principles clinical oncology Flashcards
(114 cards)
1
Q
causes predispositions to female mammary cancer
A
oestrogens and progesterones
2
Q
causes predisposition to male prostate carcinoma or perianal adenoma
A
testosterone
3
Q
3 viruses that cause cancer
A
- retrovirus
- poxvirus
- helicobacter pylori
4
Q
define proto-oncogenes
A
genes that promote cell growth and proliferation or inhibit apoptosis
5
Q
2 tumour suppressor genes
A
- Rb
- p53
6
Q
2 things that need to mutate to allow oncogenesis
A
- tumour suppressor genes
- proto-oncogenes
7
Q
number of mutations to make oncogenesis clinically significant
A
10-12
8
Q
Rb action
A
- prevents excessive cell growth by inhibiting cell cycle till its ready to divide
- stops G1 going into S phase
9
Q
p53 action
A
stops G1 to S phase in prescence of DNA damage
- can cause apoptosis if damage not fixed
10
Q
tumour mutation development
A
mutation inactivates suppressor gene –> call proliferation (benign) –> mutation inactivates DNA repair genes –> protooncogenes turned into oncogenes –> more mutations and more genetic instability –> metastasis
11
Q
hallmarks of cancer (6)
A
- sustaining proliferative signal
- evading growth suppressors
- active invasion and metastasis
- enabling replicative immortality
- inducee angiogenesis
- resist cell death
12
Q
sustaining proliferative signal done by
A
- local stimulation
- altering to always be on
- overexpression of receptors
13
Q
example of a gene mutation to sustain proliferative signal
A
KIT gene mutation meaning receptor autophosphorylates so is always on
14
Q
evading growth suppressors how
A
- loosing growth suppressor receptors
- making receptors unfunctional
15
Q
avoiding cell death
A
- upregulation of survival factors
- not displaying death receptor
16
Q
enabling replicative immortality
A
enzyme telomerase is needed to add telomeres to DNA
17
Q
telomeres and DNA
A
some are lost during every replication so eventually replication stops as no more telomeres
18
Q
induction of angiogenesis
A
secrete angiogenic factors
19
Q
activating invasion and metastasis
A
- need matrix metalloproteinases to disrupt surroundings
- need change in cell adhesion molecules so that no longer stuck to neighbouring cells
20
Q
2 emerging hallmarks of cancer
A
- deregulation of cell energetics
- avoiding immune destruction
21
Q
how cancers avoid immune destruction (4)
A
- decrease immunogenic antigen
- kill tumour infiltrating lymphocytes
- immunosuppressive mediators
- inducing immune tolerance
22
Q
inflammation and tumours
A
promote tumour growth as inflammation is immunosuppressive, has growth factors and angiogenic mediators
23
Q
gold standard for cancer diagnosis
A
histopathology
24
Q
patnaik system grading mast cell tumours grade 1
A
- low grade
- acts benign
- well behaved
25
patnaik system grading mast cell tumours grade 2
intermediate
26
patnaik system grading mast cell tumours grade 3
- high grade
- aggressive
- likely to spread
27
staging of tumours define
decide if local or if has spread
28
TNM system for staging tumour
T - primary tumour
N - associated lymph node
M - metastasis
29
For T of TNM staging system
- size
- mobility- ulceration
- relationship to surrounding tissues
30
for N of TNM staging system (5)
- size
- mobility
- relationship to surrounding tissues
- texture
- consistency
- may need to FNA for metastasis
31
for M of TNM staging system
- history
- physical exam
- imaging?
32
lymphoma stage 1
limited to single lymph node or lymphoid tissue in organ excluding bone marrow
33
lymphoma stage 2
more than 1 lymph node affected in local area
34
lymphoma stage 3
generalised involvment across the diaphragm
35
stage 4 lymphoma
liver and or spleen involvment
36
stage 5 lymphoma
maifestation in blood or bone marrow/other organ systems affected
37
2 substages in the staging of lymphoma
a - no systemic signs
| b - systemic signs
38
prior to cancer tx do
- CBC
- haematology
- urinalysis
- coagulation profile
- as then you have a baseline for any changes
39
define hyperviscosity
thick sludgy blood
40
tx options cancer
- cure
- remission
- palliation
- control
41
important to consider in cancer treatment
ensure a good quality of life!
42
chemotherapy is mainly used in tumours with
high metastatic potential
43
cytotoxic drugs must not be
- handled by pregnant women
if in tablet or capsule form
- must not be crushed or opened
44
when giving chemotherapy use what system
phaseal
45
chemotherapy patient animal poop and urine
- double bag poo and wee
| - do not let animal go where children play
46
4 ways that tumours spread
- lymphatic
- vascular
- local
- trans-cavity
47
local spread is usually done by what tumour type
carcinomas
48
vascular spread is usually done by what tumour type
sarcomas
49
trans-cavity spread is usually done by what tumour type
mesotheliomas
50
what cell type makes a mesothelioma
lining of body cavity
51
define multicentric tumours
where cant determine primary tumour/tumour of origin at presentation
52
immunohistochemistry and tumours
can be used to identify surface markers on tumour cells so can figure out cell types
53
cytokeratin is a marker for what cell types
epithelial
54
carcinomas are made of what type of cell
epithelial
55
vimentin is a marker for what cell type
mesenchymal
56
sarcomas are made of what cell types
mesenchymal
57
CD3 is a marker for what cell
T cell
58
CD79a is a marker for what cell
B cell
59
2 things to think about when fixing a sample in formalin
- formalin to sample ratio no smaller than 4:1
| - longest dimension 2cm max
60
6 reasons for chemotherapy
- primary treatment for disseminated (widespread) disease
- adjuvant therapy following surgery on highly metastatic tumour
- following incomplete resection
- neoadjuvant therapy to shrink prior to surgery
- treatment of tumours not amenable to radiation or surgery
- primary tx for venereal tumour
61
when giving adjuvant chemo consider
surgical wound needs time to heal before you start
62
cell kill hypothesis (chemo)
a given dose will kill a fixed percentage of the tumour population
63
theory of pulse dosing (chemo)
time between doses is so much to allow body to recover but not too long that tumour regrows
64
drugs used for chemo better
if used in combination
65
combination therapy use drugs that (chemo) 4
- are effective against tumour individually
- do not have overlapping toxicities
- different modes of action
- affect cells at different stage of cell cycle
66
combination therapy chemo pro
can use less of each drug
67
4 stages of chemo
- induction
- maintenance
- re-induction
- rescue
68
rescue stage in chemo is when
tumour becomes resistant to therapy so need different drugs
69
metronomic chemotherapy
continuous low dose cytotoxic drugs
70
aim of metronomic chemotherapy
to slow growth of tumour
71
receptor tyrosine kinase inhibitors and chemo (4)
- inhibit angiogenesis
- promote apoptosis
- reduce proliferation
- not cytotoxic
72
4 adverse effects chemo
- myelosuppression
- GIT toxicity
- poor hair growth
- drug extravasation
73
define myelosuppression
bone marrow suppression
74
define drug extravasation (chemo)
where drug spills onto tissues, can do a lot of damage in chemo
75
if drug is extravasated then (3)
- keep catheter in place
- try to withdraw as much as possible
- apply ice pack or heat. this is drug specific so contact drug company
76
doxorubicin side effects
- dysrhythmias during administration
- chronic toxicity leads to dilated cardiomyopathy
- mast cell degranulation causes allergy like response
77
cyclophosphamide side effects
haemorrhagic cystitis
78
vincristine side effects
- peripheral neuropathies
| - constipation
79
lomustine side effects
- hepatotoxicity
| - nephrotoxicity
80
platinum drugs side effects
- nephrotoxic
| - vomiting
81
do not give cats 2 drugs for chemo
- cisplatin
| - 5-FU
82
alkylating agents chemo action
- substitute alkyl group for H+ causing breaking of DNA strands
- not cell cycle phase specific
83
mitotic spindle inhibitors chemo action
- bind to tubulin stopping microtubule formation
| - stop cycle in metaphase
84
anti-metabolites chemo action
- inhibit enzymes or cause production of non-functioning molecules
- work during S-phase
85
anti-tumour antibiotics chemo action
- stop DNA/RNA synthesis
| - not cell cycle phase specific
86
platinum compounds chemo action
- interferes with DNA/RNA synthesis similar to alkylating agents
- not cell cycle phase specific
87
corticosteroids in chemo why
cause apoptosis of lymphoid cells
88
L-asparaginase in chemo why
- treatment of lymphoma and leukaemia
| - cancer cells rely on other sources of L-asparagine as they cant make it like normal cells
89
NSAIDs chemo use why
- inhibit angiogenesis
- promote apoptosis
- anti-inflammatory
- analgesic
- used in metronomic therapy
90
3 different types of radiation used in radiation therapy
- x-ray photons
- gamma ray photons
- particles
91
effect of radiation in radiation therapy
- particle effect
| - creates oxygen free radicles
92
effect of oxygen free radicals in tissues
damages cell membranes, proteins and nucleic acid
93
best tumours for radiation therapy
- well oxygenated ones so smaller tumours
| - proliferative tumours
94
acute effects of radiation therapy occur
- in rapidly dividing tissue in radiation field
| - no permanent damage
95
late effects of radiation therapy occur
- in slow dividing cells in irradiation field
- radiation kills of stem cells so when the slow proliferating cells die theres nothing to replace them
- permanent changes
96
5 common tumours for radiation therapy
- brain
- nasal
- oral
- soft tissue sarcomas
- mast cell tumours
97
when taking multiple biopsies consider
use fresh instruments for each one to limit contamination
98
a biopsy should include
junction of normal and abnormal tissue
99
most active and invasive parts of a tumour are
the edges
100
when dissecting a tumour do not
handle the tumour directly instead handle normal adjacent tissue
101
after tumour removal change
instruments for closure
102
ligation and tumours
ligate the veins and lymphatic drainage of tumour then the arteries before removal
103
3 types surgical margin of excision of tumours
- local excision
- wide local excision
- radical local excision
104
local excision of tumours is where
tumour removal through natural capsule, immediate boundaries or with minimum adjacent tissue
105
indications for local tissue excision of tumours
benign tumors with no tendency for local infiltaration
106
wide local excision of tumours is where
tumour is removed with substantial margin of surrounding tissue
107
2 indications for wide local excision of tumour
- benign with capacity for local infiltration
| - malignant with limited potential for infiltration
108
radical local excision is
tumour removed with margins that extend into fascial planes that are undisturbed by tumour growth
109
3 techniques for radical local excision of tumours
- compartmental excision
- muscle group excision
- amputation
110
compartmental excision is
removal of tumour with all the blood vessles and nerves in the compartment and overlying skin
111
muscle group excision
tumour removed with whole muscle that it involves
112
amputation and local radical excision
tumour removed with entire limb
113
define debulking of tumour (cytoreductive surgery)
incomplete removal to improve efficacy of treatment
114
palliative surgery define
improves patients quality of life but not the length
