Introduction to Oncology Flashcards
cancer occurs when there is a genetic mutation that leads to
proliferation of a colony of malignant cells
define uncontrolled proliferation
cancer cells lack or fail to respond to normal mechanisms that control cell division or growth
what are some cellular changes of cancer
loss of some or all of their differentiation characteristics
some changes to chromosomes, proteins, enzymes
can’t perform ntended functions of origin tissue
solid tumors are classified by
their tissue of origin
carcinomas originated in
surface epithelium
adenocarcinomas originated in
glandular (epithelial) tissue
osteosarcoma originated in
bone (connective tissue)
rhabdomyosarcoma originated in
striated muscle (connective tissue)
leiomyosarcoma originated in
smooth muscle (connective tissue)
glioblastomas originate in
glial tissue (neural)
astrocytomas originate in
astrocytes (neural)
melanomas originate in
melanocytes (dermal tissue)
germinomas originate in
germ cells (gonadal tissues)
liquid or hematologic malignancies are classified based on ____ and further divided based on ________
cell origin
pathology/cell lineage and presentation
leukemia cell of origin
hematopoetic cells
lymphoma cell of origin
lymphoid tissue cells
multiple myeloma cell of origin
plasma cells
carcinogenesis 4 steps
initiation
promotion
conversion
progression
initiation is
genetic alteration / exposure to carcinogen
promotion is
carcinogens or other things changes the environment to favor the growth of the changed cell pp
conversion/ transformation is
the altered cells become cancerous
progression is
further genetic alterations that result in increased proliferation of cancerous cells
T or F: germline mutation is inherited and present in all cells
T
T or F: somatic gene mutation is acquired and only in some cells
T
a gene that has the potential to cause cancer
oncogene
oncogenes begin as ______ and are upregulated through mutations to oncogenes
protooncogenes
an activated oncogene leads to
excessive production of genetic product (cell signals/ products) = dysregulation
T or F: protooncogenes are normal and are still regulators of normal cellular function
T
the mutation that takes a protooncogene to an oncogene is usually
acquired
what regulates and inhibits inappropriate cellular growth and proliferation
tumor suppressor genes
damage to DNA repair genes results in
errors in DNA not corrected, leading to activation of oncogenes or deactivation of tumor suppressor genes
6 hallmarks of cancer
- sustained proliferative signaling
- replicative immortality
- resisting cell death
- evading growth suppressors
- inducing angiogenesis
- activating invasion and metastasis
T or F: cancer cells are differentiated
F- and can’t perform function of origin tissue
local metastasis generally invade the
lymphatic system
distant metastasis commonly involve the
brain, lungs, bone, liver
metastasis retain the characteristics of the ________________
primary cancer
cancer’s 7 warning signs (referral)
- changing bowel/ bladder habits
- lump in breasts
- unusual bleed or discharge
- diff swallowing/ indigestion
- obvious changes in wart or mole
- chronic cough or hoarseness
radiation therapy kills cancer cells or slows their growth by
damaging the DNA
(once DNA is damaged beyond repair = die)
3 ways that surgery can treat cancer
removal of primary tumor
removal of lymph nodes
reduce metastases
what therapy damages or kills dividing cells, targeting more rapidly reproducing cells
cytotoxic chemo
what therapy impacts cell signaling or signal transduction within the cell by targeting specific gene mutations or cell surface receptors
targeted therapies
immunotherapies MOA
influence the body’s immune response to malignant cells
endocrine therapies MOA
manipulate hormone production or actions for cancers that are hormone dependent
angiogenesis inhibitors MOA
impact cell signaling or processes that influences angiogenesis
impetus for workup may include
palpation of a mass or nodule
routine lab tests
new or nonresolving sx
screening test results
cancer pt workup includes
hx and physical exam (consider exposure to carcinogens)
lab tests (tumor markers if available)
imaging
why is a pathologist dx essential
many benign tumors can mimic appearance of cancer
tissue is obtained through a biopsy through
excision, core, or fine needle aspirate
(or surgical resection)
what tests can be performed on tissues to characterize the maligancy
tumor classification
identify any biomarkers
determine tumor grade
a tumor grade is assigned based on
histopathologic type
morphologic features
degree of differentiation
`a higher tumor grade means
more aggressive tumor and worse prognosis
indicative of pt survival independent of treatment received + indicator of innate tumor aggressiveness
prognostic biomarker
indicative of therapeutic efficacy because there is an interaction between the biomarker and therapy on pt outcome
predictive biomarker
identification and documentation of the structure of a specific DNA, RNA, or protein molecule for purpose of dx or characterization of a genetic disorder
molecular profiling
what can summarize the somatic mutations present
molecular profiling
testing samples of tissue (cancer) to look for changes in the chromosomes of the cells
cytogenetics
gene mutation screening assays include
fluorescence in situ hybridization
PCR
next gen sequencing
4 types of mutations
insertion
deletion
translocation
insertion
trade of DNA pieces between chromosomes
translocation
ki-67 measures
growth rate or doubling time
is a protein in dividing cells
ki-67 is measured by
immunohistochemsitry
ki-67 could be a _______ biomarker and provide insight into
prognostic
aggressiveness + response to chemo
TNM system for staging solid tumors stands for
T- size of primary tumor
N- lymph node involvement
M- presence of metastases
S- serum markers (only for testicular cancer)
cancer staging signifies the extent of disease for
solid tumors
the higher the stage, the _____ the cancer
worse (0-4)
define neoadjuvant chemo
use of chemo prior to local treatment
usually to increase effectiveness of later treatment by reducing tumor bruden
define adjuvant therapy
use of a treatment after local treatment
may be to destroy residual or undetectable tumor cells/ reduce risk of recurrance
palliative therapy is
use of a treatment to alleviate/ reduce sx, stabilize disease/ slow progression, improve/ maintain quality of life
define induction therapy
giving chemo to induce remission
define consolidation
after induction, given to keep pt in remission
define maintenance after induction and consolidation
to hold remission
considerations when choosing pharm for cancer
age, ECOG, comorbidities. cancer type/ stage/ grade, molecular profiling, tx goals
what is the ECOG
a performance scale on 0-5 and informs how the disease is impacting a pt’s daily living abilities and inform tx decisions
“cure” of cancer as a GOT is defined as _______________
and measured as ___________ in literature
pt is cancer free and expected to have a lifespan eq to general pop
literature/ trials = 5 yrs disease free survival
for prolonging survival, antineoplastic pharmcol is measured in trials as
progression free survival = number/ proportion of pts that are still alive and free of disease progression
what is median progression free survival
the time that 50% died/ progressed with cancer
what is overall survival
proportion of pts that are still alive at any spec time
takes into account death of any cause- even from med toxicities
antineoplastic agents often have a _____ therapeutic window
narrow
dose limiting toxicity is
an agent’s specific toxicities that caps how much can be administered
dosing can be based on
BSA
renal fxn
flat dosing
adj for organ fxn
frequency for cytotoxic agents
given cyclically to give body time to recover
frequency for targeted oral agents (small molecules_
many administered daily for several consecutive days followed by rest period
freq for targeted IV therapies (monoclonal antibodies)
administered IV cyclically with chemo
v long half life
concepts to max efficacy in combo therapies
each drug must have clinical activity against tumor alone
each drug should have a different MOA
combinations should be synergistic
