The Emperor of All Maladies - Siddhartha Mukherjee - Oncology Notes

Question 1

In what way is radiation similar to chemotherapy?

Answer 1

It damages DNA, and so it also damages the rapidly dividing cells preferentially (Just like chemotherapeutic agents) (However, it is obviously still not nearly as specific as we would like).

Question 2

What are two common results of excessive radiation exposure?

Answer 2

Anemia (Following severe bone marrow damage) and neoplastic growth secondary to the radiation

Question 3

What term refers to a pharmacological agent’s ability to discriminate between healthy and diseased tissue?

Answer 3

Specificity

Question 4

What is 6-mercaptopurine?

Answer 4

A chemotherapeutic purine analog that can inhibit cellular growth.

Question 5

What is cyclophosphamide?

Answer 5

A chemotherapeutic agent that damages cellular DNA and induces apoptosis.

Question 6

What is asparaginase?

Answer 6

An enzyme that takes advantage of the fact that ALL and some other tumor cells are unable to synthesize the non-essential amino acid asparagine, whereas normal cells are able to make their own asparagine.

So, it starves leukemic cells of asparagine.

Question 7

What is vincristine?

Answer 7

A chemotherapeutic agent that binds tubulin and prevents successful mitosis; thus, resulting in apoptosis.

Question 8

What is methotrexate?

Answer 8

A chemotherapeutic agent and dihydrofolate reductase inhibitor
(An antifolate)

Question 9

What is the ironic factor surrounding cancer and the blood-brain barrier?

Answer 9

The isolating mechanism that is meant to protect the CNS from infection can also serve as a harboring point that prevents chemotherapy from reaching cancer cells in the CSF.

Question 10

The VAMP regimen (The first 4-drug chemotherapy regimen ever) is still used today in the treatment of which malignancy?

Answer 10

Hodgkin’s Lymphoma

Question 11

What are large masses in the anterior chest usually due to?

Answer 11

The four T’s

Thyroid cancers,
Teratomas,
Thymomas,
and (Terrible) lymphomas

Question 12

What is characteristic about the progression of Hodgkin’s lymphoma?

Answer 12

It progresses in a regional, stepwise manner through the lymph nodes (Many cancers do, but HL tends to walk more slowly through the nodes)

Question 13

How does Cisplatin induce apoptosis?

Answer 13

By crosslinking and irreparably damaging DNA

Question 14

What are two metastatic growths that are often sensitive to hormone therapy?

Answer 14

Prostatic and breast cancers

Question 15

What is tamoxifen’s mechanism of action?

Answer 15

It is an estrogen analog and antagonist.

Question 16

How far before a diagnosis of cervical cancer can a Pap smear identify precancerous lesions?

What percentage of cases of cervical cancer can be prevented through Pap smears?

Answer 16

Up to 20 years before the cancer would have been caught otherwise.

Up to 80%

Question 17

Due to mammograms, how large is the reduction in breast cancer mortality for women ages 54 and lower?

Due to mammograms, how large is the reduction in breast cancer mortality for women ages 55 and higher?

Answer 17

Very little discernable difference

A 20-30% reduction in mortality

Question 18

In mammogram screening, what age group of women results in false positives more frequently?

Answer 18

Women younger than 55 (Especially from 40-50)