Principles of medical oncology

Question 1

What are the 4 phases of the cell cycle and what do G0 and R mean

Answer 1

-4 phases: M phase (mitosis), G1 (first gap), S phase (DNA synthesis), G2 (second gap)
-G0= non-proliferating cells
-R= restriction point

Question 2

What factors drive progression through the cell cycle, and what are the regulators of this factor

Answer 2

-Cyclin dependent kinases (CDKs)
-CDK regulators: Cyclins, Phosphorylation (CDK activating kinase CAK), CKD inhibitors (CKIs)

Question 3

What is p53 responsible for

Answer 3

-Cell cycle arrest and apoptosis, so a mutation of this can lead to uncontrolled cell growth (neoplasia)

Question 4

What are some reasons for developing neoplasia

Answer 4

-Loss of function of tumor suppressor genes (p53)
-Gain of function of proto-oncogenes
-Loss of regulation of the R point
-Genetics
-environment
-Carinogenic chemicals
-Exposure to radiation
-infectious disease
-hormones
-age
-obesity
-inflammation

Question 5

What are the 10 hallmarks of cancer

Answer 5

1) self sufficiency in growth signals
2) insensitivity to anti-growth signals
3) the ability to evade apoptosis
4) limitless replicative potential
5) sustained angiogenesis
6) the capacity to invade tissues and metastasis
7) de-regulated metabolism
8) evading immune system
9) genomic instability
10) inflammation

Question 6

What are the local, distant, and systemic effects of tumors

Answer 6

-Local: pain, dysfunction, rupture/hemorrhage
-Distant: pain, dysfunction
-Systemic: paraneoplastic disorders, degranulation

Question 7

How to diagnose the primary tumor

Answer 7

-Analysis of tissue: benign vs malignant
-Cytology: assess individual cells (carcinoma vs sarcoma), often lacks sensitivity
-Histopathology: assessment of tissue and invasion, grading, more accuracy
-IHC: application of special stains to determine cell origins
-Clonality: PCR to determine if monoclonal or polyclonal
-Proliferation markers: Ki-67 and AgNOR, marker for prognosis

Question 8

What are some risks of FNA

Answer 8

-Hemorrhage
-Damage to adjacent structures
-Seeding

Question 9

What is the difference between staging and grading a tumor

Answer 9

-Staging: extent of tumor burden (size, invasion, metastasis, often requires diagnostic imaging and cytology), general health of patient, “a clinical assessment”
-Grading: tumor type, signs of malignancy within biopsy, “a pathological assessment”

Question 10

What does staging a tumor often involve

Answer 10

-History
-Physical exam
-Hematology/biochem
-Urinalysis/culture
-Imaging (US, Rads, CT)
-Cytology or biopsy
-Individual tumor staging (Immunophenotyping, CADET/BRAF)

Question 11

What will staging often alter

Answer 11

-Prognosis
-Management options
-Owner decisions

Question 12

What does the staging TNM system look at

Answer 12

-T: primary Tumor
-N: lymph Nodes
-M: Metastasis