Oncology I 2 Flashcards

tumor suppressor gene
Terms Definitions
AML/M6
-Erythroleukemia

>50% erythroblasts in bone marrow
Busulfan
Myleran

Ankylating agent
carcinoma
cancerous tumor (malignant)
MPDs (6)
-"Pre-leukemic disorders"
CML**
-Chronic Neutrophilic leukemia
-Chronic Eosinophilic Leukemia/HES
-Polycythemia Vera
-Essential Thrombocytosis
-Primary myelofibrosis
Clonarchis Sinesis bug
Biliary Cancer
Leukocoria
-sign of retinoblastoma
-pupil reflects incident light due to the tumor in the vitreous chamber
-pupil is not black as it should be
Cyclophosphamide
Cytoxan

Ankylating agent

side effect - hemorrhagic cystitis
Prevents tubulin dissasembly
Paclitaxel and -taxols
BRCA2 tumor suppressor gene
Breast cancer
Examples of growth factors
EGF/TGFα, TGFβ
enchondroma
benign hyaline cartilage lesion centrally in bone. asx and occur in hands
Pegfilgrastim
-polyethylene glycol attached, higher MW, which decreases clearance
-longer half life, but clearance increases as neutrophils recover (self regulating)

**only given once after chemo!
Side effects: fever, bone pain, increases in uric acid, LDH, alkaline phosphatase, rash

Downside: EXTREMELY EXPENSIVE
Blast crisis
-resembles acute leukemia
-profound block in differentiation of cells

2/3 of cases are AML, 1/3 ALL
-inevitable progression within 3-5 yrs after dx and 3-18mo after accelerated phase
Accelerated phase
-increasing WBC
-increasing splenomegaly, tissue infiltration
-need more intensive myelosuppression therapy
-impairment of neutrophil differentiation
-increasing left shift
-increasing circulating and BM blasts

-still good myeloid cell maturation (unlike AML/ALL)

**percentage of blasts is <20%
Other anal cancers include (4)
basoloid
adenocarcinomas
melanoma
mucoepidermoid
Mucositis
Inflammation of any mucus membrane
Strep. Bovis
Colon cancer and bacterial endocarditis.
malignant
tending to become progressively worse and to cause death, as in cancer
What neoplasms are associated with salted fish (Chinese style)?
Stomach
Which neoplasm does estrogen replacement without progestin highly increase the risk for?
Endometrial cancers
Osteosarcoma
teen during growth spurtmetaphysis of long boneslocal pain and swelling, often hx of injryusunburst on XR
Erythropoietin (Epo)
30-50% of patients respond

*treats anemia from chemo ONLY IF THERE ARE ALREADY ADEQUATE IRON STORES (ex: cisplatin effects on kidney reduce erythropoietin production)
-do iron studies before tx, if iron low, replete iron first

*Side effects: HT, rash, arthralgia

**At 12 Hgb, stop treatment until Hgb drops below 12 again (above 12 can cause death)

-Procrit (short acting, every 1-2 weeks, but works faster to increase HgB) or Darbepoetin (long acting, every 2-3 weeks)
-reassess every 4-6 weeks (should have >1Hgb increase)

Note: **this is ONLY used for chemo patients, not all cancer patients w/ anemia
Presentation of PMF
-nonspecific systemic symptoms, fatigue
-marked HSM
-anemia
-high or low platelets and WBC counts
Tumor markers
-cell surface antigens, cytoplasmic proteins, enzymes, hormones
**NOT diagnostic of cancer!! can be elevated in reactive or inflammatory conditions (ex: PSA)

*indicators of the recurrence of a tumor, or support diagnosis of cancer; can be used to monitor response to therapy (PSA for prostate, CEA for colonic adenocarcinoma, AFP for hepatocellular carcinoma and germ cell tumors, or CA-125 for ovarian carcinoma)

-can be detected in plasma or body fluids
The presences of microvilli enhance the process of ____.
absorption
Paracortial hyperplasia is a proliferation of what?
T lymphocytes
electrosurgery***
high-frequency electrical currents destroy cancer cells
excisional*** cutting cancerous tissue with scalpel remove it and surrounding tissue
many types excisional surgeries each named for particular area of body or particular purpose
Bands
An immature developing leukocyte in the circulating blood
SE of hemorrhagic Cystitis
Cyclophosphamide. Can cause hemorrhagic cystitis
Relative contraindications
 
to TACE
 
Serum bilirubin >2 mg/dL
Lactate dehydrogenase >425 units/L
Aspartate aminotransferase >100 units/L
Tumor burden involving >50 percent of the liver
Cardiac or renal insufficiency
Ascites, recent variceal bleed, or significant thrombocytopenia
Which specific gene does smoking cause mutations in?
p53
Primitive neuroectodermal tumors (PNET)
metastisize within CNS. medullloblastoma, supratentorial PNET, ependymoblastoma.
What is MGUS?
-monoclonal gammopathy of unknown significance
*most common plasma cell dyscrasia (2% of population over 50!)
-associated with autoimmune disease (immune response not shut off after response to infection, antibody production continues)

*incidental diagnosis
-prognosis is good, 1%/yr progression
Primary PCL
-no preceding diagnosis of MM (5%)
-emerge with ability to travel in bloodstream
-bias towards IgA
-patients present with extensive lytic bone lesions
-same tx as with MM (transplant, etc..leukemia tx don't work)
Stage 0 breast cancer
T0N0M0 ... in situ
CML epidemiology
-low incidence; 20% of adult leukemia
*people live a long time so prevalence is high
Risk factors for PMF (3)
-ionizing radiation
-benzene
-thorium dioxide
The _____ stores and concentrates bile
gall bladder
The large intestine lacks the ___ present in the small intestine and is made up of a series of ___, called ___.
villi
pouches
haustra
Complications of high dose in colorectal ca mostly involve the
small bowel
What hormone is measured in patients with Thyroid cancer to rule out "Medullary" subtype?
Calcitonin
Median age of breast cancer in women
61
What Ig type do Burkitt's cells express?
IgM
TNM staging
Tumor
Nodes
Metastases
each categorized separately classified with number total stage TINIM0 TI tumor/NI lymph node involvement M0/no**** metastases
Xerostomia
Dry mouth- usually caused by salivary impairment caused by cancer treatment.
leiomyoma
a benign tumor composed of nonstriated muscular tissue.
in vitro
within a glass, observable within a test tube
for indolent lymphoma PET scan ?
not needed yet
What are the molecular prognostic factors for early stage breast cancers
Estrogen receptor/Progesterone receptor; HER2/neu; 21-gene recurrence score
Is a higher or lower therapeutic index desirable?
Lower
What is multiple myeloma?
-clonal proliferation of terminally differentiated, Ig secreting plasma cells; it is a post-germinal center B-cell that have the ability to mature to plasma cells
-can switch Ig class, because it is not yet committed to a particular class
What are ringed sideroblasts?
-dysplastic erythroid precursors w/ iron laden mitochondria surrounding nucleus
Chronic Eosinophilic Leukemia
-rare clonal chronic MPD like disorder
-dysplastic eosinophils in BM, peripheral blood overproduced
-secondary cause of eosinohpilia must be excluded (infection, allergy, etc)
-exclude eosinophilic variant of CML (PH+) or AML-M4 (inv16)
Pancreas ca occurs slightly more in __ than in ___ with an age rage of __-__
men
women
65-80
__ __ for the columnar epithelium reside in the crypts of Lieberkuhn
Stem cells
It is of fecal material through the colon in western culture because of the refined ___ and lack of unabsorbed ___.
carbohydrates
cellulose
It is difficult to treat small bowel w/ RT because it is a _____ target
moving
What two races experience the highest cancer rates?
Caucasian, African-American
Which has a higher incidence of CNS disease, AML or ALL?
ALL
How do patients with precursor T-cell often present? (unique to this phenotype)
Mediastinal mass
sarcoma 2 types
soft tissue tumors/bone tumors***** rare**** children young mostly in arms/legs
most common bone sarcomas
osteosarcoma**** tumor ends of long bones where new bone tissue forms
Plasma Cell
A cell that originates from B-cell Lymphoctyes and secretes an antibody
Alpha Fetoprotein marker
Hepatocellular carcinomas (Hep B and C pts). Yolk sak tumor of testis.
summary of follicular thyroid cancer
Follicular thyroid cancer, a well-differentiated tumor of thyroid epithelium, is the second most common type of thyroid cancer after papillary thyroid cancer. It is more common in iodine deficient areas, and tends to occur in an older population when compared to papillary thyroid cancer. (See 'Clinical presentation' above.)The diagnosis of follicular thyroid cancer usually occurs during the evaluation of a cold thyroid nodule. FNA biopsy alone cannot distinguish between follicular adenomas and cancers. Microscopically, the diagnosis of follicular cancer requires identification of tumor extension through the tumor capsule and/or vascular invasion. (See 'Pathologic features' above.)Most FTCs contain either RAS mutations or a PAX8-PPAR gamma 1 rearrangement but not both, indicating that similar yet distinct molecular events may originate with these two oncogenes. (See 'Molecular pathogenesis' above.)Important prognostic features include stage, age, and tumor characteristics (tumor size, vascular invasion, capsular extension, histologic grade, and distant metastases). (See 'Prognostic features' above.)Therapy — The treatment options available for follicular thyroid cancer are the same as for all differentiated thyroid cancers [30]. The optimum
tyrosine kinases receptor
which include the EGFR (also called HER1 or ERBB-1) and the epidermal growth factor receptor 2 (ERBB-2, also called HER2).
3 main components of cytoskeleton (in order from smallest to largest)
Microfilaments, intermediate filaments, microtubules


What type of carcinogen is UV-B?
Initiation agent (causes sunburn)
Pathways of Metastasis (3)
1) Direct seeding of body cavities/surfaces
2) Lymphatic spread
3) Hematogenous spread
How do you diagnose CLL?
-lymphocytosis >5000 / uL
-30% lymphocytes in BM
-<50% immature lymphocytes in peripheral blood (> would instead lead to dx of prolymphocytic leukemia diagnosis)
-clonal expansion of abnormal B cells

*Note: some ppl have CLL cells under 5000 count (analogous to MGUS) but never get CLL
TK inhibitor mechansim
-competes with ATP for binding to kinase catalytic domain
What is overexpressed in ET?
platelets and bone marrow megakaryocytes
Refractory anemia with excess blasts
-cytopenias
-excess blasts (5-9% in type I, 10-19% in type II)
What are the histochemical characteristics of AML?
-myeloperoxidase (in primary granules of granulocytic precursors)
-lysozyme

-non specific esterase in the monocytic subtype (M5)
Small intestine cancers via ___ ___ or ___ and ___ system
direct extension
lymph
blood
___ and ___ are treatment of choice for locally advanced, unresectable tumors of the pancreas
RT
Chemo (5FU/leuovorin)
How is small cell lung cancer treated?
Chemotherapy +/- radiation
Progesterone with estrogen ___________ the risk of breast cancer.
markedly increases (compared with estrogen alone)
What are the cytogenetic abnormalaties commonly seen in AML? Designate prognosis of each as good or poor.
t(15;17) [acute promyelocytic leukemia] - good
t(8;21) - good
t(16;16) - good
-5 - poor
-7 - poor
T
classifies extent primary tumor T0-T4 T0=non invading tumor to local tissues ******IN SITU T4 large primary tumor invaded other organs direct extension/inoperable******
N
classifies amount regional lymph node involvement only from draining area of primary***** tumor N0/no lumph node involvement N/4 extensive involvement combo nodes involved
radiation therapy 2 forms
external/internal**** sometimes both needed
external radiation machine aims rays at specific area of body outpatient no radioactivity in body after treatment
In the process of carcinogenesis, which two stages can be stabilized or reversed if the cell has the ability to repair the genetic alteration?
Initiation and promotion stage
Most common translocation in Anaplastic LCL Alk +
t 2;5 ALK and NPM1
active modes of cancer prevention:definition and examples
being proactive in preventing cancer; eg vaccination against oncogenic viruses, dietary modifications, antihormones
Properties of dependent stage neoplasm
Preneoplastic lesion arising from a spontaneously initiated cell is still completely dependent on promoting agent
How does clonal hematopoiesis occur? (MPDs)
-acquired dominant bone marrow disorder
What is the staging system for MM?
-Durie/Salmon

-presence vs. absence of:
anemia
hypercalcemia
lytic bone lesions
amount of M protein
presence or absence of renail failure

*if all absent, stage I; if grossly abnormal, III, in middle is II

*if renal failure, add a B; if absent, add an A

**NO STAGE IV

Note: in D/S, IB is worse than IIIA (unlike with TNM system where IIIA is worse than IIB)

Now use a new ISS prognostic scoring system like the IPI using just two parameters
The duodenum start at the ___ ___ in the stomach and eventually joins the jejunum ___ to the stomach
pyloric opening
posterior
Chronic symptoms of colorectal ca RT include (5)
-persistant diarrhea
-increased bowel frequency
-urinary incontinence
-bladder atrophy
-proctitis
Why are hematopoietic stem cell transplants (HSCT)used in cancer treatment?
restore hematopoietic function asap after high dose chemo treatment
Exposure to what is a risk factor for CLL?
Agent orange
cervix
Pap test/smear cancer of the cervix cells rom cervix under microscope detects cancer/changes
colon/rectum
colorectal cancer over 50 family histoy sometimes bleed fecal occult blood test checks for blood in stool
chemo in cycles treatment period/recovery period injection into vein IV into muscle or under skin or mouth
sometimes through catheter stays until treatment over into large vein in arm/chest
treated with surgery radiation therapy chemotherapy hormone therapy biological therapy one/combo
clinical trials research studies treatment options evaluate promising new theapies scientific questions
sx for TCC in muscle invasion
be aggressive man - bladder prostatectomy- b/l pelvic LN total cystectomy, hyster and oophro salpinog, and b/l pelvic LN
What carcinogenesis model are federal regulations based on and what is the problem with this model?
MKV multihit model of carcinogenesis, problem is in the model all stages are irreversible


What class of drug is Gefitinib and what is its target?  How does this affect the neoplasm?
Small molecule protein kinase inhibitor; EGFR, blocks growth of neoplasm
Genetic alterations of solid tumors
-much more complex, hard to isolate targets for drugs in order to treat
-in comparison to sarcomas and hematopoietic cancers, which are due to translocations, etc. as discussed before
Three properties of the acute leukemic cell
1) survival and proliferation
2) impaired differentiation
3) self-renewal (possibly via the Wnt signalling pathway)
What are lab findings associated with CML?
-low leukocyte alkaline phosphatase (LAP) = how you tell infection from CML
-splenomegally
-mild anemia
-WBC > 100,000
-high platelets (>600,000)
Most important factor in determining the treatment and prognosis of a tumor
-histologic diagnosis!
-made by a surgical pathologist
-benign or malignant
What is the preferred diagnostic test for colon cancer. Why?
Colonoscopy; permits biopsy for pathologic confirmation

-BE/CT colonoscopy if cant reach rectum or obstructive tumor
The FAB L3 morphology of ALL is classically associated with what? (3)
Blue cytoplasm
Prominent cytoplasmic vacuoles
Abnormalities of the c-myc oncogene
foods containing fiber nutrients help protect against some cancers
reduce cancer risk healthy food choices fiber vitaminss minerals low in fat fruits vegies whole-grain breads cereals less eggs less high-fat meat/dairy products
What happens when abnormal cells develop and then migrates?
abnormal cells detach itself to migrate onto normal cells...they spread throughout body.
what increase risk of transformation in ET - ( cytogenetics)
17 p deletion, no increase with HU
What is a common biomarker?
Serum AFP (low in normal, high in cancer)
How do you treat aggressive NHL lymphoma that has is localized?
-determined by who can tolerate tx

-3-4 cycles chemo+XRT
-or 6-8 cycles chemotherapy (if tolerated, sufficient if not over-treatment of disease)

-or XRT (rare)
What is expressed on CLL cells?
-CD19,20,24

**CD5 is the ONLY T cell marker expressed on the CLL B cells
-B cell is monoclonal, either kappa or lambda light chains
-low density Ig (IgD?)
Doses for long term palliation of colorectal ca ____ split course. ____ for definate course
4500-5000 cGy split course
6000 cGy definate course
What is removed in a modified radical mastectomy?
entire breast
skin, nipple, & areolar complex
pectoral fascia and nodes
when blood cells affected more infecstions/bruise/bleed/weak/tired cells in hair roots line digestive tract=hair loss nausea vomiting diarrhea
hair loss major concern sometimes hair thins/loss all body hair prepare wig/hat
What does nucleus/cytoplasm raito in abnormal cells mean?
nucleus is larger and cytoplasm is smaller in amount
role of del 11 i CLL/ SLL
CLL with del (11q)h,j · Outcomes aremore favorable in patients with 11q deletion who receive regimens containing an alkylator.
What class of drug is BIBW 2993 and what is its target?  How does this affect the neoplasm?
Small molecule protein kinase inhibitor; EGFR and HER2/neu; blocks growth of neoplasm
Has this corresponded with a decrease in mortality for breast cancer?
-yes
-more women are treated at a stage that is more curable
When should you biopsy a breast mass?
all suspicious masses on PE and mammography
-non suspicious mass if persists through 2 menstrual cycles
Which has a higher remission rate, ALL or AML?
ALL
(95% at day 28 of therapy)
Most common translocation in maltoma
T11;18 API2 and MALT1T 14;18 Ig H and MALT1t 1 ;14 Bcl10 and Ig H "


What does an IARC evaluation of 3 mean and what evidence is there of carcinogenicity?
Agent is not classifiable as to carcinogenicity, inadequate evidence in humans, and sufficient in animals but carcinogenic mechanism is not operable in human
Which stage of B cell is overproduced in classical HL?
-Mature B cells from the germinal center that have undergone IgH rearrangement
What will the total white count be (low, high, etc.) in a patient presenting with AML?
It can be elevated, normal, or low
RIT- zevalin ( Y 90 ibritumomab tiuxetan ) and tositumomab I131- use in /
effective in tumor less than 5 cm , chemo senstive, dont give to - MArrow more 25 % / cytopenia prior RT to marrow
What is the role of allogeneic SCT in MM?
-very toxic with chemo and radiation .. not currently used
t 14;18 in ???
FL in 80 -90 % and in 10 - 20 % DLBCL produce BCL 2 - inhibit apoptosis
Small B cell NHL Immunophenotype ( distinct)
CD 5 only in SLL, MCL/ CD 23 is never + in MCLMCL allways Cyclin D 1 + FL- always and only CD 10 + all Bcl @ +
/ 125
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