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USLME Kiss my ass and pray > Oncology DIT > Flashcards

Oncology DIT Flashcards

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1
Q

Most prevelent Cancers in Males and Females

A

Males

  • Prostate
  • Lung
  • Colon

Women

  • Breast
  • Lung
  • Colon
  • uterus
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2
Q

Cancer w/ highest mortality in M and F

A

Males

  • Lung
  • Prostate
  • Colon
  • Pancreatic

Females

  • Lung
  • Breast
  • Colon
  • Pancreatic
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3
Q

What is an oncogene?

-Quinessential example?

A

Proto -Oncogenes normally regulate signal for cell growth, lack of response due to a mutation -> oncogene. Only one mutation is needed -> gain of function

RAS (G protein in the MAP kinase pathway that is always on -> cancer)

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4
Q

What is a tumor suppressor gene?

Quientessential example?

A

Tumor suppressor genes regulate the cell cycle. They but on the brakes while DNA repair goes on and encourages apoptosis if not

BOTH alleles must be lost for be cancerous

p53(TF for p21 and blocking G1-S phase)
RB (hypophos binds to ETF)
are classic

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5
Q

Retinoblastoma herititable vs sporadic

Screen kids how?

A

1/4 is bilateral w/ Rb tumor suppressor mutation inherited (have one KO, a lot easier to have the other go)

3/4 are sporadic meaning both alleles were lost sporadically

(overall 60% mutations sporadic, 40% inheritied)

See a white reflex in the kids eye instead of red

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6
Q

rb is ?

Mutated in what CA (2)

A

tumor suppressor gene that inhibits E2F when hypophosphorylated
blocks G1-S phase

Retinoblastoma and osteosarcoma

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7
Q

p53 is?

A

tumor suppressor gene lost in most cancers

Acts through p21 to cause cell arrest

causes apoptosis through transcription of BAX if DNA repair not complete

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8
Q

BRCA1 and 2 is?

Mutated in what CA(2)

A

tumor suppressor gene involved in DNA repair

Ovarian and Breast

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9
Q

APC is?

Mutated in what CA

A

is a tumor suppresor gene

mutated in colorectal CA in familal adenomatous polyposis

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10
Q

WT1 is?

mutated in what CA

A

tumor suppresor gene

mutated in Wilms tumor

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11
Q

NF1 is?

mutated in what CA

A

tumor suppresor gene involved q/ RAS GTPase activating protein - > cutaneous neurofibromas

Chromosome 17

mutated in nerofibromatosis type 1

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12
Q

NF2 is ?

mutated in what CA?

A

tumor suppresor gene on chromosome 22

mutated in neurofibromatosis type 2 -> bilateral acoustic schwannomas

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13
Q

DPC 4 is?

mutated in what CA

A

tumor suppresor gene

Deleated in Pancreatic Cancer

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14
Q

DCC is?

mutated in what CA

A

tumor suppresor gene

Deleted in Colon Cancer

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15
Q

VHL is?

mutated in what CA?

A

tumor suppresor gene implicated in von hippel lindau

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16
Q

TSC is?

mutated in what CA?

A

tumor suppresor gene implicated in tuberous sclerosis

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17
Q

abl is?

mutated in what CA

A

oncogene -> mutated Tyrosine kinase that is always on w? proximity for BCR (9:22)

CML

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18
Q

c-myc is?

Mutated in what CA

A

oncogene leading to a transcription factor

mutated in Burketts

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19
Q

bcl 2 is?

mutated in what CA?

A

oncogene-> anti apoptotic molecule

mutated in follicular and undifferentiated lymphomas

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20
Q

HER2/neu is?

mutated in what CA?

A

oncogene-> tyrosine kinase

breast
ovarian
gastric CA

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21
Q

ras is?

mutated in what CA? (4 types)

A

oncogene -> mutated G protein -> constitutively active MAP kinase -> cell proliferation

quitessential oncogene

K -Ras - colon, lung, pancreatits
H-Ras - bladder, kidney (hematuria)
N-Ras- melanomas ans hematologic

also follicular thyroid carcinoma

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22
Q

L myc is?

Mutated in what CA

A

oncogene-> mutated TF

lung tumor (small cell)

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23
Q

N-myc is?

Mutated in what CA?

A

oncgone -> mutated TF

neuroblastoma

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24
Q

Ret is?

mutated in what CA(3)

A

oncogene-> mutated tyrsine kinase

MEN2A
MEN2B
Papillary carcinoma of the thyroid

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25
afalatoxin CA risk
Hepatocellular
26
vinyl choride CA risk
angiosarcoma - liver
27
odd smoking CA risks (3)
pancreatic transitional cell bladder renal cell carcinoma
28
inherited predespositions to CA are inherited in what form? Examples
inherited in auto dominant pattern APC, BRCA, RET
29
aspestos exposure CA (2)
bronchogenic carinoma ** | mesothelioma
30
Arsenic exposure CA(2)
squamous cell carcinoma of skin | angiosarcoma
31
napthalene CA risk?
transiotional cell
32
benzyne CA risk
leukemia/lymphoma
33
beryllym CA risk
lung CA
34
Radiation CA risk(3)
ALL AML thyroid CA
35
UV radiation of harm? What CA risk (3)
UVB -> pyrimadine dimers | UVA, free radicals
36
EBV associated w/ (3) CA
Hodgins lymphoma burkitts lymphoma nasopharyngeal carcinoma
37
liver fluke (clonorchis sinensis) associated w/ what CA
cholangiocarcinoma
38
HCV risk of what CA (2)
Hepatocellular CA | papillary thyrois CA
39
Down syndrome associated CA (2)
ALL** | AML
40
Tuberous sclerosis CA (3)
giant cell astrocytoma cardiac rhabdomyoma renal angiomyyolipoma
41
pagers disease of the bone CA risk? (2)
secondary osteosarcoma | fibrosarcoma
42
Hashimotos disease associated w/ what CA
B cell marginal lymphoma
43
Dyplastic nevi CA
melanoma
44
vulvar leukoplakia CA risk
squamous cell
45
ataxia telangirtasia CA risk
decreased DNA repair -> leukemia and lymphoma
46
Hyperplasia means?
increased number of cells | - reversible
47
metaplasia means?
change in cell type from one to another | -reversible
48
dysplasia means?
abnormal cell growth w/ loss of cell orientation, shape and size(disorganized) reversible
49
anaplasia means? characterized by (4)
abnormal cells lacking differentiation, cells regress and become less differentiated -> - high nuclear :cytoplasmic ratio - prominent nucleoli - clumping of nuclear chromatin - many mitotic spindles
50
Neoplasm means?
clonal proliferation of cells that is uncontrolled and excessive neoplasia may be benign or malignant
51
Grade of a tumor looks at?
the amount of differentiation, high grade = less differentiation
52
Stage of a tumor refers to?
the amount of localization or spread from the primary site TNM Tumor Size Nodes METS
53
Benign epithelial tumor is (2)
adenoma - glandular look even if not derived | Papilloma - finger like projection
54
Malignant epithelial tumor is (2) Spreads how?
adenocarcioma papillary carcinoma spreads via lymphatics
55
Malignant mesenchymal tumors generally end w? Spreads?
sarcoma spreads hematogenously, usually benign mesenchymal CA rarely -> malignant (as epithelial CA does)
56
Benign vs malignant CA of blood vessel
Hemangioma Angiosarcoma
57
Benign vs malignant CA of the smooth muscle
leiomyoma leiomyosarcoma
58
benign vs malignant CA of striated muscle
rhabdomyoma rhabdomyosarcoma
59
benign vs malignant CA of bone
osteoma osteosarcoma
60
benign vs malignant CA of Fat
lipoma liposarcoma
61
Harmatoma
growth of mature tissue that is endogenous to the site where it arises, a lot of normal tissue
62
Tumor marker in colorectal CA
CEA -also detected in pancreatic CA as well (w/ CA 19-9)
63
CEA marker(2)
tumor marker for Colorectal and Pancreatic
64
Tumor marker for HCC?
Alpha fetoprotein - aslo in nonseminomatous germ cell tumors
65
AFP tumor marker(2)
hepatocellular colorectal cancer | nonseminomatous germ cell tumors
66
beta hCG tumor marker (2)
hydatriform moles | Choriocarcinoma
67
Tumor marker for ovarian CA
CA 125
68
CA 125 tumor marker
ovarian CA
69
tumor marker for melanoma
S 100 also in neural crest cell derived like schwanomma
70
S 100 tumor marker for (3)
melanoma schwanoma neural crest cell derived
71
Alkaline phos tumor marker (3)
pages disease of the bone METs to the bone biliary disease
72
CA 19-9 tumor marker
pancreatic CA
73
Calcitonin tumor marker
Medullary thyroid CA
74
2 signals released by tumors to allow angiogenesis
VEGF - vascular endothelia growth factor | bFGF - basic fibroblast growth factor
75
Common sources of METS - Brain (5)
most common brain CA is METS - 50% (gray/white matter junction Lots of Bad Stuff Kills Glia - Lung - Breast - Skin (melanoma) - Kidneys (renal cell) - GI ( colon CA)
76
Common sources of METS - Bone (6)
permanently relocated tumors like bone ``` prostate Renal cell testes/thyroid Lung Breast ```
77
Common sources of METS - Liver (5)
Cancer Sometimes Penetrates Benign Liver ``` Colon Stomach pancreas Breast Lung ```
78
Lytic vs blastic METS to the bone
Prostate is blastic Lung is Lytic Breast can be lytic or blastic
79
Cachexia is? Due to?
profound weight loss - fat and lean muscle Due to the release of cytokines that raise basic metabolic rate -> (TNF alpha)
80
3 paraneoplastic effects of small cell carcinoma
ACTH -> cushings ADH -> SIADH Ab to presynaptic Ca channels -> lambert eaton
81
Cushing syndrome due to paraneoplasm
Small cell CA of lung
82
SIADH due to paraneoplastic (2)
small cell CA of lung | intracranial neoplasm
83
PTHrP releasing neoplasms (4)
squamous cell CA renal cell carcinoma breast CA head and neck squamous cell
84
Most common cause of hypercalcemia #2 and details? (4 subtypes)
primary hyperparathyroidism malignancy is #2 - PTHrP - hodgkins -> Vit D - multiple myelinoma -> local osteolytic - lytic bone mets (breast maybe, Lungs definitely)
85
Hodgkins lymphoma paraneoplastic syndrome
release active Vit D -> hypercalcemia
86
Erythropoeitin released from 4 CA
potentially really high hemotocrit pheochromocytoma renal cell carcinoma Hemangiobalstoma Hepatocellular carcinoma
87
Lambert Eaton due to? Characterized by
paraneoplastic disorder of small cell CA of lung where Ab are produced against the presynaptic Ca channels in the neuromuscular junction Presents similar to myasthenia gravis differs in that it IMPROVES w/ use
88
5 most important lifestyle factors affecting CA risk
``` Smoking Obesity Activity level Diet Sun exposure (esp sun burns early-> melanoma and continued UVB -> squamous cell and basal) ```
89
Recommendation for breast CA screening
mammogram q/2 yrs starting age 50 informed age 40 unknown after 75 self breast NOT recommended, Clinical unknown
90
Cervical CA screening
PAP smear > 21 q 3yrs > 65 yrs stop
91
Prostate CA screening
informed 50-75 none after 75 DRE insufficient PSA not sensitive enough
92
Colon CA screening
colonoscopy q 10 yrs starting age 50 - start earlier w/ family history 10 yrs before youngest also have fecal occult blood annually flex sig q 5 yrs
93
What immune cell protects from CA cells in the body?
CD8 cytotoxic T cells, looks for antigens: mutated genes, over expressed proteins, oncogenic viruses, ocncofetal antigens, altered surface glycoproteins (CA125, CA19-9), cell type specific also NK cells and macrophages
94
Lung CA screening (NEW 2013)
annual chest CT ages 55-80 - 30 pack yr history - current smoker or quit w/in last 15 yrs
95
antineoplastic drugs working in the S Phase of cell cycle
antimetabolites - methotrexate - 5 FU - 6 MP - cytarabine
96
Etoposide works in what phase of the cell cycle
G2 and S phase
97
Vinca alkaloids and taxols work in what part of the cell cycle
the M phase
98
What cells are susceptible to collateral damage w/ antineoplastics (3)
bone marrow -> hematopoetic GI tract hair follicles all divide rapidly
99
Methotrexate blocks what enzyme and is used in 3 general situations
folic acid analog -> blocking dihydrofolate reductase which converts DHF-> THF Used in the syntheses of dTMP thus less DNA made 1. cancers - leukemias: ALL/AML. breast , sarcomas 2. immune suppression: RA and psoriasis 3. Uterine path: ectopic pregnancies, choriocarcinoma, hydradidiform mole
100
Toxicity w/ methotrexate (3)
myelosuppression - reversible w/ leucovorin fibrotic lung disease teratogenic - > neural tube defects
101
Leucovorin works in what toxicity but not another?
folinic acid rescue in methotrexate does NOT work in 5 - FU
102
3 antineoplastic drugs that cause fibrotic lung changes
Bleomycin Busulfan methotrexate
103
Used topically in actinic keratosis and basal cell CA
5 FU
104
treatment of childhood tumors: Ewing, Wilms and rhabdosarcomas
Dactinomycin - intercalates DNA
105
Which drugs decrease production of dTMP
5 FU | Methotrexate
106
Toxicity w/ 5 fluorouracil(2)
Myelosuppression - NOT reversible w/ leucovorin | photosensitivity
107
Uses of 5 FU(4)
colon CA pancreatic CA basal cell CA actinic keratosis
108
S cell cycle actor that inhibits DNA polymerase, antineoplastic
Cytarabine acts as a pyrimidine analog -> leukemia and lymphomas
109
Purine analogs that inhibit PRPP amidotransferase
Azathioprine 6 mercaptopurine - metab by xanthine oxidase 6 thioguanine - can be given w/ allopurinol
110
S cycle specific antineoplastic that is metabolized by xanthine oxidase
6 mercaptopurine 6 thioguanine is also a purine analog but does not have increased toxicity w/ the use of allopurinol
111
Toxicity of 6 mercaptopurie and 6 thioguanine
myelosuppression | hepatotoxicity
112
Alkylating agents (antineoplatics) (3)
Busulfan nitrosureas (carmustine, etc.) cyclophosphamide (ifosfamide) attaches an alkyl group to DNA -> cross linking of stands making it difficult to divide
113
Used in brain tumors b/c crosses BBB risk of what?
nitrosureas - carmustine, lomustine, semustine risk of CNS toxicity
114
Cyclophosphamide used in what 2 categories
Solid tumors - testicular, breast, ovarian, leukemia etc.. Immune suppression - lupes nephritis - PAN
115
hemorrhagic cystitis is associated w/ this antineoplastic rx:
cyclophosphamide, an alkylating agent Mesna
116
Mesna is used in what antineoplastic toxicity
hemorragic nephritis due to cyclophasphamide | -> binds to acrolein, the toxic metabolite
117
covalently cross links DNA at guanine at N-7 Requires bioactivation
cyclophosphamide an alkylating agent
118
Busulfan toxicity (2)
an alkylating agent pulmonary fibrosis and hyperpigmentation
119
Dactinomycin is useful in these 3 tumors
All kids - Ewings - rhadomyosarcoma - Wilms intercalates DNA
120
cardiomegaly is the biggest concern w/ these 2 antineoplastics Rx w?
daunorubicin and doxorubicin treat w/ dexrazoxane- Fe chelating agent
121
Bleomycin toxicity
pulmonary fibrosis an antitumor antibiotic-> free radical formation
122
Antitumor antibiotics (4)
Dactinomycin Doxorubicin/daunorubicin Bleomycin
123
toxicity of vinblastine
Blasts bone marrow -> myelosuppression
124
Toxicity of vincristine? (2)
neurotoxicity | peripheral neuritis
125
Microtubule binding and modulating drugs (5)
``` vincristine/vinblastine paclitaxel mebendazole/albendazole griseofulvin colchicine ```
126
antineoplastic bind to tubin in M phase to block polymerization
vincristine/vinblastine
127
antineoplastic that hyper stabilizes polymerized microtubules in M phase so mitotic spindle cannot break down
paclitaxel and the like
128
Toxicity of paclitaxel (2)
myelosuppression | hypersensitivity
129
Vincristine and vinblastine are used in (4)
hodgkinlymphoma wilms tumor Ewing Sarcoma Choriocarcinoma
130
Paclitaxels are used for(2)
ovarian and breast Carcinomas
131
antineoplastics that are nephrotoxic and ototoxic (3)
cisplatin, carboplatin, oxaliplatin cross link DNA
132
Cisplatin, carboplatin and oxaliplatin risk?(2)
nephrotoxic and ototoxic use amifostine to prevent nephrotoxic
133
Uses of the platens (cisplatin ) (3)
testicular bladder ovary
134
Testicular CA regiment (3)
Eradticates ball Cancer epotoposide Bleomycin (ifosfamide) cisplatin
135
Anti topoisomerase inhibitors antineoplastics
inhibits topo II - Etoposide - teniposide inhibits topo I - Irinotecan - topotecan
136
Use of etoposide and teniposide (3)
small cell lung prostate testicular CA inhibit topo II
137
Nephrotoxic and ototoxic drugs (4)
vancomycin aminoglycoside loop dieuretics cisplatin and carboplatin
138
Uses of Irinotecan
METS Colon CA | inhibits topo I - like topotecan
139
Uses of topotecan (3)
small cell lung CA Ovarian CA cervical CA inhibits topo 1- like irinotecan
140
inhibits ribonucleotide reductase -> decreased DNA synthesis in the S cell cycle
Hydroxyurea
141
Prednisone as an antineoplastic?
may torgger apoptosis
142
Symptoms of prednisone toxicity ? Alot
BAM CUSHINGOID Buffalo hump Amenorrhea Moon facies ``` Crazy - agitation Ulcers Skin changes Hypertension Infection Necrosis of femoral head Glaucoma - cataracts Osteoperosis Immune depression Diabetes ```
143
SERM used in osteoporosis agonist and antogonist prop?
Raloxifene ER agonist in bone ER antagonist in breast and endometrial
144
Monoclonal ab against her2 -neu? What is her2 Neu
trastuzumab her 2 is a tyrosine kinase
145
Toxicity with trastuzumab
cardiotoxicity
146
monoclonal antibody against CD20
ratuximab used in non hodgkins lymphoma and RA and phemigus vulgarism and ITP and vascultiis
147
drug acting as a bcr-abl tyrosine kinase inhibitor
imatinib used in CML

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