Oncology DIT Flashcards Preview

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Flashcards in Oncology DIT Deck (147):
1

Most prevelent Cancers in Males and Females

Males
-Prostate
-Lung
-Colon

Women
-Breast
-Lung
-Colon
-uterus

2

Cancer w/ highest mortality in M and F

Males
-Lung
-Prostate
-Colon
-Pancreatic

Females
-Lung
-Breast
-Colon
-Pancreatic

3

What is an oncogene?

-Quinessential example?

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)

4

What is a tumor suppressor gene?

Quientessential example?

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

5

Retinoblastoma herititable vs sporadic

Screen kids how?

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

6

rb is ?

Mutated in what CA (2)

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

Retinoblastoma and osteosarcoma

7

p53 is?

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

8

BRCA1 and 2 is?

Mutated in what CA(2)

tumor suppressor gene involved in DNA repair

Ovarian and Breast

9

APC is?

Mutated in what CA

is a tumor suppresor gene

mutated in colorectal CA in familal adenomatous polyposis

10

WT1 is?

mutated in what CA

tumor suppresor gene

mutated in Wilms tumor

11

NF1 is?

mutated in what CA

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

Chromosome 17

mutated in nerofibromatosis type 1

12

NF2 is ?

mutated in what CA?

tumor suppresor gene on chromosome 22

mutated in neurofibromatosis type 2 -> bilateral acoustic schwannomas

13

DPC 4 is?

mutated in what CA

tumor suppresor gene

Deleated in Pancreatic Cancer

14

DCC is?

mutated in what CA

tumor suppresor gene

Deleted in Colon Cancer

15

VHL is?

mutated in what CA?

tumor suppresor gene implicated in von hippel lindau

16

TSC is?

mutated in what CA?

tumor suppresor gene implicated in tuberous sclerosis

17

abl is?

mutated in what CA

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

CML

18

c-myc is?

Mutated in what CA

oncogene leading to a transcription factor

mutated in Burketts

19

bcl 2 is?

mutated in what CA?

oncogene-> anti apoptotic molecule

mutated in follicular and undifferentiated lymphomas

20

HER2/neu is?

mutated in what CA?

oncogene-> tyrosine kinase

breast
ovarian
gastric CA

21

ras is?

mutated in what CA? (4 types)

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

22

L myc is?

Mutated in what CA

oncogene-> mutated TF

lung tumor (small cell)

23

N-myc is?

Mutated in what CA?

oncgone -> mutated TF

neuroblastoma

24

Ret is?

mutated in what CA(3)

oncogene-> mutated tyrsine kinase

MEN2A
MEN2B
Papillary carcinoma of the thyroid

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