Oncology Training - Tumors Flashcards
(121 cards)
1
Q
True / False - Normal cells become converted to cancer cells through a single alteration in a single cell.
A
False
2
Q
The period of rapid, exponential tumor growth is called the _________________ phase, while the period at which tumor
growth levels off is called the ___________________ phase.
A
The period of rapid, exponential tumor growth is called the __log__ phase, while the period at which tumor growth levels off is called the __plateau__ phase.
3
Q
Most tumor cells are not clinically detectable until they have grown to approximately _____ cells, at which time the tumor has usually entered the ________________ phase.
A
Most tumor cells are not clinically detectable until they have grown to approximately __10*9___ cells, at which time the tumor has usually entered the __plateau__ phase.
4
Q
What is the clinical significance of the statement in question 3?
A
Many chemotherapeutic agents are more effective against tumor cells that are rapidly proliferating than tumor cells that have reached the plateau phase; thus, the efficacy of therapy may be limited.
5
Q
List four factors that may be responsible for slowing tumor growth in the plateau phase.
A
inadequate oxygen and nutrient supply; contact with normal cells (crowding); growth-inhibiting
substances produced by the tumor; increased hormone levels
6
Q
Match the following: \_\_\_\_ measures the proportion of cells that are actively dividing at any one time \_\_\_\_ measures the proportion of cells participating in cell division \_\_\_\_ measures the percentage of cells that die \_\_\_\_ measures the proportion of cells synthesizing DNA \_\_\_\_ measures the time it takes for number of tumor cells to double
A. labeling index B. doubling time C. cell death fraction D. mitotic index E. growth fraction
A
E. growth fraction____ measures the proportion of cells that are actively dividing at any one
time
D. mitotic index____ measures the proportion of cells participating in cell division
C. cell death fraction____ measures the percentage of cells that die
A. labeling index____ measures the proportion of cells synthesizing DNA
B. doubling time____ measures the time it takes for number of tumor cells to double
7
Q
If a drug kills only cells that are actively dividing, which of the following would be most susceptible to it? A. tumor with large cell death fraction B. tumor with large growth fraction C. tumor with small mitotic index D. tumor with small labeling index
A
B. tumor with large growth fraction
8
Q
Match the following:
____ the number of deaths from a disease over a specified time period
____ the number of new cases of a disease discovered each year
____ a general description of the severity of sickness
____ the number of total cases of a disease at a point in time
A. incidence
B. prevalence
C. mortality
D. morbidity
A
C.mortality____ the number of deaths from a disease over a specified time period
A. incidence____ the number of new cases of a disease discovered each year
D. morbidity____ a general description of the severity of sickness
B. prevalence____ the number of total cases of a disease at a point in time
9
Q
True / False For most types of cancer, an individual inherits a susceptibility to that cancer, not the cancer itself.
A
TRUE
10
Q
True / False Genetic and environmental factors together usually determine whether or not an individual develops cancer.
A
TRUE
11
Q
What is an oncogene?
A
a gene that has been altered by a mutation to increase cell proliferation without regul
12
Q
List three mechanisms by which a normal gene may be converted to an oncogene.
A
translocation;
amplification;
deletion
13
Q
How can a mutation in a tumor suppressor gene lead to the development of cancer?
A
cause tumor suppressor genes inhibit cell proliferation and tumor development, a mutation in such a gene may lead to increased cell proliferation and cancer.
14
Q
Give two reasons why the risk of most types of cancer might increase with age.
A
a weakening of the immune system with age;
further exposure to carcinogens
15
Q
True / False Individuals with compromised immune systems due to disease or drug therapy are at increased risk of developing certain types of cancer.
A
True
16
Q
True / False Viruses may contain DNA or RNA as their genetic material.
A
True
17
Q
True / False Viruses require host cell machinery to reproduce.
A
True
18
Q
True / False If viral DNA is incorporated into host DNA, this altered genetic material is duplicated when the host cell divides.
A
True
19
Q
Explain how a virus can cause an oncogene from a normal cell to be expressed in a cancer cell.
A
A virus can incorporate an oncogene from a host cell into its RNA or DNA and copy it into a different location in the host DNA, which may lead to its expression and the development of cancer.
20
Q
Explain how exposure to chemicals in the environment can lead to cancer.
A
Exposure to chemicals can cause a variety of genetic mutations. The carcinogenic chemical
component binds irreversibly to DNA and can then disrupt normal DNA replication in several different ways. The body is capable of repairing DNA that has been damaged by exposure to chemical carcinogens; however, some individuals carry genes which make them more susceptible to certain environmental carcinogens.
21
Q
List the seven early warning signs of cancer. C: \_\_\_\_\_\_\_\_ A: \_\_\_\_\_\_\_\_ U: \_\_\_\_\_\_\_\_\_ T: \_\_\_\_\_\_\_\_\_ I: \_\_\_\_\_\_\_\_\_ O: \_\_\_\_\_\_\_\_\_ N: \_\_\_\_\_\_\_\_\_
A
Change in bowel or bladder habits; A sore that does not heal; Unusual bleeding or discharge; Thickening or lump in breast or elsewhere; Indigestion or difficulty in swallowing; Obvious change in wart or mole; Nagging cough or hoarseness
22
Q
List three screening tests and the type of cancer for which they are used.
A
any three:
mammography (breast cancer);
PAP smear (cervical cancer);
digital rectal
examination (colon and rectal cancer, prostate cancer);
stool blood test (colon and rectal cancer);
prostate-specific antigen test (colon and rectal cancer)
23
Q
List the five principal steps in the diagnosis of cancer.
A
clinical evaluation;
histological examination;
grading; staging;
performance status
24
Q
Name two types of diagnostic imaging studies used to visualize masses inside the body.
A
any two:
conventional x-rays;
computerized tomography (CT) scans; ultrasonography;
magnetic resonance imaging (MRI)
25
What are tumor markers?
substances produced by cancers that circulate in the blood or accumulate in body fluids and can be analyzed by laboratory tests
26
What type of biopsy allows the most complete examination of tumor tissue?
excisional biopsy
27
```
Characteristics of malignancy that may be revealed from a biopsy include:
A. highly ordered cells.
B. loss of normal tissue boundaries.
C. low rate of mitosis.
D. cells in inappropriate places.
```
B. loss of normal tissue boundaries.
| D. cells in inappropriate places.
28
The evaluation of tumor size and extent of metastasis is called:
staging
29
Grading measures:
the degree of anaplasia and number of proliferating cells
30
Match the following:
____ human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA)
____ Ann Arbor Classification System
____ TNM System
____ G1 = well differentiated; G2 = moderately well differentiated; G3, G4 = poorly to very poorly differentiated
A. tumor markers
B. staging system for solid tumors
C. example of histologic grade
D. staging system for Hodgkin’s disease
A. tumor markers____ human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA)
D. staging system for Hodgkin's disease ____ Ann Arbor Classification System
B. staging system for solid tumors ____ TNM System
C. example of histologic grade ____ G1 = well differentiated; G2 = moderately well differentiated; G3, G4 = poorly to very poorly differentiated
31
In the diagnosis of cancer, what is the performance status?
the degree to which a neoplasm affects a patient’s health and daily activities
32
Define morphology in terms of its use in cancer diagnosis.
In oncology, morphology refers to the study of individual cells or clusters of cells, also known as cytology or cytopathology.
33
In immunohistochemistry (IHC), cell samples are stained using a special solution containing ____________.
antibodies
34
Number each of the following steps in flow cytometry.
____ the cell sample is suspended in fluid
____ the cell sample is passed under a laser light source
____ results are recorded electronically and interpreted in a color-coded visual display
____ cells specific to the fluorescent dyes give off light
____ the cell sample is stained with one or more fluorescent dyes
1. the cell sample is stained with one or more fluorescent dyes
2. the cell sample is suspended in fluid
3. the cell sample is passed under a laser light source
4. cells specific to the fluorescent dyes give off light
5. results are recorded electronically and interpreted in a color-coded visual display
35
```
Cytogenetic testing may be used to:
A. confirm the presence of a neoplasm.
B. identify a specific disease.
C. determine prognosis.
D. all of the above.
```
A. confirm the presence of a neoplasm.
36
Match each of the following molecular genetic tests with the appropriate description.
____ amplifies specific sequences of DNA
____ examines DNA using electrophoresis and DNA probes
____ amplifies specific sequences of RNA
____ examines RNA using electrophoresis and DNA probes
____ examines chromosomes that have been painted with fluorescent molecules of various
colors
```
A. fluorescencein situ hybridization (FISH)
B. Southernblotting
C. Northern blotting
D. polymerase chain reaction (PCR)
E. reversetranscriptase PCR (RT-PCR)
```
A. fluorescencein situ hybridization (FISH)____ examines chromosomes that have been painted with fluorescent molecules of various
colors
B. Southernblotting____ examines DNA using electrophoresis and DNA probes
C. Northern blotting____ examines RNA using electrophoresis and DNA probes
D. polymerase chain reaction (PCR) ____ amplifies specific sequences of DNA
E. reversetranscriptase PCR (RT-PCR)____ amplifies specific sequences of RNA
37
Carbohydrate antigen 15-3 (CA 15-3) is elevated in
| ______________________.
women with breast cancer
38
Briefly describe the role of testing for epidermal growth factor receptor (EGFR) in cancer diagnosis, including at least one type of cancer for which EGFR testing is used.
EGFR is found in increased amounts in tumor tissue in many types of cancer.
Answer should include any one of the following: glioblastoma, cancer of the head and neck, colon,
breast, or pancreas, lung cancer
39
True/ False HER-2/neu is overexpressed in at least 25% of breast cancers.
True
40
A microarray is a small, flat chip containing:
A. fluorescent dyes specific to a single coding sequence of a human gene.
B. thousands of probes, each specific to a coding sequence of a human gene.
C. complementary DNA from specific coding sequences of a human gene.
D. all of the above
B
41
Lifestyle factors that can increase an individual’s risk of developing cancer include:
tobacco use; high-fat diet; alcohol consumption; exposure to sunlight; sedentary lifestyle
42
List five general guidelines for cancer prevention.
Don’t smoke or use tobacco;
if you drink alcoholic beverages, do so in moderation;
limit your intake of high-fat foods, particularly from animal sources and especially red meat;
the majority of your food should come from plant sources; exercise.
43
Existing hormones and agents that have an antihormone effect can:
disrupt or block the effects of hormones that contribute to the growth and spread of some cancers
44
How might NSAID use aid in cancer prevention?
NSAID use may inhibit the production of certain enzymes that affect cell proliferation, tumor growth, and immune function.
45
What are three major goals of cancer therapy?
remove all known tumors; prevent the cancer from recurring or spreading; balance the possibility of achieving a cure against the potential for side effects
46
The treatment of recurrent or rapidly growing cancer should
| focus on:
controlling the tumor’s growth and spread for as long as possible; treating and relieving symptoms if cancer is determined to be incurable
47
What is the survival rate?
the ratio of the number of patients alive at the end of a specified time period to the number of patients diagnosed with the disease at the beginning of that time period
48
Hormones, metabolites, and immunological markers released by the tumor are all examples of:
tumor products
49
Match the following categories of objective response with the correct criteria for solid tumors.
____ tumors have been reduced by less than 50% or have not increased by more than 25%
____ tumor size has increased by more than 25% or new lesions have appeared
____ tumors have been reduced by 50% or more
____ all evidence of cancer has completely disappeared for at least two measurement periods at least 4 weeks apart
A. complete response
B. partial response
C. stable disease
D. progression
C. stable disease____ tumors have been reduced by less than 50% or have not increased by more than 25%
D. progression____ tumor size has increased by more than 25% or new lesions have appeared
B. partial response____ tumors have been reduced by 50% or more
A. complete response____ all evidence of cancer has completely disappeared for at least two measurement periods at least 4 weeks apart
50
Why can’t tumor size be used to provide an objective response for leukemias and lymphomas?
Neoplastic cells in leukemia and lymphomas tend not to cluster in tissue masses and occupy defined anatomical locations, but instead are found migrating within the circulatory and lymphatic systems and lodged in lymph organs and bone marrow.
51
True / False - A partial response for liquid tumors is defined by a 50% decrease in the number of circulating leukemic cells, a decrease in the size of enlarged lymph nodes, liver, or spleen, and at least a 50% improvement in one or more abnormal
hematopoietic parameters.
true
52
True / False - Progressive disease for liquid tumors is defined by a 50% increase in the number of circulating leukemic cells, a decrease in the size of enlarged lymph nodes, liver, or spleen, and at least a 50% improvement in one or more abnormal
hematopoietic parameters.
false
53
Subjective response is particularly important in the
| _________________ treatment of cancer.
palliative
54
Which treatment modality is often the first choice of therapy for the early stages of colon cancer, lung cancer, breast cancer, or melanoma?
Surgery
55
What two treatment modalities are used primarily for localized
tumors?
surgery;
| radiation therapy
56
Which of the following treatment modalities is likely to be most effective in treating metastases throughout the body?
A. surgery
B. radiation therapy
C. chemotherapy
C. chemotherapy
57
What treatment modality uses biologically active agents to stimulate or modify the immune system to control tumor growth?
immunotherapy
58
List three new approaches that are being used in the treatment of cancer.
gene therapy;
monoclonal antibodies (MABs);
cancer vaccines
59
A combination regimen consisting of several treatment modalities is referred to as _________________ therapy.
multimodal
60
True / False - Bone marrow transplantation reduces the effects of chemotherapy on the patients’ bone marrow by allowing lower doses to be administered.
false
61
True / False - First-line therapy may consist of surgery, radiation therapy, chemotherapy, or any combination of the three.
True
62
The multidisciplinary committee of physicians and allied health professionals that reviews the management of cancer patients is known as the:
Tumor Board
63
What is the overall goal of radiation therapy?
to kill a maximum number of cancer cells and a minimum number of normal cells
64
List four ways in which radiation therapy is used in the treatment of cancer.
to destroy a tumor and cure the patient;
to shrink a tumor so that it can be surgically removed;
to destroy cancer cells that have invaded normal tissues surrounding the surgically removed primary tumor or cells that have metastasized;
to relieve pain
65
Radiation is most effective in destroying (more than one answer may be correct):
A. microscopic tumors.
B. large tumor masses.
C. isolated cancer cells around the periphery of a tumor.
D. cancer cells in the center of a tumor.
A. microscopic tumors.
C. isolated cancer cells around the periphery of a tumor.
66
Radiation treatment usually consists of a series of individual treatments called _________________.
fractions
67
True / False - Irradiation causes irreversible damage to biologically critical molecules such as DNA.
True
68
True / False - Radiation may be used as primary therapy for certain types of cancer, such as certain head and neck malignancies and non-Hodgkin’s lymphomas.
True
69
True / False - X-rays, gamma rays, and beta rays are all types of ionizing radiation used in radiation therapy.
True
70
True / False -In external beam therapy, lower energy radiation is used to treat malignancies located deep within tissues.
False
71
True / False - In internal radiation therapy, the radioactive material is either temporarily or permanently implanted within tissues.
True
72
True / False - Because radiation therapy and chemotherapy are both effective against metastases, they are rarely combined due to the increased risk of side effects.
False
73
Radiation sensitizers may be used with radiation therapy to:
increase the sensitivity of the cancer cells to radiation; inhibit the ability of cells to repair
themselves following radiation; kill cells that are more resistant to radiation
74
What are the three most common side effects of radiation therapy?
fatigue;
loss of appetite;
feeling of general sickness
75
Name a side effect that is typically caused by radiation therapy in the abdomen.
diarrhea
76
Name a side effect that is typically caused by radiation therapy in the scalp area.
alopecia
77
What is the overall goal of chemotherapy?
to maximize the toxic effects of the agent(s) on cancer cells and minimize these effects on normal cells
78
List three ways in which chemotherapeutic agents interfere with DNA.
any three:
alteration or damage of the helical structure of DNA;
intercalation into DNA;
cross-linkage between strands of DNA; interference with purine or pyrimidine synthesis;
interference with transcription;
interference with microtubule function
79
A chemotherapeutic agent that is able to kill cells is called:
cytotoxic
80
List four classes of chemotherapeutic agents.
antimetabolites;
alkylating agents;
naturally derived substances;
hormones and hormone antagonists
81
Match the following:
____ agents that kill all cells
____ agents that kill only proliferating cells
____ agents that kill only cells in a sensitive phase
____ agents that kill only cells in mitosis
A. cycle-specific
B. cycle-nonspecific
C. phase-specific
B. cycle-nonspecific____ agents that kill all cells
A. cycle-specific____ agents that kill only proliferating cells
C. phase-specific____ agents that kill only cells in a sensitive phase
C. phase-specific____ agents that kill only cells in mitosis
82
True / False Like surgery and radiation therapy, chemotherapy exerts its effects locally.
false
83
True / False - Drug resistance is the principal cause of treatment failure in cancer therapy.
True
84
True / False - Drug resistance can develop spontaneously or in response to drug treatment.
True
85
True / False - The smaller and less advanced the tumor, the more likely it is to contain resistant cells.
False
86
True / False - Cancer cells are thought to be less likely to be resistant to combination regimens with several chemotherapeutic agents than to single-agent therapy.
True
87
What protein is believed to be involved in the development of multidrug resistance?
P-glycoprotein (Pgp)
88
What is the importance of the p53 gene in terms of tumor growth?
It plays a role in the cell’s decision to repair itself or undergo apoptosis in response to cell injury. If it is damaged, cells that would otherwise die will survive.
89
What is myelosuppression?
the depletion of blood cells formed within the bone marrow
90
Match the following side effects of chemotherapy with the sign or symptom produced.
____ toxic effects on hair follicle
____ toxic effects on gastrointestinal epithelium
____ toxic effects on bone marrow
____ effect of chemotherapy on emetic center of the brain
____ toxic effects to epithelial lining of the mouth
```
A. leukopenia, thrombocytopenia, and anemia
B. alopecia
C. stomatitis
D. nausea and vomiting
E. diarrhea
```
B. alopecia____ toxic effects on hair follicle
E. diarrhea____ toxic effects on gastrointestinal epithelium
A. leukopenia, thrombocytopenia, and anemia____ toxic effects on bone marrow
D. nausea and vomiting____ effect of chemotherapy on emetic center of the brain
C. stomatitis____ toxic effects to epithelial lining of the mouth
91
Match the following:
____ most effective in removing localized macroscopic tumors
____ most effective in eradicating localized microscopic tumors or isolated cancer cells around
the periphery of a tumor
____ effective in eradicating micrometastases throughout the body
A. radiation therapy
B. surgery
C. chemotherapy
B. surgery____ most effective in removing localized macroscopic tumors
A. radiation therapy____ most effective in eradicating localized microscopic tumors or isolated cancer cells around the periphery of a tumor
C. chemotherapy____ effective in eradicating micrometastases throughout the body
92
True / False - Chemotherapy is administered after surgery to suppress or prevent the occurrence of micrometastases.
True
93
True / False - Radiation aids in the healing of postsurgical wounds.
False
94
True / False - Some chemotherapeutic agents sensitize tumors to radiation therapy and increase the effectiveness of radiation.
True
95
Name two reasons why chemotherapy is used in combination with radiation.
to reduce the size of tumors too extensive to be treated with radiation;
to attack and control metastases that may be out of range of the field of irradiation
96
List three advantages of administering chemotherapy before radiation therapy.
unirradiated tumor vessels permit optimal drug delivery;
the condition and nutritional state of the patient is generally better before radiation treatment, thus permitting improved tolerance to chemotherapy;
to avoid delay in institution of systemic treatment
97
Combining radiation and chemotherapy increases the risk of:
immunosuppression; secondary neoplasms; localized reactions and toxicities
98
What is immunotherapy?
the administration of biologically active agents to enhance or supplement the ability of the
patient’s immune system to eradicate cancer
99
Biologically active agents used in immunotherapy are referred to as:
biological response modifiers, or BRMs
100
List and describe the two general approaches to
| immunotherapy.
nonspecific active immunotherapy — agents that activate a wide range of immune cells are used to induce a patient’s general immune response
passive immunotherapy — specific types of immune cells or secreted products are administered; they act against the patient’s cancer cells
101
List four agents used in immunotherapy.
```
any four:
interferons;
cytokines (interleukins);
monoclonal antibodies (MABs);
tumorinfiltrating lymphocytes;
tumor necrosis factor
```
102
What is cytotoxic therapy?
tumor cell modulation — the biology of a cancer cell is altered so that it becomes weak and dies
103
Explain the three general steps of bone marrow transplantation.
1. Bone marrow is removed from the patient or another person.
2. The patient is treated with extremely high doses of chemotherapy and/or radiation.
3. The marrow removed in Step 1 is infused into the patient.
104
What is the rationale behind bone marrow transplantation?
A patient can receive higher doses of chemotherapy or radiation without suffering life-threatening myelosuppression.
105
The transplantation of bone marrow between a genetically different donor and recipient is called:
allogeneic transplantation
106
Define autologous bone marrow transplantation.
transplantation of a patient’s own bone marrow that has been removed prior to high doses of chemotherapy and/or radiation
107
What is graft-versus-host disease (GvHD)?
in BMT, a syndrome induced by T cells (T lymphocytes) from the donated bone marrow;
donor T cells attack recipient (patient) tissues, especially the skin, liver, and gastrointestinal tract
108
In what two ways do antimetabolites interfere with normal cell function?
inhibit critical enzymes involved in nucleic acid synthesis; become incorporated into the
nucleic acid and produce incorrect codes
109
Name four classes of antimetabolites.
pyrimidine analogs;
folic acid analogs;
purine analogs;
ribonucleotide reductase inhibit
110
The primary mechanism of action for many alkylating agents is
___________________ of DNA strands.
cross-linking
111
In what two ways do antimetabolites interfere with normal cell function?
inhibit critical enzymes involved in nucleic acid synthesis; become incorporated into the
nucleic acid and produce incorrect codes
112
Name four classes of antimetabolites.
pyrimidine analogs;
folic acid analogs;
purine analogs;
ribonucleotide reductase inhibit
113
The primary mechanism of action for many alkylating agents is
___________________ of DNA strands.
cross-linking
114
Name seven classes of alkylating agents.
```
nitrogen mustards;
aziridines and aziridine derivatives;
alkyl sulfonates;
nitrosoureas;
tetrazines;
platinum complexes;
other alkylating agents
```
115
List two major classes of naturally derived antineoplastic products.
plant alkaloids; anthracyclines and other antibiotics
116
Name two agents that belong to the anthracycline group of antibiotics.
any two: daunorubicin; doxorubicin; idarubicin
117
True / False - Hormones and hormone antagonists exert antineoplastic effects on tumors that are hormone-sensitive.
True
118
True / False Typical examples of hormone-sensitive tumors are those of the breast, ovaries, and prostate gland.
True
119
List five classes of hormone agents.
any five: estrogens, estradiol mustard, and antiestrogens; androgens and antiandrogens;
progestins; corticosteroids; gonadotropin-relea sing hormone analogs; aromatase inhibitors
120
Why is parenteral administration of chemotherapy often preferred over oral administration?
Parenteral administration can deliver high concentrations of a cytotoxic agent to the site of
the tumor, while oral administration can result in erratic drug levels in the blood.
121
Match the following:
____ administration of drug into the bladder, using a catheter
____ administration of drug into an artery
____ administration of drug by mouth
____ injection of drug into fluid surrounding the spinal cord
____ injection just under the skin
____ administration of drug into muscle tissue
____ administration of drug into the peritoneum
```
A. oral
B. intrathecal
C. intra-arterial
D. intramuscular
E. subcutaneous
F. intraperitoneal
G. intravesical
```
G. intravesical____ administration of drug into the bladder, using a catheter
C. intra-arterial____ administration of drug into an artery
A. oral____ administration of drug by mouth
B. intrathecal____ injection of drug into fluid surrounding the spinal cord
E. subcutaneous____ injection just under the skin
D. intramuscular____ administration of drug into muscle tissue
F. intraperitoneal____ administration of drug into the peritoneum
