Intro to Oncology Flashcards by Nicole Gaudreau

What is initiation in carcinogenesis?

Exposure of normal cells to carcinogenic substances

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What is promotion in carcinogenesis?

Carcinogens or other factors create an environment that favors growth of mutated cells over normal cells

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What is conversion or transformation of carcinogenesis?

Cell becomes cancerous

Could be years before diagnosis occurs

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What is progression of carcinogenesis?

Tumor invasion into local and distal sites (metastasis)

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Which process in carcinogenesis is reversible?

Promotion

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What are RFs for carcinogenesis?

Chemical
Physical agents
Biologic
Age/gender
Diet
Chronic irritation
FH

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What are chemical RFs for carcinogenesis?

Aniline dye exposure (bladder cancer)
Benzene (leukemia)
Smoking
Drugs/hormones (BC, Hydroxyurea, GLP-1 agonists, AZA)

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What are the physical agents RFs for carcinogenesis?

Radiation (free radicals)

UV (free radicals)

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How is chronic irritation a RF for carcinogenesis?

Persistent cell damage and repair

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What are the two major classes of genes in cancer?

Oncogenes

Proto-oncogenes

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What are oncogenes?

Develop from normal genes called proto-oncogenes

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What are proto-oncogenes?

Present in all cells to regulate cell cycle and function

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How do proto-oncogenes become oncogenes?

Alterations lead to oncogenes by point mutations, chromosomal rearrangements, or gene amplification

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What are some examples of oncogenes?

ALK
EGFR
HER2
KRAS/NRAS
RET
BCR-ABL
BCL-2

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What function is the oncogene ALK?

Kinase

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What are the cancers associated with ALK?

Lung
Lymphoma
Ovarian

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What function is the oncogene EGFR?

Growth factor receptor

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What cancers are associated with EGFR?

Breast
Head/neck
Colon

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What function is the oncogene HER2?

Growth factor receptor

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What cancers are associated with HER2?

Breast
Ovarian
Bladder
Prostate

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What is the function of the oncogene KRAS/NRAS?

Cytoplasmic protein in signaling pathway

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What cancers are associated with KRAS/NRAS?

Colon
Lung
Acute leukemia

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What is the function of the oncogene RET?

Growth factor receptor

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What cancers are associated with RET?

Thyroid

Lung

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What is the function of the oncogene BCR-ABL?

Cytoplasmic kinase

What cancers are associated with BCR-ABL?

Chronic myeloid leukemia

What is the function of BCL-2?

Blocks apoptosis

What cancers are associated with BCL-2?

Indolent B-cell lymphoma

How are tumor suppressor genes involved in cancer?

Regulate and inhibit inappropriate cell growth and cell proliferation

What does mutation or loss of the gene lead to?

Uncontrolled, unregulated, unchecked, and unimpeded cell growth

What are DNA repair genes classified as?

Tumor suppressor genes

Which tumor suppressor gene is thought to be mutated in 1/2 of all cancers?

p53

What are some Tumor suppressor genes?

``` p53 BCRA1 BCRA2 APC RB1 ```

What is the function of p53?

Halts cell division | Induces apoptosis

What is the function of BRCA1 and BRCA2?

DNA repair

What cancers are associated with BRCA1 and BRCA2?

Breast | Ovarian

What is the function of APC?

Cytoplasmic signaling step

What cancers are associated with APC?

Colon | Gastric

What is the function of RB1?

Cell cycle master brake

Are single mutations sufficient enough to initiate cancer?

No, multiple mutations are necessary for carcinogenesis

How do passenger mutations affect cancer?

They do not contribute to cancer development

How do driver mutations affect cancer?

Support growth of the cancer

How are cyclins and CDKs involved in cancers?

Promote entry into the cell cycle | Overexpressed in several cancers

What happens to apoptosis in cancer cells?

Dysfunctional or non-existent

What are the steps for cancer immunoediting?

Elimination Equilibrium Escape

What is dysplasia?

The presence of cells of an abnormal type of tissue

What is "in situ"?

Means in place - not malignant

What is the log linear growth phase?

High growth fraction | Short doubling time

Does chemotherapy affect actively dividing cells or cells at rest?

Actively dividing cells

Does chemotherapy work better during the log linear growth phase or the plateau phase?

Log linear, the plateau is not dividing as much

Why do we stop giving chemotherapy during the microstatic disease area of treatment?

In hopes the body's own immune system will kick in and take care of the rest of the cancer

Is there a specific number of cells killed through a chemotherapy course?

No, it is a percentage

What is the benign term for a cancer originating from surface epithelium?

Papilloma

What is the benign term for a cancer originating from glandular cells?

Adenoma

What is the benign term for a cancer originating from fibrous tissue?

Fibroma

What is the benign term for a cancer originating from bone?

Osteoma

What is the benign term for a cancer originating from smooth muscle?

Leiomyeoma

What is the benign term for a cancer originating from striated muscle?

Rhabdomyoma

What is the benign term for a cancer originating from fat?

Lipoma

What is the benign term for a cancer originating from glial tissue?

Gliomas

What is the benign term for a cancer originating from Melanocytes

Pigmented nevus (mole)

What is the benign term for a cancer originating from nerve sheath?

Neurofibroma

What is the benign term for a cancer originating from gonadal tissue?

Teratoma

What is the malignant term for a cancer originating from surface epithelium?

carcinoma

What is the malignant term for a cancer originating from glandular cells?

Adenocarcinoma

What is the malignant term for a cancer originating from fibrous tissue?

Fibrosarcoma

What is the malignant term for a cancer originating from bones?

Osteosarcoma

What is the malignant term for a cancer originating from smooth muscle?

Leiomyosarcoma

What is the malignant term for a cancer originating from striated muscle?

Rhabdomyosarcoma

What is the malignant term for a cancer originating from fat?

Liposarcoma

What is the malignant term for a cancer originating from lymphoid tissue?

Lymphomas

What is the malignant term for a cancer originating from plasma?

Multiple myeloma

What is the malignant term for a cancer originating from glial tissue?

Glioblastoma | Astrocytoma

What is the malignant term for a cancer originating from melanocytes?

Melanoma

What is the malignant term for a cancer originating from nerve sheath?

Neurofibrosarcoma

What is the malignant term for a cancer originating from gonadal tissue?

Teratocarcinoma

What are the ways cancer survives?

``` Sustaining proliferative signaling Evading growth suppressors Resisting cell death Activating invasion and metastasis Inducing angiogenesis Enabling replicative immortality ```

What steps are necessary for invasion and metastasis?

Neoplastic transformation Angiogenesis Detachment and embolization (seeds)

What are the 7 warning signs of cancer?

``` Change in bowel or bladder habits A sore that does not heal Unusual bleeding/discharge Thickening/presence of lump in breast/elsewhere Indigestion/difficulty swallowing Obvious change in wart/mole Nagging cough/hoarseness ```

What does TNM stand for?

Tumor: size and invasion (T1-T4) Lymph node involvement (N0-N3) Metastasis: (M0-M1)

What are the stages of cancer based on the TNM system?

Stage 1: localized cancer Stage 2-3: regional cancer invasion: N 1+ Stage 4: metastatic cancer: M must = 1

What level of Karnofsky is chemotherapy eligibility?

60+

What ECOG score is chemotherapy eligibility?

less than or equal to 2

Who is the Lansky score used for?

16 years and under

What are the modalities of cancer treatment?

Surgery Radiation Chemotherapy Biologic therapy

What is the treatment of choice for solid tumors (if possible)?

Surgery

What are the AEs of surgery?

Surgical complications Damage to surrounding tissue Possible metastasis

How does radiation affect cancer?

Helps eradicate cancer cells left behind by surgery | Aids in tumor size reduction prior to other therapies

What are the AEs of radiation?

Irritation of the skin and tissue underneath Fatigue Infertility and secondary cancers are a possibility

When is chemotherapy used?

Management and treatment of primary tumor and any metastatic disease

What are the AEs of chemotherapy?

``` N/V Alopecia Fatigue Myelosuppresssion Mucositis Infertility Extravasation Cutaneous reactions Secondary malignancies ```

What is a neoadjuvant?

Chemotherapy administered before surgery or radiation (a primary treatment)

What is an adjuvant?

Given after the primary therapy to enhance the possibility of a cure

What is salvage therapy?

Administered after primary therapy has failed. | Usually a different regimen