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Comprehensive Prep > Chapter 11: Oncology > Flashcards

Chapter 11: Oncology Flashcards

(89 cards)

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1
Q

MC cancer related death in women

A

Lung cancer

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2
Q

MC Cancer in men

A

Prostate cancer

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3
Q

Need MHC complex to attack tumor

A

Cytotoxic T cells

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4
Q

Can independently attack tumor cells

A

Natural killer cells

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5
Q

Tumor marker: colon ca

A

CEA

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6
Q

Tumor marker: liver CA

A

AFP

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7
Q

Tumor marker: pancreatic CA

A

CA 19-9

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8
Q

Tumor marker: Ovarian ca

A

CA 125

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9
Q

Tumor marker: testicular Ca, choriocarcinoma

A

Beta-HCG

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10
Q

Tumor marker: prostate CA

A

PSA

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11
Q

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

A

PSA

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12
Q

Tumor marker: small cell lung CA, neuroblastoma

A

NSE

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13
Q

Tumor marker: breast CA

A

BRCA I and II

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14
Q

Tumor marker: carcinoid tumor

A

Chromogranin A

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15
Q

Tumor marker: thyroid medullary CA

A

Ret oncogene

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16
Q

Half life: CEA

A

18 days

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17
Q

Half life: PSA

A

18 days

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18
Q

Half life: AFP

A

5 days

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19
Q

Oncogenesis: time between exposure and formation of clinically detectable tumor

A

Latency period

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20
Q

Three phases of latency period

A
  1. Initiation (carcinogen acts with DNA)
  2. Promotion (then occurs)
  3. Progression (cancers cells to clinically detectable tumor)
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21
Q

What do retroviruses contain?

A

Oncogenes

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22
Q

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

A

Ebstein-Barr Virus

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23
Q

Infectious agent: nasopharyngeal carcinoma

A

EBV

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24
Q

Infectious agent: Burkitt’s lymphoma

A

EBV

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25
Infectious agent: various lymphomas
HIV
26
Most vulnerable stage of cell cycle for XRT
M phase
27
Radiation therapy: what causes most of the damage?
Most damage to DNA done by formation of oxygen radicals -> maximal effect with high oxygen levels
28
How does high-energy radiation have a skin--preserving effect?
Maximal ionizing potential not reached until deeper structures
29
What do fractionate XRT doses allow?
- Repair of normal cells - Re-oxygenation of tumor - Redistribution of tumor cells in the cell cycle
30
Very radiosensitive tumors
Seminomas, lymphomas
31
Very radioresistant tumors
Epithelial, sarcomas
32
Brachytherapy
Source of radiation in or next to tumor (Au-198, I-128); delivers high, concentrated doses of radiation
33
Chemo Agent: exhibit plateau in cell-killing ability
Cell cycle-specific agents (5FU, methotrexate)
34
Chemo Agent: Linear response to cell killing
Cell cycle-nonspecific agents
35
Chemo Agent: Decreases short-term (5 year) risk of breast CA 45%
Tamoxifen (blocks estrogen receptor)
36
Complications: tamoxifen therapy
1% risk of blood clots | 0.1 % risk of endometrial cancer
37
Chemo Agent: promotes microtubule formation and stabilization that cannot be broken down; cells are ruptures
Taxol
38
Chemo Agent: can cause pulmonary fibrosis
Bleomycin | Busulfan
39
Chemo Agent: nephrotoxic, neurotoxic, ototoxic
Cisplatin (platinum alkylating agent)
40
Chemo Agent: bone (myelo) suppression
Carboplatin (platinum alkylating agent) *and* | Vinblastine (microtubule inhibitor)
41
Chemo Agent: peripheral neuropathy, neurotoxic
Vincristine (microtubule inhibitor)
42
Cyclophosphamide
Alkylating agent: transfer alkyl groups; forms covalent bonds to DNA - Acrolein is the active metabolite. - Side effects: gonadal dysfunction, SIADH, hemorrhagic cystitis
43
Tx: hemorrhagic cystitis s/t cyclophosphamide
Mesna
44
Chemo Agent: antihelminthic drug thought to stimulate immune system against cancer
Levamisole
45
Methotrexate
Chemo Agent: inhibits dihydrofolate reductase (DHFR), which inhibits purine and DNA synthesis - Side effects: renal toxicity, radiation recall
46
Reverses effects of methotrexate by re-supplying folate
Leucovorin rescue (folinic acid)
47
5-fluorouracil (5FU)
Chemo Agent: inhibits thymidylate synthetase, which inhibits purine and DNA syntehsis
48
Increases toxicity of 5-fluorouracil
Leucovorin (folinic acid)
49
Doxorubicin
Chemo Agent: DNA intercalator, oxygen radical formation
50
Side effects: doxorubicin
Heart toxicity secondary to oxygen radicals at total doses > 500 mg/m^2.
51
Etoposide (VP-16)
Chemo Agent: inhibits topoisomerase (which normally unwinds DNA)
52
Chemo Agents: least myelosuppression
Bleomycin, vincristine, busulfan, cisplatin
53
GCSF (granulocyte colony-stimulating factor
Used for neutrophil recovery after chemo | Side effect - Sweet's syndrome (acute febrile neutropenic dermatitis)
54
When to consider resection of a normal organ to prevent cancer -> breast
BRCA I or II with strong family history
55
When to consider resection of a normal organ to prevent cancer -> thyroid
RET proto-oncogene with family history thyroid cancer
56
Tumor suppressor gene: chromosome 13; involved in cell cycle regulation
Retinoblastoma
57
p53
Tumor suppressor gene: chromosome 17; involved in cell cycle Normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth
58
APC
Tumor suppressor gene: chromosome 5, involved with cell cycle regulation and movement
59
DCC
Tumor suppressor gene: chromosome 18; involved in cell adhesion
60
bcl
Tumor suppressor gene: involved in apoptosis (programmed cell death)
61
Chromosome: p53
17
62
Chromosome: APC
5
63
Chromosome: DCC
18
64
ras
Proto-oncogene: G protein defect
65
src
Proto-oncogene: tyrosine kinase defect
66
sis
Proto-oncogene: platelet-derived growth factor receptor defect
67
erb B
Proto-oncogene: epidermal growth factor receptor defect
68
myc (c-myc, n-myc, l-myc)
Proto-oncogenes: transcription factors
69
Li-Fraumeni syndrome
Defect in p53 gene -> patients get childhood sarcomas, breast CA, brain tumors, leukemia, adrenal CA
70
Colon cancer
- 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
71
Carcinogens: coal tar
Larynx, skin, bronchial CA
72
Carcinogens: beta-naphthylamine
Urinary tract CA (bladder CA)
73
Carcinogens: benzene
Leukemia
74
DDX: suspicious supraclavicular node
Neck, breast, lung, stomach (Virchow's node), pancreas
75
DDX: suspicious axillary node
Lymphoma (#1), breast, melanoma
76
DDX: suspicious periumbilical node
Pancreas (Sister Mary Joseph's node)
77
DDx: ovarian metastases
Breast (#1), prostate
78
DDx: skin metastases
Breast, melanoma
79
DDx: small bowel metastases
Melanoma (#1)
80
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
81
What is induction therapy?
Sole treatment; use for advanced disease or when no other treatment exists
82
En bloc multiorgan resection
Can be attempted for some tumors (colon into uterus, adrenal into liver, gastric into spleen); aggressive local invasiveness is different from metastatic disease
83
Colon metastases to the liver: prognosis
35% 5-year survival rate if successfully resected
84
Prognostic indictors for survival after resection of hepatic colorectal metastases
Disease-free interval > 12 months, tumor number
85
One of the few tumors for which surgical debunking improves chemotherapy (not seen in other tumors)
Ovarian CA
86
Curable solid tumors with chemotherapy only
Hodgkin's and non-Hodgkin's lymphoma
87
T cell lymphomas
``` HTLV-1 (skin lesions) Mycosis fungoides (Sezary cells) ```
88
HIV related malignancies
Kaposi's sarcoma, non-Hodgkin's lymphoma
89
Causes angiogenesis; involved in tumor metastasis
V-EGF (Vascular epidermal growth factor)

Comprehensive Prep (45 decks)

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