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HY Oncology
Day 8 (includes anti-cancer drugs)
Question | Answer |
---|---|
What are the 2 MC cancer mutations? | p53 and RAS; of the 2, RAS is the MC |
Which RAS mutation is associated with colon,lung, and pancreatic tumors? | K-RAS (Kolon and panKreatic) |
Which RAS mutation is associated with bladder and kidney tumors? | H-RAS (Hematuria) |
Which RAS mutation is associated with is associated with melanomas and hematologic malignancies? | N-RAS |
White reflex caused by tumor outgrowing the vascular supply | Retinoblastoma |
How do most cases of sporadic retinoblastoma present? | Always unilateral; most cases are sporadic |
How do most cases of heritable retinoblastoma present? | May be bilateral or unilateral; all bilateral cases are inherited point mutations |
How do the 2 "hits" arise in heritable retinoblastoma? | 1 hit comes from a parent, and the second hit arises sporadically |
p53 is the "guardian" of which cell cycle checkpoints? | G1/S and G2/M |
How does p53 cause apoptosis? | By inducing the transcription of pro-apoptotic genes such as BAX. |
Strep bovis is associated with which malignancy? | Colon cancer |
H pylori is associated with which malignancy? | Gastric cancer |
Schistosoma hematobium is associated with which malignancy? | Squamous cell carcinoma of the bladder |
Clonarchis sinesis is associated with which malignancy? | Biliary carcinoma |
Name 3 drugs used to treat testicular cancer. | Etoposide, Bleomycin, and Cisplatin (Eradicate Ball Cancer!) |
Cells have increased in number | Hyperplasia |
Abnormal proliferation of cells with loss of size, shape, and orientation | Dysplasia |
Name two factors that allow neoplastic cells to invade the basement membrane. | Collagenases and hydrolases. ALso metalloproteases. |
What do the seed and soil of the "seed and soil" theory of metastasis stand for? | Seed: tumor embolus Soil: target organ |
How does increased expression of laminins help mediate metastasis? | Allows for adherence to basement membrane (Let me/LAMI INto this basement membrane now!) |
How do neoplastic cells mediate detachment from the surrounding cells for the purpose of metastasis? | Loss of E cadherins |
Very poor differentiation of a neoplastic cell | Anaplasia |
Name 4 features of anaplastic cells. | 1. High nucleus to cytoplasmic ratio 2. Prominent nucleoli 3. Nuclear chromatin clumping 4. Many mitotic figures |
Which -plasias are reversible? | Hyperplasia (increase in # of cells) and Dysplasia (abnormal growth with loss of cellular orientation, shape, and size in comparison with normal tissue maturation) |
What test detects dysplasia of the cervix? | Pap smear |
Which plasias are irreversible? | Anaplasia (little or no resemblance to tissue of origin), neoplasia (clonal proliferation), and desmoplasia (fibrous tissue formation in response to neoplasm) |
Which has more prognostic value-- stage or grade? | Stage (how much tumor has spread) |
What is the TNM staging system? | T: size of Tumor N: Node involvement M: Metastases |
Via which route do epithelial tumors spread? | Lymph nodes |
Via which route do mesenchymal tumors spread? | Hematogenous |
Can an adenoma progress to an adenosarcoma? | Yes (note that the majority of benign tumors do not progress to their malignant counterparts; epithelial tumors are the exception) |
Which teratoma is malignant in men? | Both immature and mature teratomas are malignant in men. In women, the mature teratoma is benign (older, mature women will behave benignly) |
Which immunohistochemical stain is used to ID sarcomas and some carcinomas? | Vimentin (CT stain) |
Which immunohistochemical stain is used to ID rhabdomyosarcomas or leiomyosarcomas? | Desmin (muscle stain) |
Which immunohistochemical stain is used to ID carcinomas and some sarcomas? | Cytokeratin (epithelial cell stain) |
Which immunohistochemical stain is used to stain neuroglial cells? | GFAP |
Which immunohistochemical stain is used to ID adrenal neuroblastoma and primitive neuroectodermal tumors (PNETs) | Neurofilaments (neuron stain) |
Which cancer(s) does the following condition predispose the patient to?: Down syndrome | ALL (we ALL fall DOWN), AML |
Which cancer(s) does the following condition predispose the patient to?: xeroderma pigmentosum, albinism | Melanoma, basal cell carcinoma, and especially squamous cell carcinoma |
Which cancer(s) does the following condition predispose the patient to?: chronic gastritis, pernicious anemia, postsurgical gastric remnants | Gastric adenocarcinoma |
Which cancer(s) does the following condition predispose the patient to?: tuberous sclerosis (facial angiofibroma/adenosebaceum, seizures, mental retardation, ash leaf spots) | Astrocytoma, angiomyolipoma, and cardiac rhabdomyoma (2/3!) |
Which cancer(s) does the following condition predispose the patient to?: actinic keratosis | SCC of skin |
What is the treatment for actinic keratosis? | 5-fluorouracil cream |
Which cancer(s) does the following condition predispose the patient to?: Barret's esophagus | Esophageal adenocarcinoma |
Which cancer(s) does the following condition predispose the patient to?: Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, anemia; all due to iron deficiency) | SCC of esophagus |
Which cancer(s) does the following condition predispose the patient to?: Cirrohsis (alcoholic, HepB, HepC) | Hepatocellular carcinoma |
Which cancer(s) does the following condition predispose the patient to?: Ulcerative colitis (UC) | Colonic adenocarcinoma (UC U have Colon cancer now) |
Which cancer(s) does the following condition predispose the patient to?: Paget's disease of bone | secondary osteosarcoma adn fibrosarcoma |
Which cancer(s) does the following condition predispose the patient to?: immunodeficiency states | Malignant lymphoma |
Which cancer(s) does the following condition predispose the patient to?: AIDS | aggressive malignant lymphoma (non-Hodgkin's or primary CNS lymphoma) and Kaposi sarcoma |
Which cancer(s) does the following condition predispose the patient to?: Autoimmune diseases (e.g., Hashimoto's thyroiditis, Myasthenia Gravis) | Lymphoma |
Which cancer(s) does the following condition predispose the patient to?: Acanthosis nigricans (hyperpigmentation and epidermal thickening) | Visceral malignancy (sotmach, lung, breast, uterus), esp in a patient with new onset acanthosis nigricans who is >40yo |
What non-malignant condition can acanthosis nigricans be seen in? | Diabetes |
Which cancer(s) does the following condition predispose the patient to?: Dysplastic nevus (mole) | Malignant melanoma |
Which cancer(s) does the following condition predispose the patient to?: Radiation exposure | Sarcoma, papillary thyroid cancer |
Which cancer(s) does the following condition predispose the patient to?: achalasia (narrowing of the LES) | SCC of esophagus |
Which cancer(s) does the following condition predispose the patient to?: Sjogren's | B cell lymphoma |
Which cancer(s) does the following condition predispose the patient to?: Ataxia telangiectasia | Lymphomas and acute leukemias |
What is the associated gene and gene product for the following tumor?: CML | abl gene; tyrosine kinase product |
What is the treatment for CML? What translocation is CML associated with? | Treatment is imatinib (anti-bcr abl antibody); t(9;22) translocation |
What is the associated gene and gene product for the following tumor?: Burkitt's lymphoma | c-myc gene; transcription factor product |
What is the translocation associated with Burkitt's lymphoma? With what virus is it associated? | t(8;14); EBV |
What is the associated gene and gene product for the following tumor?: Follicular and undifferentiated lymphomas | bcl-2 gene (inhibits apoptosis); anti-apoptotic molecule product |
What is the associated gene and gene product for the following tumor?: Breast, ovarian, and gastric carcinomas | erb-B2 gene; tyrosine kinase product |
What is the associated gene and gene product for the following tumor?: Colon carcinoma | ras (K-ras specifically) gene; GTPase product; Ras is also assoc'd with follicular thyroid carcinoma |
What is the associated gene and gene product for the following tumor?: Lung tumor (specifically small cell) | L-myc gene; transcription factor product |
What is the associated gene and gene product for the following tumor?: neuroblastoma (adrenal tumor with Homer Wright rosettes) | N-myc gene; transcription factor product |
What is the associated gene and gene product for the following tumor?: multiple endocrine neoplasia (MEN types 2A and 2B) | ret gene; tyrosine kinase gene product; ret mutation is also assoc'd with papillary carcinoma of the thyroid |
What is the associated gene and gene product for the following tumor?: gastrointestinal stromal tumor (GIST) | c-kit gene; cytokine receptor product |
Which gene is mutated in retinoblastoma, osteosarcoma? | Rb |
Which gene is mutated in Li-Fraumenni syndrome? | p53 |
Which BRCA mutation is associated with breast cancer only? | BRCA 2 (you only have 2 breasts-- i hope!); BRCA 1 is both breast and ovarian |
Which gene is mutated in melanoma? | p16 |
Which gene is mutated in colorectal cancer associated with Familial Adenomatous Polyposis (FAP)? | APC |
Which gene is mutated in Wilm's tumor? | WT1 |
Which gene is mutated in neurofibromatosis type 1? | NF1 (neurofibromatosis type 2 is just NF2 mutation) |
Which gene is mutated in pancreatic cancer? | DPC (Deleted in Pancreatic Cancer) |
Which gene is mutated in colon cancer? | DCC (Deleted in Colon Cancer) |
What is the proper usage of a tumor marker? | To confirm a diagnosis, to monitor for tumor recurrence, and to monitor response to therapy. Tumor markers should NEVER be used as the primary tool for making a cancer diagnosis. |
Name that tumor marker: elevated in BPH and prostatitis | PSA |
Name that tumor marker: elevated in prostate carcinoma | Prostatic acid phosphatase |
Name that tumor marker: GI tumors, breast, and thyroid medullary carcinomas | CEA (carcinoembryonic antigen) |
Name that tumor marker: HCC, nonseminomatous germ cell tumors of the testis (e.g., yolk sac tumor aka endodermal sinus tumor) | AFP (America's Favorite Pancakes go great with eggs=yolk) |
Name that tumor marker: Hyaditiform moles, Choriocarcinomas, and Gestational trophoblastic tumors | beta-HCG (HCG for Hyatidiform, Choriocarcinoma, and Gestational trophoblastic) |
Name that tumor marker: Ovarian, malignant epithelial tumors | CA-125 (caused by peritoneal irritation, so not a good screening tool for ovarian cancer) |
Name that tumor marker: melanoma, neural tumors, astrocytomas | S100 |
Name that tumor marker: metastases to bone, obstructive biliary disease, Paget's disease of bone | Alkaline phosphatase |
Name that tumor marker: Adrenal neuroblastoma, lung and gastric cancer | Bambesin (little bambinos get adrenal neuroblastoma) |
Name that tumor marker: Hairy cell leukemia (a mature B cell tumor in the elderly) | TRAP (tartrate resistant acid phosphatase); TRAP the hairy animal |
Name that tumor marker: Pancreatic adenocarcinoma | CA-19-9 |
Name that tumor marker: Thyroid medullary carcinoma | Calcitonin |
Which oncogenic microbe causes adult T cell leukemia/lymphoma? | HTLV-1 |
Which oncogenic microbe causes Burkitt's lymphoma, nasopharyngeal carcionma, Hodgkin's, and oral hairy leukoplakia? | EBV |
Which oncogenic microbe is asociated with papillary thyroid carcinoma? | HepC |
Which oncogenic microbe causes primary CNS lymphoma? | HIV |
Aflatoxins cause which type of cancer? | HCC (liver) |
Vinyl chloride causes which type of cancer? | Angiosarcoma of the liver |
CCl4 causes which type of liver damage? | Centrilobular necrosis and fatty change |
Nitrosamines cause cancer in which two organs? | Esophagus and stomach |
What is the carcinogen found in cigarette smoke? | PAH (polycyclic aromatic hydrocarbons) |
What cancers are caused by asbestos? | Mesothelioma and bronchogenic carcinoma |
What cancers are caused by arsenic? | Skin (SCC) and angiosarcoma of the liver |
Naphthalene (aniline) dyes found in mothballs cause which cancer? | Transitional cell cancer of the bladder |
Anti-cancer alkylating agents are linked to which type of cancer? | Leukemia |
Radon exposure is associated with with type of cancer? | Lung cancer |
Which neoplasm is associated with Cushing's syndrome? | Small cell lung carcinoma (elevated ACTH or ACTH-like peptide) |
Which neoplasm is associated with SIADH? | Small cell lung carcinoma and intracranial neoplasms (elevated ADH) |
Which neoplasm is associated with hypercalcemia? | Squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, and multiple myeloma (elevated PTH related peptide, TGF-beta, TNF, and IL-1) |
Which neoplasm is associated with polycythemia (an abnormal increase in the # of RBCs)? | Renal cell carcinoma, hemangioblastoma, pheochromocytoma, and HCC |
Which neoplasm is associated with Lamber-Eaton syndrome (m weakness that improves with use)? | Thymoma, small cell lung carcinoma |
Which neoplasm is associated with gout and urate nephropathy? | Leukemias and lymphomas (hyperuricemia due to excess nucleic acid turnover; i.e., cytotoxic therapy; salvage pathway can't keep up) |
Psammoma bodies can be seen in which neoplasms? | Papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, meningioma, and malignant mesothelioma |
What are the 3 most common cancers in men (in order of frequency? | 1. Prostate 2. Lung 3. Colorectal |
What are the 5 most common cancers in women (in order of frequency? | 1. Breast 2. Lung 3. Colorectal 4. Uterine 5. Ovarian |
What are the 4 most common cancers causing mortality among men (in order of frequency)? | 1. Lung 2. Prostate 3. Colorectal 4. Pancreatic |
What are the 4 most common cancers causing mortality among women (in order of frequency)? | 1. Lung 2. Breast 3. Colorectal 4. Pancreatic |
What are the top 4 causes of death in the US? | 1. Heart disease 2. Cancer 3. Stroke 4. COPD |
What are the most common sites of origin for tumors metastasis to the brain? | Lung, Breast, Skin (melanoma), Kidney (renal cell CA), GI (Lots of Bad Stuff Kills Glia) |
What percentage of brain tumors are metastases? | 50% |
What are the most common sites of origin for tumors metastasis to the liver? | Colon, Stomach, Pancreas, Breast, Lung (Cancer Sometimes Penetrates Big Livers) |
What is the MC liver tumor? | Metastases |
What are the most common sites of origin for tumors metastasis to the bones? | Prostate, Thyroid, Testes, Breast, Lung, Kidney; breast and prostate are most common (P.T. Barnum Loves Kids) |
Lytic or blastic? Lung metastasis to the bone | Lytic (L for Lung and Lytic) |
Lytic or blastic? Prostate metastasis to the bone | Blastic (prostate builds the bone) |
Lytic or blastic? Breast metastasis to the bone | Both (Breast does Both) |
What is the most common tumor in the bone? | Metastases |
Rx: Forms a complex between topoisomerase II and DNA | Etoposide |
Rx: Alkylates DNA, toxicity=pulmonary fibrosis | Busulfan |
Rx: Fragments DNA; toxicty=pulmonary fibrosis | Bleomycin |
Rx: Blocks purine synthesis; metabolized by xanthine oxidase | 6-mercaptopurine (increased toxicity with allopurinol; activated by HGPRTase) |
Rx: Crosslinks DNA, nephrotoxic, ototoxic | Cisplatin and carbaplatin |
Rx: Nitrogen mustard, alkylates DNA (electrophil that binds DNA) | cyclophosphamide |
Rx: Folic acid analog that inhibits dihydrofolate reductase | MTX |
Rx: Prevents tubulin disassembly | Paclitaxel (-taxols); it's TAXing for microtubules to stay stuck together |
Rx: Intercalates DNA, produces oxygen free radicals, cardiotoxic | Doxorubicin and Daunorubicin (Dox and Daun the Double D twins will break your heart= cardiotoxicity, and your DNA strands!) |
Rx: Prevents tubulin assembly | Vincristine, vinblastine (BLAST the vines=microtubules) |
Rx: Inhibits thymidylate synthase--> decreased nucleotide synthesis | 5-flurouracil (5-FU) |
Rx: SERM; blocks estrogen binding to ER + cells | Tamoxifen, raloxifene |
Rx: Mechanism similar to antivirals acyclovir and foscarnet | Cytarabine |
Rx: Mechanism similar to fluoroquinolones | Etoposide |
Rx: Mechanism similar to trimethoprim | MTX |
Rx: Monoclonal Ab against HER-2 (erb-B2) | Trastuzumab (Herceptin) |
Rx: Free radical induced DNA strand breakage | Bleomycin, Doxorubicin, Daunorubicin |
Rx: Inhibitor of PRPP synthetase | 6-mercaptopurine |
Rx: Reversible with leucovorin | MTX |
Rx: Treatment for choriocarcinoma | MTX, vincristine, vinblastine |
Rx: Treatment for AML | Cytarabine |
Rx: Treatment for CML | Imatinib, busulfan |
Rx: Prevents breast cancer | Tamoxifen, raloxifene |
Rx: Applied topically for actinic keratosis and BCCs | 5-fluorouracil |
Rx: Treatment for childhood tumors (Ewing's sarcoma, Wilm's tumor, rhabdomyosarcoma) | dACTinomycin (kids ACT out) |
Rx: Inhibits ribonucleotide reductase | Hydroxyurea |
Rx: Side effect of hemorrhagic cystitis | Cyclophosphamide |
Rx: Antibody against Philadelphia chromosome | Imatinib |
What are the 10 potential side effects of prednisone use? MUST know all 10! | 1. Acne 2. Cushingoid symptoms 3. Cataracts 4. HTN 5. Hyperglycemia 6. Immunosuppression 7. Insomnia 8. Osteoporosis 9. Peptic ulcer 10. Psychosis |
Rx: Inhibits thymidylate synthase; pyrimidine analog | 5-fluorouracil |
Rx: Reversible with leukovorin (folinic acid) | MTX |
Rx: Not reversible with leukovorin | 5-FU |
Rx: Use thymidine to "rescue" from overdose | 5-FU |
Rx: Same mechanism as 6-mercaptopurine, but can be given with allopurinol | 6-thioguanine (6-TG) |
How can hemorrhagic cystitis toxicity in cyclophosphamide use be partially prevented? | By using mesna (binds toxic metabolite) |
Name 4 general drugs/drug classes that are both ototoxic and nephrotoxic. | Vancomycin, Aminoglycosides (-mycins), Loop diuretics, and Cisplatin/Carboplatin |
How can osteoporosis from prednisone therapy be prevented? | Prophylax with bisphosphonates if therapy will last longer than 3 mos |
Rx: Nephrotoxicity and acoustic n damage in a drug used to treat testicular cancer | Cisplatin, carboplatin |
The presence of which organ determines which SERM a woman should receive? | Uterus |
Women without a uterus can be given which SERM? | Raloxifene (endometrial and breast antagonist; bone agonist) or tamoxifen (breast antagonist; endometrial and bone agonist) |
Women with a uterus can be given which SERM? | Raloxifene only (endometrial and breast antagonist; bone agonist); no increased risk for endometrial carcinoma via partial agonist effects |
Treatment for doxorubicin cardiotoxicity | Dexrazoxane (an iron chelator) |
What causes hemorrhagic cystitis with cyclophosphamide use? | Urinary excretion of acrolein, a toxic metabolite |
Person with mass in upper lobe of lung. What will it stain + for? | Neurofilaments; small cell CA of lung shows evidence of neuroendocrine differentiation |
What is the main mediator of paraneoplastic cachexia? | TNF-alpha (also responsible for necrosis of some tumors in vitro); acts on hypothalamus--> appetite suppression, inhibits lipoprotein lipase, and increases insulin resistance in peripheral tissues |
What agent can limit the nephrotoxicity seen with cisplatin? | Amifostine (also aggressive hydration); prob lower yield (not in FA) |
Patient treated with MTX experiences fever, painful mouth sores, and pancytopenia. Which agent could have prevented his condition? | Folinic acid (leukovorin) |
Why is leukovorin (folinic acid) unaffected by MTX? | B/c it doesn't req' the action of dihydrofolate reductase (which is inhibited by MTX) to be converted into tetrahydrofolate. |
________ of the Rb protein results in its inactivation and allows cells with damaged DNA to proceed through the G1-->S checkpoint. | Hyperphosphorylation (activated/hypOphosphorylated Rb normally stops the cell cycle from progressing when DNA is damaged) |