oncology Flashcards
half lives CEA, PSA, AFP
CEA: 18 days
PSA: 18 days
AFP: 5 days
most radiosensitive tumors?
seminomas, lymphomas
most radioresistant tumors?
epithelial, sarcomas
brachytherapy?
radiation source is right next to or IN tumor (Au-198, I-128) for very concentrated doses
gamma knife?
cobalt XRT
Retinobastoma gene. Rb1
TSG. Ch 13. Cell cycle regulation
P53?
TSG. Ch. 17. Controls arrest to apoptosis.
APC ?
TSG. Ch 5. Cell cycle regulation.
DCC?
TSG. Ch 18. Cell adhesion.
Proto oncogenes… ras?
GTPase
Src proto-onc?
Tyroskine kinase defect
Sis proto-oncogene
PDGF-R defect.
Erb B proto onc
EGFR defect
Myc proto-onc?
Transcription factors
Li-Fraumeni syndrome?
P53 gene defect…
SARCOMA
BREAST
BRAIN
LEUKEMIA
ADRENAL
KRAS gene mutation
LUNG
PANCREATIC
COLON
Colon ca associated genetic mutations?
APC, p53, DCC, K-ras
Virchow’s nodes
Stomach ca related supraclavicular nodes
Sister Mary Joseph’s node?
Pancreatic ca related periumbilical node
Krukenberg tumor
Stomach cancer to OVARY.
type of T cell lymphomas?
HTLV-1 (skin lesions)
Mycosis fungoides (Sezary cells)
common chemo regimens
breast
colon
gallbladder ca \
pancreatic
Gemcitabine with cisplatin: gallbladder carcinoma.
Doxorubicin and paclitaxel: breast cancer and sarcoma.
FOLFOX: colorectal cancer.
FOLFIRINOX: pancreatic cancer as neoadjuvant chemotherapy in an attempt to convert the tumor to resectability.
retinoblastoma presentation
strabismus, leukocoria, and a white mass on the retina on fundoscopy
Von Hippel-Lindau disease
von Hippel-Lindau tumor suppressor gene.
CNS
clear cell renal carcinoma
pheochromocytoma
neuroendocrine tumors of the pancreas.
desmoid tumors
stable in size for many years or even spontaneously regress
homogenous on imaging
Bx: reveals bundles of spindle cells and an abundant fibrous stroma
can just watchful wait (image q3 mos MRI)
mgmt desmoid tumor that is sx (intraabdominal)
resect en bloc with SBR
if malignant, will need RADIATION.
medical therapy: sulindac and tamoxifen
dx of desmoid tumor
because need to rule out like a met.
so image guided core needle bx (no incisional bx because it can seed)
Bx; spindle cell bundles and fibrous stroma
MC melanoma sites
skin > eyes > anal *canal (APR)
if can’t give octreotide for sx NET, what else
Everolimus
rhabdomyosarcoma dx
first CNBx
MRI for invasion of organs, LNs
RMS txS
if no invasion, then PRIMARY COMPLETE EXCISION
if invasion, then NEOADJ CHEMO then resection +/- radiation if residual disease
SLNB if changes treatment
Routine LN dissection if perineal or anal (without SLNB)
SB mets
- melanoma
- lung, breast, RCC
intraperitoneal mets
- ovarian
- colon, appendix, gastric
chemotx for recurrent medullary thyroid
vadetanib - TK inhibitor
pembrolizumab
celld eath protein -1 blocking Ab for MELANOMA
ipilimumab
cytotoxic T lympho associated protein CTL-4 blocking Ab for MELANOMA
cetuximab
inhibits EGFR in CRC
imatinib
TK-receptor bcr-abl for GIST, CML
undiff spindle cell tumor
of bone….
MC prox tibia, distal metaphyses of femur
tx; chemo and wide resection
levamisole
immune modulator; given with FLUROURACIL in colon ca
given within1 mo of FU and extended for 1 yr
adverse: agranulocytosis, AMS-syndromes, disulfiram like rxn
purine synth inhibitors
azathioprine, Mycophenolate mofetil
mitotic MT kinetics
vincrinstine, vinblastineDN
A alkylation
chlorambucil, cyclophosphamid, streptozocin
ttopoisomerase inhibitors
irinotecan, doxorubicin, etoposide-VP-16
most sensitive localization test for PNETS
gadolinium dotatate PET CT
EBV ca
nasopharyngeal
Hodgkin
Burkitt
gastric ca
lymphoproliferative disease in AIDS
EBV gastric
DNA methylation of promoter to SILENCE genes…. (maybe escapes immune detection in dormancy)
MALE
CARDIA or postsurgical STUMP
LYMPHOCYTIC INFILTRATION
DECREASE LN METS
BETTER PX
histology for Burkitts
B cell with MYC translocation…. starry sky appearance of mature B cells
histology of MALTomas
reactive follicles of CD20+ neoplastic cells in MARGINAL zones…. h pylori
histology of DLCBL
prominent nucleoli large CD20+ cells
very responsive to chemo
histology of Hodgkin type lymphoma
numerous 45 um cells with multiple nuclei with large inclusion like nucleoli Reed Sternberg cells
best prognosis HL
lymphocyte predominant
MC lymphoma type
nodular sclerosing
celiac lymphoma
T cell enteropathy associated lymphoma EATL….
adjacent villous atrophy… monotonous anaplastic clonal cells expressing T cell markers CD 3 CD 7
false negative for PETs
bronchoalveolar lung cancer
carcinoid cancer
highest sensitivity tumor marker
PSA (low specificity though)
stages of cancer progression during latency period
- initiation (carcinogen acts on DNA)
- promotion (of cancer cells)
- progression (to clinically detectable tumor)
neuron specific enolase NSE
marker for small cell lung ca and neuroblastoma
burkitts oncogene
EBV with 8;14 translocation
nasopharyngeal ca oncogene
EBV with c=myc
most susceptible to XRT
M
cyclphosphamide active metabolite
acrolein
side effect cyclophosphamide
hemorrhagic cystitis (give mesna)
SIADH
gonadal dysfunction
methotrexate MOA
inhibit DHFR, purine synthesis
save with leukovorin
5-FU MOA
thymidylate synthetase
leukovorin actually makes it MORE toxic
MC met TO BONE
BREAST > prostate
coal tar association
larynx
skin
bronchial carcinoma
beta-naphtylamine association
bladder cancer
benzene association
leukemia
asbestos association
mesothelioma
sweet syndrome
febrile acute neutropenic dermatitis after GCSF (side effect)
