tumor); colon
135
What is the #1 and #2 causes of bone mets?
breast & prostate
136
what two cancers produce skin mets?
breast and melanoma
137
what is the #1 cause of small bowel mets?
melanoma
138
What two questions are answered during Phase I of clinical trials?
is it safe and at what dose?
139
What question is answered during Phase II of clinical trials?
is it effective
140
What question is answered during Phase III of clinical trials?
is it better than existing therapy
141
What is the function of Phase IV of clinical trials?
implementation & marketing
142
what is the function of induction chemotherapy
sole treatment, used for advanced disease or when no other treatment is available
143
what is the function of primary / neoadjuvant chemotherapy?
chemo is usually given FIRST, followed by another (secondary) therapy
144
what is the function of adjuvant chemotherapy?
combined with another modality, given AFTER another therapy is used
145
what is the function of salvage chemotherapy?
for tumors that fail to respond to initial chemotherapy
146
why should you view lymph nodes as a source of probable metastasis?
lymph nodes have poor barrier function?
147
when should you consider en bloc multiorgan resection?
not for mets, for aggressive local invasiveness that can be attempted for some tumors (colon into ureter, adrenal into liver, gastric into spleen)
148
name two indications of palliative surgery for hollow viscus cancer
hollow viscus tumor causing obstruction or bleeding (ex: colon CA)
149
name two indications for palliative surgery for breast CA
breast CA with skin or chest wall involvement
150
when is sentinel lymph node biopsy indicated with clinically palpable lymph nodes
it isn't. Don't do it.
151
what is the 5 year survival rate s/p resection of colon cancer mets to the liver?
35% 5 year survival rate
152
What disease-free interval is a good prognostic indicator for survival after resection of hepatic colorectal mets?
disease-free interval \> 12 months
153
What tumor number is a good prognostic indicator for survival after resection of hepatic colorectal mets?
tumor number \< 3
154
What CEA level is a good prognostic indicator for survival after resection of hepatic colorectal mets?
CEA \< 200
155
What tumor size is a good prognostic indicator for survival after resection of hepatic colorectal mets?
\< 5 cm
156
What lymph node finding is a good prognostic indicator for survival after resection of hepatic colorectal mets?
negative lymph node
157
what are the two most successfully cured metastases with surgery?
colon CA in the liver; sarcoma to the bone
158
what is a tumor with which surgical debulking improves chemotherapy?
ovarian CA
159
name two solid tumors curable with chemotherapy only?
Hodgkin's and non-Hodgkin's lymphoma
160
name two types of T-cell lymphomas and how they manifest
HTLV-1 (skin lesions); mycosis fungoides (Sezary cells)
161
Name two HIV-related malignancies
Kaposi's sarcoma, non-Hodgkin's lymphoma
162
name two oncogenic processes that VEGF is involved with
vascular epidermal growth factor causes angiogenesis and is involved in tumor metastases
