Oncology Flashcards
Alkylating Agent: Cyclophaphamide
Alopecia, bone marrow toxicity, gonadal failure;
Alkylating Agent: Cisplatin
Ototoxicity, nephrotoxicity, neuropathy -> give amifostine (antidote)
Alkylating Agent: Busulfan
Pulmonary fibrosis
Alkylating Agent: Nitrosureas
Neurotoxicity
Alkylating Agent: Oxaliplatin
Neurotoxicity
Alkylating Agent: Procarbazine
Disulfiram-like reaction
Antitumor Antibiotic: Bleomycin
Pulmonary fibrosis
Antitumor Antibiotic: Dactinomycin/Actinomycin D
Myelosuppresion
Antitumor Antibiotic: Doxorubicin/Adriamycin
Cardiotoxicity -> give dexrazoxane (antidote)
Antimetabolite: Methotrexate
Inhibits dihydrofolate reductase
Antimetabolite: 5-FU
Inhibits thymidylate synthase
Antimetabolite: Azathioprine and 6-Mercaptopurine
Purine analogue
Antimetabolite: Cytarabine
Pyrimidine analogue
Antimetabolite: Hydroxyurea
Inhibits ribonucleotide reductase
Microtubule Inhibitor: Taxanes
Hyperstabilize polymerized microtubules preventing their breakdown during anaphase
Microtubule Inhibitor: Vinblastine and Vincristine
Attach to B tubulin and inhibit polymerization
Topoisomerase Inhibitor: Etoposide, Teniposide
Inhibit topoisomerase II
Topoisomerase Inhibitor: Ironotecan, Topotecan
Inhibit topoisomerase I
Hypercalcemia
PTHrP: squamous cell carcinoma (lung, head & neck, skin, breast, GU, GI)
SIADH
Small cell carcinoma of the lung, carcinoid tumors, GI, GU, ovarian cancer
Cushing’s syndrome
Ectopic ACTH: small cell lung cancer, carcinoid, pancreatic islet cell tumors
Hypoglycemia from IGF-2 excess
Mesenchymal tumors, hepatocellular and adrenal carcinomas
Erythrocytosis
Renal and hepatocellular cancer, cerebellar hemangioblastomas
Trousseau’s Sndrome (migratory thrombophlebitis)
Pancreatic cancer
Myasthenia gravis, pure red cell aplasia
Thymoma
Lambert-Eaton myasthenic syndrome (LEMS)
Small cell carcinoma of the lung
Xeroderma pigmentosa
Lack of an endonuclease for thymidine dimer repair -> increased susceptibility to skin cancers of all types
Basal cell carcinomas
One or few small waxy, semitranslucent nodules forming around a central depression that may be ulcerated, crusted or bleeding, edge is rolled or pearly with rodent ulcer, rare metastasizes
Face/head and neck area
Most common site of basal cell carcinoma
Classical or nodular type
Most common type of basal cell carcinoma
Squamous cell carcinoma
Dome-shaped, elevated, hard infiltrating lesion (deeply nodular), may eventually develop an ulcer, occurs on sun-exposed areas
Bowen’s disease
In situ form of squamous cell carcinoma
Chronic long term sun exposure
Major risk factor for squamous cell carcinoma of the skin
Actinic keratosis
Known precursor lesion of squamous cell carcinoma of the skin
Superficial spreading
Most common type of melanoma
Asymmetry
Characteristics of a malignant lesion melanoma (versus benign nevus
Depth of invasion (Breslow thickness)
Single greatest determinant of metastasis of melanoma
Personal history of melanoma
Single greatest risk factor for melanoma
Acral-lentiginous melanoma
Most common type of melanoma in dark-skinned individuals and Asians
Regional lymph node metastasis
Single most important prognostic factor for melanoma
Early excision
Most important determinant of outcome in melanoma
Wheal
Primary lesion erythematous edematous evanescent rash
Lichenification
Thickening of skin with accentuation of skin fold markings
Erosion
Loss of epidermis without loss of dermis
Ulcer
Loss of both epidermis and dermis
Lungs
Most common site of metastasis of soft tissue sarcomas
Chemotherapy
Mainstay of the treatment for Ewing’s sarcoma, PNET, and rhabdomyosarcoma
Plasma cell tumors
Most common malignant tumor of bone
Osteosarcoma
Account for majority of bone sarcomas, predominant in young males, usually occurring on the metaphysis of long bones, distal femur, proximal tibia, and humerus
Moth-eaten appearance
Radiographic hallmarks of osteosarcoma
Response to chemotherapy
Most important prognostic factor for long-term survival in osteosarcoma
Vertebrae
Site most commonly involved in bone metastasis
Urinary bladder
Most common site of malignancy in the urinary tract
Urinary bladder
Most common source of gross hematuria
Painless hematuria
Most common presentation of bladder, renal pelvis, and ureteric cancer
BCG
Vaccine component used as intravesicular therapy in bladder cancer
Smoking
Most common environmental risk factor for bladder and renal cell carcinoma
Clear cell carcinoma
Most common hisopathologic type of renal carcinoma
Hematuria
Classic triad of renal cell carcinoma
Peripheral zone
Site where most prostate cancers develop
5-alpha reductase inhibitors (finasteride/dutasteride)
Predominant therapy to reduce future risk of prostate cancer
Free PSA <10%, PSA density >0.15ng/ml/cm^3
PSA levels suggestive of cancer requiring biopsy
Transrectal ultrasound-guided needle biopsy
Test to establish prostate cancer diagnosis
Gleason scoring
Scoring used to measure histologic aggressiveness of the dominant and secondary glandular histology of prostate cancers
Pancreatic head
Most common location of pancreatic cancer
Smoking
Most common environmental risk factor for pancreatic cancer
Hepatomegaly
Most common physical sign in hepatocellular carcinoma (HCC)
Non-cirrhotic or Child-Pugh A cirrhosis
Candidates for resection in HCC
Single lesion <=5cm or <=3 nodules each <=3cm, no gross vascular invasion
Criteria for orthotopic liver transplant (Milan criteria)
Fibrolamellar HCC
Variant of HCC associated with younger females, elevated blood neurotensin levels, no cirrhosis
Hemangioma
Most common benign liver tumor among women
Adenoma
Benign liver mass associated with contraceptive use, with low potential for malignant change and risk of bleeding
Focal nodular hyperplasia
Benign liver mass with characteristic central scar, hypovascular on arterial phase and hypervascular on delayed phase CT
Triphasic CT scan
Most useful diagnostic tool in differentiating between benign and malignant liver masses
Cholangiocarcinoma
Mucin-producing adenocarcinomas that arise from the bile ducts, majority of which are located in the hilar or central area
Klatskin tumors
Nodular tumors arising at the bifurcation of the common bile duct
Ampullary carcinoma
Adenocarcinoma arising within 2 cm of the distal end of the common bile duct
Courvoisier’s sign
Palpable gallbladder associated with obstructive biliary malignancy
Pylorus preserving pancreaticoduodenectomy (modified Whipple’s procedure)
Standard surgical procedure for pancreatic head and uncinate tumors
Villous sessile adenomatous polyps, >2.5 cm in size
Characteristics of colonic polyps most associated with malignancy
FAP (familiar adenomatous polyposis)
Familial autosomal dominant condition with multiple polyps (polyposis coli)
Gardner’s syndrome
Multiple polyps in the small and large intestines with osteomas, fibromas, and congential hypertrophy of the retinal pigment epithelium
Turcot’s syndrome
Multiple polyps in the large intestine with brain tumors
Peutz-Jeghers syndrome
Multiple small and large intestinal polyps (hamartomatous/juvenile), mucocutaneous pigmentation, tumors of the ovary, breast and pancreas
Hereditary nonpolyposis colon cancer (Lynch syndrome)
Hereditary autosomal dominant predisposition to colon, ovarian and endometrial cancers caused by defects in DNA mismatch repair
Aspirin and NSAIDs
Most effective class of agents to reduce the risk of colon adenomas and carcinomas
Right-sided colon cancers
Usually non-obstructive, discovered late, with iron-deficiency anemia
Left-sided colon cancers
Usually with obstructive symptoms and apple-core or napkin ring deformity on barium studies
Rectosigmoid cancers
Hematochezia, tenesmus, narrowing of stool caliber
Within the first 4 years
Period of time when most recurrencies after surgical resection of large bowel cancer occur
Minimum of 12 lymph nodes
Number of sampled lymph nodes necessary to accurately define tumor stage during surgery
Liver
Most frequent visceral site of metastasis for colon cancer
5-fluorouracil (5-FU)
Backbone chemotherapeutic agent for colon cancer and acts as a radiosensitizer for treatment of rectal cancer
Diarrhea
Major side effect of irinotecan used in FOLFIRI regiman for colon cancer
Dose-dependent sensory neuropathy
Common side effect of oxaliplatin used in FOLFOX regimen for colon cancer
Squamous cell carcinoma
Esophageal cancer related to smoking and alcohol, arising in the middle 1/3
Adenocarcinoma
Esophageal cancer related to acid reflux and Barrett’s esophagus arising in the distal 1/3
Progressive dysphagia and weight loss
Initial symptoms of esophageal cancer in majority of patients
> 60% of esophageal circumference is infiltrated
Threshold of dysphagia
Diffuse type
Type of gastric carcinoma with loss of cell cohesion developing throughout the stomach resulting to loss of distensibility (linitis plastica or leather bottle appearance)
Intestinal type
Type of gastric carcinoma frequently ulcerative and involving the antrum and lesser curvature, often initiated by H. pylori
Low socio-economic class, H. pylori infection, ingestion of high concentrations of nitrates in preserved foods, Menetrier’s disease (hypertrophy of rugal folds), blood group A
Implicated risk factors for gastric cancer
Krukenberg tumor
Gastric cancer metastatic to the ovar
Sister Mary Joseph nodes
Gastric cancer metastatic to the periumbilical region
Blumer’s nodes
Gastric cancer metastatic to the peritoneal cul-de-sac
Virchow’s nodes
Gastric cancer metastatic to the supraclavicular lymph nodes
Liver
Most common site for hematogenous spread of gastric cancer
Complete surgical removal of the tumor with resection of adjacent lymph nodes
Only chance of cure for gastric cancer
Stomach
Most frequent site of extra-nodal lymphoma
Eradication of H. pylori
Primary treatment of gastric lymphoma
Age of menarche
Three dates in a woman’s life with major impact on breast cancer risk
Days 5-7 of the menstrual cycle
Best time for breast examination
Tumor stage
Most important prognostic variable in breast cancer
Selective estrogen receptor modulators (SERM)
Hormonal treatment for breast cancer which increases the risk of endometrial cancer
Oral contraceptive pills
Treatment that increases breast cancer risk but decreases ovarian and endometrial cancer risk
Trastuzumab
Monoclonal antibody directed against the erb/her2-neu receptor used for breast cancers
Lobular neoplasia
Premalignant lsion that suggests elevated risk of breast cancer
Smoking
Primary cause of lung cancer worldwide
Small cell and squamous cell lung cancer
Types of lung cancer implicated with smoking which tend to present centrally
Adenocarcinoma of the lung
Most prevalent type of lung cancer among women, young adults and non-smokers presenting peripherally
Bronchioalveolar carcinoma
Subtype of lung adenocarcinoma that grows along the alveoli without invasion (lepidic growth), may present with classic ground glass appearance on CT
Pancoast syndrome or superior sulcus tumor
Results from local extension of tumor growing in the apex involving C8 and TI-T2 nerve roots with shoulder pain radiating to the ulnar distribution and Horner’s syndrome
Hypercalcemia from extopic PTH/PTH-related protein production
Most common life-threatening metabolic complication of malignancy associated with squamous cell cancer of the lung
SIADH, Cushing’s Syndrome, Lambert Eaton Syndrome
Paraneoplastic syndromes associated with small cell lung cancer
Chemotherapy
Treatment of choice for small cell lung cancer
Surgical resection
Treatment of choice for early (stage 1 or 2) non-small cell lung cancer
Lungs
Location of majority of hamartomas
Alyklating agents and benzene
AML
Aromatic dyes and Schistosoma hematobium
Bladder cancer
Asbestos, arsenic
Lung cancer, mesothelioma
Epstein-Barr virus
Burkitt’s lymphoma, nasopharyngeal cancer
Diethylstilbestrol (DES)
Vaginal clear cell cancer (in daughters exposed to it during fetal development)
HIV
Lymphoma, Kaposi’s sarcoma (HHV-8 Virus)
Human Papilloma Virus (HPV)
Cervical cancer, head and neck cancer
HTLV-1
Adult T-cell leukemia
UV radiation (sunlight)
Skin
Vinyl chloride
Liver angiosarcoma
Smoking
Bladder, lung, esophageal, kidney, head and neck and pancreatic cancers
H. pylori
Gastric adenocarcinoma and MALT lymphoma
HBV, HCV, aflatoxin-1, ethanol
Hepatocellular carcinoma
APC
Colon cancer (FAP)
BRCA1, BRCA2
Breast and ovarian cancer
DCC
Colon cancer
MEN1
MEN 1
NF1, NF2
Neurofibromatosis 1 and 2
p53 (guardian of the genome)
Li-Fraumeni Syndrome
Rb
Retinoblastoma, osteosarcoma
VHL
Von Hippel Lindau Syndrome
WT1, WT2
Wilm’s Tumor
BRAF
Melanoma, lung, colorectal cancer
BCR-ABL
CML, ALL
BCL-2
Follicular lymphoma
C-myc
Burkitt’s lymphoma
L-myc
Lung and bladder cancer
N-myc
Neuroblastoma, lung cancer
RAS
Colon, lung, pancreatic cancer
RET
Multiple endocrine neoplasia (MEN) 2A and 2B
hCG (human chorionic gonadotropin)
Trophoblastic disease, gonadal germ cell tumor, choriocarcinoma
Calcitonin
Medullary thyroid cancer
Catecholamines
Pheochromocytoma
AFP (alpha fetoprotein)
Hepatocellular, gonadadal germ cell tumor, yolk sac or endodermal sinus tumor
CEA (carcinoembryonic antigen)
Colon, pancreatic, breast, lung and ovarian cancer
Prostatic acid phosphatase, prostate specific antigen (PSA)
Prostate cancer
Neuron-specific enolase
Small cell lung cancer, neuroblastoma
Lactate dehydrogenase (LDH)
Lymphoma, Ewing’s sarcoma, dysgerminoma
Monoclonal immunoglobulins
Myeloma
CA-125
Ovarian cancer, lymphoma
CA 19-9
Colon, pancreatic, and breast cancer
S-100
Cancers of neural crest origin (melanomas, schwannomas, Langerhans cell histiocytosis)
Sigmoidoscopy
Adults >=50 years old; screen every 5 years
FOBT (fecal occult blood testing)
Adults >=50 years old; screen every year
Colonoscopy
Adults >=50 years old; screen every 10 years
Pap smear
Begin 3 years after first intercourse or by age 21
Mammography
Women >=40 years old: screen annually (ACS)
DRE and PSA
Men >=50 years old: screen annually
Age
Most significant risk factor for cancer overall
Lung cancer
Most common cancer worldwide
Breast cancer
Second most common cancer worldwide
Lung cancer
Most common cause of cancer death
Tumor suppressor genes
Genes involved in restraining cell growth and requiring both alleles to be mutated for tumorigenesis
Oncogenes
Genes involved in cellular growth wherein mutation of one allele may lead to tumorigenesis
Surgery
Most effective means of treating cancer
Teletherapy
Delivery of radiation therapy from a distance
Brachytherapy
Encapsulated sealed sources of radiation implanted directly or adjacent to tumor
Systemic radiation therapy
Radionuclides targeted to the site of the tumor
Alcohol and smoking
Most significant risk factor for head and neck cancer
Chemoradiotherapy
Most commonly used treatment for head and neck cancers
Serotonin receptor antagonists (i.e. ondansetron)
Most effective drugs against highly emetogenic agents
