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26 Cards in this Set

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Bony mets - lytic (7)

RCC


Melanoma


MM (unless POEMS - then sclerotic!!)


NSCLC


Thyroid


NHL


Langerhans Cell histiocytosis




Most likely to cause hypercalcaemia


Best seen on plain XR


overactive bone RESORPTION mechanisms

Bony mets - sclerotic/blastic (5)

Prostate


Carcinoid


SCLC


HL


Medulloblastoma




more prominent on bone scan


overactivity of bone FORMING mechanisms

Bony mets - mixed lytic/sclerotic (3)

Breast


GI


SCC (most sites)

PTH-rp production (3)

SCC: lung, head and neck, skin


Breast


GU


GIT

ADH production (4)

Lung: SCC, SCLC


GIT


GU


Ovary

ACTH secreting tumours (5)

Cushing Syndrome


Lung: SCLC, bronchial carcinoid, adenocarcinoma, SCC


thymus


pancreatic islet


Medullary thyroid carcinoma

IGF secreting tumours (7)

Symptomatic hypoglycaemia




Mesenchymal tumours


sarcomas


Adrenal


hepatic


GIT


kidney


prostate

Major genes involved in initiating cancer

Lead to unregulated cell division, or ability to avoid programmed cell death




Oncogenes


- only one mutation required for activation


- autosomal dominant




Tumour suppressor genes


- both copies need to be inactivated for loss of function





Caretaker genes - function?

Subset of tumour suppressor genes with no direct effect on cell growth. Help to protect integrity of genome by repairing DNA defects.

Tyrosine Kinase - functin

signal transduction pathway often activated in cancer cells


normally only active for short periods


malignancy - permanently activated through mutation, gene amplification, gene translocation




TKI - effects


- decreaesd proliferation


- decreased survival


- impaired angiogenenesis

Imatinib - target?


- Indications

Bcr-Abl


(also c-abl, c-Kit, PDGFR-alpha or beta)




CML and GIST

Sunitinib - target?


- Indications

c-KIT, VEGF, PDGFR-beta, Flt-3




GIST (cKIT, PDGFR-beta)


RCC: VEGF

Sorafenib - target?


- Indications

RAF, VEGFR, PDGFR-alpha/Beta, Flt-3, c-KIT




RCC, HCC

Erlotinib


- target


- indications

EGFR




NSCLC, pancreatic

Gefitinib


- target


- indications

EGFR




NSCLC

Bortezomib


- target


- indication

Proteasome




Mulitple myeloma

Cetuximib


- target


- indication

EGFR




colon cancer, head and neck SCC

Panitumumab


- target


- indication

EGFR




colon cancer


(very similar to cetuximab)

Rituximab

- target


- indications

CD20




B-cell lymphoma and leukaemia expressing CD20





Alemtuzumab


- target


- indication

CD52




CLL and CD52-expressing lymphoid tumours

Bevacizumab


- target


- indications

VEGF



Colon, lung, breast (maybe other!)

Breast cancer - poor prognostic signs (7)

Pathologic staging


ER/PR negative


HER2+


high growth rate --> early relapse


More than medium number of cells in S phase --> higher risk of relapse


Higher nuclear grade


p53 overexpression


early menarche, late menopause, late first pregnancy (higher overall oestrogen exposure)

Target of BRCA?

DNA repair gene






10% of ovarian cancer


BRCA1: 30-50% lifetime risk ovarian cancer, breast cancer more common


BRCA2: Ovarian cancer 20-40%, lower risk of breast cancer, later onset, slight increased risk pancreatic cancer

Cytokeratin - positive in what sort of tumours?

Carcinomas




Good initial test for tumour unknown primary to establish whether carcinoma/other

Paraneoplastic syndromes associated with thymoma?

Pure red cell aplasia ~5%


Myasthenia gravis ~30%


Hypogammaglobulinaemia ~5%




Asymptomatic ~60%




Rarely can be associated with a huge range of other things including polymyositis, SLE, thyroiditis, Sjogren's, UC, pernicious anaemia, Addison's, scleroderma, panhypopit

DDx anterior mediastinal mass? (4)

Thymoma 40%


lymphoma


germ cell tumour


substernal thyroid tumours