Oncology Cecil's Chap 54-58

Front 1

What are some ways that cancer cells differ from normal cells?

Back 1

• Invasive capcity
• Induction of angiogenesis
• Loss of contact inhibition in vitro
• Loss of differentiation
• Reduced apoptosis
• Uncontrolled growth

Hint 1

None

Front 2

What are general examples of genetic mutations that can lead cancer?

Back 2

• mutations of proto-oncogenes to oncogenes (ie Philadelphia chromosome) • mutation or deletion of tumor suppressor genes • mutations that lead to an interruption of apoptosis

Front 3

What are some etiologic factors that cause cancer?

Back 3

• tobacco • environmental exposure (alcohol, benzene, asbestos, ionizing radiation) • medications • infectious agents • diet

Front 4

List some infectious agents that predispose to the development of cancer

Back 4

• H. Pylori » gastric cancer • Epstein-Barr virus » Burkitt's lymphoma • Hepatitis B virus » Hepatocellular carcinoma • HPV 16 & 18 » cervical cancer

Front 5

Give examples of chemopreventative drugs and the cancer that they prevent (primary prevention)

Back 5

• Tamoxifen for breast ca • Oral contraceptives for ovarian cancer • Folic acid & NSAIDS for colon cancer • topical sunscreens for melanoma • Lycopene for prostate cancer

Front 6

What are the 2 major types of lung cancer?

Back 6

• Non-small cell lung cancer • Small cell lung cancer

Front 7

What are the different types of non-small cell lung cancer?

Back 7

• squamous cell • adenocarcinoma • large cell

Front 8

Which type of lung cancer usually present as a centrally located endobronchial lesion?

Back 8

Squamous cell carcinoma

Front 9

Which type of lung cancer is the most common lung cancer and is the type seen most often in non-smokers?

Back 9

adenocarcinoma

Front 10

What are characteristic of small cell lung cancer?

Back 10

• highly linked to cigarette exposure • the most common cancer associated with paraneoplastic syndromes (such as SIADH & Cushing's syndrome) • often presents with a large, central tumor with mediastinal involvement

Front 11

What are common signs and symptoms of all types of lung cancer?

Back 11

• cough • chest pain • hemoptysis • radiographic evidence of a mass or pneumonia • weight loss

Front 12

Describe the staging for non-small cell lung cancer

Back 12

• Stage I: No lymph node involvement; tumor may be of any size; not closer than 2 cm from carina • Stage II: Tumor may be of any size; peribronchial and/or hilar nodes involved; not closer than 2 cm from carina • Stage IIIA: any size tumor & may invade chest wall, but not thoracic structures; involves ipsilateral nodes • Stage IIIB: any size tumor & may invade any structure; nodes extend to contralateral mediastinum, supraclavicular, or scalene area • Stage IV: presence of metastases

Front 13

The majority of cancers of the head and neck are what type?

Back 13

squamous cell carcinoma

Front 14

What are the 2 types of esophageal cancer and where do they commonly occur?

Back 14

• Squamous cell cancers most commonly occur in the cervical and thoracic esophagus • Adenocarcinomas commonly occur in the lower esophagus down to the gastroesophageal junction

Front 15

What are signs and symptoms of esophageal cancer?

Back 15

• Dysphagia (most common) • Chest pain • weight loss

Front 16

What are the 2 most common sites of metastasis of esophageal cancer?

Back 16

chest and liver

Front 17

What are some signs, symptoms, and physical findings of gastric cancer?

Back 17

• abdominal pain • anemia • early satiety • hematemesis • weakness • weight loss • physical findings include: gastric mass, umbilical node, left supraclavicular node (Virchow's node)

Front 18

Describe the staging for colon & rectal cancer

Back 18

• Stage 0: In situ • Stage 1: Invades mucosa only • Stage 2: May incade muscularis or through serosa • Stage 3: Any size tumor or any level of invasion; nodal involvement • Stage 4: Any size or depth, positive nodes present or absent, metastasis

Front 19

What is the most common presentation of epithelial pancreatic cancer?

Back 19

• abdominal pain accompanied by rapid weight loss • pain is located in the periumbilical region and pierces through to the back

Front 20

What are other symptoms of pancreatic cancer?

Back 20

• intestinal angina • jaundice due to obstruction of the common bile duct • palpable gallbladder (Courvoisier's sign) • recent onset of diabetes

Front 21

Name a common paraneoplastic complication of pancreatic adenocarcinoma

Back 21

migrating thromboplebitis (Trousseau's sign)

Front 22

What are some risk factors of breast cancer?

Back 22

• early menarche • exogenous estrogen use • first-term pregnancy after age 25 • genetics (BRCA1 & BRCA2) • late menopause • nulliparity (never carrying a pregnancy) • older age • positive family history

Front 23

What is the most common type of breast cancer?

Back 23

ductal adenocarcinoma (70-80%)

Front 24

What is the most common type of bladder cancer?

Back 24

• transitional cell carcinoma • squamous cell & adenocarcinoma account for only 10% of tumors in this region

Front 25

What is the most common presentation of bladder cancer?

Back 25

gross or microscopic hematuria

Front 26

What are symptoms of renal cell carcinoma?

Back 26

• classic triad (hematuria, abdominal mass, and flank pain) occur in 10% of cases • bilateral lower extremity edema (due to occluded inferior vena cava) • paraneoplastic syndromes (fever, polycythemia, and hypercalcemia)

Front 27

What are the 2 most common cancers of the skin?

Back 27

basal cell carcinoma & squamous cell carcinoma

Front 28

Which is more likely to metastasize, basal cell carcinoma or squamous cell carcinoma?

Back 28

squamous cell carcinoma

Front 29

What are risk factors for melanoma?

Back 29

• history of dysplastic nevi • family history of melanoma

Front 30

What causes Superior Vena Cava (SVC) syndrome?

Back 30

obstruction of blood flow caused by compression or invasion of the SVC by tumor thrombi

Front 31

What are symptoms of SVC syndrome?

Back 31

• arm swelling • chest pain • cough • dysphagia • dyspnea • facial fullness * symptoms begin insiduously and are often worse on bending, stooping, or lying down

Front 32

What are physical findings of SVC syndrome?

Back 32

• venous distention of the neck & chest wall • facial & arm edema • cyanosis & plethora (an excess of blood in one area or organ)

Front 33

What is a paraneoplastic syndrome?

Back 33

• disease manifestations of tumors through immunologic & metabolic factors that are not the direct result of invasion by neoplastic cells • can be caused by autoantibodies produced in response to the tumor OR ectopic peptide hormone production by the tumor

Front 34

What is the most common paraneoplastic syndrome and what causes it?

Back 34

• Humoral hypercalcemia of malignancy is the most common paraneoplastic syndrome • caused by secretion by the tumor of parathyroid hormone-related polypeptide

Front 35

Describe the TMN staging method

Back 35

Requires 3 measurements: • T score: size and local invasion of the primary tumor • N score: number, location, or fixation of lymph nodes • M score: presence or absence of metastases

Front 36

List some hormonal therapy used to treat prostate cancer

Back 36

• Luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide and poserelin • Nonsteriodal antiandrogens (such as bicalutamide and flutamide) that inhibit adrenal synthesis of testosterone

Front 37

What are some hormonal therapies that can be used to treat breast cancer?

Back 37

• tamoxifen • aromatase inhibitors (AIs) such as anastrozole

Front 38

What are the 3 pneumonics for chemotherapy agents?

Back 38

• ABVD
• MOPP
• CHOP

Front 39

List the ABVD drugs

Back 39

• Adriamycin
• Bleomycin
• Vincrysteine
• Dacarbazine

Front 40

List the CHOP drugs

Back 40

• Cyclophosphamine (Cytoxan)
• Hydroxy-adrianmycin (Doxirubicin)
• Oncavin (Vincrysteine)
• Prednisone

Front 41

List the MOPP drugs

Back 41

• Mustagen
• Oncavin
• Procarbazine
• Prednisone