Misc Solid Tumors EXAM 3 Flashcards by o e

Name a drug that increases the risk of a solid tumor.

Tamoxifen for endometrial cancer

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What are the 4 symptoms of Ovarian cancer?
Ovarian cancer symptom index

OBJECTIVE !!!

“Silent cancer” - unspecific symptoms, also common in postmenopausal women (65y), which is the population affected by this cancer

-bloating
-pelvic or abdominal pain
-early satiety
-increased urinary frequency or incontinence

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Which procedure is required to treat Ovarian cancer?

debulking surgery (by a specialist) then chemo

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What is the first-line therapy for ovarian cancer?

FYI, no objective

paclitaxel + carboplatin (+/- bevacizumab)

may administrate directly into the peritoneal cavity
Intraperitoneal (IP)
but very toxic, hard to tolerate, more effective

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Why are PARP inhibitors so effective in BRCA-mutated cancer cells? What is the name of the mechanism behind it?

bc these cells cant repair ds breaks (BRCA mutation)

if we block PARP they can’t repair ss breaks either

Synthetic lethality

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What is the side effect profile of PARP inhibitors?

-mild myelosuppression
-Nausea
-rare: secondary leukemia and/or myelodysplastic syndrome (MDS)

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What are the risk factors for endometrial cancer?

OBJECTIVE !!!

-Obesity
-Unopposed estrogen exposure
-Nulliparity, early menarche/late menopause (more estrogen exposure)
-Tamoxifen !!!
-Endometrial hyperplasia

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What is a symptom of endometrial cancer?
!!!

Abnormal vaginal bleeding

example: a woman is postmenopausal and stopped having her period and now presents with vaginal bleeding

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What is the biggest risk factor for Cervical cancer?

-HPV (subtype 16 & 18)
HPV vaccine with high efficacy for prevention (vaccinate boys and girls)

-early coitarche (intercourse), multiple sexual partners, history of STDs

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What are the common screening tools for cervical cancer?

-21-29y
cervical cytology (PAP smear) every 3 years

-30-65y
cervical cytology (PAP smear) every 3 years
(high-risk) hrHPV testing every 5 years +/- cytology

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What is the biggest risk factors for bladder cancer?

Smoking
(excretion of carcinogens (smoke) through urine)

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Symptoms of Bladder Cancer

blood in the urine

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What is the treatment for Stage I (non-muscle invasive) Bladder cancer?

!!!

Transurethral endoscopic resection (TURBT) + intravesicular gemcitabine + adjuvant intravesicular BCG

Bacillus Calmette-Guerin (tuberculosis vaccine)

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What is the purpose of the BCG injection after surgery for bladder cancer?

OBJECTIVE !!!

local immune response reduces the risk of cancer to come back

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Treatment for Stage II or III Bladder cancer

Neoadjuvant cisplatin chemo
radical cystectomy (removing parts or complete bladder)

some patients get
1. TURBT
2. chemo + radiation

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Drugs for Stage IV Bladder Cancer

Enfortumab vedotin (EV) + pembrolizumab

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Why is pancreatic cancer removable (surgery) in only 15-20% of patients?

-it is hard to get access
-it is surrounded by the small intestine and major blood vessels
-they form an extracellular matrix outside the tumor that impairs drug delivery

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Which drugs are used for pancreatic cancer?

Dont need to know drugs

-FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin)
-Gemcitabine + nab-paclitaxel
-Gemcitabine

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What made the number of Gastric cancer go down?
Name other risk factors.

-Recognition/treatment of H. pylori infection
-Refrigeration (Less salt-preserved foods; more fresh fruits/vegetables)

other risk factors:
-smoking and EtOH

Treatment options for Gastric cancer

FYI? no objective

-Surgery
-Chemoradiation (5-FU based)
-Chemotherapy (5-FU, platinums, anthracyclines)
-Immune checkpoint inhibitors if high PD-L1 expression

Head and Cancer are associated with which pathogen?

OBJECTIVE !!!

HPV !!! HPV vaccine helps in the prevention
HSV (herpes simplex virus)
EBV (Epstein-Bar-virus)

What is the biggest risk factor for head and neck cancer?

OBJECTIVE !!!

use of tobacco and EtOH !!
200x increased risk if done together

other:
-HPV, HSV, EBV
-Vitamin A deficiency

What is the Goal of Head and neck cancer treatment?

Cure
Organ and function preservation

it is not easy to remove affected organs and keep the function (oral/nasal cavity, pharynx, larynx, salivary gland)

Which drugs are used for Head and neck cancer?

Surgery and chemoradiation

cisplatin, 5-FU + XRT (radiation)
Cetuximab + XRT
Immunotherapy

What are the risk factors of Hepatocellular Carcinoma?

-Hepatitis B & C -cirrhosis (alcohol or fatty liver disease) -anabolic steroids (also oral steroid meds, IV steroid meds are fine)

What are the treatment options for Hepatocellular Carcinoma? FYI

-Surgery (including liver transplantation) -Transarterial chemoembolization (TACE) -Radiation (palliative) -TKIs -Immunotherapy + VEGF-targeting mab (e.g. bevacizumab

Which drug is used for brain tumors, especially for Grades III and IV? !!!

Temozolomide (Temodar) -every day at a low dose with radiation for 6 weeks (some cycles with high dose for 5 days of the cycle)

What are the side effects of Temozolomide? What has the be given for prophylaxis? OBJECTIVE !!!

-Myelosuppression (lymphopenia !!!) -> risk for pneumocystis pneumonia !!! -Alopecia, N/V PJP prophylaxis -need prophylaxis

Which drugs are used for PJP prophylaxis? OBJECTIVE !!!

-Bactrim DS daily M-W-F or BID Sat/Sun if sulfa allergy: -inhaled pentamidine 300 mg -Dapsone

What is the biggest risk factor for kidney cancer?

Smoking!! -obesity -HTN in males -Von Hippel-Lindau disease (inherited)

What is the most common sign of kidney cancer? (same sign for Bladder cancer)

-Hematuria (blood in the urine) -also flank pain

What are the treatment options for kidney cancer?

Surgery (partial or complete nephrectomy) if advanced: -immunotherapy + VGEF-targeting TKIs -VGEF-targeting TKIs only (risk patients) -Dual immune checkpoint inhibitors: nivolumab + ipilimumab

How does the Von Hippel-Lindau disease increase the risk for kidney cancer?

no production of the Von Hippel-Lindau protein (tumor suppressor) which should turn OFF HIF (hypoxia-induced growth factor, active when there is no oxygen) HIF will stimulate VGEF -> more blood supply for the cancer cell

What are the 2 types of testicular cancer?

Seminoma (immature -> very sensitive to radiation) Nonseminoma (less easy to cure) -embryonal, teratoma, choriocarcinoma, yolk-sac

What are the treatment options for testicular cancer?

for all patients: orchiectomy (removal the testes) -lymph node dissection -pelvic radiation if they need chemo: -Carboplatin alone -Etoposide/cisplatin (EP) -Bleomycin/etoposide/cisplatin (BEP)

What is the treatment option for most solid tumors? What if there are metastases? Explain the role of solid tumor metastasis in colon cancer. What are the cure chances for testicular cancer? !!!

1. Surgery 2. if there are metastasis, there is no cure 3. if there is metastasis from colon cancer to some part of the liver, there may be a chance to cure 4. We assume, we can cure every patient with testicular cancer (there is no stage IV in testicular cancer)

What is a common side effect of Bleomycin?

Pulmonary fibrosis

Signs for Skin cancer OBJECTIVE !!! NAPLEX !!!

ABCDE Asymmetric Borders (irregular) Color variation Diameter > 6mm Evolving lesion -> if they have 1 of these -> REFER

What are the 2 types of skin cancer?

Melanoma: aggressive, can move to any part of the body -> Surgery, Immunotherapy (adjuvant if stage III) Non-melanoma Basal cell & squamous cell carcinomas

What is a side effect of pembrolizumab that affects the skin?

Vitiligo -> the immune system attacks melanocytes (white spots)

What is a Site-Agnostic Disease?

a disease with a specific genetic profile -> the treatment is not based on where the cancer is (lung, brain, breast) but it is based on the genes of the cancer

Which agent might be used for MSI-H cancer (mismatch repair deficient)? Site-agnostic disease

Pembrolizumab Dostarlimab

Which agent might be used for NTRK(+) cancer? Site-agnostic disease

-Larotrectinib Neurotrophic receptor TKI

Which agent might be used for BRAF(v600E) cancer? Site-agnostic disease

Dabrafenib + trametinib