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1

What is the most common type of carcinoma in Africa?

Liver cell carcinoma most common in Africa due to link with viral hepatitis.

2

What are the principles of optimal scheduling with anti-cancer drugs?

• Design optimal scheduling-e.g., maintain constant intervals with treatment free interval as short as possible, while allowing most sensitive tissue adequate time to recover (e.g., bone marrow).

3

Hydrochlorothiazide

Treats Meniere disease. Diuretic-regulate fluid volume and pressure in inner ear.

4

What are the characteristics of neoplasms and what are the main ones?

1. Uncontrolled growth of cells, progeny of a single cell

2. Names usually end in –oma

3. Benign epithelial tumor is adenoma (if glandular), a papilloma (if papillary)

4. Malignant tumor (metastasizes)

• Epithelial= carcinoma

• Mesenchymal= sarcoma

• Lymphoid= lymphoma

• Melanocytic tumor=melanoma

• Hematopoietic= leukemia

 

• Squamous cell carcinomas

• Adenosarcomas-grandular epithelium

• Lipoma-benign

• Liposarcoma-malignant

• Osteosarcoma-malignant bone cancer

• Rhabdomyosarcoma-malignant skeletal muscles, usually kids

• Rhabdomyoma-benign

• Leiomyosarcoma-malignant tumor of smooth muscle

• Leiomyoma- benign tumor

5

What are the characteristics of prostate cancer?

• 1 in 8 men, Elevates PSA and acid phosphatase

• Treat by eliminating testosterone production through surgical castration

• LH-releasing hormone agonists

6

Diazepam

Treats Meniere disease. It is an anxiolytic.

7

Metastatic patterns are almost identical between tumors. True or False?

False. They vary due to varying growth factors.

8

What are the stages of breast cancer?

• Stage I: small, primary tumor --surgery alone is an 80% cure

• Stage II: positive node; post-operative use of chemo (e.g., 6 cycles of cyclophosphamide, methotrexate and fluorouracil).

• Stage III-IV: a major challenge

• Breast cancer-much more effective resolution due to early treatments

9

Cisplatin

Treats cancer, is a platinum analog. Used for broad range of solid tumors. Is nephrotoxic.

10

What are the three main types of treatment for cancer?

a. Surgical removal

b. Radiation therapy-maximize exposure of tumor and minimize exposure of normal tissue

c. Chemotherapy

  • • most damage to rapidly proliferating cells
  • • treats whole body
  • • tumor can develop resistance
  • • often multiple drugs required
  • • can cause cancer later

11

Dexamethasone

Treats Meniere disease. Long-acting steroid/inject into the ear—it reduces fluid.

12

Epinephrine

Alpha-agonist non-selective that can help treat glaucoma.

13

What is open-angle glaucoma?

Open-angle glaucoma: wide space between iris and cornea

• most common-90%

• slow clogging of drainage canals

• symptoms subtle and often undetected

• 3 million cases in US

• African Americans especially vulnerable

• Increased risk with diabetes and HP

14

What is the definition of mortality when referring to cancer terms?

• Mortality: death/time period

15

What causes self-limiting colitis?

• Caused by microorganisms such as salmonella, E. coli, shigella, clostridium

16

Erlotinib

Cancer treatment strategy. Blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer.

17

Procarbazine

Treats cancer, is a nitrosourea. Used for combination regimens for Hodgkin's Lymphoma. Passes blood brain barrier and used to treat brain tumors.

18

How does grading of tumors work and what are the four main serological tests and when are they used?

• TNM grading -T, size and extent of primary tumor -N, presence and number of lymph node metastases -M, presence of distant mestatses

• Serological tests- most useful for assessing cancer recurrence after treatment -PSA: prostate specific antigen -CBA: carcinoembryonic antigen-colon carcinoma -CA-125: serous ovarian carcinoma -HCG: choriocarcinoma

19

Pilocarpine

Treats glaucoma. Cholinomimetic-contract ciliary muscle and increases outflow of aqueous humor. ACh1 agonist.

20

Meclizine

Treats Meniere disease. H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, causes xerostomia.

21

Which type of cells do most chemotherapies target?

Proliferating cells. Consequently, good for killing fast growing tumors, not so good for slow or non-growing tumor cells. Injure rapidly proliferating normal cells such as bone marrow, intestinal mucosa, hair.

22

What is a retinoblastoma?

It is the most common tumor in children

23

What are the two main causes of intestinal obstruction of the small bowel, colon?

a. Usually mechanical (80%)

b. Neoplasm and infarction (20%)

24

What is Hirschsprung disease, and what part of the GI does it involve?

Hirschsprung disease

• Congenital defect in colonic innervation

• Failure to pass meconium The small bowel, colon.

25

What are the characteristics of Otitis Media?

• Typically associated with blockage of the Eustachian tube

• Often associated with infections by strep. Pneum. Or Haemophilus influe.

a. Symptoms: pain, ear discharge, headache, hearing loss, tinnitus, vertigo, immobile eardrum (swollen and inflamed), fever

26

What are the characteristics of reflux esophagitis?

a. Relaxation of gastroesophageal sphincter

b. Symptoms: Burning, Excessive salivation, Choking

c. Aggravating factors: obesity, pregnancy, (decrease esophageal pressure: alcohol/tobacco, narcotics, nicotine patch) use

d. Medical treatment: antacids, H2 blockers, PPI -lose weight, stop smoking/drinking

e. lifestyle treatment: lose weight, stop smoking and drinking

f. Complications: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus

27

What are the main causes of cancer?

• Mutation (e.g., chemical carcinogens-alkylating agents or nitrosamines in food, UV light-skin cancers, radiation)-

• Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen

• Tumor viruses • HPV-human papilloma virus-carcinoma of cervix and oropharyngeal

• Epstein-Barr: mononucleosis

• Hep B & C viruses: hepatocellular carcinoma

• HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS)

• Bacteria and inflammation (H. pylori [gastric adenocarcinoma], and asbestosis)

• Chemical carcinogens

• Reactive chemical (e.g., free radicals) alter DNA

• Alkylating agents—some of which are used to tx cancer

• Polycarbon aromatics: e.g., benzopyrene in smoke and cooked meat

• Aflatoxin- fungus on peanuts and other foods- not so much in US

• Nitrosamine/nitates in foods

• Metal ions: nickel, arsenic

• Hormonal activation (sex hormones)

• Lack of immune responses (i.e., immunocompromised) - altered host response to tumor can interfere with natural defense mechanisms -immunosuppressed children have 200X increased risk for cancer

• Genetic predisposition

• Variation in hepatic susceptibility of CYP1A1 and glutathione activity

• Radiation: -skin cancer caused by UV rays

• X-rays/gamma radiation -leukemias -papillary thyroid and breast cancers

28

What are the characteristics of Multiple Myeloma?

1. Plasma cell malignancy, primarily in bone marrow

2. Symptoms: • Bone pain • Fractures • Anemia

• Tx: alkylating agent; prednisone

29

Imatinib

Cancer treatment strategy. Tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia.

30

What are the main genetic targets for tumors?

• Oncogenes (promote proliferation)-e.g. growth factors or corresponding receptors

• Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary)

• P53 gene is most common suppressor gene mutation (lost in 50% of malignancies)

• WT-1 gene- regulates apoptosis such as in Wilms tumor

• APC-adenomatous polyposis coli-tumors in bowel and pancreas

• Apoptosis regulating genes (P53 gene also affects apoptosis)

• DNA repair genes

• Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer)

• Angioneogenesis (tumors release vascular endothelial growth factor)

• Develop properties for invasiveness