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USLME Kiss my ass and pray > Oncology DIT > Flashcards

Oncology DIT Flashcards

1
Q

Most prevelent Cancers in Males and Females

A

Males

  • Prostate
  • Lung
  • Colon

Women

  • Breast
  • Lung
  • Colon
  • uterus
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2
Q

Cancer w/ highest mortality in M and F

A

Males

  • Lung
  • Prostate
  • Colon
  • Pancreatic

Females

  • Lung
  • Breast
  • Colon
  • Pancreatic
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3
Q

What is an oncogene?

-Quinessential example?

A

Proto -Oncogenes normally regulate signal for cell growth, lack of response due to a mutation -> oncogene. Only one mutation is needed -> gain of function

RAS (G protein in the MAP kinase pathway that is always on -> cancer)

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4
Q

What is a tumor suppressor gene?

Quientessential example?

A

Tumor suppressor genes regulate the cell cycle. They but on the brakes while DNA repair goes on and encourages apoptosis if not

BOTH alleles must be lost for be cancerous

p53(TF for p21 and blocking G1-S phase)
RB (hypophos binds to ETF)
are classic

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5
Q

Retinoblastoma herititable vs sporadic

Screen kids how?

A

1/4 is bilateral w/ Rb tumor suppressor mutation inherited (have one KO, a lot easier to have the other go)

3/4 are sporadic meaning both alleles were lost sporadically

(overall 60% mutations sporadic, 40% inheritied)

See a white reflex in the kids eye instead of red

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6
Q

rb is ?

Mutated in what CA (2)

A

tumor suppressor gene that inhibits E2F when hypophosphorylated
blocks G1-S phase

Retinoblastoma and osteosarcoma

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7
Q

p53 is?

A

tumor suppressor gene lost in most cancers

Acts through p21 to cause cell arrest

causes apoptosis through transcription of BAX if DNA repair not complete

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8
Q

BRCA1 and 2 is?

Mutated in what CA(2)

A

tumor suppressor gene involved in DNA repair

Ovarian and Breast

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9
Q

APC is?

Mutated in what CA

A

is a tumor suppresor gene

mutated in colorectal CA in familal adenomatous polyposis

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10
Q

WT1 is?

mutated in what CA

A

tumor suppresor gene

mutated in Wilms tumor

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11
Q

NF1 is?

mutated in what CA

A

tumor suppresor gene involved q/ RAS GTPase activating protein - > cutaneous neurofibromas

Chromosome 17

mutated in nerofibromatosis type 1

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12
Q

NF2 is ?

mutated in what CA?

A

tumor suppresor gene on chromosome 22

mutated in neurofibromatosis type 2 -> bilateral acoustic schwannomas

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13
Q

DPC 4 is?

mutated in what CA

A

tumor suppresor gene

Deleated in Pancreatic Cancer

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14
Q

DCC is?

mutated in what CA

A

tumor suppresor gene

Deleted in Colon Cancer

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15
Q

VHL is?

mutated in what CA?

A

tumor suppresor gene implicated in von hippel lindau

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16
Q

TSC is?

mutated in what CA?

A

tumor suppresor gene implicated in tuberous sclerosis

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17
Q

abl is?

mutated in what CA

A

oncogene -> mutated Tyrosine kinase that is always on w? proximity for BCR (9:22)

CML

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18
Q

c-myc is?

Mutated in what CA

A

oncogene leading to a transcription factor

mutated in Burketts

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19
Q

bcl 2 is?

mutated in what CA?

A

oncogene-> anti apoptotic molecule

mutated in follicular and undifferentiated lymphomas

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20
Q

HER2/neu is?

mutated in what CA?

A

oncogene-> tyrosine kinase

breast
ovarian
gastric CA

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21
Q

ras is?

mutated in what CA? (4 types)

A

oncogene -> mutated G protein -> constitutively active MAP kinase -> cell proliferation

quitessential oncogene

K -Ras - colon, lung, pancreatits
H-Ras - bladder, kidney (hematuria)
N-Ras- melanomas ans hematologic

also follicular thyroid carcinoma

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22
Q

L myc is?

Mutated in what CA

A

oncogene-> mutated TF

lung tumor (small cell)

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23
Q

N-myc is?

Mutated in what CA?

A

oncgone -> mutated TF

neuroblastoma

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24
Q

Ret is?

mutated in what CA(3)

A

oncogene-> mutated tyrsine kinase

MEN2A
MEN2B
Papillary carcinoma of the thyroid

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25
Q

afalatoxin CA risk

A

Hepatocellular

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26
Q

vinyl choride CA risk

A

angiosarcoma - liver

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27
Q

odd smoking CA risks (3)

A

pancreatic
transitional cell bladder
renal cell carcinoma

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28
Q

inherited predespositions to CA are inherited in what form?

Examples

A

inherited in auto dominant pattern

APC, BRCA, RET

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29
Q

aspestos exposure CA (2)

A

bronchogenic carinoma **

mesothelioma

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30
Q

Arsenic exposure CA(2)

A

squamous cell carcinoma of skin

angiosarcoma

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31
Q

napthalene CA risk?

A

transiotional cell

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32
Q

benzyne CA risk

A

leukemia/lymphoma

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33
Q

beryllym CA risk

A

lung CA

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34
Q

Radiation CA risk(3)

A

ALL
AML
thyroid CA

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35
Q

UV radiation of harm?

What CA risk (3)

A

UVB -> pyrimadine dimers

UVA, free radicals

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36
Q

EBV associated w/ (3) CA

A

Hodgins lymphoma
burkitts lymphoma
nasopharyngeal carcinoma

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37
Q

liver fluke (clonorchis sinensis) associated w/ what CA

A

cholangiocarcinoma

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38
Q

HCV risk of what CA (2)

A

Hepatocellular CA

papillary thyrois CA

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39
Q

Down syndrome associated CA (2)

A

ALL**

AML

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40
Q

Tuberous sclerosis CA (3)

A

giant cell astrocytoma
cardiac rhabdomyoma
renal angiomyyolipoma

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41
Q

pagers disease of the bone CA risk? (2)

A

secondary osteosarcoma

fibrosarcoma

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42
Q

Hashimotos disease associated w/ what CA

A

B cell marginal lymphoma

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43
Q

Dyplastic nevi CA

A

melanoma

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44
Q

vulvar leukoplakia CA risk

A

squamous cell

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45
Q

ataxia telangirtasia CA risk

A

decreased DNA repair

-> leukemia and lymphoma

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46
Q

Hyperplasia means?

A

increased number of cells

- reversible

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47
Q

metaplasia means?

A

change in cell type from one to another

-reversible

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48
Q

dysplasia means?

A

abnormal cell growth w/ loss of cell orientation, shape and size(disorganized)

reversible

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49
Q

anaplasia means?

characterized by (4)

A

abnormal cells lacking differentiation, cells regress and become less differentiated ->

  • high nuclear :cytoplasmic ratio
  • prominent nucleoli
  • clumping of nuclear chromatin
  • many mitotic spindles
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50
Q

Neoplasm means?

A

clonal proliferation of cells that is uncontrolled and excessive

neoplasia may be benign or malignant

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51
Q

Grade of a tumor looks at?

A

the amount of differentiation, high grade = less differentiation

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52
Q

Stage of a tumor refers to?

A

the amount of localization or spread from the primary site

TNM
Tumor Size
Nodes
METS

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53
Q

Benign epithelial tumor is (2)

A

adenoma - glandular look even if not derived

Papilloma - finger like projection

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54
Q

Malignant epithelial tumor is (2)

Spreads how?

A

adenocarcioma

papillary carcinoma

spreads via lymphatics

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55
Q

Malignant mesenchymal tumors generally end w?

Spreads?

A

sarcoma

spreads hematogenously, usually

benign mesenchymal CA rarely -> malignant (as epithelial CA does)

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56
Q

Benign vs malignant CA of blood vessel

A

Hemangioma

Angiosarcoma

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57
Q

Benign vs malignant CA of the smooth muscle

A

leiomyoma

leiomyosarcoma

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58
Q

benign vs malignant CA of striated muscle

A

rhabdomyoma

rhabdomyosarcoma

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59
Q

benign vs malignant CA of bone

A

osteoma

osteosarcoma

60
Q

benign vs malignant CA of Fat

A

lipoma

liposarcoma

61
Q

Harmatoma

A

growth of mature tissue that is endogenous to the site where it arises,

a lot of normal tissue

62
Q

Tumor marker in colorectal CA

A

CEA

-also detected in pancreatic CA as well (w/ CA 19-9)

63
Q

CEA marker(2)

A

tumor marker for Colorectal and Pancreatic

64
Q

Tumor marker for HCC?

A

Alpha fetoprotein

  • aslo in nonseminomatous germ cell tumors
65
Q

AFP tumor marker(2)

A

hepatocellular colorectal cancer

nonseminomatous germ cell tumors

66
Q

beta hCG tumor marker (2)

A

hydatriform moles

Choriocarcinoma

67
Q

Tumor marker for ovarian CA

A

CA 125

68
Q

CA 125 tumor marker

A

ovarian CA

69
Q

tumor marker for melanoma

A

S 100

also in neural crest cell derived like schwanomma

70
Q

S 100 tumor marker for (3)

A

melanoma
schwanoma
neural crest cell derived

71
Q

Alkaline phos tumor marker (3)

A

pages disease of the bone
METs to the bone
biliary disease

72
Q

CA 19-9 tumor marker

A

pancreatic CA

73
Q

Calcitonin tumor marker

A

Medullary thyroid CA

74
Q

2 signals released by tumors to allow angiogenesis

A

VEGF - vascular endothelia growth factor

bFGF - basic fibroblast growth factor

75
Q

Common sources of METS - Brain (5)

A

most common brain CA is METS - 50% (gray/white matter junction

Lots of Bad Stuff Kills Glia

  • Lung
  • Breast
  • Skin (melanoma)
  • Kidneys (renal cell)
  • GI ( colon CA)
76
Q

Common sources of METS - Bone (6)

A

permanently relocated tumors like bone

prostate
Renal cell
testes/thyroid
Lung
Breast
77
Q

Common sources of METS - Liver (5)

A

Cancer Sometimes Penetrates Benign Liver

Colon
Stomach
pancreas
Breast
Lung
78
Q

Lytic vs blastic METS to the bone

A

Prostate is blastic
Lung is Lytic

Breast can be lytic or blastic

79
Q

Cachexia is?

Due to?

A

profound weight loss - fat and lean muscle

Due to the release of cytokines that raise basic metabolic rate -> (TNF alpha)

80
Q

3 paraneoplastic effects of small cell carcinoma

A

ACTH -> cushings
ADH -> SIADH
Ab to presynaptic Ca channels -> lambert eaton

81
Q

Cushing syndrome due to paraneoplasm

A

Small cell CA of lung

82
Q

SIADH due to paraneoplastic (2)

A

small cell CA of lung

intracranial neoplasm

83
Q

PTHrP releasing neoplasms (4)

A

squamous cell CA
renal cell carcinoma
breast CA
head and neck squamous cell

84
Q

2 and details? (4 subtypes)

Most common cause of hypercalcemia

A

primary hyperparathyroidism

malignancy is #2

  • PTHrP
  • hodgkins -> Vit D
  • multiple myelinoma -> local osteolytic
  • lytic bone mets (breast maybe, Lungs definitely)
85
Q

Hodgkins lymphoma paraneoplastic syndrome

A

release active Vit D -> hypercalcemia

86
Q

Erythropoeitin released from 4 CA

A

potentially really high hemotocrit

pheochromocytoma
renal cell carcinoma
Hemangiobalstoma
Hepatocellular carcinoma

87
Q

Lambert Eaton due to?

Characterized by

A

paraneoplastic disorder of small cell CA of lung where Ab are produced against the presynaptic Ca channels in the neuromuscular junction

Presents similar to myasthenia gravis

differs in that it IMPROVES w/ use

88
Q

5 most important lifestyle factors affecting CA risk

A 
Smoking
Obesity
Activity level
Diet
Sun exposure (esp sun burns early-> melanoma and continued UVB -> squamous cell and basal)
89
Q

Recommendation for breast CA screening

A

mammogram q/2 yrs starting age 50
informed age 40
unknown after 75

self breast NOT recommended, Clinical unknown

90
Q

Cervical CA screening

A

PAP smear > 21 q 3yrs

> 65 yrs stop

91
Q

Prostate CA screening

A

informed 50-75
none after 75

DRE insufficient

PSA not sensitive enough

92
Q

Colon CA screening

A

colonoscopy q 10 yrs starting age 50
- start earlier w/ family history 10 yrs before youngest

also have fecal occult blood annually
flex sig q 5 yrs

93
Q

What immune cell protects from CA cells in the body?

A

CD8 cytotoxic T cells,
looks for antigens: mutated genes, over expressed proteins, oncogenic viruses, ocncofetal antigens, altered surface glycoproteins (CA125, CA19-9), cell type specific

also NK cells and macrophages

94
Q

Lung CA screening (NEW 2013)

A

annual chest CT ages 55-80

  • 30 pack yr history
  • current smoker or quit w/in last 15 yrs
95
Q

antineoplastic drugs working in the S Phase of cell cycle

A

antimetabolites

  • methotrexate
  • 5 FU
  • 6 MP
  • cytarabine
96
Q

Etoposide works in what phase of the cell cycle

A

G2 and S phase

97
Q

Vinca alkaloids and taxols work in what part of the cell cycle

A

the M phase

98
Q

What cells are susceptible to collateral damage w/ antineoplastics (3)

A

bone marrow -> hematopoetic
GI tract
hair follicles

all divide rapidly

99
Q

Methotrexate blocks what enzyme and is used in 3 general situations

A

folic acid analog -> blocking dihydrofolate reductase which converts DHF-> THF

Used in the syntheses of dTMP thus less DNA made

  1. cancers - leukemias: ALL/AML. breast , sarcomas
  2. immune suppression: RA and psoriasis
  3. Uterine path: ectopic pregnancies, choriocarcinoma, hydradidiform mole
100
Q

Toxicity w/ methotrexate (3)

A

myelosuppression - reversible w/ leucovorin
fibrotic lung disease
teratogenic - > neural tube defects

101
Q

Leucovorin works in what toxicity but not another?

A

folinic acid rescue in methotrexate

does NOT work in 5 - FU

102
Q

3 antineoplastic drugs that cause fibrotic lung changes

A

Bleomycin
Busulfan
methotrexate

103
Q

Used topically in actinic keratosis and basal cell CA

A

5 FU

104
Q

treatment of childhood tumors: Ewing, Wilms and rhabdosarcomas

A

Dactinomycin - intercalates DNA

105
Q

Which drugs decrease production of dTMP

A

5 FU

Methotrexate

106
Q

Toxicity w/ 5 fluorouracil(2)

A

Myelosuppression - NOT reversible w/ leucovorin

photosensitivity

107
Q

Uses of 5 FU(4)

A

colon CA
pancreatic CA
basal cell CA
actinic keratosis

108
Q

S cell cycle actor that inhibits DNA polymerase, antineoplastic

A

Cytarabine

acts as a pyrimidine analog -> leukemia and lymphomas

109
Q

Purine analogs that inhibit PRPP amidotransferase

A

Azathioprine
6 mercaptopurine - metab by xanthine oxidase
6 thioguanine - can be given w/ allopurinol

110
Q

S cycle specific antineoplastic that is metabolized by xanthine oxidase

A

6 mercaptopurine

6 thioguanine is also a purine analog but does not have increased toxicity w/ the use of allopurinol

111
Q

Toxicity of 6 mercaptopurie and 6 thioguanine

A

myelosuppression

hepatotoxicity

112
Q

Alkylating agents (antineoplatics) (3)

A

Busulfan
nitrosureas (carmustine, etc.)
cyclophosphamide (ifosfamide)

attaches an alkyl group to DNA -> cross linking of stands making it difficult to divide

113
Q

Used in brain tumors b/c crosses BBB

risk of what?

A

nitrosureas - carmustine, lomustine, semustine

risk of CNS toxicity

114
Q

Cyclophosphamide used in what 2 categories

A

Solid tumors - testicular, breast, ovarian, leukemia etc..

Immune suppression

  • lupes nephritis
  • PAN
115
Q

hemorrhagic cystitis is associated w/ this antineoplastic

rx:

A

cyclophosphamide, an alkylating agent

Mesna

116
Q

Mesna is used in what antineoplastic toxicity

A

hemorragic nephritis due to cyclophasphamide

-> binds to acrolein, the toxic metabolite

117
Q

covalently cross links DNA at guanine at N-7

Requires bioactivation

A

cyclophosphamide an alkylating agent

118
Q

Busulfan toxicity (2)

A

an alkylating agent

pulmonary fibrosis and hyperpigmentation

119
Q

Dactinomycin is useful in these 3 tumors

A

All kids

  • Ewings
  • rhadomyosarcoma
  • Wilms

intercalates DNA

120
Q

cardiomegaly is the biggest concern w/ these 2 antineoplastics

Rx w?

A

daunorubicin and doxorubicin

treat w/ dexrazoxane- Fe chelating agent

121
Q

Bleomycin toxicity

A

pulmonary fibrosis

an antitumor antibiotic-> free radical formation

122
Q

Antitumor antibiotics (4)

A

Dactinomycin

Doxorubicin/daunorubicin

Bleomycin

123
Q

toxicity of vinblastine

A

Blasts bone marrow -> myelosuppression

124
Q

Toxicity of vincristine? (2)

A

neurotoxicity

peripheral neuritis

125
Q

Microtubule binding and modulating drugs (5)

A 
vincristine/vinblastine
paclitaxel
mebendazole/albendazole
griseofulvin
colchicine
126
Q

antineoplastic bind to tubin in M phase to block polymerization

A

vincristine/vinblastine

127
Q

antineoplastic that hyper stabilizes polymerized microtubules in M phase so mitotic spindle cannot break down

A

paclitaxel and the like

128
Q

Toxicity of paclitaxel (2)

A

myelosuppression

hypersensitivity

129
Q

Vincristine and vinblastine are used in (4)

A

hodgkinlymphoma
wilms tumor
Ewing Sarcoma
Choriocarcinoma

130
Q

Paclitaxels are used for(2)

A

ovarian and breast Carcinomas

131
Q

antineoplastics that are nephrotoxic and ototoxic (3)

A

cisplatin, carboplatin, oxaliplatin

cross link DNA

132
Q

Cisplatin, carboplatin and oxaliplatin risk?(2)

A

nephrotoxic and ototoxic

use amifostine to prevent nephrotoxic

133
Q

Uses of the platens (cisplatin ) (3)

A

testicular
bladder
ovary

134
Q

Testicular CA regiment (3)

A

Eradticates ball Cancer

epotoposide
Bleomycin (ifosfamide)
cisplatin

135
Q

Anti topoisomerase inhibitors antineoplastics

A

inhibits topo II

  • Etoposide
  • teniposide

inhibits topo I

  • Irinotecan
  • topotecan
136
Q

Use of etoposide and teniposide (3)

A

small cell lung
prostate
testicular CA

inhibit topo II

137
Q

Nephrotoxic and ototoxic drugs (4)

A

vancomycin
aminoglycoside
loop dieuretics
cisplatin and carboplatin

138
Q

Uses of Irinotecan

A

METS Colon CA

inhibits topo I - like topotecan

139
Q

Uses of topotecan (3)

A

small cell lung CA
Ovarian CA
cervical CA

inhibits topo 1- like irinotecan

140
Q

inhibits ribonucleotide reductase -> decreased DNA synthesis in the S cell cycle

A

Hydroxyurea

141
Q

Prednisone as an antineoplastic?

A

may torgger apoptosis

142
Q

Symptoms of prednisone toxicity ? Alot

A

BAM CUSHINGOID

Buffalo hump
Amenorrhea
Moon facies

Crazy - agitation
Ulcers
Skin changes
Hypertension
Infection
Necrosis of femoral head
Glaucoma - cataracts
Osteoperosis
Immune depression
Diabetes
143
Q

SERM used in osteoporosis

agonist and antogonist prop?

A

Raloxifene

ER agonist in bone
ER antagonist in breast and endometrial

144
Q

Monoclonal ab against her2 -neu?

What is her2 Neu

A

trastuzumab

her 2 is a tyrosine kinase

145
Q

Toxicity with trastuzumab

A

cardiotoxicity

146
Q

monoclonal antibody against CD20

A

ratuximab

used in non hodgkins lymphoma and RA and phemigus vulgarism and ITP and vascultiis

147
Q

drug acting as a bcr-abl tyrosine kinase inhibitor

A

imatinib

used in CML

USLME Kiss my ass and pray (33 decks)

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