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ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn COPY > Chapter 11 - Oncology+ > Flashcards

Chapter 11 - Oncology+ Flashcards

1
Q

Most common cancer in women?

A

Breast

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2
Q

Most common cause of CA related death in women?

A

Lung

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3
Q

Most common cancer in men?

A

Prostate

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4
Q

Most common CA related death in men?

A

Lung

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5
Q

What is a PET scan?

A

positron emission tomography scan. Identifies fluorodeoxyglucose molecules to help find metastases.

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6
Q

What do T-cells require to attack tumor cells?

A

MHC complex

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7
Q

Do natural killer cells require MHC to attack tumor cells?

A

no

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8
Q

Hyperplasia means what?

A

increased number of cells

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9
Q

Metaplasia means what?

A

replacement of one tissue with another (GERD - squamous esophagus changed to columnar gastric tissue)

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10
Q

Dysplasia means what?

A

altered size, shape, and organization of cells (Barrett’s esophagus)

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11
Q

Colon cancer marker?

A

CEA

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12
Q

Liver cancer marker?

A

AFP

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13
Q

Pancreatic cancer marker?

A

CA 19-9

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14
Q

Ovarian cancer marker?

A

CA 125

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15
Q

Testicular cancer marker?

A

Beta-HCG

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16
Q

Choriocarcinoma marker?

A

Beta-HCG

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17
Q

Prostate cancer marker?

A

PSA

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18
Q

Small cell lung cancer marker?

A

NSE

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19
Q

Neuroblastoma marker?

A

NSE

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20
Q

What happens in cancer transformation?

A

heritable alteration in genome - loss of growth regulation

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21
Q

What is the latency period of oncogenesis?

A

time between exposure and formation of clinically detectable tumor

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22
Q

What are the steps of oncogenesis?

A

Initiation - carcinogen interacts with DNA

Promotion of cancer cells

Progression to clinically detectable tumor

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23
Q

What are three mechanisms neoplasms can arise?

A
  • carcinogenesis (smoking)
  • viruses (EBV)
  • immunodeficiency (HIV)
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24
Q

How do viruses cause cancer?

A

Contain oncogenes

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25
Q

What is translocation that occurs with EBV?

A

8:14 causes Burkitt’s lymphoma

c-myc causes nasopharyngeal carcinoma

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26
Q

Cervical cancer can be caused by what virus?

A

HPV

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27
Q

Gastric cancer can be caused by what organism?

A

H. Pylori

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28
Q

Hepatocellular can be caused by what virus?

A

Hep C (also causes splenic lymphoma), Hep B

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29
Q

Kaposi’s sarcoma can be caused by what virus?

A

HHV-8 (also causes primary effusion lymphoma)

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30
Q

Primary effusion lymphoma can be caused by what virus?

A

HHV-8 (also causes Kaposi’s sarcoma)

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31
Q

Splenic lymphoma can be caused by what virus?

A

Hep C (also causes HCC)

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32
Q

Nasopharyngeal carcinoma can be caused by what virus?

A

EBV (also causes Burkitt’s lymphoma) c-myc association

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33
Q

Burkitt’s lymphoma can be caused by what virus?

A

EBV (also causes nasopharyngeal carcinoma)

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34
Q

Adult T-cell leukemia/lymphoma can be caused by what virus?

A

Human T-cell leukemia virus-1

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35
Q

What cell phase is the most vulnerable for radiation?

A

M phase

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36
Q

How does radiation therapy cause damage?

A

formation of oxygen radicals - damage DNA and other molecules. XRT can also cause small breaks in DNA primarily

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37
Q

How does higher energy radiation have a skin preserving effect?

A

maximal energy not reached until it gets to deeper structures

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38
Q

Why are fractionated doses of radiation helpful?

A
  • allows for repair of normal cells
  • allows reoxygenation of tumor cells
  • allows for redistribution of tumor cells in cell cycle
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39
Q

What tumor types are very radiosensitive?

A

seminomas, lymphomas, head and neck cancers

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40
Q

What tumor types are very radioresistant?

A

epithelial, sarcomas

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41
Q

Why are large tumors less responsive to XRT?

A

lack of oxygen in the tumor

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42
Q

What is brachytherapy?

A

source of radiation in or next to tumor (Au-198, I-128)

uses: localized prostate cancer, advanced cervical cancer

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43
Q

What are cell-cycle specific agents?

A

5FU, methotrexate

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44
Q

What does tamoxifen do?

A

blocks estrogen receptor - decreases short-term (5 yr) risk of breast Ca by 45%

1% risk of blood clots, 0.1% risk of endometrial ca

uses: metastatic breast ca, adjuvant as well

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45
Q

What does taxol (paclitaxel) do?

What is it used for?

A

promotes microtubule formation and stabilization that cannot be broken down - cell ruptures

uses: adjuvant for node-positive/metastatic breast cancer, second-line for Kaposi sarcoma, first-line for NSCLC, subsequent and first-line for advanced ovarian cancer

46
Q

What are side effects of bleomycin and busulfan?

A

pulmonary fibrosis

47
Q

What is the mechanism of cisplatin?

What are the side effects?

What are its uses?

A
  • Platinum alkylating agent
  • Nephrotoxic, neurotoxic, ototoxic
  • Advanced bladder cancer - not candidates for local therapy (surg/radx)
  • Metastatic ovarian cancer - adjuvant after surgery and/or radx
  • Metastatic testicular cancer - adjuvant after surgery and/or radx
48
Q

What is carboplatin and what is a side effect?

A
  • platinum alkylating agent
  • bone myelosuppression
  • uses: initial in advanced ovarian cancer
49
Q

What is vincristine and what are side effects?

A
  • microtubule inhibitor
  • periperal neuropathy, nephrotoxic
  • uses: ALL, HL, NHL, neuroblastoma, rhabdomyosarcoma, Wilms tumor
50
Q

What is vinBlastine and what is a side effect?

A
  • microtubule inhibitor
  • bone myelosuppression
  • HL, Kaposi sarcoma, Langerhans cell histiocytosis, NHL, testicular cancer
51
Q

How do alkylating agents work?

A

transfer alkyl groups; form covalent bonds

52
Q

What is the active metabolite of cyclophosphamide and what are the side effects?

A

Acrolein; gonadal dysfunction, SIADH, hemorrhagic cystitis

53
Q

What can help with hemorrhagic cystitis from cyclophosphamide?

A

Mesna

54
Q

What is levamisole, what is its role in CA tx?

A

Anti-helminthic drug - can stimulate the immune system against CA

55
Q

How does methotrexate work, what are its side effects?

What are its uses?

A
  • inhibits dihydrofolate reductase, which inhibits purine and DNA synthesis
  • renal toxicity, hematologic sfx
  • careful in patients w/ alcoholism, liver dz, immunodeficiency, blood dyscrasias
  • Many uses: ALL, BRCA, ENT cancer, T-cell lymphoma, lung cancer, NHL, osteosarcoma, psoriasis, RA, pJIA
56
Q

What is leucovorin rescue?

A

reverses toxic effects of methotrexate by increasing folate

57
Q

How does 5-fluorouracil work?

What is it used for?

A
  • inhibits thymidylate synthesis which inhibits purine and DNA synthesis
  • Uses: breast cancer, CRC, gastric cancer, pancreatic cancer
58
Q

What does leucovorin do in combination with 5-FU?

A

increases toxicity

59
Q

What is Doxyrubicin and what is its toxicity?

A
  • DNA intercalator, O2 radical formation
  • Heart toxicity
  • Uses: breast cancer, metastatic solid tumors, leukemia, lymphoma
60
Q

How does etoposide work?

A
  • inhibits topoisomerase which normally unwinds DNA
  • SCLC, testicular cancer
61
Q

Which chemo agents have the least myelosuppressive effects?

A
  • bleomycin
  • vincristine
  • busulfan
  • cisplatin
62
Q

What is GCSF used for in chemo? What is the side effect?

A

Neutrophil recovery after chemo

Sweet’s syndrome - acute febrile neutropenic dermatitis

63
Q

In what cancer syndromes are normal organs resected to prevent cancer?

A
  • FAP - colon
  • BRCA I, II - breast
  • RET or MENIN - thyroid
64
Q

Rb1 is found on what chromosome and is involved in what?

A
  • Chromosome 13
  • Cell cycle
  • Bladder cancer
65
Q

p53 is found on what chromosome and does what in normal cell-cycle?

A
  • Chromosome 17
  • normal gene induces cell cycle arrest and apoptosis
  • Li Fraumeni
66
Q

APC is found on what chromosome and does what?

A
  • chromosome 5
  • cell adhesion and cytoskeletal function
  • colorectal cancer
67
Q

DCC (deleted in colorectal carcinoma) is found on what chromosome and does what?

A
  • chromosome 18
  • cell adhesion
  • CRC
68
Q

Ras proto-oncogene has a defect on what protein?

A
  • G-protein
  • pancreatic ductal adenocarcinoma
69
Q

Src proto-oncogene has a defect on what enzyme?

A

tyrosine kinase defect

70
Q

Sis oncogene has a defect on what receptor?

A

platelet-derived growth factor receptor defect

71
Q

Erb B oncogene has a defect on what receptor?

A

epidermal growth factor receptor defect

72
Q

Myc oncogene has a defect where?

A
  • transcription factor defect
  • nasopharyngeal carcinoma
73
Q

what is Li Fraumeni syndrome?

A

defect in p53 gene - pts get childhood sarcomas, breast ca, brain tumors, leukemia, adrenal CA

74
Q

Medullary ca of the thyroid is associated with what oncogene?

A

Ret proto oncogene on chromosome 10. (defect + family hx = 90% chance of medullary thyroid CA- prophylactic total thyroidectomy

75
Q

Genes involved in development of Colon cancer include?

A
  • APC (cell adhesion/cytoskeletal fxn; 1st mutation in development of ca)
  • p53
  • DCC
  • K-ras
76
Q

Coal tar is carcinogenic to what?

A

larynx, skin, bronchial Ca

77
Q

Beta-naphtylamine is carcinogenic to what?

A

Urinary tract

78
Q

Benzene causes what cancer?

A

leukemia

79
Q

Asbestos causes what cancer?

A

mesothelioma

80
Q

Supraclavicular node suspicious for what types of cancer?

A
  • neck
  • breast
  • lung
  • stomach (virchow’s node)
81
Q

Axillary node suspicious for what types of cancer?

A
  • lymphoma (#1)
  • breast
  • melanoma
82
Q

Ovarian metastases from what primary cancer?

A
  • stomach (Krukenberg tumor)
  • colon
83
Q

Periumbilical node suspicious for what cancer?

A

-pancreatic ca (Sr. Mary Joseph’s node)

84
Q

Bone metastases usually from what primary?

A
  • breast (#1)
  • prostate

*almost never colon cancer

85
Q

Skin metastases from what primary cancer?

A
  • breast
  • melanoma
86
Q

Small bowel metastases from what primary cancer?

A

Melanoma (#1)

87
Q

Phase I trial determines what?

A

is it safe and at what dose?

88
Q

Phase II determines what?

A

is it effective?

89
Q

Phase III determines what?

A

is it better than existing therapy?

90
Q

Phase IV determines what?

A

implementation and marketing

91
Q

What is induction therapy?

A

sole treatment - for advanced disease or when no other tx exists

92
Q

What is primary neoadjuvant therapy?

A

chemo given first followed by another therapy

93
Q

What is adjuvent therapy?

A

combined with another modality; given after another therapy

94
Q

What is salvage therapy?

A

used when tumors fail to respond to initial therapy

95
Q

What is en bloc multiorgan resection used for?

A

locally invasive tumors (colon into uterus, adrenal into liver, gastric into diaphragm)

96
Q

What is palliative surgery?

A

not curative - hollow viscus obstructing tumors, pancreatic with biliary obstruction, breast with skin or chest wall involvement

97
Q

Does sentinal lymph node biopsy have a role in patients with clinically palpable nodes?

A

No. Palpable nodes need to be sampled.

98
Q

Liver mets from colon have what percentage 5 year survival if successfully resected?

A

25%

99
Q

What are the most successfully cured metastases with surgery?

A
  • Colon to liver
  • Sarcoma to lung
100
Q

What is one tumor that has improved outcome with debulking?

A

ovarian

101
Q

What solid tumors are curable with chemo alone?

A
  • Hodgkins
  • non-Hodgkins lymphoma
102
Q

What are the T-cell lymphomas caused by?

A
  • HTLV-1 (skin lesions)
  • Mycosis fungoides (Sezary cells)
103
Q

What are HIV related malignancies?

A
  • Kaposi’s sarcoma
  • non-Hodgkin’s lymphoma
104
Q

For gallbladder cancer, what is the role for adjuvant therapy?

A
  • > or = to T2, node positive, margin positive
  • gemcitibine and cisplatin
  • follow CEA and CA 19-9
105
Q

What is the role for risk-reducing BSO in patients with BRCA1?

Lynch syndrome?

A
  • The lifetime risk of ovarian cancer is 35 to 46 percent in women with BRCA1 gene mutations, 13 to 23 percent in those with BRCA2 mutations, and 3 to 20 percent in those with Lynch syndrome.
  • Pts w/ BRCA who have completed childbearing: rrBSO is recommended over screening or chemoprevention
  • Premenopausal pts w/ Lynch syndrome who have completed childbearing: rrBSO over cancer screening or chemoprevention
106
Q

What prognostic factor does HER2 positivity represent?

A

Negative prognostic factor - correlation between HER2 overexpression and shorter disease-free and overall survival. Tx w/ trastuzumab.

Encodes a 185-kDa transmembrane glycoprotein with tyrosine kinase activity that is a member of the EGFR family

107
Q

Hepatoblastoma marker?

A

AFP

It is found in the developing fetus in the liver and yolk sac cells and not found in normal adults.

108
Q

HCC marker?

A

AFP

109
Q

What is recommended as adjuvant therapy for cutaneous melanoma that is stage III or IV, or with a BRAF mutation?

A

nivolumab

110
Q

S/p total thyroidectomy for differentiated cancer, what can be used as a biomarker for disease recurrence?

A

thyroglobulin

111
Q

The most common mutation in pancreatic cancer occurs in which gene?

A

K-ras

Also: CA 19-9, p53

ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn COPY (49 decks)

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