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Z.Fiser > Fiser.11.Oncology > Flashcards

Fiser.11.Oncology Flashcards

1
Q

What is the #2 cause of death in the US?

A

cancer

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2
Q

what is the MC CA in women?

A

breast

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3
Q

what is the MCC of CA-related death in women?

A

lung ca

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4
Q

what is the MC CA in men?

A

prostate

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5
Q

what is the MCC of CA-related death in men?

A

lung CA

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6
Q

what does the acronym PET scan stand for?

A

positron emission tomography

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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

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8
Q

what receptors to cytotoxic T cells require to attack cancer cells?

A

cytotoxic T cells require MHC to attack tumor cells

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9
Q

what receptors to NK (natural killer) cells require to attack cancer cells

A

they don’t! they can independently attack tumor cells

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10
Q

How are tumor antigens determined?

A

they aren’t! they’re random

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11
Q

in what case are tumor antigens not random?

A

in viral-induced tumors

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12
Q

define hyperplasia

A

an increased number of cells

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13
Q

define metaplasia

A

replacement of one tissue/cell type with another

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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)

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15
Q

define dysplasia

A

altered size, shape, and organization of cells

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16
Q

what is CEA a tumor marker for?

A

colon CA

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17
Q

what is AFP a tumor marker for?

A

liver CA

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18
Q

what is CA 19-9 a tumor marker for?

A

pancreatic CA

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19
Q

what is CA-125 a tumor marker for?

A

ovarian CA

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20
Q

what is beta-HCG a tumor marker for? (2)

A

testicular CA, choriocarcinoma

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21
Q

what is PSA a tumor marker for?

A

prostate CA

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22
Q

what is the sensitivity and specificity of PSA for prostate CA?

A

tumor marker with the highest sensitivity but low specificity

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23
Q

what is NSE (neuron-specific enolase) a tumor marker for?

A

small cell lung CA, neuroblastoma

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24
Q

what is BRCA I a tumor marker for?

A

breast CA

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25
Q

what is BRCA II a tumor marker for?

A

breast CA

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26
Q

what is chromogranin A a tumor marker for?

A

carcinoid tumor

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27
Q

what is Ret oncogene a tumor marker for?

A

thyroid medullary CA

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28
Q

what is the half life of CEA?

A

18 days

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29
Q

what is the half life of PSA?

A

18 days

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30
Q

what is the half life of AFP?

A

5 days

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31
Q

What are the two steps in cancer transformation of a cell?

A

heritable alteration in genome AND loss of growth regulation

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32
Q

define “latency period” in oncogenesis

A

time between exposure and formation of clinically detectable tumor

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33
Q

what is the “initiation” phase of oncogenesis?

A

carcinogen acts with DNA

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34
Q

what is the “promotion” phase of oncogenesis?

A

after carcinogen interacts with DNA, you get the increased growth (promotion) of cancerous cells

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35
Q

what is the “progression” phase of oncogenesis?

A

progression of cancer cells to a clinically detectable tumor

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36
Q

name three potential mechanisms of oncogenesis

A

carcinogenesis (smoking); viruses (EBV); or immunodeficiency (HIV)

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37
Q

what type of genetic material are in retroviruses that can cause cancer?

A

oncogenes

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38
Q

what two types of CA are a/w EBV infection?

A

Burkitt’s lymphoma and nasopharyngeal CA

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39
Q

what is the genetic defect a/w Burkitt’s lymphoma?

A

8:14 translocation

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40
Q

What is the genetic defect a/w nasopharyngeal CA?

A

increased c-myc expression

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41
Q

define proto-oncogenes

A

human genes with malignant potential

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42
Q

which infectious agent is a/w cervical ca?

A

human papillomavirus

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43
Q

which infectious agent is a/w gastric CA?

A

H. pylori

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44
Q

which infectious agent is a/w hepatocellular carcinoma?

A

Hep B and HepC

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45
Q

which infectious agent is a/w nasopharyngeal CA

A

Epstein-Barr Virus

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46
Q

which infectious agent is a/w Burkitt’s lymphoma?

A

Epstein-Barr Virus

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47
Q

which infectious agent is a/w various/lotso lymphomas?

A

HIV

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48
Q

What is the most vulnerable stage of the cell cycle for radiation therapy?

A

M phase

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49
Q

what is the MOA of the most damage caused by radiation therapy in CA treatment? how can this be optimized?

A

formation of oxygen radicals –> maximal effect with high O2 levels

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50
Q

What is the target of radiation therapy?

A

main target is DNA, oxygen radicals and XRT damage DNA and other molecules

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51
Q

what type of radiation therapy has a skin-preserving effect and why?

A

higher-energy radiation has a skin-preserving effect because the maximum ionizing potential is not reached until it gets to deeper structures

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52
Q

what does it mean to fractionate XRT?

A

to spread the XRT out over several days rather than one large dose

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53
Q

what are three reasons to fractionate XRT doses?

A

allows repair of normal cells; allows reoxygenation of tumor; allows redistribution of tumor cells in the cell sycle

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54
Q

is a seminoma radiosensitive or radioresistant?

A

radiosensitive

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55
Q

is a lymphoma radiosensitive or radioresistant?

A

radiosensitive

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56
Q

is a epithelial tumor radiosensitive or radioresistant?

A

radioresistant

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57
Q

is a sarcoma radiosensitive or radioresistant?

A

radioresistant

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58
Q

why are large tumors less responsive to XRT?

A

lack of oxygen in the tumor

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59
Q

define brachytherapy and why its useful for treatment

A

source of radiation in or next to the tumor, delivers high, concentrated doses of radiation

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60
Q

What two elements are used for brachytherapy

A

Au-198, I-128

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61
Q

is 5FU cell cycle-specific or nonspecific chemotherapy?

A

cell cycle-specific

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62
Q

is methotrexate cell cycle-specific or nonspecific chemotherapy?

A

cell cycle specific

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63
Q

what happens to cell killing ability in cell cycle-specific chemotherapy

A

it plateaus

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64
Q

what happens to cell killing ability in cell cycle nonspecific chemotherapy

A

linear response to cell killing

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65
Q

what is the MOA of tamoxifen?

A

blocks estrogen receptor

66
Q

what are two adverse effects of tamoxifen and their incidence?

A

1% risk of blood clots; 0.1% risk of endometrial CA

67
Q

which cancer risk is reduced by tamoxifen and by how much at 5 years?

A

reduces 5 year risk of breast cancer by 45%

68
Q

what is the MOA of taxol?

A

promotes microtubule formation and stabilization that cannot be broken down –> cells are ruptured

69
Q

what is an AE of bleomycin?

A

pulmonary fibrosis

70
Q

what is an AE of busulfan?

A

pulmonary fibrosis

71
Q

what is the MOA of cisplatin?

A

platinum alkylating agent

72
Q

name 3 AEs of cisplatin

A

nephrotoxic, neurotoxic, ototoxic

73
Q

what is the MOA of carboplatin?

A

platinum alkylating agent

74
Q

what is the AE of carboplatin?

A

bone marrow (myelo) suppression

75
Q

what is the MOA of alkylating agents as chemo?

A

transfer alkyl groups and form covalent bonds to DNA

76
Q

what is the active metabolite in cyclophosphamide?

A

cyclophosphamide is an alkylating agent for chemo, acrolein is the active metabolite

77
Q

what are four side effects of cyclophosphamide?

A

gonadal dysfunction, SIADH, hemorrhagic cystitis

78
Q

what drug can help treat hemorrhagic cystitis a/w cyclophosphamide?

A

mesna

79
Q

what does levamisole treat?

A

an anthelminthic drug

80
Q

how does levamisole treat cancer?

A

thought to stimulate the immune system against cancer

81
Q

what is the MOA of methotrexate

A

chemotherapy, inhibits dihydrofolate reductase, which inhibits purine DNA syntehsis

82
Q

name two AEs of methotrexate

A

renal toxicity, radiation recall

83
Q

what is radiation recall?

A

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
Q

what is leucovorin rescue?

A

leucovorin = folinic acid, reverses effects of methotrexate by resupplying folate

85
Q

what is the MOA of 5-fluorouracil?

A

chemotherapy, inhibits thymidyl synthetase, which inhibits purine and DNA synthesis

86
Q

how does lecovorin affect 5-FU

A

leucovorin increases toxicity of 5FU

87
Q

what is the MOA of doxorubicin (2)

A

chemotherapy, DNA intercalator, O2 radical formation

88
Q

what is one AE of doxorubicin?

A

heart toxicity

89
Q

at which doses does cardiotoxicity occur 2/2 doxorubicin and what is the MOA?

A

heart toxicity 2/2 O2 radicals at total doses > 500 mg/m2

90
Q

what is the MOA of etoposide?

A

chemotherapeutic agent, inhibits topoisomerase (unwinds DNA)

91
Q

what are the four chemotherapeutic agents that have the least myelosuppression

A

bleomycin, vincristine, busulfan, cisplatin

92
Q

what does GCSF stand for?

A

granulocyte colony stimulating factor

93
Q

what does GCSF treat?

A

used for neutrophil recovery after chemo

94
Q

name 1 AE of GCSF

A

Sweet’s syndrome: acute febrile neutropenic dermatitis

95
Q

When is breast surgery indicated in the absence of cancer?

A

if BRCA I or II with strong family history

96
Q

When is thyroid surgery indicated in the absence of cancer?

A

RET protooncogene with family history of thyroid cancer

97
Q

what type of cancer gene is Rb1?

A

tumor suppressor gene

98
Q

which chromosome is Rb1 located on?

A

chromosome 13

99
Q

what does Rb1 regulate?

A

cell cycle regulation

100
Q

what type of cancer gene is p53?

A

tumor suppressor gene

101
Q

which chromosome is p53 located on?

A

chromosome 17

102
Q

what does p53 regulate? what is its normal and abnormal function

A

involved in cell cycle, normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth

103
Q

what type of cancer gene is APC?

A

tumor suppressor gene

104
Q

which chromosome is APC located on?

A

chromosome 5

105
Q

what does APC regulate?

A

involved in cell cycle regulation & movement

106
Q

what type of cancer gene is DCC?

A

tumor suppressor gene

107
Q

which chromosome is DCC located on?

A

chromosome 18

108
Q

what does DCC regulate?

A

involved in cell adhesion

109
Q

what type of cancer gene is bcl

A

involved in apoptosis

110
Q

what type of cancer gene is BRCA

A

tumor suppressor gene

111
Q

what type of cancer gene is ras?

A

protooncogene

112
Q

what defect is a/w ras mutation?

A

G-protein deficit

113
Q

what type of cancer gene is src?

A

proto-oncogene

114
Q

what defect is a/w src mutation?

A

tyrosine kinase defect

115
Q

what type of cancer gene is erb B?

A

proto-oncogene

116
Q

what defect is a/w erb mutationB?

A

epidermal growth factor defect

117
Q

what type of cancer gene is sis?

A

proto oncogene

118
Q

what defect is a/w sis mutation?

A

platelet-derived growth factor defect

119
Q

what type of cancer gene is myc and its three subtypes?

A

protooncogene, l-myc; n-myc; c-myc

120
Q

what defect is a/w myc mutation?

A

transcription factors

121
Q

what is the underlying defect a/w Li-Fraumeni syndrome?

A

p53 gene defect

122
Q

What are the 5 cancers a/w Li-Fraumeni syndrome?

A

breats CA, brain tumors, leukemia, adrenal CA, and childhood sarcomas

123
Q

Name four gene mutations a/w colon CA?

A

APC, p53, DCC, and K-ras

124
Q

what gene is thought to be the initial step in the evolution of colorectal CA?

A

APC

125
Q

does colon CA metastasize to bone?

A

does not usually metastasize to bone

126
Q

what types of cancers are caused by coal tar (3)

A

larynx, skin, bronchial CA

127
Q

what type of CA is caused by beta-naphthylamine (2)

A

urinary CA, bladder CA

128
Q

what type of CA is caused by benzene

A

leukemia

129
Q

what type of CA is caused by asbestos?

A

mesothelioma

130
Q

name five cancers you should suspect with suspicious supraclavicular nodes

A

neck, breast, lung, stomach, pancreas

131
Q

where is Virchow’s node and what cancer is it a/w with?

A

stomach

132
Q

what is the #1 cancer you should suspect with a suspicious axillary LN? Name two others as well

A

1: lymphoma; breast; melanoma

133
Q

what cancer should you suspect with a suspicious periumbilical node? What is the eponym for this node?

A

Sister Mary Joseph’s node a/w pancreatic CA

134
Q

What two cancers can spread to the ovaries? Include eponyms

A

stomach (Krukenberg tumor); colon

135
Q

What is the #1 and #2 causes of bone mets?

A

breast & prostate

136
Q

what two cancers produce skin mets?

A

breast and melanoma

137
Q

what is the #1 cause of small bowel mets?

A

melanoma

138
Q

What two questions are answered during Phase I of clinical trials?

A

is it safe and at what dose?

139
Q

What question is answered during Phase II of clinical trials?

A

is it effective

140
Q

What question is answered during Phase III of clinical trials?

A

is it better than existing therapy

141
Q

What is the function of Phase IV of clinical trials?

A

implementation & marketing

142
Q

what is the function of induction chemotherapy

A

sole treatment, used for advanced disease or when no other treatment is available

143
Q

what is the function of primary / neoadjuvant chemotherapy?

A

chemo is usually given FIRST, followed by another (secondary) therapy

144
Q

what is the function of adjuvant chemotherapy?

A

combined with another modality, given AFTER another therapy is used

145
Q

what is the function of salvage chemotherapy?

A

for tumors that fail to respond to initial chemotherapy

146
Q

why should you view lymph nodes as a source of probable metastasis?

A

lymph nodes have poor barrier function?

147
Q

when should you consider en bloc multiorgan resection?

A

not for mets, for aggressive local invasiveness that can be attempted for some tumors (colon into ureter, adrenal into liver, gastric into spleen)

148
Q

name two indications of palliative surgery for hollow viscus cancer

A

hollow viscus tumor causing obstruction or bleeding (ex: colon CA)

149
Q

name two indications for palliative surgery for breast CA

A

breast CA with skin or chest wall involvement

150
Q

when is sentinel lymph node biopsy indicated with clinically palpable lymph nodes

A

it isn’t. Don’t do it.

151
Q

what is the 5 year survival rate s/p resection of colon cancer mets to the liver?

A

35% 5 year survival rate

152
Q

What disease-free interval is a good prognostic indicator for survival after resection of hepatic colorectal mets?

A

disease-free interval > 12 months

153
Q

What tumor number is a good prognostic indicator for survival after resection of hepatic colorectal mets?

A

tumor number < 3

154
Q

What CEA level is a good prognostic indicator for survival after resection of hepatic colorectal mets?

A

CEA < 200

155
Q

What tumor size is a good prognostic indicator for survival after resection of hepatic colorectal mets?

A

< 5 cm

156
Q

What lymph node finding is a good prognostic indicator for survival after resection of hepatic colorectal mets?

A

negative lymph node

157
Q

what are the two most successfully cured metastases with surgery?

A

colon CA in the liver; sarcoma to the bone

158
Q

what is a tumor with which surgical debulking improves chemotherapy?

A

ovarian CA

159
Q

name two solid tumors curable with chemotherapy only?

A

Hodgkin’s and non-Hodgkin’s lymphoma

160
Q

name two types of T-cell lymphomas and how they manifest

A

HTLV-1 (skin lesions); mycosis fungoides (Sezary cells)

161
Q

Name two HIV-related malignancies

A

Kaposi’s sarcoma, non-Hodgkin’s lymphoma

162
Q

name two oncogenic processes that VEGF is involved with

A

vascular epidermal growth factor causes angiogenesis and is involved in tumor metastases

Z.Fiser (22 decks)

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