Oncology Flashcards
Hyperplasia
increased number of cells
Metaplasia
Normal cell type is replaced by another
Dysplasia
abnormal growth, loss of normal size/shape/orientation
Anaplasia
irreversible, regression, high N:C ration, prominent nucleoli, clumping of chromatin, & mitotic figures
Neoplasia
growing cells in an uncontrolled fashion
Adenoma nomenclature
Benign Tumor of Epithelium w/ glandular architecture
Papilloma nomenclature
Benign Tumor of Epithelium w/ finger-like projections
Carcinoma nomenclature
Malignant Tumor of Epithelium
-Adenoma or Papillary
Stain for Carcinoma
Cytokeratin
Epithelial tumors spread
via lymph
Mesenchymal tumors spread
via blood
Mesenchymal Tumors - Blood
Blood cell tumors (leukemia, lymphoma), Blood vessel tumor (hemangioma, angiosarcoma)
Mesenchymal Tumors - Bone
Osteoma, Osteosarcoma
Mesenchymal Tumors - Fat
Lipoma, Liposarcoma
Mesenchymal Tumors - Skeletal mm
Rhabdomyoma, Rhabdomyosarcoma
Mesenchymal Tumors - Smooth mm.
Leiomyoma
Leiomyosarcoma
Teratoma
tumor w/ >1 cell type
Mature teratoma
mature tissues, no anapestic cells (ovarian tumors)
Grade
cellular differentiation & mitotic activity
Low grade
resemble normal cell architecture & have few mitotic figures
Staging
size, spread (nodal involvement, metastasis)
Liver metastasis
Colon Stomach Pancreas Breast Lung
Liver Metastasis Sx
high LFTs, tenderness/abd pain, hepatomegaly, hepatic dysfunction (ascites, jaundice)
Brain Metastasis
Lung Breast Skin (Melanoma) Kidney GIT tumors
Brain Metastasis Sx
HA, Focal Neuro defects (Hemiparesis), Cognitive Dysfucntion (memory loss, personality change), Seizures
Bone Metastasis Sx
Prostate Renal Cell Carcinoma Thyroid Lung Breast
Lytic Bone Metastasis
break down bone (MM)
Blastic Bone Metastasis
builds bone (prostate)
Paraneoplastic Syndrome - Small Cell Lung Cancer
ACTH -> Cushing
ADH -> SIADH (hyponatremia)
Lambert-Eaton Syndrome
Lambert-Eaton Syndrome
Small Cell Lunch Cancer producing Ab against presynaptic Ca2+ channels at the NMJ
Testing for Lambert-Eaton Syndrome
Isometric mm. contraction (weakness that improves w/ use)
Paraneoplastic Syndrome - Squamous Cell Lung Cancer
Humoral hypercalcemia of malignancy
secretes PTHrP
Multiple Myeloma
Anemia, hypercalcemia, back pain (lytic bone lesions d/t local osteolytic factors)
Cachexia
tumors produce cytokines -> increase metabolic rate -> loss of fat & lean mm.
Psammoma Bodies are seen w/
Papillary thyroid cancer
Serous Papillary cystadenocarcinoma of the ovary
Meningioma
Malignant Mesothelioma
Psammoma Bodies
laminated concentric calcific spherules
Most common cause of hypercalcemia?
Primary hyperparathyroidism
Oncogenes
Mutation -> growth w/o GF (uncouple growth & GFs)
Tumor suppressor genes
Mutations allow unregulated cell cycle
Apoptosis genes
mutation, disables apoptosis
DNA repair genes
mutation, cells are susceptible to DNA damage
Tumor suppressor gene examples
Rb, p53 (checkpoint b/w G1/S)
p53 S/G2
Rb mutation
can’t inhibit E2F (TF)
Double-hit hypothesis
tumor-suppressor genes require mutations in both alleles
Heritable Retinoblastoma
inherit 1 mutation + 1 sporadic mutation
Sporadic Retinoblastoma
2 sporadic mutations
p53 mutations are seen in
50% of human cancers
p53 function
causes apoptosis by inducing transcription of pro-apoptotic genes (BAX) via p21
p53 mutations allow
cell replication through checkpoints despite DNA damage
APC
Familiar adenomatous polyposis
BRCA
Breast & Ovarian Cancer
DPC
Deleted in pancreatic cancer
DCC
Deleted in colon cancer
NF1
Neurofibromatosis type 1
NF2
Neurofibromatosis type 2
B/L acoustic neuromas
Neurofibromatosis type 2
WT1 & WT2
Wilms Tumors
VHL
Von Hippel-Lindau
TSC
Tuberous Sclerosis
RAS oncogenes
most common oncogene abnormality in tumors
K-RAS mutation
colon, lung, pancreatic tumors
H-RAS mutation
Bladder, Kidney tumors
N-RAS
Melanomas, Hematologic malignancies, Follicular thyroud cancer
RAS pathway
G-protein -> MAPK -> activation of TF
RAS mutation
constitutive MAPK activation
BCR-ABL
t(9:22) CML constitutive tyrosine kinase activation
RET mutation
assoc w/ MEN 2A & 2B
Pheochromocytoma, Medullar thyroid cancer
Papillary Carcinoma of the thyroid
HER2/neu
Breast, Ovarian, Gastric cancer
Trastuzumab
blocks HER2
C-myc
Burkitt Lymphoma
L-myc
Lung cancer
N-myc
Neuroblastoma (adrenal medulla)
Rb mutations are seen in
Retinoblastoma & Osteosarcoma
What TF is normally bound by Rb
E2F
Cigarette smoke is assoc w/ an increased risk of what type of cancer
Small Cell & Squamous Cell Carcinoma of the Lung
Oral Cancer, Squamous cell Laryngeal Cancer, Pancreatic Cancer, Transitional Cell Carcinoma, RCC
EtOH use is assoc w/ an increased risk of what type of cancer
Oral Cancer, Laryngeal cancers, Squamous Cell esophageal cancer, HCC
Aflatoxin is assoc w/ an increased risk of what type of cancer
Aspergillus molds (corn, soybeans) p53 mutation -> food contamination -> HCC
Nitrosamine is assoc w/ an increased risk of what type of cancer
Gastric cancer, Squamous cell esophageal carcinoma
Arsenic is assoc w/ an increased risk of what type of cancer
Lung cancer, Squamous Cell skin cancer, Angiosarcoma
Vinyl Chloride is assoc w/ an increased risk of what type of cancer
Angiosarcoma
Alkylating Agent is assoc w/ an increased risk of what type of cancer
Leukemia, Lymphoma
Benzene is assoc w/ an increased risk of what type of cancer
Leukemia, Hodgkin Lymphoma
Napthalene is assoc w/ an increased risk of what type of cancer
Transitional cell bladder carcinoma
Asbestos is assoc w/ an increased risk of what type of cancer
Bronchogenic carcinoma of the lung
Mesothelioma
Radon is assoc w/ an increased risk of what type of cancer
Lung Cancer
Ionizing radiation is assoc w/ an increased risk of what type of cancer
Myeloid cancer (AML, CML), thyroid cancer
UV radiation is assoc w/ an increased risk of what type of cancer
Squamous & Basal cell carcinoma of the skin, Melanoma
UVB radiation induces
pyrimidine dimers in DNA (high risk of skin cancer)
UVA
generation of free radicals (slight risk of skin cancer)
HBV is assoc w/ an increased risk of what type of cancer
Cirrhosis -> HCC
HCV is assoc w/ an increased risk of what type of cancer
Cirrhosis -> HCC
Papillary Thyroid Carcinoma
HTLV-1 is assoc w/ an increased risk of what type of cancer
T-cell lymphoma
HHV-8 is assoc w/ an increased risk of what type of cancer
Kaposi Sarcoma
EBV is assoc w/ an increased risk of what type of cancer
Hodgkin & Burkitt Lymphoma
Nasopharyngeal carcinoma
HPV-16, -18
Cervical, Vaginal, Vulvar, Anal, Penile, Throat cancer
H. pylori is assoc w/ an increased risk of what type of cancer
Gastric cancer
S. bovis is assoc w/ what type of cancer
Colon cancer (IE)
Schistosoma haematobiumis assoc w/ an increased risk of what type of cancer
Squamous cell cancer of the bladder
Pt w/ hematuria from the Middle East?
Schistosoma haematobium
Clonorchis sinensisis is assoc w/ an increased risk of what type of cancer
biliary cancer
Acanthosis nigricans is assoc w/
insulin-resistance or gastric carcinomas
Actinic keratosis may be a precursor to
Squamous cell skin cancer
Tx for Actinic keratosis
5-FU
Autoimmune & immunodeficient diseases are assoc w/ an increased risk of what type of cancer
Lymphoma
Tuberous sclerosis findings
Facial angiofibromas,
Seizures, low IQ
Ash-leaf spots
Tuberous sclerosis is related to what types of tumors/cancers
Cardiac rhabomyoma
Renal angiomyolipoma
Astrocytoma
Ulcerative colitis is assoc w/ an increased risk of what type of cancer
colon cancer
Most common cancers in men
prostate, lung, colon
Most common cancers in women
breast, lung, uterine
Which cancers cause the highest mortality rate in women
lung, breast, colon
Which cancers cause the highest mortality rate in men
lung, prostate, colon
Primary Prevention
Smoking, Obesity, Poor diet, Inactivity, Sun exposure
Smoking
1 cause of preventable cancer
Obesity is assoc w/ an increased risk of which cancers
increased esophageal adenoma renal cell carcinoma Endometrial cancer Gallbladder cancer Thyroid cancer
High-fat diet is assoc w/ an increased risk of which cancers
Breast, Colon, Prostate, Endometrial cancers
High-fiber diet is assoc w/
lower risk of colon polyps & colon cancer
Sedentary lifestyle is assoc w/ an increased risk of which cancers
breast & colon cancer
Sun exposure is assoc w/ an increased risk of which cancers
Basal & Squamous Cell Carcinomas, Melanoma (sun burns)
Secondary Prevention
early detection to decrease mortality
Breast Cancer Screening
Self-exams unadvised
Clinical Breast Exam
Mammograms from 50-75 q 2y
Cervical Cancer Screening
pap: 21-65yo q 3yrs
Prostate Cancer Screening
PSA (against screening)
Digital Rectal Exam (no rec)
Colon Cancer Screening
Colonoscopy: 50-75 q 10yrs
Flexible sigmoidoscopy: 50-75 q 5 yrs
FOBT: 50-75 annually
Lung Cancer Screening
Chest CT: 55-80yo smoker w/ hx of 30pack hx
HCC Tumor Marker
AFP
Prostate Tumor Marker
PSA (BPH, etc)
Ovarian Tumor Marker
CA-125 (high w/ any peritoneal irritation) - use for Tx efficacy
Bone Mets Tumor Marker
Alkaline Phosphatase
Biliary Tract Tumor Marker
Alkaline Phosphatase
Paget’s Disease Tumor Marker
Alkaline Phosphatase
Pancreatic Cancer Tumor Marker
CA 19-9, CEA
Colon Tumor Marker
CEA
Melanoma Tumor Marker
S-100
Schwannoma Tumor Marker
S-100
Hairy Cell Leukemia Tumor Marker
TRAP (Tartrate-resistant acid phosphatase)
Methotrexate MOA
inhibits Dihydrofolate reductase
Which drug can reverse the myelosuppression seen w/ Methotrexate
Leucovorin
Cyclophosphamide S/E
hemorrhagic cysitis d/t toxic metabolite acrolein
Cyclophosphamide S/E of hemorrhagic cysts can be prevented w/ what drug
Mesna
MOA of Doxorubicin & Daunorubicin
Generates free radicals & intercalates DNA
MOA of 5-FU
inhibits thymidylate synthase
MOA of 6-MP
Inhibits PRPP amidotransferase
Cytarabine MOA
inhibits DNA polymerization
Dexrazoxane
given w/ Doxorubicin & Daunorubicin to prevent cardiotoxicity
Uridine
given w/ 5-FU to rescue from myelosuppression
MOA of Etoposide
Inhibits topoisomerase II
MOA of Hydroxyurea
inhibits ribonucleotide reductase
MOA of Paclitaxel
stabilizes MTs by binding to Tubulin
MOA of Topotecan
Inhibits topoisomerase I
MOA of Vincristine
Inhibits MT formation
S/E of Tamoxifen
endometrial cancer
S/E of Trastuzumab
Cardiotoxicity
S/E of Paclitaxel
HSN rxn
S/E of Cisplatin
nephrotoxicity & ototoxicity
S/E of Vincristine
peripheral neuropathy
Bevacizumab MOA
VEGF inhibitor
Bevacizumab Uses
Metastatic cancers
Bevacizumab S/E
impaired wound healing, severe hemorrhage
Imatinib
enzyme inhibitor mutant bcr-abl