Introduction to Oncology Flashcards by Linda Chen

cancer occurs when there is a genetic mutation that leads to

proliferation of a colony of malignant cells

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define uncontrolled proliferation

cancer cells lack or fail to respond to normal mechanisms that control cell division or growth

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what are some cellular changes of cancer

loss of some or all of their differentiation characteristics
some changes to chromosomes, proteins, enzymes
can’t perform ntended functions of origin tissue

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solid tumors are classified by

their tissue of origin

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carcinomas originated in

surface epithelium

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adenocarcinomas originated in

glandular (epithelial) tissue

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osteosarcoma originated in

bone (connective tissue)

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rhabdomyosarcoma originated in

striated muscle (connective tissue)

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leiomyosarcoma originated in

smooth muscle (connective tissue)

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glioblastomas originate in

glial tissue (neural)

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astrocytomas originate in

astrocytes (neural)

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melanomas originate in

melanocytes (dermal tissue)

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germinomas originate in

germ cells (gonadal tissues)

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liquid or hematologic malignancies are classified based on ____ and further divided based on ________

cell origin
pathology/cell lineage and presentation

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leukemia cell of origin

hematopoetic cells

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lymphoma cell of origin

lymphoid tissue cells

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multiple myeloma cell of origin

plasma cells

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carcinogenesis 4 steps

initiation
promotion
conversion
progression

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initiation is

genetic alteration / exposure to carcinogen

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promotion is

carcinogens or other things changes the environment to favor the growth of the changed cell pp

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conversion/ transformation is

the altered cells become cancerous

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progression is

further genetic alterations that result in increased proliferation of cancerous cells

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T or F: germline mutation is inherited and present in all cells

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T or F: somatic gene mutation is acquired and only in some cells

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a gene that has the potential to cause cancer

oncogene

oncogenes begin as ______ and are upregulated through mutations to oncogenes

protooncogenes

an activated oncogene leads to

excessive production of genetic product (cell signals/ products) = dysregulation

T or F: protooncogenes are normal and are still regulators of normal cellular function

the mutation that takes a protooncogene to an oncogene is usually

acquired

what regulates and inhibits inappropriate cellular growth and proliferation

tumor suppressor genes

damage to DNA repair genes results in

errors in DNA not corrected, leading to activation of oncogenes or deactivation of tumor suppressor genes

6 hallmarks of cancer

1. sustained proliferative signaling 2. replicative immortality 3. resisting cell death 4. evading growth suppressors 5. inducing angiogenesis 6. activating invasion and metastasis

T or F: cancer cells are differentiated

F- and can't perform function of origin tissue

local metastasis generally invade the

lymphatic system

distant metastasis commonly involve the

brain, lungs, bone, liver

metastasis retain the characteristics of the ________________

primary cancer

cancer's 7 warning signs (referral)

1. changing bowel/ bladder habits 2. lump in breasts 3. unusual bleed or discharge 4. diff swallowing/ indigestion 5. obvious changes in wart or mole 6. chronic cough or hoarseness

radiation therapy kills cancer cells or slows their growth by

damaging the DNA (once DNA is damaged beyond repair = die)

3 ways that surgery can treat cancer

removal of primary tumor removal of lymph nodes reduce metastases

what therapy damages or kills dividing cells, targeting more rapidly reproducing cells

cytotoxic chemo

what therapy impacts cell signaling or signal transduction within the cell by targeting specific gene mutations or cell surface receptors

targeted therapies

immunotherapies MOA

influence the body's immune response to malignant cells

endocrine therapies MOA

manipulate hormone production or actions for cancers that are hormone dependent

angiogenesis inhibitors MOA

impact cell signaling or processes that influences angiogenesis

impetus for workup may include

palpation of a mass or nodule routine lab tests new or nonresolving sx screening test results

cancer pt workup includes

hx and physical exam (consider exposure to carcinogens) lab tests (tumor markers if available) imaging

why is a pathologist dx essential

many benign tumors can mimic appearance of cancer

tissue is obtained through a biopsy through

excision, core, or fine needle aspirate (or surgical resection)

what tests can be performed on tissues to characterize the maligancy

tumor classification identify any biomarkers determine tumor grade

a tumor grade is assigned based on

histopathologic type morphologic features degree of differentiation

`a higher tumor grade means

more aggressive tumor and worse prognosis

indicative of pt survival independent of treatment received + indicator of innate tumor aggressiveness

prognostic biomarker

indicative of therapeutic efficacy because there is an interaction between the biomarker and therapy on pt outcome

predictive biomarker

identification and documentation of the structure of a specific DNA, RNA, or protein molecule for purpose of dx or characterization of a genetic disorder

molecular profiling

what can summarize the somatic mutations present

molecular profiling

testing samples of tissue (cancer) to look for changes in the chromosomes of the cells

cytogenetics

gene mutation screening assays include

fluorescence in situ hybridization PCR next gen sequencing

4 types of mutations

insertion deletion translocation insertion

trade of DNA pieces between chromosomes

translocation

ki-67 measures

growth rate or doubling time is a protein in dividing cells

ki-67 is measured by

immunohistochemsitry

ki-67 could be a _______ biomarker and provide insight into

prognostic aggressiveness + response to chemo

TNM system for staging solid tumors stands for

T- size of primary tumor N- lymph node involvement M- presence of metastases S- serum markers (only for testicular cancer)

cancer staging signifies the extent of disease for

solid tumors

the higher the stage, the _____ the cancer

worse (0-4)

define neoadjuvant chemo

use of chemo prior to local treatment usually to increase effectiveness of later treatment by reducing tumor bruden

define adjuvant therapy

use of a treatment after local treatment may be to destroy residual or undetectable tumor cells/ reduce risk of recurrance

palliative therapy is

use of a treatment to alleviate/ reduce sx, stabilize disease/ slow progression, improve/ maintain quality of life

define induction therapy

giving chemo to induce remission

define consolidation

after induction, given to keep pt in remission

define maintenance after induction and consolidation

to hold remission

considerations when choosing pharm for cancer

age, ECOG, comorbidities. cancer type/ stage/ grade, molecular profiling, tx goals

what is the ECOG

a performance scale on 0-5 and informs how the disease is impacting a pt's daily living abilities and inform tx decisions

"cure" of cancer as a GOT is defined as _______________ and measured as ___________ in literature

pt is cancer free and expected to have a lifespan eq to general pop literature/ trials = 5 yrs disease free survival

for prolonging survival, antineoplastic pharmcol is measured in trials as

progression free survival = number/ proportion of pts that are still alive and free of disease progression

what is median progression free survival

the time that 50% died/ progressed with cancer

what is overall survival

proportion of pts that are still alive at any spec time takes into account death of any cause- even from med toxicities

antineoplastic agents often have a _____ therapeutic window

narrow

dose limiting toxicity is

an agent's specific toxicities that caps how much can be administered

dosing can be based on

BSA renal fxn flat dosing adj for organ fxn

frequency for cytotoxic agents

given cyclically to give body time to recover

frequency for targeted oral agents (small molecules_

many administered daily for several consecutive days followed by rest period

freq for targeted IV therapies (monoclonal antibodies)

administered IV cyclically with chemo v long half life

concepts to max efficacy in combo therapies

each drug must have clinical activity against tumor alone each drug should have a different MOA combinations should be synergistic