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29 Cards in this Set

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apoptosis
programmed cell death
a defect in a cells knowing when to die causes imbalance in favor of proliferation adn presumably cancer
defect in apoptosis
follicular low grade non-Hodgkin's lymphoma
translocation between chromosomes 14:18 results in juxtaposition of bc1-2 gene to Ig heavy chain gene
over expression of be 1-2 causes failure of apoptosis and immortality of cells. future therapies will be directed at "reminding" the cell to die
p-53
the molecular policeman
implicated for more than 50% of human cancers
p53 protein is thought to regulate cell proliferation
located on chromosome 17
Dna damage results in increased expression of p53
increased p53
causes a pause in the cell cycle between G1/S that is required for repair of DNA damage before DNA replication and cell division. Under normal circumstances, overwhelming DNA damage or unrepairable DNA damage leads to apoptosis, probably mediated by p53
Le- Fraumeni syndrome
germ line mutation or loss of p53
50% of pts develop invasive cancer by age 30
rhabdomyosarcoma, breast, brain, soft tissue, osteosarcoma, leukemia, adrenocoortical carcinoma
Lung cancer
75-80 % are non small cell lung cancer and 20-25 % are small cell
histology and associations of lung cancer
squamous cell cancer cavitates and tends to be central
SCC is associated with humeral hypercalcemia secondary to release of PTH like products
adenocarcinoma
tends to be peripheral "coin lesions" and may be associated with clubbing, hypertrophic pulmonary osteoarthropathy
small cell cancer
tends to be central and and is often associated with a variety of paraneoplastic symptoms especially hyponatremia, cushings,
variety of paraneoplastic symptoms
caused by impaired release of acetylcholine from nerve terminals and clincally manifested by weakness and fatigability of proximal msucles
diagonostic EMG shows increasing amplitude of action potential with high frequency stimulation- hypercalcemia is rare
tx of lung cancer
non small cell
surgically
PET scans superior for medistinal spread and distant metiastinal
what is not best done on a PET scan?
brain
when is a CT scan used diagnostically with non-small cell cancer
localized abnormal hot spots
+ PET scan
requires confirmation with medistinal exploration
false + occu from inflammation
- PET scan in the mediastinum
proceed to surgery
unresectable and metastic disease (lung cancer)
chemotherapy
carboplatin and taxol is most common
others are = effective (8mo survival) but may be more toxic
tx small cell lung cancer
limited disease to one hemithorax that can be encompassed within one radiation field (includes patients with mediastinal and hilar nodes)
extensive disease
outside one radiation field
gold standard of small cell cancer tx
combination of irinotecan (CPT11 and cisplatin + etopsode
colorectal cancer
90 % occus in pts ocer 50
90 % of colon cancer
spradic colon cancer
risk factors for colon cancer
+ family history
colon cancer screening
need to detect polyps
fecal occult blood test (anually)
flexible sigmoidoscopy q 5yrs
colonscopy q 10 yrs
barium enema q 5 yrs
progression of colon cancer
adenomatous polyp
evolves into a carcinoma (10-12years)
+ guaiac test
most common neoplastic lesion that is found is the adenomatous polyp
tumor suppressor gene
5q
extraclonic manifestations of colon cancer
mandibular osteomas
polyps in distal stomach
small bowel and congenital hypertrophy of the retinal pigment epithelium
gardner's syndrome
other hereditary colon cancers not assoc. with extensive polyposis
hereditary non-polyposis colon cancer = lynch syndrme
characterized by adenomatous polyps in proximal colon with high incidences of malignant degeneration
at least 5 different DNA repair genes have been incriminated for HNPCC
HNPCC
occurs in the proximal colon
pt @ higher risk for enometrium, stomach, small intestine, brain, hepatoilary system, urinary tract, and ovary