EXAM 2 - Stevich-Heemer Flashcards by Nicole Sorensen

What cancer is the second most common and the most common cause of cancer-related deaths?

Lung cancer

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What is the #1 risk factor for lung cancer?

Tobacco

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What are the molecular abnormalities in the pathogenesis of lung cancer?

KRAS
EGFR
ALK

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What are mutations in lung cancer?

activation of proto-oncogenes
inhibition of tumor suppressor genes
production of autocrine growth factors

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What the 2 types of lung cancer?

Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)

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small cell lung cancer expresses?

C-KIT (tyrosine kinase receptor)

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non-small cell lung cancer expresses?

EGFR
ALK

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Which mutations are less common in lung cancer?

BRAF
NTRK
ROS1

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what is the use of prophylactic medications to prevent cancer development?

chemoprevention

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what are chemo-preventive agents?

NSAIDs
retinoids
inhaled glucocorticoids
vitamin E
selenium

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Which type of lung cancer is more common?

non-small cell lung cancer (NSCLC)

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What type of lung cancer grows slower?

non-small cell lung cancer

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what are the s/sx of lung cancer?

cough
SOB
chest pain
anorexia
weight loss
fatigue

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what are the s/sx of paraneoplastic syndrome?

weight loss
cushing’s syndrome
hypercalcemia
SIADH
pulmonary hypertrophic osteoarthropathy
anemia

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what are extrapulmonary s/sx?

bone pain / fractures
liver dysfunction
neurologic deficits
spinal cord compression

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which type of lung cancer uses TNM staging?

non-small cell lung cancer

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what are the common histologic types of non-small cell lung cancer?

adenocarcinoma
squamous cell
large cell carcinoma

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What is the regimen for stage II lung cancer?

platinum-based regimens

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stage IIIA lung cancer is treated with?

platinum-containing regimen and concurrent radiotherapy

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what is consolidation therapy in lung cancer?

given to stage IIIB and IIIC
PD-L1 inhibitor - durvalumab
*** durvalumab is not used is patient has surgical resection

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what are the 3 pathways for advanced NSCLC

immune sensitive (PD-L1+)
genetic mutation driven
nonbiomarker-driven therapy

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bevacizumab is for which type of histology in lung cancer?

nonsquamous

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what are the 2 stages of SCLC

limited
extensive

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what is primary treatment for extensive stage SCLC?

platinum with etoposide

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what is the main side effect of cisplatin

nephrotoxicity

what is the main side effect of etoposide?

hypotension

Bevacizumab. What class and side effects?

class: VEGF inhibitor side effects: bleeding, impaired wound healing, HTN, proteinuria

what are the side effects for PD-L1 inhibitors?

immune reactions

What ENDOCRINE factors cause an increased risk of breast cancer? decreased?

increased: early menarche, late age of natural menopause, nulliparity or late age of first birth decreased: oophorectomy before 45 YO

What gene mutations are associated with breast cancer?

BRCA1 BRCA2

s/sx of metastases in breast cancer

bone pain, difficulty breathing, abdominal pain, jaundice, mental status change

What labs will be elevated in breast cancer?

tumor markers (CA 15-3, CEA) Alk Phos LFTs

breast cancer cells spread through

lymph channels blood vessels

what cytotoxic chemotherapy is used in breast cancer?

doxorubicin epirubicin cyclophosphamide methotrexate fluorouracil carboplatin paclitaxel

breast cancer: curative (stage I-III) systemic therapy is which classes?

anthracyclines (doxorubicin / epirubicin) taxanes (paclitaxel / docetaxel)

what is the ADR of anthracyclines

red urine cardiotoxicity

what is the ADR of taxanes

neuropathies

breast cancer: stage I-III biologic therapy uses what class?

HER2 therapy (trastuzumab / pertuzumab)

breast cancer: stage I-III endocrine therapy uses what classes?

aromatase inhibitors (anastrozole / letrozole) tamoxifen **gold standard**

breast cancer with bone metastases are treated with?

bone modifying agent (pamidronate / zoledronic acid / denosumab)

what is mTOR and what drug is an mTOR inhibitor?

important mediator for cell proliferation and regulation of apoptosis, angiogenesis, and cellular metabolism everolimus

What is PI3K and what drug is a Pi3K inhibitor?

PI3Ks play a critical role in regulating many biological functions Alpelisib

what drugs are PARP inhibitors?

olaparib and talazoparib

What tumor suppressor gene mutations are associated with ovarian cancer?

BRCA1 (more prevalent) BRCA2

if exposed to what hormone will you be at an increased risk of ovarian cancer?

estrogen

and increase/decrease in the total number of ovulations increases the risk of ovarian cancer?

increase

what is the incessant ovulation hypothesis

risk of mutations and cancer increase each time the ovarian epithelium undergoes cell repair

a diet high in ______ increases the risk of ovarian cancer? a diet high in _____ decreases the risk of ovarian cancer

increases: galactose, animal fat, meat decreases: vegetables

what are the 3 cell/tumor types of ovarian cancer?

epithelial carcinoma (most common) germ cell tumors stromal carcinomas

What are some preventative ways for ovarian cancer?

decrease the # of ovulations (multiparity, oral contraceptives)

ovarian cancer is often asymptomatic, so known as the ?

silent killer

What are some s/sx and labs for ovarian cancer?

symptoms: abdominal discomfort, nausea, dyspepsia, flatulence, bloating, eating/digestive issues, urinary issues, bowel issues, weight change signs: abdominal or pelvic mass, irregular vaginal bleeding, ascites labs: elevated CA-125, LFTs and renal function abnormalities

goal of ovarian cancer depends on the ______ stage at diagnosis

FIGO

What is the primary treatment for ovarian cancer?

surgery

what is needed for accurate diagnosis and staging of ovarian cancer?

comprehensive exploratory laparotomy

cannot readily biopsy a ovarian cancer tumor because of risk of ____?

tumor seeding (increases the risk of recurrence)

Radiation therapy in ovarian cancer is used for what type of care?

palliative

what is the first-line chemotherapy for ovarian cancer?

taxane and platinum regimen (following surgery)

chemotherapy regimens for ovarian cancer are typically how many days?

21 or 28

neoadjuvant chemotherapy for ovarian cancer is which classes?

taxane with platinum

Consolidation therapy is given to patients WITH or WITHOUT measurable disease (ovarian cancer)

WITHOUT

what medications are used for consolidation therapy in ovarian cancer?

bevacizumab and PARP inhibitors (olaparib / niraparib)

maintenance therapy is given to patient WITH or WITHOUT measurable disease (ovarian cancer)

WITH

what is the length of time that has lapsed since the completion of chemotherapy?

disease-free interval

a patient is considered platinum-resistant if their cancer recurs in how much time?

< 6 months

a patient is considered platinum-sensitive if their cancer recurs in how much time?

> 6 months

platinum-sensitive patients are given what drugs for recurrent ovarian cancer?

platinum in combo with gemcitabine, doxorubicin, or paclitaxel

platinum-resistant patients are given what agents for recurrent ovarian cancer?

Paclitaxel + bevacizumab Topotecan + bevacizumab cyclophosphamide + bevacizumab gemcitabine docetaxel etoposide

What are some risk factors for colorectal cancer?

age adenomatous polyps IBD DM family history

what lifestyle factors are associated with REDUCED risk of colorectal cancer?

NSAIDs and aspirin postmenopausal hormone replacement therapy

what lifestyle factors are associated with INCREASED risk of colorectal cancer?

obesity and physical inactivity alcohol consumption cigarette smoking antimicrobials antacids PPIs a diet high in red and processed meat, fat, and refined grains

what test is done to detect occult blood in the stool?

fecal occult blood testing

what are the 2 methods of FOBT?

Guaiac-based FOBT (gFOBT) immunochemical (iFOBT)

which FOBT do we need to counsel patients to avoid NSAIDs, red meat, vit. C, citrus before testing?

gFOBT

what is the gold standard for colorectal cancer screening?

colonoscopy

what are some clinical s/sx of colorectal cancer?

signs: blood in stool, jaundice, leg edema (widespread) symptoms: change in bowel habits, constipation, N/V, fatigue

what lab tests are done to diagnose colorectal cancer?

positive guaiac stool test anemia elevated CEA, and liver enzymes

what stage of colorectal cancer is curable? not curable?

curable: stage I-III not curable: stage IV

Standard adjuvant chemotherapy for colorectal cancer stages II involve what drugs?

fluoropyrimidine - fluorouracil with leucovorin in combo with oxaliplatin (FOLFOX) - capecitabine in combo with oxaliplatin (CapeOx) - capecitabine alone

in stage III colorectal cancer you can add on _______ for better treatment?

oxaliplatin better than fluoropyrimidines alone

stage IV colorectal cancer (resectable or potentially resectable) get what chemo regimen?

FOLFOX (fluorouracil, leucovorin, oxaliplatin) CAPEFOX (capecitabine, leucovorin, oxaliplatin) FOLFIRI (fluorouracil, leucovorin, ininotecan)

in stage IV colorectal cancer if it has metastasized to the liver what is done?

a permanent access catheter is implanted into the heaptic artery for direct administration of chemo into the liver floxuridine with dex fluoruracil w/ or w/out leucovorin

stage IV unresectable colorectal cancer is given?

FOLFOX, FOLFIRI, or CAPEOX add on bevacizumab

EXAM 2 - Stevich-Heemer Flashcards

(83 cards)