ONCOLOGY Flashcards
(24 cards)
Lynch:
- gene, assoc cancers, management
GENE
- HNPCC
CANCERS
- endometrial, ovarian, gastro, pancreatitis
TX
- scopes 1-2 years from age 25, 5 years younger than youngest fam member
BRAF wild type in CrCa means
test for germline mutation
CrCa MLH1 absence; what makes it suspicious for germline mutation?
If NON methylated
FAP:
Loss of APC (adenomatous polyposis coli) gene
Can also be related to MUTYH-loss polyposis < 1%
○ Autosomal dominant with high penetrance § Germaline APC mutation § 90%+ risk of developing CRC by age 45
Associations with other cancers
§ Thyroid
§ Gatric
§ Ileal
Investigations
§ Thousands of adenomatous polyps in large bowel –> ‘carpet of adenomas’
§ Occurs throughout colon
Surveillance
Colonoscopy from 10-15 years, earlier if symptomatic
FAP:
- gene, assoc cancers, management
GENE
- APC/ MUTYH-loss
CANCERS
- gastric, ill, thyroid
TX
- scopes from 10-15 years OR when symptomatic
Highest risk factor for CrCa?
Fam Hx ESP if young
UC/Crohns
Where does CrCa metastasise?
rectum distal: lungs
other: liver
CrCa screening for:
- average risk
- moderate risk
- high risk
AVERAGE RISK
- iFOBT every 2 years from 50
MOD RISK
- iFOBT every 2 years 40
- colonoscopy every 5 years from 50
HIGH RISK
- iFOBT every 2 years from 35
- colonoscopy every 5 years from 45
Colonoscopy FU?
1-2 adenomas + low risk: 5 years scope
3-4 adenomas OR high risk: 3 years scope
5-10 adenomas: yearly, if >10 then less than yearly
Breast Cancer screening?
Every 2 years
50-75
MRI if fam hx/radiotherapy
Cervical Cancer screening?
Every 5 years
25-75
Checks for high risk oncogenic types: 16,18
When to suspect BRCA?
○ Ashkenazi Jewish heritage
○ First degree relative with breast cancer before 50
○ History of ovarian cancer at any age
- SEROUS HIGHEST RISK
○ 1st/2nd degree relative with ovarian cancer
○ Breast + ovarian cancer in same person
○ >=2 2nd degree relatives with breast cancer
○ Patient/relative bilateral breast cancer
○ Male breast cancer in relative
Significance of BRCA 1 + BRCA2?
BOTH: bilateral cancers, earlier age, invasive ductal carcinomas
(1)
(ovarian, colon, prostate)
(2)
ovarian, colon, prostate, pncreatic, GB, bile duct, stomach, melanoma
BRCA cancer prevention options?
Risk-reducing mastectomy and reconstruction
○ Still at risk because does not remove all vreast tissue
Risk-reducing salpingo-oophorectomy
Intensive surveillance for breast and ovarian cancer
Mammogram every 12 months
Breast exam every 6 months beginning at age 25
Other causes of elevated Ca 19-9?
- Ovarian cyst
- Heart failure
- Hashimotos
- RA
- Diverticulitis
- Cholidocholithiasis
- Cholangiocarcinoma
- GB cancer
Tumour marker for SCLC?
Neuron specific enolase
Tumour marker for neuroendo tumours
Chromogranin A
Cell Cycle
IPMAT!
Interphase
- G1
- DNA synthesis
- G2
Protaphase/ pro metaphase
- Chromatin condenses into chromosomes
- nuclear membrane breaks down
- centromeres start moving apart
Metaphase
- Chromsomes lien up at centre
Anaphase
- break at centromere and move to app sides of cell
Telaphase
- Nuclear membrane reforms and cell splits into 2
Mechanism of cell apoptosis?
increased nuclear kappa b –> IAP bcl2 oveexpressed –> antiapoptosis
E.g. BCL2 drugs reduce anti-apoptosis proteins
Bortezeimib anti proteasome reduces nuclear kappa b
Mechanism of metastasis?
Tumour cell breaks off from main tumour and enters ECF
§ Secretes MMP –> ECM degraded –> bases through basement membrane
§ MMP also breaks ECM of blood vessel too
Tumour migrate through tight junctions of epithelial cells –> blood vessel –> other tissues
Genetics for ALK mutation?
Chromosomal rearrangement
Workup of cancer of unknown origin?
○ FBC, UEC
○ Urine
○ PSA
○ CTCAP
○ Mammography
○ IHC based on above
§ If still having difficulties
□ molecular cancer assay
Tumour markers
To have a BRCA mutation cause breast cancer, you need to be
- heterozygous?
- homozygous
Homozygous
Thymoma associations?
LEMS
MG
Pure cell aplasia
Combined immunodeficiency with hypogammaglobulinemia
