Week 3 Flashcards
Which of the following represents the patient archetype (ie prototypical example) of Myelodysplastic syndrome?
- 70 year old male with history of radiation
- 30 year old adult with cytopenias and signs of bleeding
- 5 year old boy with Down Syndrome
Answer: A. 70 year old male with history of radiation
Explanation: The archetype of myelodysplastic syndrome is an older adult (~70 years old) with a slight male predominance. History of exposure to alkylating agents or radiotherapy increases risk of myelodysplastic syndrome.
A 30 year old adult with cytopenias and signs of bleeding raises the concern for DIC associated with acute leukemia, including APL t(15;17).
A 5 year old boy with Down Syndrome is the archetype for Acute Lymphocytic Leukemia which is the most common cancer of children, effecting boys more often than girls, and with increased risk with Down Syndrome.
Lecture: 264b MDS
Learning Objective: 1. Describe key disease characteristics of myelodysplastic syndrome, including typical age at initial diagnosis, clinical presentation, major peripheral blood and bone marrow findings, genetic and laboratory findings (MKS 1b, 1d).
Why is a Vitamin A derivative the most appropriate initial treatment for a patient presenting with DIC and acute leukemia?
Answer: A patient presenting with DIC in the setting of acute leukemia raises the concern for Acute Promyelocytic Leukemia t(15;17). DIC is a unique presentation which is classically associated with Acute Promyeloyctic Leukemia t(15;17), though can be seen with other leukemias. The t(15 PML;17 RAR) translocation disrupts the retinoic acid receptor required for maturation. ATRA (All trans retinoic acid) binds the receptor and causes the blast to mature. Therefore if there is a suspicion for APL, ATRA should be initiated until disease confirmation is possible.
Lecture: 265b Acute Myeloid Leukemias
: Match which features belong with B-ALL (B lymphoblastic leukemia) or T-ALL (T lymphoblastic lymphoma).
B symptoms (fever, night sweats, bone pain)
Mediastinal Mass
CD19+
CD3+
Cd1a+
T(12;21)
T(9;22)
Answer: B-ALL: B symptoms, CD19+, t(12;21) – translocation found in 25% of kids with B-ALL, usually has a good prognosis, t(9;22) – translocation found in 25% of adults with B-ALL, usually has a poor prognosis
T-ALL: Mediastinal mass (due to thymic mass), CD3+, Cd1a+
Lecture: 266b Acute Lymphoblastic Leukemias
: What are the 2 major pathways for the development of Head and Neck squamous cell carcinomas?
Answer: (1) Tobacco and alcohol and (2) HPV
Explanation: Tobacco and alcohol expose the mucosa to carcinogens which over time can lead to the development of cancer in the oral cavity, pharynx and larynx.
HPV produces E6, which destroys p53, which would usually protect against DNA damage by inducing apoptosis. HPV also produces E7 which will destroy Rb, which usually binds up E2F until receiving the appropriate signal to progress through the cell cycle.
Lecture: 268b Head and Neck Cancer
How is a soft tissue tumor diagnosed and what is the most important feature?
Answer: Core Needle biopsy is needed to diagnose a soft tissue tumor (fine needle aspiration biopsy is insufficient) and the most important prognostic factor is nuclear grade.
Lecture: 269b Sarcomas
Learning Objective: 1. To describe the diagnosis and current treatments of bone, soft tissue sarcomas and GISTs. (MKS 1d, 1e)
In the study with patients with metastatic non-small-cell lung cancer, those with early palliative care had _____ survival compared with those receiving standard care.
- Shorter
- Longer
- Equal length of
Answer: B. longer
Explanation: “Among patients with metastatic non-small-cell lung cancer, patients receiving early palliative care…–as compared with patients receiving standard care–, had less aggressive care at the end of life but longer survival.”
Lecture: 267b Principles of Palliative Care
Learning Objective: 2. Identify three areas of impact of palliative care on patient outcomes (SATBC-1)
List the 5 most common cancers in the world (in decreasing order).
Answer:
- Lung
- Breast
- Colorectal
- Prostate
- Skin cancer/Stomach (both are acceptable depending on your source. WHO estimates 1.04 million cases of non-melanoma skin cancer and 1.03 million cases of stomach cancer worldwide)
Lecture: 270b Cancer Prevention
Learning Objective: 1. Recognize common precursor pathways related to cancer development. (MKS-1b)
Name 3 possible risk factors for breast cancer
Answer: Increasing age and female. Early menarche, late menopause, later first term pregnancy, use of exogenous hormones as contraceptives or postmenopausal therapy è all increase estrogen exposure. Obesity, alcohol use è also likely to be hormone related. BRCA1, BRCA2 genes. Prior lesions (hyperplasia – 2x risk, atypical hyperplasia – 5 x risk, Lobular carcinoma in situ – 8-10x risk).
Lecture: 271b Breast Cancer
Learning Objective: 2. Breast cancer risk factors
Mix and match the following descriptions with the appropriate phase for clinical trials.
Phase I
Phase II
Phase III
Phase IV
- Studies after drug is approved for Post-Market Safety Monitoring
- Drugs given at maximum tolerated dose and response observed as complete (CR), partial (PR), stable disease (SD), or progressive disease (PD)
- Dose escalation studies to define toxicity and determine maximum tolerated dose
- Studies that test agent in specific line of therapy to assess drug efficacy and benefit of study population
Answer:
Phase I = 3
Phase II = 2
Phase III = 4
Phase IV = 1
Lecture: 272b Chemotherapy Basics
Learning Objective: 1. Describe the different phases of chemotherapy drug development
Match the following features with each type of lung cancer
Small Cell Lung Cancer
Adenocarcinoma
Squamous Cell Carcinoma
Non-smokers
Sheets of small blue cells
Glandular, glycogen rich
Keratin pearl
+chromogranin
+synaptophysin
Central tumor
PTHrp (hypercalcemia)
SIADH
Cushing syndrome
Lambert Eaton
Answer: Small Cell Lung Cancer: Sheets of small blue cells, +chromogranin, +synaptophysin, central tumor, SIADH, Cushing syndrome, Lambert Eaton. Adenocarcinoma: Non-smokers (also smokers), glandular, glycogen rich, (central or peripheral). Squamous Cell Carcinoma: keratin pearl, central tumor, PTHrp (hypercalcemia)
Lecture: 273b Lung Cancer
Learning Objective: 5. Understand key differences in biology and pathology for Non-small Cell Lung Cancer (NSCLC) versus Small Cell
Which of the following is the correct order of the phases of the cancer immunoediting concept?
- Equilibrium, Escape, Elimination
- Elimination, Equilibrium, Escape
- Escape, Equilibrium, Elimination
Answer: B. Elimination, Equilibrium, Escape
Explanation: In Elimination phase, the immune system is able to detect a developing tumor and destroy it. In the Equilibrium phase, the tumor cell is able to change such that it can survive the elimination but is still contained by the immune system. In the Escape phase, the tumor cells have changed so much that they can evade immune recognition and destruction and progressively grow.
Lecture: 255b Tumor Immunology
Learning Objective: 2. Know the concept of the immune surveillance and immunoediting theory (cytokines, role of different immune cells,
etc)
