Oncology 2 Flashcards

tumor cells
Terms Definitions
Irinotecan
Camptosar

Camptothecins
Ifosfamide
Ifex

Ankylating agent
N-Ras
melanomas, hematologic malignancies
Review p. 261
-markers
Imatinib
Gleevec

Tyrosine kinase inhibitor
erb-B2
Breast, ovarian, gastric carcinomas
Hepatoblastoma
<3yrs beckwith-wiedemannlarge asx abdominal mass. R lobe of liver. weight loss, anorexia, v, abdmoina pain later. mets to regional lymph nodes and lungs.AFP elevated in most bili, LFT normalanemia common, thrombocytosis commoncheck HBV, HCV
AML/M2
Myeloblastic leukemia with maturation

*all stages of granulocytes present; granular blasts

*t(8,21)
Alkylates DNA. Toxicity= Pulm Fibrosis
Busulfan
Shistosoma hematobium bug
SCC of Bladder
benign
not malignant, nonrecurrent, favorable for recovery
What do lectins bind to?
Sugar
Palonosetron
-newest 5-HT3 antagonoist
-one dose per cycle of chemo (long half life, can be dosed every 5-7 days, whereas others only last a few hours)
Does MDS progress to AML?
Yes
Heterotopia
-ectopic rest of normal tissue
Open biopsy
local anesthesia
MOST RELIABLE
if needle biopsy is neg in a suspicious lesion, you must perform an open biopsy
AIDS associated with
malignant lymphoma's (non-Hodgkins) and Kaposi's Sarcoma
Alkaline Phosphatase
Metastases to bone, obstructive biliary disease, paget's disease of Bone.
marker for NSCLC
EFGR- K rasEML- ALK
Common medicinal carcinogens
Estrogens, Steroids, Ionizing radiation, Immunosuppressive drugs, alkylating agents
When does angiogenesis occur in neoplasms?
Progression
Type I Cryoglobulinemia
-monoclonal Ig, usually IgM
-associated w/ underlying lymphoproliferative disorder (need abnormal B cell clone)

*does not activate complement, no systemic inflamm
-hyperviscosity, small vessel obstruction, digit gangrene
Gompertzian curve
-mathematical model describing tumor cell growth
-tumor cells grow exponentially in the early stage
*tumor takes constant amount of time to double
-Growth fraction is high
**as tumor grows, doubling time and growth fraction slowed due to lack of nutrients, etc.
Metastasis
-tumor lesions discontinuous with the primary tumor
*primary tumors have preferential locations for metastasis, but not exact
-lets cancers penetrate, vessels, lymph, body cavities

*risk factors: more aggressive, more rapidly growing, larger the primary neoplasm
Serum Alkphos elevation could mean liver or ________mets
bone
What is the treatment for DLCL?
R-CHOP
FIGO
(staging) Federation of Gynocology and Obsteterics
myoma
a tumor composed of muscular tissue.
Inhibitor of PRPP Synthetase
6-MercaptoPurine (allopurinol causes toxicity because it blocks xanthine oxidase)
inflammation
response to injury or destrcution of tissue characterized by redness, swelling, heat and pain
If a patient lacks both estrogen receptors and progesterone receptors, is their odds response high or low?
Low
What type of carcinogen is cigarette smoke?
Complete
Ewings sarcoma
teensdiaphyses of long bones and flatlocal pain, feveronion skinning on XR, mets to lungs, bones.
Treatment for refractory patients?
-IFNa
-anagrelide if really refractory
-allopurinol to treat hyperuricemia
Thrombohemorrhagic complications of MPD
-arterial and venous thromboses
-microcirculatory disorders like erythromelalgia (painful red fingers and toes)
-mild, mucosal bleeding episodes
Bleeding occurs in over ___ of symptomatic patients w/ small intestine ca
half
In small intestines membranes inflame aka ulcerative colitis
Chron's Disease
It is called the small intestine because its ___ is smaller than that of the large intestine.
lumen
Results in colorectal ca RT are somewhat better for cancers which arise in the ___ colon then for cancer in ___ colon or ___.
right
left
rectum
Colon and rectum ca are associated with the ___ highest overall death rate in the US for any site, where males and females are equally affected
2nd
The incidence of lower alimentary tract tumors are very low in ___ and ___ in contrast to the hight rate of stomach and esophageal ca in these countries
Japan
Finland
Chemotherapy treatment puts patients at risk for what two types of cancers?
secondary leukemias
solid tumors
What percentage of ALL cases are positive for T-cell markers?
~15%
Cancer Biology
arises from normal cells- transformed by contact with a carcinogen( any substances that damages cellular DNA) and alters growth.
Well-Differentiated
Cancer cells that closely resemble the tissue of orgin
Treatment for childhood tumors (Ewings, rhabdomyosarcoma, Wilm's Tumor)
Dactinomycin (children dACTinomycin out)
ET dx r/o ??
reactive thrombocytosis,PV, CML, MDS, PMForder iron study, PFA, JAK2 , smear, and BM bx
BCL6 ?
at 3q27, a zinc finger trnscription factor, expresssed by germinal center B cells tanslocation to var or 14 lead to deregulated transcriptionmost common in DLBCL or FL
Why are oncofetal antigens expressed on tumors?
Evolving karyotypic instability
Choroid plexus tumors
most common brain tumor if <1yrintraventricular from chorioid plexusincreased ICP
Steps in carcinogenesis: promotion
-REVERSIBLE biologic processes that can favor neoplasm development (stimulate proliferation of initated cells)
-do NOT cause genetic damage
Types of treatment (6)
-single agent
-combo chemo (many agents)
-combo chemo/radiation together
-sequential therapy (combination of chemo followed by another single or combo of chemo)
ex: AC--&gt; Docetaxel
-immunotherapy
-hormonal therapy
-other combinations (radiation and surgery)
How do you detect cell surface antigens (CDs)?
Flow cytometry
What are myelodysplastic syndromes?
-clonal hematopoietic stem cell diseases that can't properly differentiate
-cytopenias with cellular BM (NOT aplastic anemia, just have dysplasia), dysplasia, and ineffective hematopoiesis in 1+ cell lines
-variable progression to acute myeloid leukemia
-may be de novo or after therapy
What is leukostasis?
-while some patients present with leukopenia and have few blasts in peripheral blood, patients can also present with leukocytosis resulting in stasis of blood flow in pulmonary and cerebral circulation
-blast count above 50,000

cerebral leukostasis = headache, visual disturbance, confusion, progresses to coma/stroke

pulmonary leukostasis = dyspnea, tachypnea, crackles on physical exam, infiltrates

**Much more common in AML b/c blasts are larger and have adhesion molecules
Gall bladder is located in __Q, behind the ___
RUQ
liver
The slpenic flexure is in which quadrant
upper left
Etioligical factors appear in cancers of the lower alimentary tract (2)
familial polyps
ulcerative colitis
The colon that crosses obliquely to the left
transverse colon
Signs of proximal colon ca
fecal occult blood, anemia
Aspirin and NSAIDS are used as chemoprevention for __________
colorectal cancer
What is the most common type of NHL?
DLCL
extra rest necessary external radiation permanent darkening or bronzing of skin in treated area hair loss skin red dry tender itchy decrease wbc (fight infection)temporary
chemotherapy****
drugs kill cancer cells neoaduvant chemo drugs given before surgery shrink tumor
adjuvant chemo drugs after surgery
Cancer staging/grading
Classifies the cancer according to its clinical presentation- determines exact location.
Beta-hcg can cause gynecomastia
Treatment of seminomatous testicular cancer?
Actinic Keratosis associated with
Squamous cell carcinoma of the skin
FLORINEX in france trial
FOLFIRINOX treatment consisted of a 2-hour infusion of oxaliplatin (85 mg/m2), followed by a 2-hour infusion of leucovorin (400 mg/m2) combined with irinotecan (180 mg/m2), followed by a bolus of fluorouracil (400 mg/m2), and then a continuous 46-hour infusion of fluorouracil (2400 mg/m2); this regimen was repeated every 2 weeks.
teratoma syndrom -
serum marker normal but mass is growing in chest - do resection
What effect allows cells to "talk" to each other?
Bystander effect
When does GvHD develop?
-2-4 weeks after transplant (when donor cells engraft in recipient)
How do you diagnose MGUS?
-routine lab
-total protein exceeds albumin by a lot
-monoclonal Ig is present but not more than 3g/dl and &lt;10% plasma cells in bone marrow
**If exceeds these criteria, = Multiple Myeloma!

Globulin protein = Total protein - albumin (so Total protein = globulin + albumin) therefore, if total protein highly exceeds albumin, the total protein is mostly globulin
What is the MOA for radioimmunotherapy (MoAbs linked to radionuclides)?
-crossfire effect!!

-Radiolabeled MoAbs deliver low dose, site specific radiation to lymphoma cells
-lymphoma cells w/ low Ab binding are killed by radiation from the labeled MoAbs bound to ADJACENT (crossfire) tumor cells

**great for indolent lymphoma, but expensive (similar results to chemo+rituximab)
Classification: CNS tumors, leukemias, lymphomas
-own nomenclature system DIFFERENT from the solid tumors listed above
___ spread is found in about 50% of patients and follow the mesenteric vessels.
Lymphatic
The colon that travels upward on the right side
ascending colon
The liver is an ___ gland that ___ bile, ___ bile, and ___ toxins
endocrine
secretes
produces
filters
It lies in the ___ abdomen and is quite ___.
upper
mobile
What is the most common histologic type of breast cancer? 80-90%
Infiltrating Duct (NOS)
Are CML and CLL more common in males or females?
Males
local treatments**** affect cancer cells in tumor and area near it systemic**** treatments travel through bloodsteam reaching cancer cells all over body
surgery radiation**** therapy local treatment****
chemo**** hormone therapy biological therapy systemic ****treatment
TRAP (tartrate resistant acid phosphatase)
Hairy Cell leukemia (B cell neoplasm)
FLORINOX results
RR 31.6% in the FOLFIRINOX group and 9.4% in the gemcitabine group ( FOLFIRINOX; median OS was 11.1 months vs 6.8 months in the gemcitabine Median PFS was 6.4 months vs 3.3 months FOLFIRINOX was associated with significantly greater toxicity, including a higher incidence of grade 3 or 4 neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, and sensory neuropathy.
mature peripheral B cell neoplasm
CLL/ SLLextranodal marginal zone lymphoma of MALT type nodal marginal zone lymphomasplenic marginal zonelymphoplasmacytic lymphomafollicular
What does the Deletion hypothesis state?
Carcinogenesis results from "a permanent alteration or loss of protein essential for the control of growth"
Which neoplasms are associated with Kaposi's sarcoma herpes virus (HHV8)?
Kaposi's sarcoma, lymphoma (red/purple patches on skin/mouth/throat)
Benign (and 4 characteristics)
1) differentiation/anaplasia
2) rate of growth
3) local invasion
4) metastasis
-tumor does not metastasize
1) well differentiated tissue, usually typical of the tissue of origin
2) progressive, slow growth; may stop or regress..**rare, normal mitotic figures
3) well demarcated, cohesive, expansile masses that DO NOT invade surrounding tissue
4) NO METASTASIS)
What is the MOA for rituximab?
-attacks CD20 via ADCC, complement-dependent cytotoxicity, and apoptosis
-Fab binds to CD20
-Fc portion recruits immune effector functions that trigger B cell lysis
Biopsy site for leukemia
-bone marrow (even though the tumor cells are circulating)
What are the causes of de novo MDS?
-unknown
-viruses
-benzene and chemicals
-cigarette smoking
-fanconi anemia (congenital BM failure)
The ___ ___ is the opening between the terminal part of the ileum and the cecum
ileocecal opening
Axillary node characteristics in patients with breast cancer
firm, hard &gt;1cm
matted feeling or fixed to skin or deep structures = advanced dz
What is the mechanism of imatinib (Gleevec)?
Inhibits BCR-ABL kinase function
indigestion****/difficulty swallowing
unexplained changes in weight****
unusual bleeding discharge
not always caused by cancer may be infecions benign tumors other problems do not wait to feel pain early cancer does not cause pain
Tumor Marker
a product produced by a cancer cell or in response to the presence of cancer, which may be released into the circulation or may remain associated with the cancer cell.
molecular studies in low grade lymphoma
Ig H rearrangement usefull in differentiating lymphoid hyperplasia from lymphomaPCR assay 14-18 translocation
Example of non-hormonal paraneoplastic syndrome
multiple myeloma of the B-cells can lead to an overproduction of antibodies to various organs -> renal failure; autoimmunity
Properties of transformation of cells in culture
-Digested hamster embryos into little bits (essentially single layer cells) and dispersed the cells onto "feeder layers" of cells (i.e. cells whose growth has been arrested by irradiation or chemical means)
-The hamster embryo cells attached and began to grow
-Cells were then exposed to carcinogen (chemicals added to the culture media or direct irradiation)
-cells were allowed to grow, then examined under the microscope
-morphological changes were observed
What are SERMs and which hormone did they have similar effects to?
Selective Estrogen Receptor Modulators; estrogen
Properties of Responsive stage neoplasm
Has a cellular population that can survive in the absence of hormone but grows relatively slowly in the stage of progression
What is the pathogenesis of acute leukemia?
-block the normal differentiation pattern of progenitors

*mutations in transcription factors that regulate genes involved in myeloid differentiation

==overgrowth of immature cells
How does atypical CML present?
-analyze by FISH or RT-PCR detects BCR-ABl fusion

-behave just like classic Ph+ CML
What are the metabolic abnormalities of AML? other general metabolic problems of the two?
-hypokalemia due to renal tubular injury by the lysozyme released from myeloid blasts

-in ALL especially, LDH elevaeed
-both types may have hepatic enzymes elevated, or artificial hypoglycemia after phlebotomy draw
The advantages of postop adjuvant RT (4)
-no delay to surgery
-precise definition of staging of the tumor
-resection of the tumor bulk
-accurate RT planning for residual disease
Symptoms of breast cancer (other than a lump)
breast pain - rare
nipple discharge
erosion
retraction of nipple or dimpling
abnormal change in breast size
What is teletherapy?
external beam is aimed at the tumor - more precise
What are the three things listed for dx of amyloidosis?
Rectal biopsy
Supcutaneous fat aspiration
Examine under polarized light, stain with Congo red
names of doctors from local medical society nearby hospital med school
methods of treatments side effects
local or systemic
distint clinical finding in small NHL
every thing common in all small lymphocyte NHL except MCL - male predominaceMALT - rarely involve BM and offer present as stage 3 or 4
Smoldring MM/ MGUS criteria
MGUS• • ANDSMM• ≥3 g M spike • ≥10% plasma cells Active MM• ≥10% plasma cells• M spike +
7 Ways in which neoplasms evade host immune response
Expression of HLA-G
Defects in antigen processing
T-cell deletion
Modulation
Masking
Immunosuppression
Sneaking Through
What about patients with high risk for relapse?
-cytogenetic abnormalities, failure to achieve remission

-allogeneic HSCT! especially if a sibling matches as a donor
Can you treat acute leukemia with blood transfusions?
-yes - required for effective treatment
-for RBC transfusion, depends on patient's status (younger patients tolerate a lower Hgb level)

-for platelets, transfuse if fewer than 10,000/uL platelets (prophylactically for bleeding)

*make sure you give leukodepleted blood products to prevent CMV transmission, decrease risk of alloimmunization (Abs against transfused platelets); irradiate blood products to prevent GvHD especially in BMT
Which non-small cell lung cancer stages are resectable?
Stage I, II, and IIIA (ipsilateral lymph nodes)
Presenting complaint for breast cancer patients (2)
lump (70%) -90% discovered by the patient
swelling in axillae or arm
bone sarcomas 0.2% all cancers 2500 new cases a year spread to other parts of body lungs
terms related to bone sarcomas cocnfusing
VISTA: VELCADE as Initial Standard Therapy in MM: Assessment With Melphalan and Prednisone - results
700 pts compared with VMP / MPVMPCycles 1–4Bortezomib 1.3 mg/m2IV, d 1, 4, 8, 11, 22, 25, 29, 32Melphalan 9 mg/m2 , and prednisone 60 mg/m2 , d 1–4 Cycles 5–9 Bortezomib 1.3 mg/m2IV, d 1,8,22,29Melphalan 9 mg/m2and prednisone 60 mg/m2, d 1–4MPCycles 1–9 Melphalan 9 mg/m2and prednisone 60 mg/m2, d 1–4
Why are liver microsomes added to Ames test medium?
Bacteria differ in their metabolic capabilities compared to mammals, and we want the drug-metabolizing ability of the bacteria to be comparable to human metabolism
What is the goal of treatment for an aggressive NHL?
-cure!
-however, get sick very quickly, high burden of disease
*those who survive the first couple of years are likely to be cured, rarely die of lymphoma (attributed to complications from aggressive therapy, and the aggressive tumor itself)
**Begin treatment promptly!!
What are the flow cytometry (immunophenotyping) results for AML? ALL?
-AML - CD13, CD33, CD117

-ALL - most are B precursor cell type = CD10, CD19, CD22; those of precursor T type have 1a,2,3,4,5,7,8

**BUT 5% of ALL has myeloid markers CD13 and CD33
What is the correlation between uterine and breast cancer?
breast cancer = higher risk of uterine cancer and vise-versa
screening tests lab tests x-rays used for few types cancers
screening mammogram best tool to find breast cancer before symptoms 40's over have mammograms every 1-2 years
Active regimen in bladder ca
MVAC - standard of care can cure ( 36%HD MVAC 58% cureGC-gem+cis) + MVAC best - GC + MVAC gives same result
How do you treat limited stage (I,II), non bulky HL?
-radiation alone or short course chemo (3-4 cycles) + reduced dose radiation, or chemo alone
cancers related to use of tobacco what people eat and drink exposure to UV ****radiation from sun exposure to carcinogens cancer-causing agents in environment and workplace
some people more sensitive than others to factors that cause cancer
most people who get cancer have none of known risk factors
How does this differ from NHL?
-NHL can spread to and from any LN at any time
What is the only curative therapy for CML?
Allogenic BMT
-best is BM is from HLA matched siblings
Why are patients who are in bed >50% of day not often treated with chemo?
normal cells are not able to recover between rounds of chemo
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