Chapter 11: Oncology Flashcards Preview

ABSITE. > Chapter 11: Oncology > Flashcards

Flashcards in Chapter 11: Oncology Deck (115):
1

#2 cause of death in the United States

Cancer

2

MC Ca in women

Breast cancer

3

MCC cancer related death in women

Lung cancer

4

MC Cancer in men

Prostate cancer

5

Used to identify metastases; defects fluorodeoxyglucose molecules

PET (positron emission tomography)

6

Need MHC complex to attack tumor

Cytotoxic T cells

7

Can independently attack tumor cells

Natural killer cells

8

Are random unless viral-induced tumor

Tumor antigens

9

Increased numbers of cells

Hyperplasia

10

Replacement of one tissue with another (GERD squamous epithelium in esophagus changed to columnar gastric tissue; e.g. Barrett's esophagus)

Metaplasia

11

Altered size, shape, and organization (e.g., Barrett's dysplasia)

Dysplasia

12

Tumor marker: colon ca

CEA

13

Tumor marker: liver CA

AFP

14

Tumor marker: pancreatic CA

CA 19-9

15

Tumor marker: Ovarian ca

CA 125

16

Tumor marker: testicular Ca, choriocarcinoma

Beta-HCG

17

Tumor marker: prostate CA

PSA

18

Prostate CA: thought to be tumor marker with the highest sensitivity, although specificity is low

PSA

19

Tumor marker: small cell lung CA, neuroblastoma

NSE

20

Tumor marker: breast CA

BRCA I and II

21

Tumor marker: carcinoid tumor

Chromogranin A

22

Tumor marker: thyroid medullary CA

Ret oncogene

23

Half life: CEA

18 days

24

Half life: PSA

18 days

25

Half life: AFP

5 days

26

Two components of cancer transformation

1. Heritable alteration in genome and;
2. Loss of growth regulation

27

Oncogenesis: time between exposure and formation of clinically detectable tumor

Latency period

28

Three phases of latency period

1. Initiation (carcinogen acts with DNA)
2. Promotion (then occurs)
3. Progression (cancers cells to clinically detectable tumor)

29

What can neoplasms arise from?

Carcinogenesis (e.g. smoking)
Viruses (eg, EBV)
Immunodeficiency (eg HIV)

30

What do retroviruses contain?

Oncogenes

31

Associated with Burkitt's lymphoma (8:14 translocation) and nasopharyngeal CA (c-myc)

Ebstein-Barr Virus

32

Human genes with malignant potential

Proto-oncogenes

33

Infectious agent: cervical cancer

Human papillomavirus

34

Infectious agent: gastric cancer

Helicobacter pylori

35

Infectious agent: hepatocellular carcinoma

Hepatitis B and hepatitis C viruse

36

Infectious agent: nasopharyngeal carcinoma

EBV

37

Infectious agent: Burkitt's lymphoma

EBV

38

Infectious agent: various lymphomas

HIV

39

Most vulnerable stage of cell cycle for XRT

M phase

40

Radiation therapy: what causes most of the damage?

Most damage done by formation of oxygen radicals -> maximal effect with high oxygen levels

41

Main target of radiation therapy

DNA: oxygen radicals and XRT itself damage DNA and other molecules

42

How does high-eneregy radiation have a skin--preserving effect?

Maximal ionizing potential not reached until deeper structures

43

What do fractionate XRT doses allow?

- Repair of normal cells
- Re-oxygenation of tumor
- Redistribution of tumor cells in the cell cycle

44

Very radiosensitive tumors

Seminomas, lymphomas

45

Very radio resistant tumors

Epithelial, sarcomas

46

Less responsive to XRT due to lack of oxygen in the tumor

Large tumors

47

Source of radiation in or next to tumor (Au-198, I-128); delivers high, concentrated doses of radiation

Brachytherapy

48

Chemo Agent: exhibit plateau in cell-killing ability

Cell cycle-specific agents (5FU, methotrexate)

49

Chemo Agent: Linear response to cell killing

Cell cycle-nonspecific agents

50

Chemo Agent: Decreases short-term (5 year) risk of breast CA 45%

Tamoxifen (blocks estrogen receptor)

51

Complications: tamoxifen therapy

1% risk of blood clots
0.1 % risk of endometrial cancer

52

Chemo Agent: promotes microtubule formation and stabilization that cannot be broken down; cells are ruptures

Taxol

53

Chemo Agent: can cause pulmonary fibrosis

Bleomycin
Busulfan

54

Chemo Agent: nephrotoxic, neurotoxic, ototoxic

Cisplatin (platinum alkylating agent)

55

Chemo Agent: bone (myelo) suppression

Carboplatin (platinum alkylating agent) *and*
Vinblastine (microtubule inhibitor)

56

Chemo Agent: peripheral neuropathy, neurotoxic

Vincristine (microtubule inhibitor)

57

Chemo Agent: transfer alkyl groups; forms covalent bonds to DNA

Alkylating agents

58

Chemo Agent: Acrolein is the active metabolite.
- Side effects: gonadal dysfunction, SIADH, hemorrhagic cystitis

Cyclophosphamide

59

Tx: hemorrhagic cystitis s/t cyclophosphamide

Mesna

60

Chemo Agent: antihelminthic drug though to stimulate immune system against cancer

Levamisole

61

Chemo Agent: inhibits dihydrofolate reductase (DHFR), which inhibits purine and DNA synthesis
- Side effects: renal toxicity, radiation recall

Methotrexate

62

Reverses effects of methotrexate by re-supplying folate

Leucovorin rescue (folinic acid)

63

Chemo Agent: inhibits thymidylate synthetase, which inhibits purine and DNA syntehsis

5-fluorouracil (5FU)

64

Increases toxicity of 5-fluorouracil

Leucovorin (folinic acid)

65

Chemo Agent: DNA intercalator, oxygen radical formation

Doxorubicin

66

Side effects: doxorubicin

Heart toxicity secondary to oxygen radicals at total doses > 500 mg/m^2.

67

Chemo Agent: inhibits topoisomerase (which normally unwinds DNA)

Etoposide (VP-16)

68

Chemo Agents: least myelosuppression

Bleomycin, vincristine, busulfan, cisplatin

69

Used for neutrophil recovery after chemo; side effects - Sweet's syndrome (acute febrile neutropenic dermatitis)

GCSF (granulocyte colony-stimulating factor

70

Acute febrile neutropenic dermatitis

Sweet's syndrome

71

When to consider resection of a normal organ to prevent cancer -> breast

BRCA I or II with strong family history

72

When to consider resection of a normal organ to prevent cancer -> thyroid

RET proto-oncogene with family history thyroid cancer

73

Tumor suppressor gene: chromosome 13; involved in cell cycle regulation

Retinoblastoma

74

Tumor suppressor gene: chromosome 17; involved in cell cycle

p53

75

Normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth

p53

76

Tumor suppressor gene: chromosome 5, involved with cell cycle regulation and movement

APC

77

Tumor suppressor gene: chromosome 18; involved in cell adhesion

DCC

78

Tumor suppressor gene: involved in apoptosis (programmed cell death)

bcl

79

Chromosome: p53

17

80

Chromosome: APC

5

81

Chromosome: DCC

18

82

Proto-oncogene: G protein defect

ras proto-oncogene

83

Proto-oncogene: tyrosine kinase defect

src proto-oncogene

84

Proto-oncogene: platelet-derived growth factor receptor defect

sis proto-oncogene

85

Proto-oncogene: epidermal growth factor receptor defect

erb B proto-oncogene

86

Proto-oncogene: proto-oncogenes - transcription factors

myc (c-myc, n-myc, l-myc)

87

Defect in p53 gene -> patients get childhood sarcomas, breast CA, brain tumors, leukemia, adrenal CA

Li-Fraumeni syndrom

88

- Gene involved in development include APC, p53, DCC, and K-ras
- APC though to be initial step in evolution
- Does not usually go to bone

Colon cancer

89

Carcinogens: coal tar

Larynx, skin, bronchial CA

90

Carcinogens: beta-naphthylamine

Urinary tract CA (bladder CA)

91

Carcinogens: benzene

Leukemia

92

Carcinogens: asbestos

Mesothelioma

93

DDX: suspicious supraclavicular node

Neck, breast, lung, stomach (Virchow's node), pancreas

94

DDX: suspicious axillary node

Lymphoma (#1), breast, melanoma

95

DDX: suspicious periumbilical node

Pancreas (Sister Mary Joseph's node)

96

DDx: ovarian metastases

Breast (#1), prostate

97

DDx: skin metastases

Breast, melanoma

98

DDx: small bowel metastases

Melanoma (#1)

99

Clinical trials:
- Phase 1
- Phase 2
- Phase 3
- Phase 4

- Phase 1: Is it safe and at what dose?
- Phase 2: Is it effective?
- Phase 3: Is it better than existing therapy?
- Phase 4: implementation and marketing

100

What is induction therapy?

Sole treatment; use for advanced disease or when no other treatment exists

101

What is primary therapy?

(Neoadjuvant) - chemo give 1st (usually), followed by another (secondary) therapy

102

What is adjuvant therapy?

Combined with another modality; given after other therapy is used

103

What is salvage therapy?

For tumors that final to respond to initial chemotherapy

104

Have poor barrier function -> better to view them as signs of probably metastasis

Lymph nodes

105

Can be attempted for some tumors (colon into uterus, adrenal into liver, gastric into spleen); aggressive local invasiveness is different from metastatic disease

En bloc multiorgan resection

106

Tx: tumors of hollow visit causing obstruction or bleeding (colon Ca), breast CA with skin or chest wall involvement

Palliative surgery

107

No role in patients with clinically palpable nodes; you need to get after and sample these nodes

Sentinel lymph node biopsy

108

35% 5-year survival rate if successfully resected

Colon metastases to the liver

109

Prognostic indictors for survival after resection of hepatic colorectal metastases

Disease-free interval > 12 months, tumor number

110

Most successfully cured metastases with surgery

Colon CA in liver, sarcoma to the lung, but survival still low overall for these

111

One of the few tumors for which surgical debunking improves chemotherapy (not seen in other tumors)

Ovarian CA

112

Curable solid tumors with chemotherapy only

Hodgkin's and non-Hodgkin's lymphoma

113

T cell lymphomas

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

114

HIV related malignancies

Kaposi's sarcoma, non-Hodgkin's lymphoma

115

Causes angiogenesis; involved in tumor metastasis

V-EGF (Vascular epidermal growth factor)