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181 Cards in this Set
- Front
- Back
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What are the most common cancers in men? Women?
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(men) prostate, lung, melanoma, colon; (women) breast, colon, melanoma, lung
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What cancers have the highest mortality rates in men? Women?
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(men) lung; (women) breast
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Regardless of sex, what is the biggest killer?
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Lung cancer (followed by breast/prostate)
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What cancer is prominent in Japan, due to their diet?
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Stomach and Liver
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The greatest risk factor for cancer is? Why?
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Age. Cumulative damage with time, and lowered immune surveillance
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Smoking is strongly associated with which cancers?
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Lung, mouth, laryngeal, esophageal, stomach, pancreas, bladder, cervical
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Do cancers commonly have a Mendelian pattern of inheritance?
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No, not commonly.
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What cancers generally have an early onset (ie. Affect young people)?
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Testicular, Hodgkin's Lymphoma
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Name the pre-neoplastic disease that affects the cervix? The liver? Precedes SCC? Colon cancer?
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Cervical dysplasia; (HBV) cirrhosis; actinic keratosis; ulcerative colitis or villous adenoma
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What are the seven changes in cellular physiology required to create a neoplasia from normal tissue?
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The changes needed are:
a. Self-sufficiency in growth signals b. Insensitivity to growth-inhibiting signals c. Evasion of apoptosis d. Defective DNA repair mechanisms e. Limitless replicative potential f. Sustained angiogenesis g. Ability to invade/metastasize |
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In CML, what is the normal function of c-abl and what is used to treat it commonly?
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It is a signal-transducing protein, with kinase activity. Imatinib is an effective therapy, as it targets the ATPase portion of the abl-bcr chimera.
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What is the normal function of ras, and what happens when it is mutated?
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Ras is a membrane-bound G-protein (couple to a GPCR), which has kinase activity that stimulates transcription. Normally, it is inactivated when it's GTP is hydrolyzed, but when it is mutated it allows for greater activation of kinases which activate transcription.
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What transcription factor is overexpressed in Burkitt's lymphoma?
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c-myc
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Rb, the retinoblastoma protein, is normally phosphorylated to control cell cycle progression between which phases?
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CDK4 and Cyclin D phosphorylate Rb, to control progression from G1 to S
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What portion of cancers have a p53 mutation, and what are its normal functions?
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Over 50% of cancers have a mutation of p53, which normally arrests the cell cycle (via p21) upon DNA damage. Both alleles of this tumour-suppressor gene must be damaged
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What is the normal function of bcl-2? What happens if it is excessively produced?
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It acts as a free radical scavenger, and prevent apoptosis. In excess it prolongs cell life.
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What is the normal function of bax?
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P53 induces bax, which creates heterodimers (instead of homodimers) with bcl-2, and thus accelerates cell death.
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Describe senescence
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Telomere repair is maintained by telomerases, which are not expressed later in life and allowing normal death of cells once the telomere is dysfunctional
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What are the 4 basic steps in pain relief?
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The four basic steps are:
a. Decrease the noxious stimulus b. Raise the threshold for pain (counselling and anxiolytics) c. Titrate opioids for non-bone pain d. Treat residual neuropathic pain (steroids, anticonvulsants, TCAs) |
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Potential side effects from steroid treatment include?
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Insomnia, depression, hyperglycemia
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What is Vogelstein's cascade?
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The progression, in colon cancer, from normal epithelium to early benign adenoma (pedunculated polyp, from APC gene) to late benign adenoma (from ras and DCC genes) to colonic cancer (from p53 gene)
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HNPCC stands for? This variant of colon cancer has mutations of what?
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HNPCC stands for hereditary non-polyposis colon cancer. It has mutations in 4 enzymes involved in DNA repair
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What are the different types of polyps, and which is the most common?
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Depressed, sessile (flat) and pedunculated (stalk). The latter is most common
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What percent of the population has polyps by age 50? Age 70?
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1/3 at age 50. 1/2 at age 70
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What is the most common site for polyps?
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The most common place to find polyps is in the rectosigmoid area, where over 1/2 occur
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How does a polyp present clinically?
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It may cause bleeding or a change in bowel habit, but usually is asymptomatic
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Are most hamartomas at risk of becoming malignant?
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No, as most will regress or autoamputate.
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True or false: most polyps found are hyperplastic, and not malignant?
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True, they are benign.
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Most neoplastic polyps are of what type?
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Adenomatous. 10% of which may become invasive.
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For investigations, is a flexible sigmoidoscope sufficient?
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Likely not, but it can reach 60% of those in men, and 35% of those found in women
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If polyps are detected on sigmoidoscopy, what would be the next investigation?
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Colonoscopy, with biopsy
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How often should one get follow-up colonoscopies, after having adenomas removed?
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Every 5 years. Or every 3 if polyp >1cm, or >3 adenomas, or high grade dysplasia
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At what age does one screen adults, who present with iron deficiency anaemia, for CRC?
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Over the age of 50
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What layer do most CRCs originate from?
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The epithelial layer is where most CIS arises from.
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The most common spread of CRC (metastases) is?
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Lymphatic and haematological. Metastasis to the liver is most common.
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Peritoneal seeding of CRC can put which organ at risk?
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The ovaries
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True or false: though often asymptomatic, CRC may also present with abdominal pain
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True.
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Which risk factor do most patients with CRC have?
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None; no specific risk factor. Secondly, would be age.
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What does FAP stand for, and what is the implication?
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Familial adenomatous polyposis. This means, these individuals can develop hundreds (or thousands) of polyps by their 20s, and virtually all will develop CRC
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Which of the following are risk factors for CRC: smoking, alcohol, senditary lifestyle, low body weight, diabetes, red meat
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All except for low body weight; high BMI is a risk factor
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What are the disadvantages and risks of colonoscopy?
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It is expensive, not readily available and requires sedation. There is the risk of bleeding and perforation, in the process
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How sensitive is a virtual colonoscopy?
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Over 90%
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Aside from DM, what other endocrinological disorder is a risk factor for CRC?
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Acromegaly. Both conditions stimulate growth of colonic mucosal cells
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What do mutations in the hMSH2 and hMLH1 genes confer?
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Abnormalities in DNA repair mechanisms
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What are two tumour suppressor genes commonly seen mutated in CRC?
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APC and DCC
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In CRC, invasion of the muscularis propia layer would receive what staging?
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Staging of T2 (T3 is through serosa (review staging)
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What two investigations should one do to look for metastases of CRC?
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CXR and abdominal ultrasound
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Spread through what confers less than 50% 5 year survival, for a patient with CRC?
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Spread through lymph nodes
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If metastasis has occurred in CRC, is surgical removal of colon still performed?
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Palliatively, yes.
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Colo-rectal Cancer: In what window do 80% of recurrences happen after surgery?
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Within 2 years
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Colo-rectal Cancer: What adjuvant therapies should be considered?
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Radiotherapy for rectal cancers; chemotherapy for colon cancers
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What percentage of cancer related deaths are lung cancer?
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18%
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On CXR, what does a lesion with a popcorn pattern mean?
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It is a hamartoma (slow growing, benign lesion)
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What percent of solitary pulmonary nodules are malignant?
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30%
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How do malignancies appear on chest Xray?
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Greater than 3cm in diameter, spiculated, poorly-defined margins, lymphadenopathy ... Grows quickly (serial CXRs)
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Lung Cancer: If one is to use 'watchful waiting', how often should a CXR be performed?
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At 3, 6, 9 and 12 months
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Common clinical presentations which are associated with lung cancer, (though it may be asymptomatic)?
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Cough, haemoptysis, atelectasis, recurrent pneumonia, wheezing
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T or F: paraneoplastic syndrome only occurs with malignant neoplasias?
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False. For instance, bronchial carcinoids may produce paraneoplastic syndromes
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Which type of lung cancer most commonly sees paraneoplastic syndrome?
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Small Cell Lung Cancer
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Lung Cancer: The stereotypical population in which hamartomas are seen is what? What action should be taken?
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60 year old males. They are usually silent and benign, so likely require no action
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Smoking is attributed to what percentage of lung cancers?
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85% (even passively)
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What is the RR of lung cancer, due to asbestos exposure? With smoking?
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The RR is 5.0. With smoking it is 80-90.
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What are some other risk factors for lung cancer?
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Radiation exposure, arsenic, chromium, nickel, air pollution, HIV and parenchymal scarring
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What pulmonary malignancy is not related to smoking, and what is the 5 year survival rate?
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Adenocarcinoma of the lung, which accounts for 40% of lung cancers and is on the rise. 12% will live 5 years.
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Lung Cancer: What is the prognosis for SCLC? SCC?
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(SCLC) 1%; (SCC) 25%
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Clubbing is seen in what percentage of those with lung cancer?
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About 20%; 1/5
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Lung Cancer: What nervous lesions may be seen, attributed to lung tumours?
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Diaphragmatic palsy (impinged phrenic n.); Horner's syndrome (pancoast tumour); brachial plexus palsy; laryngeal hoarseness (recurrent n)
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Lung Cancer: What is SVC syndrome?
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Compression of the SVC from the tumour, resulting in neck/facial swelling, dyspnea and cough
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Where do lung cancers typically metastasize to?
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(BLAB) brain, liver, adrenal, bone
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Lung Cancer: What are the three most common paraneoplastic syndromes?
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Hypercalcaemia (due to PTHrp), Cushing's syndrome (due to ACTH), and Syndrome of Inappropriate ADH (SIADH)
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What are two (relatively) non-invasive means of sampling the lung tissue?
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Sputum (not reliable), and lavage
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Lung Cancer: For NSCLC, what is the prognosis for stage 1? At what stage does care become palliative?
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Stage 1 has a 50% 5 year survival. At Stage 4, care becomes purely palliative (surgery becomes contraindicated).
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What is the perioperative mortality rate for a pneumonectomy? Lobectomy?
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6% and 3% respectively.
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HPV produces E6 and E7 proteins, which target what cellular proteins?
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E6 targets p53, and E7 targets Rb.
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What two subtypes of HPV contribute to the majority (99%) of cervical cancers? What two subtypes are included in Guardasil to protect from anogenital warts?
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Subtypes 16 and 18 for cervical cancer. Subtypes 6 and 11 for anogential warts
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True or False: Condoms are an effective means of protection from HPV
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False, condoms do not protect.
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Cervical Cancer: What changes are seen in the cervix, in the clinical infection?
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Visible wart-like lesions; hyperkeratotic, verroucous or flat, macular lesions; vulvar oedema
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Cervical Cancer: upon cytology, what changes will one find?
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Koilocytosis (nuclear enlargement and atypia, with perinuclear halo)
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What are the two patient administered treatments available for cervical cancer?
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Podofilox, and Imiquimod
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What are three options for physician administered treatment for cervical cancer?
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Cryotherapy; podophyllin resin tincture; trichloroacetic acid; surgical/laser removal; intralesional interferon
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95% of malignant cervical tumours are of what type? What are the remaining 5%
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SCC (95%); adenocarcinoma (5%)
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What is the average age of onset of cervical cancer?
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52
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The number one method of reducing the risk of cervical cancer is?
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Annual Pap Test
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Where does the HPV virus typically invade the cervical lining?
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In the transformation zone
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What kind of discharge is seen in early cervical cancer?
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Watery, at first, turning to brown or red
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What are the common presentations of late cervical cancer?
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Bleeding (post-coital, post-menopausal or irregular); back or pelvic pain; bladder/bowel symptoms
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Is smoking a risk factor for cervical cancer?
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Yes
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What is the course of injections for the 3 inoculations? When is full protection reached?
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0, 2 and 6 months. Full protection is seen 30-days after the final injection.
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How often is a Pap Smear result a false positive? False negative?
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10% false positive; 10% false negative.
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When should females get Pap Smears?
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Starting at age 18, or 3 years after first intercourse, then every 2-3 years.
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At what age are Pap Smears ceased?
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Age 70, if Pap Smear have been normal for past 10 years.
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Cervical Cancer: involvement of the lower 1/3 of the vagina would receive what stage?
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Stage III.
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What defines stage I cervical cancer?
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Confinement to just the cervix
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What is the 5 year survival for Stage II cervical cancer?
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Spread has continued beyond the uterus, but does not include the pelvic wall, in Stage II, and 5-year survival is 55%.
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What are the odds of developing breast cancer is one has the BRCA1 mutation? Ovarian cancer?
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Greater than 50% (breast); 20% (ovarian)
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What is the normal function of BRCA1?
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It is a tumour suppressor gene, involved in DNA repair, ubiquitination, regulation of the cell cycle, and regulation of transcription
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What is the most common diagnosis of cancer in women (both Australia and Canada), and what proportion of women are diagnosed with it?
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Breast Cancer, which 1 in 9 women will be diagnosed with (1 in 27 die from it)
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How often should mammography be used? At what age does screening begin?
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1-2 years, beginning at age 50
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If a family member has been diagnosed with breast cancer, at what age should one begin annual screening?
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10 years prior to the onset in their family member
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Three common presentations of breast cancer are?
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Lump, Pain, Discharge
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T or F: breast cancers will appear with a smooth border on CXR?
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False. They appear to have a poorly defined, spiculated border.
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If a mammography is negative, does that rule out breast cancer?
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No, invasive lobular carcinoma and lobular carcinoma in situ (LCIS; non-invasive) are hard to detect on MMG.
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What percentage of breast cancers are male?
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<1%
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80% of females with breast cancer are over what age?
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Age of 40
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T or F: radiation exposure is a risk factor for breast cancer?
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TRUE
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When does Hormone Replacement Therapy become a risk factor for breast cancer?
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When taken in excess of 5 years.
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What reproductive qualities increase the risk of breast cancer (ie. No. Of children, menarche, menopause)
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nulliparity; first pregnancy after age 30; menarche before age 12; menopause after age 55
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What reproductive qualities decrease the risk of breast cancer?
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lactation, early menopause, early childbirth
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what is the definitive means of diagnosis for breast cancer?
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biopsy
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When should one test for BRCA1/2?
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If a patient is diagnosed with breast and ovarian cancer, or if there is a strong family history
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At what stage of breast cancer are mobile ipsilateral node seen?
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Stage IIA
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If dermal lymphatics are involved, what is the minimum stage of breast cancer?
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Stage IIIB
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Skin or chest wall invasion is at what stage of breast cancer?
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Stage IIIB
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Ipsilateral clavicular nodal involvement occurs at what stage of breast cancer?
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Stage IIIC
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Stage IV breast cancer is defined by what?
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Distant metastases
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What are the two types of non-invasive carcinomas of the breast?
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Ductal Carcinoma In Situ (DCIS); Lobular Carcinoma In Situ (LCIS)
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What percent of DCIS is non-palpable, and only detectable on MMG?
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80%
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What percent of DCIS will become infiltrating ductal carcinoma within 10 years?
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35%
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What is the treatment of DCIS?
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Lumpectomy (Mastectomy if large area of disease). Tamoxifen may be used as an adjuvant
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5 year survival for DCIS?
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99%
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How is LCIS detected?
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Usually incidental finding on biopsy. It is NOT detectable by MMG or palpation.
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What is the risk of LCIS developing into invasive ductal carcinoma in 20 years?
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30%
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LCIS is not commonly treated with surgery, but what is used instead?
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Tamoxifen
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What is the most common type of invasive breast cancer?
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Infiltrating ductal carcinoma (80%)
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What is the second most common invasive breast cancer, after infiltrating ductal carcinoma?
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Invasive lobular carcinoma (15%)
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Ductal carcinoma of the breast which invades the nipple is called?
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Paget's disease
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What is the most aggressive form of breast cancer?
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Inflammatory Carcinoma (4%), which has characteristic erythema and peau d'orange (later) in addition to ductal involvement
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What type of breast cancer do men typically get?
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Infiltrating ductal carcinoma
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Where does breast cancer typically metastasize to?
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To bones, lungs, pleura, liver, brain (BBLL)
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At what stages of breast cancer is breast conservation surgery performed, with radiotherapy?
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Stages 0, I, II
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How does one determine if a breast tumour will respond to tamoxifen?
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If it is ER (estrogen receptor) positive
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Mastectomy should be performed if breast cancer reaches what stage?
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Stage III
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How is Stage IV breast cancer treated?
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Primarily with systemic therapy (chemo and hormones)
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Breast Cancer: what does ALND stand for?
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axillary lymph node dissection
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After axillary lymph node dissection, what percent of women experience lymphedema?
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10-15%
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Sentinel nodes are identified by injecting the tumour with a blue dye mixed with ...?
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technetium-99
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T or F: radical mastectomies are the best way to treat advanced breast cancer?
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False, they are no longer performed (modified radical mastectomies are now performed)
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What is removed in a modified mastectomy?
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all breast tissue, nipple-areolar complex, skin, axillary nodes
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What is removed in a simple mastectomy?
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all breast tissue, nipple-areolar complex, skin
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How does tamoxifen work?
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It is an estrogen receptor antagonist
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How do aromatase inhibitors work?
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By inhibiting the conversion of precursors to estrogen
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How often should follow up investigations be performed after breast cancer is successfully treated?
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Every 3-6 months for 2 years. Annually thereafter.
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What are three AIDS defining conditions?
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pneumocystis carinii pneumonia; Kaposi's Sarcoma; oesophageal candidiasis; NHL; mycobacterium avium; HIV wasting; encephalopathy; cryptococcosis; toxoplasmosis; HSV; CMV
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The main mode of transmission for HIV is?
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Sexual (70-85% of cases)
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The chance of transmitting from an HIV-infected mother to her child during vaginal delivery?
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25%
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What are three risk factors for HIV?
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STIs; non-circumcision (reduces by 60%); lack of barrier protection; low SES; multiple partners; IVDU; MSM
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Currently, what is the incidence of HIV infection in Australia?
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About 1000 per year
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What is the primary population that acts as a reservoir for HIV in Australia?
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Men who have sex with men (MSM)
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What percent of individuals are born overseas, who contracted HIV through heterosexual transmission?
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60%
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The rate of HIV in prison entrants is (a) increasing OR (b) decreasing?
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Increasing, since 2000
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T or F: the incidence of HIV amongst Aboriginals is higher than non-Indigenous?
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False. It is the same incidence rate
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The total number of HIV infections worldwide is estimated to be?
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34 million
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How many children (under 15) are living with HIV, globally?
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2.1 million
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How many people died of AIDS in 2008 (last estimate)?
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2 million
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Globally, what is the division of HIV infection, between the sexes?
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About half and half.
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In sub-Saharan Africa, what percentage of HIV carriers are women?
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About 60%
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50% of AIDS deaths in sub-Saharan Africa are related to what infection?
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TB
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How can vertical transmission of HIV be minimized?
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Education, Caesarean section and anti-virals during pregnancy
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What was the outcome of the multicentre vaccination trial for HIV, in 2007?
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Vaccinated individuals were twice as likely to get infected, and the trial was stopped
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What was the outcome of the vaccination trial for HIV in Thailand, in 2009?
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vaccine showed a 30% efficacy rate, amongst the 16,400 volunteers (modestly protective)
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In what state is homosexuality still a criminal offence?
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Tasmania
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Can pregnant women refuse consent for screening of HIV?
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Yes
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What are the most common side effects of opioid therapy?
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Nausea & vomiting, constipation, drowsiness, urinary retention, respiratory depression
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When initiating opioid therapy, what contraindication should one be mindful of?
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Renal impairment
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And what should one consider giving concurrently to alleviate one of the symptoms?
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An aperient, for the constipation
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What are some short-acting PRN options of opioids, to control mild, intermittent pain?
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Morphine, oxycodone, hydromorphone
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What are some longer-acting PRN opioid options?
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MS contin, oxycontin, transdermal fentanyl
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When should naloxone be administered in opioid therapy?
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This antagonist should be avoided, unless the respiratory rate declines below 8 bpm (or <10-12bpm if difficult to rouse, cyanosed or <90%SaO2
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What is the relative strength of codeine to morphine?
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Codeine has 1/8 the potency of morphine (2 panadeine forte = 10mg morphine)
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What weak opioid agonist also has SNRI-like activity, and is of limited use in cancer patients?
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Tramadol
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What are two slow-release formulas of morphine?
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MS contin and kapanol
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Buprenorphine is a partial mu receptor agonist. What is its effectiveness in cancer pain treatment?
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It is limited, and has a ceiling effect.
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What is the first choice opiate for pain relief in cancer?
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Morphine
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Oxycodone is an morphine derivative, with 1.5x the potency and half-life. What are the common names of it, and what is the name of the slow-release formulas?
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Endone and oxynorm. Slow-release is Oxycontin
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What opiate should be used in the case of renal impairment. Why? What is its potency relative to morphine?
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Hydromorphone, as it does not have active metabolites, like morphine does. It is 5x the potency.
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What are the benefits of the opioid fentanyl?
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It is potent and short acting, making it useful for PRN (transdermally). It also has less constipation associated with it.
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Besides opioid receptors, what other receptors are affected by methadone?
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NMDA receptors, which are antagonized.
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The word for pain experienced in response to non-noxious stimuli is?
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Allodynia
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Three descriptors often used for neuropathic pain are?
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Burning, shooting, electric
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If neuropathic pain does not respond to opioids, what are some well recognized adjuvants?
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Antidepressants, anticonvulsants, ketamine and anaesthetic agents
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What are useful options for bone pain?
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Paracetamol, NSAIDs, dexamethasone, opioids, bisphosphonates
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