Cancer Flashcards

Terms Definitions
What are oncogenes?
cancer causing genes
the process by which particulate material is engulfed ("eaten") by a cell. Prominent in predatory cells, such as Amoeba proteus and in cells of the vertebrate immune system such as macrophages 
What does metastasis mean?
Cancer cells spreading
Three common treatments for cancer
surgery, chemotherapy, radiation
benign tumors
when abnormal cells remain at the original site
Tumors reduce which class of MHC's expression?
The gene regulation systems that go wrong during cancer are the same systems that play important roles in_____ ______. They also regulate ____ ____ and ____.  
embryonic development
regulate cell growth and division
also codes for growth factors, their receptors and intracellular molecules of signalling pathways
How do healthy cells become transformed into malignant cells?
- radiation
- carcinogens
- pathogens - viruses and bacteria
What does the p53 gene do?
it encodes a tumor-suppressor protein
it is also a specific transcription factor 
it promotes the synthesis of cell cycle-inhibiting proteins for example when DNA is damaged
What is anchorage dependence? 
most animal cells exhibit this. it means they must be attached to a solid surface in order to divide (for example the solid glass or plastic surface of a culture dish)
What are the most common types of cancer (2)?
Adenomas and carcinomas
Why do well-developed countries have more cancers?
a) live longer
b) active screening
c) diet
d) pollution
What is a carcinoma?
Cancer of the body linings such as skin
what are some problems with cytokine therapies?
a) complexity of cytokine interaction
b) harder to administer
c) short half life
d) serious side effects
Mutations that knock out the p53 gene can lead to what?
excessive cell growth and cancer
What is found during cancer with fetal proteins?
Fetal proteins decrease throughout life, but are found to increase during cancers e.g growth factors
e.g CEA: Carcinoembryoic antigen      AFP: alpha-fetoprotein      Oncogenes proteins as tumor antigens          - neutrophils on human breast cancer cells           - TATA's on human melanomas: MAGE 1,
How are TIL (tumor infiltrating lymphocytes) used as therapy?-
- may have more tumor specificity activity
- need less IL-2
When a proto-oncogene is converted to an oncogene what can result from the following
a. mutation in coding sequence
b. gene amplification
c. chromosome rearrangement 
a. hyperactive protein made in normal amounts
b. normal protein greatly overproduced
c. nearby regulatory DNA sequence causes normal protein to be overproduced, or fusion to actively transcribed gene produces hyperactive fusion protein
What cells can attack and kill?
Macrophage and NK can attack. NK can also kill
Explain the mechanism for the tumor destruction via CTL activation?
Tumor cell transfected w/ B7 gene to activate CTL to destroy the tumor.
What is the role of the Ras protein?
it relays a signal from a growth factor receptor on the plasma membrane to a cascade of protein kinases
Philadelphia Chromosome
Leukemia in children
bones connective tissues
Bence Jones protein
Multiple Myeloma
What is carcinogenesis?
Cancer development
Microtubule inhibitor that causes peripheral neuropathy, foot drop (ataxia) and 'pins and needles' sensation
Tumor marker for what?
Pancreatic adenocarcinoma
"Fried Egg" Plasma Cells
Multiple Myeloma
prep-cleansing of bowel; conscious sedation; no driving for 24 hrs; barium enema; & prep-cleansing of bowel are all given to the pt prior to a ___?
Inhibits topoisomerase I, CCNS
Topotecan, Irinotecan (Camptothecins)
Soft tissue sarcoma of striated muscle
Leukemia that most commonly affects children
Neutrophilic Leukocytosis w/ a left shift
Stage 1
limited to tissue of origin
Wound heals by ____ intention?
secondary intention
secondary malignancies are ....
resistant to therapy
What is an epithelial tissue tumor called?
What is the process whereby normsl cells are transformed into cancer cells?
Defective Repair
Xeroderma pigmentosum- defect in UV damage repair, autosomal recessive
What is a lab test for parathyroid?
Hodgkin's Lymphoma- More common in men or women overall?
What is the following gene:
a/w Burkitt's lymphoma
neoplasm associated with Cirrhosis
diseases associated with HCC
Jaundice; clay colored stools, dark urine; Abdominal pain; digestive problems; gallbladder enlargement; & wt loss (late) are all S&S of ___ CA?
pancreatic CA
Are Normal & Benign Tumor Cells migratory?
what is the main disadvantage of CVAD?
Prevention of cyclophosphamide induced hemorrhagic cystitis
Hydration and mercaptoethanesulfonate (MESNA)
How much of childhood cancer is related to environmental enfluence?
Very little
-not a very accurate test for Prostate cancer-*beginning at age 50 (to men who have a life expectancy of at least 10 yrs) should have yearly PSA tests. -when men get older, their prostate gets larger (increases chance)
Epstein-Barr Virus
Produces a common infection in young adults called infectious mononucleosis. Member of the herpes family and it is a large DNA virus with as many as 150 genes.Eventually immune system recognizes virus infected cells and kills them, this eliminates the virus producing cells but DNA induced by the virus remains
What is Oncogenic theory?
Stimulus changes proto-oncongenes to mutated cell onogene. Normally immune system will control these. In cancer, growth is uncontrollable
Most common cancer to metastasize to liver?
Colon cancer
neoplasm associated with AIDS
diseases associated with Aggressive malignant Non-Hodgkin's lymphomas, Kaposi's sarcoma
What does TNM stand for?
TNM: tumor, node, metastasis.
What does T stand for in TNM?
Primary Tumor
Change in bowel habits; Feeling need to have BM that is not relieved by doing so Rectal bleeding or blood in stool; Cramping or steady abdominal pain; Decreased appetite; Weakness & fatigue; Jaundice are all SS of ___?
Colorectal CA
Nitrosureas with high lipophilicity, used for brain tumors
Carmustine (BCNU) and lomustine (CCNU)
What are some common areas of mets in Prostate CA?
venous blood flow=spread to viscera.
Evidence-based approach to cancer prevention
1. primary prevention- (immunizations, folic acid)-prevents disease from occurring @ all2. secondary-(best-screening tools)-detects early disease when it is asymptomatic & when treatment can stop it from progressing (ex.paps,mams.)3. teritary- clinical activities that prevent further deterioration or reduce complications after a disease has declared itself (prevents complications from occurring-ex.diabetic)
In colon cance: (continued)
Loss of p53- induces immortality, cells become carcinoma in situLoss/mutation of other genes- invasion of b.m. and metastisis
How does Green Tea protect against cancer?
Camelia sineensis
-polyphenols (flavonols)
-Anticarcinogenic effects in skin, lung, liver stomach...
-ECGC inhibits cancer cell growth by blocking VEGF (catechins) also have antioxidant effect
-Decrease stomach cancer by killing helicobacter pylori
What are S.E. of chemo?
Stomatisis, n/v, alopecia, GI disturbances, cardiac effects, liver and neuro toxicities, and bone marrow effects (neutropenia, thrombocytopenia, and anemia)
What is the following gene:
Tumor suppressor gene
a/w Colon cancer
chrom 18q
associated with what tumor? Hyperclacemia
paraneoplastic effects of: Squamous cell lung carcinoma, RCC, breast carcinoma, multiple myeloma, bone mets (via PTHrp, TGF-b, TNF-a, IL-1)
neoplasm associated with chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants
diseases associated with gastric adenocarcinoma
What tissue of Origin does the prefix Hemangio indicate?
blood vessel
How do you treat prostate ca?
Surgery; Radical prostatectomy; Transurethral resection of prostate; Cryosurgery; Radiation; Hormone therapy; Expectant therapy; Chemotherapy (minimal effective)
___ has a poor prognosis: 90% patients die within 1 yr of diagnosis?
Pancreatic CA
what chemo drugs are specific? (3)
1. anti-metabolites
2. mitotic inhibitors
3. topoisomerase
when is excisional biopsy used?
involve removal of entire tumor
What types of cancer is cigarette smoking DIRECTLY related to?
Lund and laryngeal cancer.
What are some S/E of Hodgkin's Tx?
Radiation: fatigue, pneumonitis, pericardial effusion, wt loss, hypothyroidism, cardiac damage, sterility, pharyngitis.
Pulmonary fibrosis.
emergence of leukemia.
Rous Sarcoma Virus
Rare form of virus that can transform tissue culture cells very quickly and form cancer in animals very soon after infectionIsolated from a stock of avian leucosis virus, which cause leukemia in chickens after prolonged incubation periodCapable of rapidly producing sarcomas after injection almost anywhere
How do Berries protect against cancer?
-Anthocyanadin is an antioxidant, decrease in DNA synthesis leading to apoptosis,
-Delphinidin (blueberry) inhibits VEGF
-Ellagic Acid (Rasberry) - Inhibits VEGF and conversion of carcinogens to toxins
What are the S.E. of Biotherapies?
Flu-like symptoms
fever, chills, HA, rigors, malaise
What neoplasms are a/w:
Actinic keratosis
Squamous cell carcinoma of the skin
associated with what tumor? S-100
name the marker: Melanoma, neural tumors, astrocytomas
associated with what tumor? Gout, urate nephropathy
paraneoplastic effects of: Leukemias and lymphomas (excess nuclear acid turnover, esp with cytotoxic tx)
U in the word caution stands for?
Unusual bleeding or discharge
What does recurrent CA mean?
Recurrent disease means that the cancer has come back (recurred) after it has been treated.
how do cancer cell escape death?
by staying in G0 phase
what is tumor lysis syndrome characterized by?
rapid release of intracellular components in response to chemo
What is the major early sign of colorectal cancer?
Blood in the stool!
What is the overall risk of Prostate CA?
0-39y:  < 1:10,000
40-59y: 1:78
60-79y: 1:6
life span: 1:5
Effects of chromosome break and repair:
remove gene from normal promotercreate fusion protein under control of different promoter or fusion protein which has oncogenic (tyrosine kinase activity) activities added to itdeletions of anti cancer genes
What is a lab test for GI cancers and ovarian?
CA 125
Least common type of Hodgkin's Lymphoma
Lymphocyte Depleted type of Hodgkin's Lymphoma
associated with what tumor? ret
name the oncogone / tumor suppressor: MEN II and III (IIB)
What are the treatments for breast ca?
Surgical options; Chemotherapy & radiation; Hormone therapy; Estrogen/Progesterone-receptor positive vs. negative tumors; Tamoxifen; Stem cell transplant; Evista; Fareston; Herceptin
what is human epidermal growth factor and how to tx it?
causes breast cancer

tx: trastuzumab (herceptin)
what are 2 types of ionizing radiation available?
1. electromagnetic radiation
2. particulate radiation
What are some diagnostic studies used to screen for Ovarian CA?
PET: for monitoring disease not screening
transabdominal U/S
Best method: manual exam & pelvic U/S. if + family hx, or risk is up to 50%.
What is Multistage theory?
when can cancer be stopped or slowed?
(1) Initiation (2) promotion &amp; (3) progression
Cancer can be stopped or slowed in the initiation and promotion stages
associated with what tumor? p16 (9p)
name the oncogone / tumor suppressor: Melanoma
associated with what tumor? WT1 (11q)
name the oncogone / tumor suppressor: Wilms tumor
What should you do for early detection of colorectal CA?
follow American Cancer Society screening guidelines
What are some of the test/procedures that can diagnose prostate CA?
PSA & DRE; Prostate biopsy; Transrectal ultrasound
what are 2 examples of skin rxn that occur in radiation/chemo?
1. photosensitivity
2. radiation recall
List the diagnostic orders on a pt with suspected Lymphoma.
CBC, chem, sed rate.
LFTs, Uric acid, calcium, protien electrophoresis
CT of chest, abdomen, & pelvis. Head if suspected.
Bone marrow (2 sides)
endoscopy, LP
Scans of involved organs.
How do Soy Products protect against cancer?
-may be reason for Cancer instance difference between asia and NA.
-Geinsten from Glycine Max(Soybeans) competes with estrogen for its receptors. Less response than estrogen, partial agonist (decrease in breast and ovarian).
-Soy isoflavones resemble estrogen
associated with what tumor? Alkaline Phosphatase
name the marker: Mets to bone, Paget's disease of bone (excess osteoclast activity), obstructive biliary disease
What is the Most commonly bladder CA growth and where does it grow?
Most commonly papillomatous growths in bladder urothelium
permenant cessation of menses occurs at what measurement in radiation?
500-1000cGy in 95% of women less than 40 y.o
when does tumor lysis sydrome usually occur?
within the first 24-48hrs after chemo and persists for a week
Why can viral DNA integrate or leave the host DNA?
Viral DNA contains sequences on both ends of the DNA molecule that facilitate integration, the process is analogous to genetic recombination.
Stage ___: CA has spread beyond the primary site?
stage IIA: cancer has spread beyond the primary site
why are chemo/radiation pt at risk for infection?
what can be done?
b/c of neutropenia

-give wbc growth factors (neupogen)
What are the 3 genes retroviruses code for?
The gag gene codes for capsid proteins in the nucleocapsidThe pol gene codes for the reverse transcriptase enzymeThe env gene codes for the envelope glycoprotein
What are the 4 major types of Lung Cancer?
Four major types: Small cell carcinoma (oat cell); Adenocarcinoma; Squamous cell; (non-small cell); Large cell
How are Lymphomas classified & why is this important?
Tx based on type of tumor & less freqently by stage. Classified by pattern & rate of growth.
Low Grade: middle age/older, longer survival.
Intermediate Grade: short survival,
High Grade: aggressive, short survival.
what is okay for pt as far as CBC is concerne with chemo/radiation pt and when?
common to have lowest blood counts (aka nadir) between 7-10day s after initiation of therapy
bcr-abl hybrid
Stage 4
T/F Lung->Prostate/Breast CA->Colorectal-> Pancreas->ovary->Lymphoma->Leukemia is the breakdown statistics of the highest % to the lowest % of CA deaths?
Inhibits ribonucleotide reductase, which converts ribonucleotides to deoxyribonucleotides for DNA synthesis
c-myc gene translocation
Burkitt's Lymphoma
Toxicities of Doxorubicin
myelosuppresion and cardiotoxicity
asco:antiemetics 2006
3 drug combination:5-OHtryptamine serotnin receptor antagonist (ondansetron) + dex + aprepitant for high risk;  aprepitant only for highly emetic;
CD30+ and CD15+ B-cells
Hodgkin's Lymphoma
Liver mets
&quot;Cancer Sometimes Penetrates Benign Liver&quot; (Colon &gt; Stomach &gt; Pancreas &gt; Breast &gt; Lung)
Blows DNA (breaks DNA strands), limiting SE is pulmonary fibrosis
Newer estrogen receptor antagonist used in advanced breast CA
Toremifene (Fareston)
New anticancer drug that inhibits tyrosine kinases, sarc and abl. Very effective on chronic myelogenous leukemia, has almost no side effect.Does't cure leukemia because mutations in p53 and p16 can cause a leukemic cell to override Gleevec's effects.
Lacunar Cells
type of Reed-Sternberg Cell
a/w Nodular Sclerosing type of Hodgkin's Lymphoma
What neoplasms are a/w:
Aggresive malignant lymphomas(non-hodgkins) &amp; Kaposi's sarcoma
a/w EBV
Hodgkin's Lymphoma &amp; Burkitt's Lymphoma
What does Mo mean?
No distant metastasis
Prostate CA grows fast/slow?
Grows very slowly
Constant proportion of cell population killed rather than a constant number
Log-Kill hypothesis
Is the latency period of childhood cancer short or long?
True or false:
A PSA maybe increased with BPH
What is Colchicum autumnale?
Historical: Gout
Modern: Colchicine (alkaloid)
-inhibits spindle formation during mitosis.
2nd most common cancer in females?
Lung (13%)
3rd most common cancer in males?
Colorectal (12%)
2nd most common cancer in males?
Lung (16%)
T/F Nearly five million lives have been lost to cancer since 1990. In 2000, about 1,220,100 new cancer cases are expected to be diagnosed?
Medical; Chemotherapy & radiation; surgical; pulmonary resection lobectomy; pneumonectomy; and laser surgery are all ____ treatments?
lung cancer treatments
radiation vs chemo, which one may cause more wbc suppression?
appearance under microscope is same as tissues where they came from, remain localised and do not spread. Do not cause problems unless grow in confined space
What is the lack of differentation in cancerous tissue called?
Deletion of chromosome 13. To get the tumor both copies of chromosomes in the same cell had to have the deletion. Thus, it was the loss of both copies of a gene on chromosome 13 that led to cancer.
What is Laterile?
Apricot pit
-Selective death of tumor cells from cyanide
-Clinics in Mexico, cyogenics being tests again as treatment
Lymphoma a/w jaw lesions in the endemic form in Africa
Burkitt's Lymphoma
Exercise and arm elevation; Physical therapy; Gentle massage; & compression sleeve are some nursing care given for _____ patients post op?
breast CA patients
What does Tx mean?
Primary tumor cannot be assessed
Skills; O2 therapy; post-op care; positioning-Simi-fowlers; & side-to-side are all nursing care required for what type of pt?
lung CA pt
Name 4 target therapy
1. tyrosine kinase inhibitors
2. monoclonal antibodies
3. antiangiogenic agents (VEGF)
4. proteasome inhibitors
Pyrimidine analog that causes 'Thymine-less death' given with leucovorin rescue
(Pyrimidine antagonist, CCS - antimetabolite)
List somethings that may elevate a PSA.
Prostate CA
Urinary retention
Pelvic Trauma
Pros. Needle Bx.
Prostate volume
Black race
Hereditary Polyposis Coli
caused by an inherited, mutated or deleted APC gene. The initiation starts with a mutation in this gene.
DNA damaged induced by the Epstein-Barr virus can lead to 4 cancers
Chronic Myelogenous LeukemiaBurkitt's LymphomaHodgkin's LymphomaNasopharyngeal Carcinoma
What is a lab test for Pancreatic, colon?
CA 19.9
Lytic or blastic?
Breast metastases to bone
Both lytic &amp; blastic
neoplasm associated with Plummer-Vinson syndrome (iron defiency --&gt; anemia, esophageal webs, atrophic glossitis)
diseases associated with Squamous cell carcinoma of esophagus
What tissue of Origin does the prefix Melano indicate?
Pigment-producing skin
Stage ___: CA has spread to nearby areas but is still inside the primary site?
Stage II
what are common problems associated with radiation in terms of respiratory?
1. pneumonitis
2. cough
3. dyspnea
Endogenous hormones increase the risk of which cancers?
Breast, ovary and endometrial cancers.
Define Stage 4 Lymphoma.
Either of the following define stage 4:
Spread in more than one spot to organs outside of lymph system.
Spread only to one organ but distant nodes involved.
Loss of anticancer genes
Both must be lost to produce malignancy but if you inherit a defective gene you are much more likely to get cancer due to spontaneous loss of other copy
What are the common manifestation of grieving: spiritual?
Q past beliefs, hopelessness
Bilobed Tumor Giant Cell that looks like &quot;owl's eyes&quot;
Reed-Sternberg Cells
a/w Hodgkin's Lymphoma
associated with what tumor? B-HCG
name the marker: Hydatidiform moles, Choriocarcinomas, Gestataionl trophoblastic tumors
neoplasm associated with actinic keratosis
diseases associated with squamous cell carcinoma of skin
______ is very early cancer and the abnormal cells are found only in the first layer of cells of the primary site and do not invade the deeper tissues?
Carcinoma in situ
Breast CA common sites of metastasis is?
Bone*, lung*, liver, brain
what is the tx for hypercalcemia (3)
1. hydration
2. diuretics
3. biphosphonate (like zometa or aredia)
radiation can be delivered what 2 ways?
1. externally (teletherapy)
2. internally (brachytherapy)
What is the tx for Lymphoma?
radiation: neck, chest, nodes
can be used alone or with chemo.
chemo: usually 14-21d cycles of either CHOP or CHOP & bleomycin.
Cancer and Inheritance: 3 Kinds of Susceptibility
Defective repairIncreased chemical activation of carcinogensLoss of anticancer genes
What is Viral theory?
Genes from viruses affect a N host cell during mitosis
What are some special precautions for the health care worker using chemotherapy?
use specialized equipment
wear gloves and gown when exposed to body fluids of pt
wash hands immediately if any exposure to drug
associated with what tumor? ras
name the oncogone / tumor suppressor: Colon carcinoma
associated with what organ? Alkylating agents
name the associated toxin: Blood (leukemia)
What surgery is done to determine whether CA has spread?
Axillary dissection (to determine whether CA has spread)
What % of Breast CA is Infiltrating ductal carcinoma?
Infiltrating ductal carcinoma (70-80%)
~ 25% found of ____ CA is found at early stage? (Hint leading cause of reproductive malignancies)
Ovarian Cancer
what are s/s of cardiac tamponade?(9)
1. heavy feeling over chest
2. SOB
3. tachycardia
4. cough
5. hiccups
6. hoarseness
7. distant or muted heart sounds
8. extreme anxiety
9. extreme perspiration
why is targeted therapy good?
it kills more cancer cell without killing normal cells
Define State 3 Lymphoma.
Cancer is in lymph node areas on BOTH sides of diaphram.
Spread to other organs near the nodes or to the spleen.
Integration of virus DNA
can occur randomly at any place in the host DNA. The virus DNA can also be cut out of the host DNA to become a free floating cyclic DNA again.
2nd most common type of Hodgkin's Lymphoma
Mixed Cellularity type of Hodgkin's Lymphoma
associated with what tumor? DPC (18q)
name the oncogone / tumor suppressor: Pancreatic cancer
What surgery is the removal of entire breast & the axillary lymph nodes?
Modified radical mastectomy (removal of entire breast & the axillary lymph nodes)
What is the growth of Normal and Embryonic Cells?
The Growth is Well regulated
how is the skin care for desquamation?
1. NS compress
2. modified burow solution soaks with moisture vapor pemeable dressing or vaseline petrolatum gauze
Sequences that allow the virus to enter the genome of the host
LTR or long terminal repeat sequences flanking both ends of the virus genome. The LTR also contains the virus promoter which insures it gets transcribed.
Weight loss may be due to ______? what should you do to solve this problem?
small meals, high caloric, avoid noxious odors
At what age should a man that is at HIGH RISK for Prostate CA start getting tested?
Age 45 (high risk)
What are the benefits of breast reconstruction?
Goals: Symmetry & Contour; benefits that women still look normal and have a better self esteem related to their image
what is the goal of tumor lysis syndrome mgmt?
what is the tx?
prevention of ARF

tx: hydration and allopurinol
What are the expected findings on a DRE for a pt with Prostate CA?
Usually a hard nodular and irregular legion.
Nonelevated with compressible tissue around it.
Remember that rapid development of s/s is suggestive of CA.
What % of Men and Females have corectoral cancer in the sigmoid colon?
Sigmoid colon M 25% F 23%
What is a Lyphoma & what is the most common type?
A neoplastic transformation of cells in lymphatic tissue. 80% are B type. It is the most common neoplasm from 20-40yrs of age.
What are the risk factors for pancreas CA?
Age, gender & race: Over 50, male; Cigarette smoking; Diet: High fat, meats, low in fiber; Chronic pancreatitis; Family history; Currently no tests are available for early detection
what shoud be avoided in tx filed areas skin?
1. heat pad
2. ice pack
3. hot water bottles
What are the 5 yr survival rate of liver CA based on stage?
19% if localized to the liver; 6.6%if regional: lymph nodes or just beyond the primary site; 3.4% for metastatic disease; 3.3% for unstageable disease.
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