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Flashcards in Chapter 11 - Oncology Deck (105):
1

Most common cancer in women?

Breast

2

Most common cause of CA related death in women?

Lung

3

Most common cancer in men?

Prostate

4

Most common CA related death in men?

Lung

5

What is a PET scan?

positron emission tomography scan. Identifies fluorodeoxyglucose molecules.

6

What do T-cells require to attack tumor cells?

MHC complex

7

Do natural killer cells require MHC to attack tumor cells?

no

8

Hyperplasia means what?

increased number of cells

9

Metaplasia means what?

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

10

Dysplasia means what?

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

11

Colon marker?

CEA

12

Liver marker?

AFP

13

Pancreatic marker?

CA 19-9

14

Ovarian marker?

CA 125

15

Testicular marker?

Beta-HCG

16

Choriocarcinoma marker?

Beta-HCG

17

Prostate marker?

PSA (highest sensitivity of markers)

18

Small cell lung marker?

NSE

19

Neuroblastoma marker?

NSE

20

CEA, PSA, AFP marker half lives?

CEA 18; PSA 18; AFP 5

21

What is cancer transformation?

heritable alteration in genome- loss of growth regulation

22

What is the latency period of oncogenesis?

time between exposure and formation of clinically detectable tumor

23

What is the steps of oncogenesis?

initiation- carcinogen interacts with DNA; Promotion of cancer cells; Progression of cancer cells to clinically detectable tumor

24

What are three ways neoplasms can arise?

carcinogenesis (smoking), viruses (EBV), Immunodeficiency (HIV)

25

How do viruses cause cancer?

Contain oncogenes

26

What is translocation that occurs with EBV?

8:14- causes Burkitt's; c-myc causes nasopharyngeal

27

Cervical caused by?

HPV

28

Gastric caused by?

H. Pylori

29

Hepatocellular caused by?

Hep B and Hep C

30

Kaposi's caused by?

HHV-8

31

Primary effusion lymphoma caused by?

HHV-8

32

Splenic lymphoma caused by?

Hep C

33

Nasopharyngeal caused by?

EBV

34

Burkitt's caused by?

EBV

35

Adult T-cell leukemia/lymphoma caused by?

Human T-cell leukemia virus-1

36

What cell phase is the most vulnerable for radiation?

M phase

37

How does radiation therapy cause damage?

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

38

How does higher energy radiation have a skin preserving effect?

maximal energy not reached until it gets to deeper structures

39

Why are fractionated doses of radiation helpfule?

-allows for repair of normal cells
-allows reoxygenation of tumor cells
-Allows for redistribution of tumor cells in cell cycle

40

What tumor types are very radiosensitive?

seminomas and lymphomas

41

What tumor types are very radioresistant?

epithelial, sarcomas

42

Why are large tumors less responsive to XRT?

lack of oxygen in the tumor

43

What is brachytherapy?

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

44

What are cell cycle specific agents?

5FU, methotrexate- exhibit plateau in cell killing ability

45

What does tamoxifen do?

blocks estrogen receptor- decreases short term (5 year) risk of breast Ca by 45%. 1% risk of blood clots, 0.1% risk of endometrial ca

46

What does taxol do?

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

47

What are side effects of bleomycin and busulfan?

pulmonary fibrosis

48

What is cisplatin and what are the side effects?

platinum alkylating agent. Nephrotoxic, neurotoxic, ototoxic.

49

What is carBoplatin and what is a side effect?

platinum alklating agent; Bone myelo suppresion

50

What is vincristine and what are side effects?

microtubule inhibitor; periperal neuropathy, nephrotoxic

51

What is vinBlastine and what is a side effect?

microtubule inhibitor; Bone myelo suppression

52

How do alkylating agents work?

transfer alkyl groups; form covalent bonds

53

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

Acrolein; gonadal dysfunction, SIADH, hemorrhagic cystitis

54

What can help with hemorrhagic cystitis from cyclophosphamide?

Mesna

55

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

Anti-helminthic drug- can stimulate immune system against CA

56

How does methotrexate work, what are its side effects?

inhibits dihydrofolate reductase which inhibits purine and DNA synthesis; renal toxicity

57

What is leucovorin rescue?

decreases folate, reverses effects of methotrexate

58

How does 5-fluorouracil work?

inhibits thymidylate synthesis which inhibits purine and DNA synthesis

59

What does leucovorin do in combination with 5-FU?

increases toxicity

60

What is Doxyrubicin and what is its toxicity?

DNA intercalator, O2 radical formation; Heart toxicity

61

how does etoposide work?

inhibits topoisomerase which normally unwinds DNA

62

Which agents have the least myelosuppressive effects?

-bleomycin
-vincristine
-busulfan
-cisplatin

63

What is GCSF used for? what is the side effect?

Neutrophil recovery after chemo; Sweet's syndrome- acute febrile neutropenic dermatitis

64

In what syndromes are normal organs resected to prevent cancer?

-FAP colon
-BRCA I, II- breast
-RET or MENIN - thyroid

65

Rb1 is found where and is involved in what?

Chromosome 13; involved in cell cycle

66

p53 is found where and does what in normal cell cycle?

Chromosome 17; normal gene induces cell cycle arrest and apoptosis

67

APC is found where and does what?

chromosome 5; cell adhesion and cytoskeletal function

68

DCC is found where and does what?

chromosome 18; cell adhesion

69

ras proto oncogene has a defect where?

G-proten

70

src proto oncogene has a defect where?

tyrosine kinase defect

71

sis oncogene has a defect where?

platelet derived growth factor receptor defect

72

erb B oncogene has a defect where?

epidermal growth factor receptor defect

73

myc oncogene has a defect where?

transcription factor defect

74

what is Li Fraumeni syndrome?

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

75

Medullary ca of the thyroid is associated with what oncogene?

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

76

Genes involved in development of Colon Ca includes?

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

77

Where does colon cancer not metastasize to?

Bone

78

Coal tar is carcinogenic to what?

larynx, skin, bronchial Ca

79

Beta-naphtylamine is carcinogenic to what?

Urinary tract

80

Benzene causes?

leukemia

81

Asbestos causes?

mesothelioma

82

Supraclavicular node suspicious for what?

-neck
-breast
-lung
-Stomach (virchow's node)

83

Axillary node suspicious for what?

-Lymphoma (#1)
-breast
-melanoma

84

Ovarian metastases from what primary?

-Stomach (krukenberg tumor)
-colon

85

Periumbilical node suspicious for what?

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

86

Bone metastases from what primary?

-breast (#1)
-prostate

87

Skin metastases from what primary?

breast, melanoma

88

Small bowel metastases from what primary?

Melanoma (#1)

89

Phase I trial determines what?

is it safe and at what dose

90

Phase II determines what?

is it effective

91

Phase III determines what?

is it better than existing therapy

92

Phase IV determines what?

implementation and marketing

93

What is induction therapy?

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

94

What is primary neoadjuvant therapy?

chemo given first followed by another therapy

95

What is adjuvent therapy?

combined with another modality; given after another therapy

96

What is salvage therapy?

used when tumors fail to respond to initial therapy

97

What is en bloc multiorgan resection used for?

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

98

What is palliative surgery?

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

99

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

No. palpable nodes need to be sampled.

100

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

25%

101

What are the most successfully cured metastases with surgery?

-Colon to liver
-Sarcoma to the lung

102

What is one tumor that has improved outcome with debulking?

ovarian

103

What solid tumors are curable with chemo alone?

-hodgkins
-non-hodgkins lymphoma

104

What are the T-cell lymphomas caused by?

-HTLV-1 (skin lesions)
-Mycosis fungoides (Sezary cells)

105

What are HIV related malignancies?

-Kaposi's sarcoma
-non-hodgkin's lymphoma