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Hematology / Oncology > Pathophysiology: Oncology > Flashcards

Pathophysiology: Oncology Flashcards

1
Q

Where do Oncogenes come from?

A

Proto-Oncogenes (important for normal cellular function) mutate into Oncogenes. Mutations can be genetic / inherited or due to toxins.

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2
Q

What do Oncogenes do?

A

Oncogenes cause abnormal cell growth - growth that can become out of control & doesn’t adhere to normal signals to stop.

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3
Q

Tumor Suppressor Gene

A

Gene that makes tumor suppressor protein. Mutations in these can lead to cancer. “Anti-Oncogene”

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4
Q

Hyperplasia

A

Increased number of cells

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5
Q

Dysplasia

A

Cells look abnormal but are not yet “cancer”; change from mature ell to cell with abnormalities in differentiation and maturation.

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6
Q

Metaplasia

A

Change from one type of mature cell to another type of mature cell that is found elsewhere.

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7
Q

Carcinoma In Situ

A

Group of abnormal cells that have not spread beyond their area of origin; Cancer Stage 0

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8
Q

Invasive Carcinoma

A

Cancer has spread beyond layer of tissue in which it was developed

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9
Q

Metastatic Carcinoma

A

Cancer has spread beyond its primary site

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10
Q

Hypertrophy

A

Enlargement due to increase in cell size

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11
Q

Neoplasia

A

Abnormal, uncontrolled growth of tissue; can be cancerous (malignant) or non-cancerous (benign)

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12
Q

Anaplasia

A

Cells that are not differentiated

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13
Q

Adjuvant

A

Treatment given in addition to the primary treatment, i.e. chemo in addition to surgery or hormone therapy in addition to surgery.

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14
Q

Neoadjuvant

A

Additional treatment given before the primary treatment. For example, radiation to treat a tumor before surgery.

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15
Q

Remission

A

Signs and symptoms of someone’s cancer are reduced or gone

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16
Q

Paraneoplastic Syndrome

A

Caused by the “remote” effects of cancer; caused by the hormonal and metabolic changes that cancer causes.

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17
Q

Where does cervical cancer spread?

A

Peritoneum

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18
Q

Where does breast cancer spread?

A

1 Bones, #2 Lungs

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19
Q

Where does colon cancer spread?

A

Liver

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20
Q

Where does lung cancer spread?

A

1 Brain, #2 Bones

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21
Q

What type of cancer rapidly goes to the brain?

A

Small cell lung cancer (also renal cell carcinoma & melanoma)

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22
Q

Where does prostate cancer go?

A

Bone

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23
Q

Where does testicular cancer go?

A

Lung

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24
Q

How do cancers spread?

A

Lymph, blood, local invasion, angiogenesis

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25
Q

Carcinoma

A

Cancer beginning in skin or tissue that cover organs

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26
Q

Sarcoma

A

Cancer of bone, cartilage, fat, muscle, blood vessels, connective tissue

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27
Q

Leukemia

A

Cancer in blood-forming tissue (marrow)

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28
Q

Lymphoma / Myeloma

A

Cancers of the immune system

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29
Q

Angiogenesis

A

Tumor lay down new blood vessels

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30
Q

“Two Hit Theory” of cancer

A

You have 2 genes… if you knock one out, you have a backup… when you knock both out - cancer.

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31
Q

What # of leading cause of death is cancer?

A

2nd

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32
Q

What factors are 30% of cancer deaths attributable to? (5)

A

High BMI, low fruit/veggie intake, low physical activity, tobacco use, alcohol

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33
Q

What are the 3 most common cancers in men?

A
  1. Prostate, 2. Lung, 3. Colorectal
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34
Q

Which 3 cancers kill the most men?

A
  1. Lung, 2. Prostate, 3. Colorectal
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35
Q

What are the 3 most common cancers in women?

A
  1. Breast, 2. Lung, 3. Colorectal
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36
Q

What 3 cancers kill the most women?

A
  1. Lung, 2. Breast, 3. Colorectal
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37
Q

What does TNM stand for?

A

Tumor, Nodes, Metastases

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38
Q

T in TNM.

A

Tumor (size, extent of invasion of primary tumor); T0=no tumor, TIS = in situ, T1-T4

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39
Q

N in TNM

A

Nodes (number and location of histologically involved regional lymph nodes); N0=no nodes, N1-N3

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40
Q

M in TNM

A

Metastases (Presence or absence of distant metastases); M0=no metastases, M1=yes distant metastases.

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41
Q

If a cancer has spread anywhere, what are you going to do to treat it?

A

You have to use systemic chemotherapy.

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42
Q

What are systemic cancer therapies?

A

Chemotherapy, hormonal therapy, targeted therapy

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43
Q

What does TX, NX, or MX mean

A

That component cannot be assessed

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44
Q

Example of Stage I Cancer (1)

A

T1-T2 tumors, N0

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45
Q

Examples of Stage II Cancer (2)

A

T-T2, N1 or T3, N0

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46
Q

Examples of Stage III Cancer (1)

A

T1-T3 with N1-N3

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47
Q

Example of Stage IV

A

Anything M1

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48
Q

Primary Prevention

A

REMOVING RISK FACTORS; risk factor modification.

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49
Q

What are examples of primary prevention?

A

Avoiding UV light, taking folic acid, weight management, avoiding tobacco.

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50
Q

What is Chemoprophylaxis?

A

Use of substances to reduce the risk of getting cancer or having it recur; used in groups who are at high risk for certain cancers.

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51
Q

What are examples of Chemoprophylaxis?

A

Aunt Susan taking Tomoxifen to keep Breast Ca from recurring; Someone who is BRCA1 positive taking Tomoxifen.

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52
Q

What form of Prevention is Chemoprophylaxis?

A

Primary

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53
Q

Secondary Prevention

A

Early detection and treatment; Identifies and treats individuals who are asymptomatic but have developed risk factors. “Pre-Clinical disease.”

54
Q

Examples of Secondary Prevention

A

Pap smear in someone who is sexually active, cholesterol screening in someone with HTN.

55
Q

Principles of Screening

A

Disease should have high mortality, early tx available, disease=common, tx inexpensive/non-invasive, high sens/spec

56
Q

Oncogenic Viruses

A

HPV, HBV/HCV, HIV, EBV, Herpes

57
Q

Ionizing Radiation

A

Radiology procedures (CT scans); high doses increase chemical activity in cells and can lead to cancer. EX someone gets Ca treated w/radiation - yrs later, get cancer somewhere else.

58
Q

UV Light

A

Increases risk of cancer - sun, tanning booths

59
Q

Cancer stages potentially treated by surgery

A

Stages I and II

60
Q

Systemic Cancer Therapy

A

Use of cytotoxic drugs, hormones, antihormones, and biologic agents

61
Q

Radiation works by:

A

Damaging DNA

62
Q

What is the critical target of Radiation Therapy?

A

DNA

63
Q

How can Radiation Therapy cause a secondary malignancy?

A

Radiation breaks DNA; DNA can repair itself BUT there can be mis-repairs & if you get another mis-repair 20 yrs later, then you can get a secondary cancer.

64
Q

What type of death does Radiation cause? / When does death occur?

A

Clonogenic or Reproductive death; Occurs only when cell attempts to go through mitosis.

65
Q

TD50/5 / goal?

A

Radiation dose that will produce complications for 50% of pop in 5 years / TD5/5

66
Q

Acute Side Effects to Radiation

A

Occur during course of radiation: fatigue, skin (dry, red, itchy), alopecia, mucosa, anorexia

67
Q

Sub Acute Side Effects of Radiation

A

Occur within next 6 months after; pneumonitis, veno-occlusive disease, SBO

68
Q

Chronic Side Effects of Radiation

A

Persist for longer than 6 months, i.e. Bone growth loss, fibrosis of skin

69
Q

Do you use radiation longer or shorter in the case of palliative care?

A

Shorter. You would want to decrease tumor size but cause as few other side effects as possible. You might treat longer & at higher dose if a CURE is possible.

70
Q

Brachytherapy

A

Radiation given using sealed radioactive sources paced into cavities or tissues

71
Q

Stereotactic Radiosurgery

A

Surgery to deliver very high dose to limited area; used on brain

72
Q

Cushing Syndrome

A

Too much corticosteroid in the body b/c of pituitary secreting ACTH

73
Q

What most frequently causes Cushing Syndrome?

A

Small cell lung cancer secreting ACTH.

74
Q

Symptoms of Carcinoid Syndrome

A

Flushing, diarrhea, wheezing, hypotension

75
Q

SIADH

A

Syndrome of Inappropriate Antidiuretic Hormone

76
Q

What type of cancers (2) cause SIADH?

A

Small and non-small cell lung cancer

77
Q

How does SIADH lead to hyponatremia?

A

ADH should be secreted when the body is dehydrated. Lung cancer can secrete it when unnecessary so the body hangs on to excess water. Lots of water: little solute = hyponatremia.

78
Q

What is the most common paraneoplastic syndrome?

A

Hypercalcemia

79
Q

Ectopic hormones / what cancer post frequently produces them?

A

Hormones produced by the cancer itself / small cell lung cancer

80
Q

What syndrome is often observed before small cell lung cancer?

A

LEMS

81
Q

What is LEMS

A

in Lambert Eaton Myasthenic Syndrome, antibodies damange calcium channel gates. Limited calcium enters nerve terminals, decreasing the amount of acetylcholine that is released. –> Muscle weakness

82
Q

Trousseau’s Sign

A

Hypercoagulability (i.e DVT) being a sign of cancer

83
Q

Cancers that cause too much clotting?

A

Lung and liver

84
Q

Why might it hard to know if someone is neutropenic from chemo?

A

They might not have enough WBCs to present in the typical fashion with elevated WBCs indicating infection

85
Q

Acute Tumor Lysis Syndrome causes (5)

A

Hyperkalemia, Hyperuricemia, Hyperphosphatemia, Hypocalcemia, Azotemia

86
Q

What is happens in Tumor Lysis Syndrome?

A

As the tumor breaks up, potassium, uric acid and phosphate are dumped into the system circulation and can wreak havoc on the kidneys

87
Q

Who is most at risk for Tumor Lysis Syndrome? (2)

A

1) People with leukemia, lymphoma (b/c tumors rapidly divide), or huge tumors, 2) After round 1 of chemo

88
Q

What is spinal cord compression?

A

Metastases to vertebral bodies are compressing the spinal cord.

89
Q

What most frequently causes spinal cord compression?

A

Lymphoma and Multiple Myeloma

90
Q

What does spinal cord compression mimic / what differentiates the 2?

A

Degenerative Disc Disease / symptoms do not get worse or better depending upon patient’s position; specifically, pain gets worse recumbent & at night

91
Q

How do you tx Spinal Cord Compression?

A

Treat immediately & before diagnosis. Give large dose of steroid and then get MRI.

92
Q

“Bones, stones, moans, groans, psychiatric overtones” relates to?

A

Hypercalcemia

93
Q

Symptoms of hypercalcemia?

A

Fatigue, anorexia, nausea, constipation, polyuria, polydypsia, weakness, lethargy, apathy, seizure, coma

94
Q

What causes hypercalcemia? (3)

A

Increased mobilization from bone, increased renal tubular reabsorption, osteolysis

95
Q

How do you treat hypercalcemia?

A

Tx the cancer, give Bisphosphonates to inhibit osteoclasts

96
Q

Which types of cancer cause Superior Vena Cava Syndrome?

A

Lung cancers

97
Q

What causes SVC Syndrome?

A

Tumor compressing spinal cord –> regurgitation of blood –> flushed face

98
Q

What are symptoms of SVC Syndrome?

A

Flushed face, dyspnea, chest pain, syncope, cough, headache, venous distension, Horner’s Syndrome

99
Q

What is Horner’s Syndrome? / What is it a sign of?

A

Drooping of the eyelid combined with constriction of that pupil / SVC Syndrome.

100
Q

When is SVC considered a true emergency?

A

When tumor is blocking trachea.

101
Q

Tumor Lysis Syndrome is also called:

A

Hyperuricemia

102
Q

Treatments for each component of Tumor Lysis Syndrome? (4)

A

1) Hyperuricemia: meds to break up uric acid, 2) Urine alkalinization by giving bicarb, 3) Forced diuresis - give IV fluids and diuretics at the same time, 3)/4) Hyperkalemia/Hyperphosphatemia - give hypertonic glucose

103
Q

Symptoms of a PE / Tx

A

Hemoptysis, syncope, dyspnea, chest pain / Antithrombolytics

104
Q

Why is a low grade fever significant in a cancer patient?

A

Might be the only sign that they are going septic.

105
Q

What is the most deadly cancer in men and women? / 5-year survival rate?

A

Lung cancer / 15%

106
Q

What is the second most deadly cancer overall?

A

Colorectal cancer.

107
Q

Second most deadly cancer in men?

A

Prostate Cancer

108
Q

Second most deadly cancer in women?

A

Breast Cancer

109
Q

Length-time bias in studies.

A

Studies are more likely to pick up slow-growing tumors then fast growing ones someone would have noticed on their own or died from

110
Q

A-D, I Scale of US Preventive Services Task Force

A

A= highly recommend, b=partially recommend, c=some benefits, some drawbacks & they equal out, d=against, I=no recommendation either way

111
Q

American Cancer Society Recommendations on Breast Cancer Screenings. (4)

A

1) Self exams starting in 20’s, 2) Clinical exams Q3yrs 20-40 then Q1yr, 3) Mammorgraphy Q1yr 40 and over, 4) high risk - get MRI

112
Q

USPSTF Recommendations on Breast Cancer (3)

A

Self exams: I, Mammography 50-74 Q2yrs: B, Mammography before 50 based on high risk: C.

113
Q

ACS recommendations on cervical cancer

A

1) Annual pap 3 years after sex or by age 21, 2) after age 30 & 3 nl paps, then Q2-3 yrs, 3) d/c after 70 if no abnormal results, 4) d/c after hysterectomy unless done as Ca tx

114
Q

USPSTF recommendations on cervical cancer (2)

A

1) Screen sexually active women with a cervix - A recommendation, 2) Don’t screen after 65 if hx of normal paps - D

115
Q

ACS and USPSTF recommendations on colorectal cancer

A

Fecal occult blood test / signoidoscopy or colonoscopy starting at 50 and going to 75 (“A”); USPSTF gives D to using aspirin/NSAIDs for prevention

116
Q

ACS on lung cancer

A

no CXR, no sputum Cx

117
Q

New USPSTF guideline on lung Ca

A

low dose CT for smokers and former smokers 55-80 with 30 pack yr Hx or who smoked for over 15 yrs.

118
Q

ACS on prostate cancer (2)

A

1) Discuss DRE / PSA at age 50, 2) high risk men should consider PSA testing at 45 if relative has died of it

119
Q

USPSTF on prostate cancer

A

D! No screening b/c of potential harm

120
Q

ACS vs USPSTF on testicular cancer

A

ACS - yearly clinical exam, USPSTF - no screening

121
Q

KPS Score

A

Karnofsky Performance Scale; score ranges 0-100 based on pt’s ability to perform ADLs; often need minimal score for enrollment in clinical trials

122
Q

KPS score of 80/50/40/10

A

Can do all ADLs but with effort / All ADLs but with a ton of assistance / Disabled / Near death

123
Q

What is meant by the “epidemic of survival?”

A

4% of the population, over 12 million people = cancer survivors

124
Q

What percent of children survive cancer?

A

80%

125
Q

Secondary condition of Hodgkin’s Lymphoma.

A

35% of girls with Hodgkin’s Lymphoma developed breast cancer by age 35.

126
Q

Secondary malignancy of testicular cancer

A

w/radiation or chemo, much more likely to get cancer in other testicle later on

127
Q

Secondary tumors of radiation

A

thyroid tumor, breast ca, GI tumors, melanoma

128
Q

Most cancer survivors would rate their health as

A

good or excellent

129
Q

Emphasis in ca tx used to be cure rate, now it’s

A

Quality of life

130
Q

Legal / social issues assc w/survivorship

A

Ability to get insurance / loans / find employment

131
Q

Primary care ramifications for Ca survivors

A

Primary care services UNDER-recommended (i.e.vision/hearing screening, flu vaccine, bone density/cholesterol screening).. even if someone had cancer in the past, their primary care goes to shit

Hematology / Oncology (9 decks)

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