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principles clinical oncology Flashcards

1
Q

causes predispositions to female mammary cancer

A

oestrogens and progesterones

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2
Q

causes predisposition to male prostate carcinoma or perianal adenoma

A

testosterone

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3
Q

3 viruses that cause cancer

A
  • retrovirus
  • poxvirus
  • helicobacter pylori
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4
Q

define proto-oncogenes

A

genes that promote cell growth and proliferation or inhibit apoptosis

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5
Q

2 tumour suppressor genes

A
  • Rb

- p53

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6
Q

2 things that need to mutate to allow oncogenesis

A
  • tumour suppressor genes

- proto-oncogenes

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7
Q

number of mutations to make oncogenesis clinically significant

A

10-12

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8
Q

Rb action

A
  • prevents excessive cell growth by inhibiting cell cycle till its ready to divide
  • stops G1 going into S phase
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9
Q

p53 action

A

stops G1 to S phase in prescence of DNA damage

- can cause apoptosis if damage not fixed

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10
Q

tumour mutation development

A

mutation inactivates suppressor gene –> call proliferation (benign) –> mutation inactivates DNA repair genes –> protooncogenes turned into oncogenes –> more mutations and more genetic instability –> metastasis

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11
Q

hallmarks of cancer (6)

A
  • sustaining proliferative signal
  • evading growth suppressors
  • active invasion and metastasis
  • enabling replicative immortality
  • inducee angiogenesis
  • resist cell death
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12
Q

sustaining proliferative signal done by

A
  • local stimulation
  • altering to always be on
  • overexpression of receptors
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13
Q

example of a gene mutation to sustain proliferative signal

A

KIT gene mutation meaning receptor autophosphorylates so is always on

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14
Q

evading growth suppressors how

A
  • loosing growth suppressor receptors

- making receptors unfunctional

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15
Q

avoiding cell death

A
  • upregulation of survival factors

- not displaying death receptor

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16
Q

enabling replicative immortality

A

enzyme telomerase is needed to add telomeres to DNA

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17
Q

telomeres and DNA

A

some are lost during every replication so eventually replication stops as no more telomeres

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18
Q

induction of angiogenesis

A

secrete angiogenic factors

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19
Q

activating invasion and metastasis

A
  • need matrix metalloproteinases to disrupt surroundings

- need change in cell adhesion molecules so that no longer stuck to neighbouring cells

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20
Q

2 emerging hallmarks of cancer

A
  • deregulation of cell energetics

- avoiding immune destruction

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21
Q

how cancers avoid immune destruction (4)

A
  • decrease immunogenic antigen
  • kill tumour infiltrating lymphocytes
  • immunosuppressive mediators
  • inducing immune tolerance
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22
Q

inflammation and tumours

A

promote tumour growth as inflammation is immunosuppressive, has growth factors and angiogenic mediators

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23
Q

gold standard for cancer diagnosis

A

histopathology

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24
Q

patnaik system grading mast cell tumours grade 1

A
  • low grade
  • acts benign
  • well behaved
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25
Q

patnaik system grading mast cell tumours grade 2

A

intermediate

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26
Q

patnaik system grading mast cell tumours grade 3

A
  • high grade
  • aggressive
  • likely to spread
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27
Q

staging of tumours define

A

decide if local or if has spread

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28
Q

TNM system for staging tumour

A

T - primary tumour
N - associated lymph node
M - metastasis

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29
Q

For T of TNM staging system

A
  • size
  • mobility- ulceration
  • relationship to surrounding tissues
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30
Q

for N of TNM staging system (5)

A
  • size
  • mobility
  • relationship to surrounding tissues
  • texture
  • consistency
  • may need to FNA for metastasis
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31
Q

for M of TNM staging system

A
  • history
  • physical exam
  • imaging?
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32
Q

lymphoma stage 1

A

limited to single lymph node or lymphoid tissue in organ excluding bone marrow

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33
Q

lymphoma stage 2

A

more than 1 lymph node affected in local area

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34
Q

lymphoma stage 3

A

generalised involvment across the diaphragm

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35
Q

stage 4 lymphoma

A

liver and or spleen involvment

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36
Q

stage 5 lymphoma

A

maifestation in blood or bone marrow/other organ systems affected

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37
Q

2 substages in the staging of lymphoma

A

a - no systemic signs

b - systemic signs

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38
Q

prior to cancer tx do

A
  • CBC
  • haematology
  • urinalysis
  • coagulation profile
  • as then you have a baseline for any changes
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39
Q

define hyperviscosity

A

thick sludgy blood

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40
Q

tx options cancer

A
  • cure
  • remission
  • palliation
  • control
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41
Q

important to consider in cancer treatment

A

ensure a good quality of life!

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42
Q

chemotherapy is mainly used in tumours with

A

high metastatic potential

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43
Q

cytotoxic drugs must not be

A
  • handled by pregnant women
    if in tablet or capsule form
  • must not be crushed or opened
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44
Q

when giving chemotherapy use what system

A

phaseal

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45
Q

chemotherapy patient animal poop and urine

A
  • double bag poo and wee

- do not let animal go where children play

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46
Q

4 ways that tumours spread

A
  • lymphatic
  • vascular
  • local
  • trans-cavity
47
Q

local spread is usually done by what tumour type

A

carcinomas

48
Q

vascular spread is usually done by what tumour type

A

sarcomas

49
Q

trans-cavity spread is usually done by what tumour type

A

mesotheliomas

50
Q

what cell type makes a mesothelioma

A

lining of body cavity

51
Q

define multicentric tumours

A

where cant determine primary tumour/tumour of origin at presentation

52
Q

immunohistochemistry and tumours

A

can be used to identify surface markers on tumour cells so can figure out cell types

53
Q

cytokeratin is a marker for what cell types

A

epithelial

54
Q

carcinomas are made of what type of cell

A

epithelial

55
Q

vimentin is a marker for what cell type

A

mesenchymal

56
Q

sarcomas are made of what cell types

A

mesenchymal

57
Q

CD3 is a marker for what cell

A

T cell

58
Q

CD79a is a marker for what cell

A

B cell

59
Q

2 things to think about when fixing a sample in formalin

A
  • formalin to sample ratio no smaller than 4:1

- longest dimension 2cm max

60
Q

6 reasons for chemotherapy

A
  • primary treatment for disseminated (widespread) disease
  • adjuvant therapy following surgery on highly metastatic tumour
  • following incomplete resection
  • neoadjuvant therapy to shrink prior to surgery
  • treatment of tumours not amenable to radiation or surgery
  • primary tx for venereal tumour
61
Q

when giving adjuvant chemo consider

A

surgical wound needs time to heal before you start

62
Q

cell kill hypothesis (chemo)

A

a given dose will kill a fixed percentage of the tumour population

63
Q

theory of pulse dosing (chemo)

A

time between doses is so much to allow body to recover but not too long that tumour regrows

64
Q

drugs used for chemo better

A

if used in combination

65
Q

combination therapy use drugs that (chemo) 4

A
  • are effective against tumour individually
  • do not have overlapping toxicities
  • different modes of action
  • affect cells at different stage of cell cycle
66
Q

combination therapy chemo pro

A

can use less of each drug

67
Q

4 stages of chemo

A
  • induction
  • maintenance
  • re-induction
  • rescue
68
Q

rescue stage in chemo is when

A

tumour becomes resistant to therapy so need different drugs

69
Q

metronomic chemotherapy

A

continuous low dose cytotoxic drugs

70
Q

aim of metronomic chemotherapy

A

to slow growth of tumour

71
Q

receptor tyrosine kinase inhibitors and chemo (4)

A
  • inhibit angiogenesis
  • promote apoptosis
  • reduce proliferation
  • not cytotoxic
72
Q

4 adverse effects chemo

A
  • myelosuppression
  • GIT toxicity
  • poor hair growth
  • drug extravasation
73
Q

define myelosuppression

A

bone marrow suppression

74
Q

define drug extravasation (chemo)

A

where drug spills onto tissues, can do a lot of damage in chemo

75
Q

if drug is extravasated then (3)

A
  • keep catheter in place
  • try to withdraw as much as possible
  • apply ice pack or heat. this is drug specific so contact drug company
76
Q

doxorubicin side effects

A
  • dysrhythmias during administration
  • chronic toxicity leads to dilated cardiomyopathy
  • mast cell degranulation causes allergy like response
77
Q

cyclophosphamide side effects

A

haemorrhagic cystitis

78
Q

vincristine side effects

A
  • peripheral neuropathies

- constipation

79
Q

lomustine side effects

A
  • hepatotoxicity

- nephrotoxicity

80
Q

platinum drugs side effects

A
  • nephrotoxic

- vomiting

81
Q

do not give cats 2 drugs for chemo

A
  • cisplatin

- 5-FU

82
Q

alkylating agents chemo action

A
  • substitute alkyl group for H+ causing breaking of DNA strands
  • not cell cycle phase specific
83
Q

mitotic spindle inhibitors chemo action

A
  • bind to tubulin stopping microtubule formation

- stop cycle in metaphase

84
Q

anti-metabolites chemo action

A
  • inhibit enzymes or cause production of non-functioning molecules
  • work during S-phase
85
Q

anti-tumour antibiotics chemo action

A
  • stop DNA/RNA synthesis

- not cell cycle phase specific

86
Q

platinum compounds chemo action

A
  • interferes with DNA/RNA synthesis similar to alkylating agents
  • not cell cycle phase specific
87
Q

corticosteroids in chemo why

A

cause apoptosis of lymphoid cells

88
Q

L-asparaginase in chemo why

A
  • treatment of lymphoma and leukaemia

- cancer cells rely on other sources of L-asparagine as they cant make it like normal cells

89
Q

NSAIDs chemo use why

A
  • inhibit angiogenesis
  • promote apoptosis
  • anti-inflammatory
  • analgesic
  • used in metronomic therapy
90
Q

3 different types of radiation used in radiation therapy

A
  • x-ray photons
  • gamma ray photons
  • particles
91
Q

effect of radiation in radiation therapy

A
  • particle effect

- creates oxygen free radicles

92
Q

effect of oxygen free radicals in tissues

A

damages cell membranes, proteins and nucleic acid

93
Q

best tumours for radiation therapy

A
  • well oxygenated ones so smaller tumours

- proliferative tumours

94
Q

acute effects of radiation therapy occur

A
  • in rapidly dividing tissue in radiation field

- no permanent damage

95
Q

late effects of radiation therapy occur

A
  • in slow dividing cells in irradiation field
  • radiation kills of stem cells so when the slow proliferating cells die theres nothing to replace them
  • permanent changes
96
Q

5 common tumours for radiation therapy

A
  • brain
  • nasal
  • oral
  • soft tissue sarcomas
  • mast cell tumours
97
Q

when taking multiple biopsies consider

A

use fresh instruments for each one to limit contamination

98
Q

a biopsy should include

A

junction of normal and abnormal tissue

99
Q

most active and invasive parts of a tumour are

A

the edges

100
Q

when dissecting a tumour do not

A

handle the tumour directly instead handle normal adjacent tissue

101
Q

after tumour removal change

A

instruments for closure

102
Q

ligation and tumours

A

ligate the veins and lymphatic drainage of tumour then the arteries before removal

103
Q

3 types surgical margin of excision of tumours

A
  • local excision
  • wide local excision
  • radical local excision
104
Q

local excision of tumours is where

A

tumour removal through natural capsule, immediate boundaries or with minimum adjacent tissue

105
Q

indications for local tissue excision of tumours

A

benign tumors with no tendency for local infiltaration

106
Q

wide local excision of tumours is where

A

tumour is removed with substantial margin of surrounding tissue

107
Q

2 indications for wide local excision of tumour

A
  • benign with capacity for local infiltration

- malignant with limited potential for infiltration

108
Q

radical local excision is

A

tumour removed with margins that extend into fascial planes that are undisturbed by tumour growth

109
Q

3 techniques for radical local excision of tumours

A
  • compartmental excision
  • muscle group excision
  • amputation
110
Q

compartmental excision is

A

removal of tumour with all the blood vessles and nerves in the compartment and overlying skin

111
Q

muscle group excision

A

tumour removed with whole muscle that it involves

112
Q

amputation and local radical excision

A

tumour removed with entire limb

113
Q

define debulking of tumour (cytoreductive surgery)

A

incomplete removal to improve efficacy of treatment

114
Q

palliative surgery define

A

improves patients quality of life but not the length

POS (13 decks)

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