03a: Cancer Flashcards by Nuna H

Cell cycle: which checkpoint is that of “no return”?

G1/S

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(X) cell cycle phase: cell synthesizes all of the proteins

necessary for mitosis.

X = G2

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RTKs are bound by (X) and activate downstream signaling pathways.

X = growth factors

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Cancer signaling: Elevated levels of Cyclin D (activate/inhibit) (X), which then do what?

Activate;
X = Cdk4/6 (cyclin-dep kinases)

Phosphorylate Rb, which then releases the E2F TFs

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30% of all cancers have which mutated oncogene?

Ras

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T/F: Cyclins are oncogenes.

True

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T/F: Rb is an oncogene.

False - tumor suppressor

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PTEN is a PI3K (stimulator/inhibitor). Which of these is an oncogene?

Inhibitor;

PI3K (oncogene)

and PTEN is tumor suppressor

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T/F: AKT and mTOR are both oncogenes.

True

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List endogenous factors that cause DNA damage/mutations.

ROS (by metabolic products)

2. DNA replication

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T/F: Only about 5% of all cancer driving mutations arise from normal mutation rates.

False - 66%!!!

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Why do BRCA1/2 mutations predispose women to breast/ovarian cancers?

BRCA1/2 are important in DNA double strand break repair; inherited mutations in these lead to cancer predisposition

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Aneuploidy refers to (X) chromosomes and occurs as a result of (Y) process.

X = abnormal (number/structure)
Y = defects in mitosis

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T/F: Normal cells mis-segregate one chromosome in every 100 divisions.

True

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EGFR inhibitors target which special function of tumor cells?

Sustained proliferative signaling

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Although many EGFR inhibitors are in trial, they’re all failing due to:

Developed resistance

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Cyclin-dep kinase inhibitors target which special function of tumor cells?

Evading growth suppressors (ex: p53, Rb)

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Why do Cyclin-dep kinase inhibitors fail as drugs?

Hard to target

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T/F: Immunocompromised patients show higher tumor rates.

True - immune system detects and eliminates tumor cells

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Aspirin (increases/decreases) risk of (X) cancer by 40%. Why?

Decreases
X = colon

Reduces inflammation (release of ROS and Cytokines)

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VEGF signaling inhibitors target which special function of tumor cells?

Inducing angiogenesis

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ITP: Most cases involve Ig(X) autoantibodies that target (Y).

X = G
Y = platelet membrane glycoproteins IIb-IIIa

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TTP and HUS: excessive (activation/inhibition) of platelets, which then do what?

Activation

deposit as thrombi in small blood vessel (causing microangiopathic hemolytic anemia)

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Two major mechanisms that trigger DIC:

Release of procoagulants (esp tissue factor) into circulation
Widespread endothelial damage

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One mediator of endothelial injury, implicated in DIC occurring with sepsis, is (X). It induces endothelial cells to express (Y) on their cell surfaces and to decrease the expression of (Z).

``` X = TNF Y = tissue factor Z = thrombomodulin ```

Among lymphoid cells, potentially oncogenic mutations occur most frequently in (X) cells during (Y) process.

``` X = germinal center B Y = antibody diversification ```

Which 3 lymphotropic viruses have been implicated as causative agents in particular lymphomas?

1. HTLV-1 (human T cell lymphoma virus) 2. Epstein-Barr virus (EBV) 3. Kaposi sarcoma herpesvirus/human herpesvirus-8 (KSHV/HHV-8)

T/F: radiation therapy and certain forms of chemotherapy increase the risk of subsequent myeloid and lymphoid neoplasms.

True - mutagenic effects of ionizing radiation and chemotherapeutic drugs on hematolymphoid progenitor cells

Virtually all Hodgkin's and (X) portion of non-Hodgkin's lymphomas present with enlarged (tender/non-tender) lymph nodes.

X = 2/3 Non-tender

Most common plasma cell neoplasm:

multiple myeloma

Lymphoid neoplasms are sorted into which 5 broad categories (according to the WHO scheme)?

1. Premature B cell neoplasms 2. Peripheral (mature) B cell neoplasms 3. Premature T cell neoplasms 4. Peripheral (mature) T and NK cell neoplasms 5. Hodgkin lymphoma

T/F: Lymphoid neoplasia can be diagnosed from the clinical features/Hx, PE, and CBC.

False - histologic examination of lymph nodes or other involved tissues is required for diagnosis

(Hodgkin/non-hodgkin) lymphoma spreads in an orderly fashion.

Hodgkin

(X) is the most common cancer of children. Which cell type(s) involved?

X = ALL (Acute lymphoblastic leukemia/lymphoma) ``` Immature (pre-) B (85%) Or immature (pre-) T ```

Mutations involved in ALL disturb (X) process of lymphoid precursors, thus arresting (Y) and inducing (Z) processes.

``` X = differentiation Y = maturation Z = self-renewal (stem cell-like phenotype) ```

T/F: Single mutations are not sufficient to produce ALL.

True - need drive for cell growth (most commonly increased Tyr kinase/Ras activity)

Majority (95%) of ALL cases have immuno-staining positive for (X), expressed only in (Y) cells.

``` X = TdT (terminal deoxyNT transferase) Y = pre-B and pre-T lymphoblasts ```

ALL: positive immuno-staining for which markers would make you think this was a "late" pre-T cell tumor?

CD1-8 | CD3, 4, 8 negative in more immature T cell tumors

ALL: positive immuno-staining for CD 19, 20, and cytoplasmic IgM heavy chain would make you think this was (early/late) pre-(B/T) cell. Would CD10 be expressed too?

Late pre-B Yes - absent in very immature pre-B cells

Sx of ALL reflect (hyperactive/depressed) bone marrow function.

Depressed (anemia, neutropenia, thombocytopenia)

T/F: With aggressive chemotherapy about 95% of children and adults with ALL obtain a complete remission; 85% are cured.

False - numbers true for children, but adults have only 40% cure rate

T/F: ALL is the leading cause of cancer deaths in children

True

Most common leukemia of adults in the Western world

CLL (Chronic lymphocytic leukemia)

Seeing "proliferation centers" on lymph node biopsy is pathognomonic for:

CLL/SLL

Overall median survival for patients diagnosed with CLL

4-6y

Lymph node biopsy showing nodular aggregates of lymphoma cells. Which disease? Which cells did the cancer arise from?

Follicular lymphoma; Germinal center B cells

Follicular lymphoma strongly associated with chromosomal translocations involving:

BCL2 (expressed in over 90% of cases)

T/F: Normal follicular B cells are BCL2 positive.

False

Follicular lymphoma: (painful/painless) lymphadenopathy with (frequent/rare) involvement of extranodal sites.

Painless; rare

Therapy for follicular lymphoma typically involves:

Palliative (survival not improved by aggressive therapy); | Low dose chemo/immuno-Rx to treat symptoms

T/F: Histo transformation to other B cell lymphomas is rare in follicular lymphoma.

False - up to 50%

Most common form of non-hodgkin lymphoma:

Diffuse large B cell lymphoma

DLBCLs (Diffuse large B cell lymphomas) contain various translocations that have which common breakpoint?

BCL6

What are the remission and cure rates for DLBCLs?

60-80% complete remission and 50% cured

All forms of Burkitt lymphoma are highly associated with translocation of (X) gene on chromosome (Y). This leads to (increased/decreased) (X) protein levels.

``` X = MYC Y = 8 ``` Increased

(X) lymphoma is the fastest growing human tumor. Why does it grow so fast?

X = Burkitt Increase MYC expression increases aerobic glycolysis (Warburg effect); more biosynthesis (NT, lipids, proteins)

(X) lymphoma: "starry sky" pattern on tumor biopsy.

X = Burkitt

(X) lymphoma often presents as a mass involving the mandible.

X = ENDEMIC (not sporadic) Burkitt

Peripheral smear: Many Auer rods in (X) precursor cell is diagnostic of:

X = promyelocyte | APML (Acute promyelocyte Leukemia)

If you suspect APML (Acute promyelocyte Leukemia) in patient based on peripheral blood smear, what's the next step?

TREAT! (All-trans retinoic acid - ATRA) even before marrow biopsy

(X)% of patients with APML will die before/shortly after diagnosis due to:

X = 25 Bleeding (CNS, lungs, GI)

03a: Cancer Flashcards

(61 cards)