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42 Cards in this Set
- Front
- Back
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what are the 2 categories of tumor AG |
1. TSA: tumor specific AG- unique to tumor
BCR-ABL (CML) 2. TAA: tumor associated, shared by cancer and normal tissue, more common Prostatic Acid Phosphatase a fetoprotein CEA CD20 on B cell lymphoma Can also just be overexpressed as in Her2/Neu (berast cancer) |
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what are antitumor effector mechs, whats the cest
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1.CMI- direct T cell killing
2. AB- dont really kill cancer, weak immunity 3. NK cells: role is unclear 4. Macro |
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how good are anti tumor AB
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ehh, no evidence that they actually fight the cancer, but perhaps they can be used to blood tests to determine dx
AB ARE being used to tx cancers: -AntiHer2/Neu (breast- poor prog) -Anti EGFR (lung, head, neck carcinoma) *AB are made but cause paraneoplastic syndromes (when there is a problem that is caused by cancer but not by teh cancer themselves, we saw this when cancer cells secreted hormones) |
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what are 2 cancers that are being treated with monoclonal AB
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1. Her2/neu- breast (traztusimab)
2. EGFR- lung, head, neck **we make AB against cacner but their role is unclaear, we are using them anyway |
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whats the status of the immune system by the time the cacner is dx
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IMMUNOSUPPRESSION
switch from the great Th1 CTL response to a Th2 AB mediated response also get immunosuppressive cytokines: IL10, TGFb. loss of MHC I (with CD8 CTL) we get Treg, macro, PMN |
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whats the role of TGFb in cancer
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its an IMMUNOSUPPRESSIVE cytokine, oh no!!! (IL10 also)
causes: increased angiogenesis, increased ECM, immunosuppression Made by Treg and fibroblasts |
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whats teh cytokine made by Treg and fibro that really is a lame one to make when we are trying to kill cancer?! why is it so lame to make it
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TGFb
causes angiogenesis makes ECM immunosuppressive |
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who gets these PRIMARY cardiotumors
Myxoma Phabdomyoma angiocarsoma |
adults
kids adults |
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tell me about myxomas
who gets them primary or secondary benign/malignant presentation location (common) composition |
adults
primary benign Ball Valve obstruction heart failure, makes IL6 to give fever, can fragment and make septic smboli, will kill you bc of the location (not bc its malignant) Common in L atria but can be anywhere in the heart made of mesenchyme gelatin |
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who might get a gelationous tumor in the ehart that will cause septic emboli
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an adult
myxoma, common in L atria release IL6 and cause fever made of mesenchyme ball valve obstruction |
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Patient presented with sudden onset of
hemiparesis; altered mental status, right facial droop, difficulty swallowing, and flaccid paralysis of the left arm. CT followed by MRI of the brain revealed multiple new infarcts of the bilateral occipital and frontal lobes, cerebellum and right temporal lobe. EKG shows ST segment elevation. CT of the abdomen demonstrated no perfusion of the right kidney, patchy perfusion of the left kidney and a filling defect of the superior mesenteric artery. • What might account for all of these diverse lesions? • What test would you request next? Echocardiography was performed that showed a dilated left atrium with a mobile mass attached to the atrial septum, 2.3 x 1.5 cm. • What is the likely cause? • Interventional angiography reveal an occlusion of the distal left anterior descending coronary artery, occlusions of both renal arteries and superior mesenteric artery. Balloon angioplasty of the coronary artery somewhat improved coronary perfusion. • The superior mesenteric artery was completely occluded by gelatinous material, removed and sent for pathologic examination. • What is the most likely diagnosis of this material |
1. heart leision in left side of heart, myxoma- mesehchymal ball valve tumor
2. echo |
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whats the most common cardiac neoplasm in kids
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Rhabdomyoma
**rare, benign tumor or hamartoma **can cause obstruction |
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whats the aggerssive tumor in the heart
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angiosarcoma, mets, usually fatal
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does an a ray or a b ray penetrate more deeply
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b
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whats a curie/becquerel
whats a gray whats a sivert |
measure of radioactive material
100 rads, rads are dose used to measure amt given to pt relative biological effectiveness of x rays, mSv is the amt of radiation a healthcare provider can be exposed to |
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what is the measure to calc a dose of radioactive iodine to give a pt
what is used to dose external beam of radiation what units are used to record exposure of a healthcare worker |
rad, 100 rad = 1 gray
curie/becquerel mili siverts |
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how is a dose of radiation tolerated best
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in divided doses
recall pts are given in RADS, 100 rads = 1 gray |
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what cells are sensitive to radiation
when is a cell MOST vulnerable |
1. dividing cells: lymphocyts, all hemapoietic cells, germ cells, Epithelium (adult bone and cart are pretty resistant)
2. DNA is the target of radiation, more sensitive in G2 or M phase |
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whats the pathogenesis of radiation injury
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well we are trying to kill dividing cells that are in G1 oe M phase to kill DNA
Dose Dependent HIGH: necrosis MOD: kill proliforating cells LOW: make O2 free radicles, indirect. DNA damaege may be delayed. leads to apoptosis. can be teratogenic |
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so we say we are targeting the DNA of cells in G1/M to target the DNA, what exactly do we do to the DNA
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usually double stranded DNA breaks
ten we get non homologous end joining (less common to see homologous recombination) |
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whats acute radiation injury
whats chronic |
ACUTE:
- kill radiosensitive cells like leukocytes, -endothelium--> stop angiogenesis. -damage to GI crypts CHRONIC: Vascular injury leads to fibrosis, thrombosis (acute too) ectatiac BV that are dilated and telangtasia--> ischemis to organs supplied by these scarred BV FIBROSIS: need to live long enough to get fibrosis |
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what cancers were related to radiation exposure? whats the latency
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1. Hiroshima
2. Chernobyl 3. Fukshima |
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why is it good that radiation will cause acute damage to endo
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stop angiogenesis
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what are 3 chronic effects of radiation damage
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1. Vascular fibrosis, dilation
2. Ischemia of organs supplied by these BV 3. Fibrosis, due to ischemia and loss of stem cells (stem are really sensitive) |
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what are the 3 things we see with acute radiation injury
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1. Cell death- replicating. stem, lymph (all BM cells), epithelium
2. Endo- stop angiogenesis 3. Damage to intestinal crypts (epithelium) |
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ok so can we get cancer from radiation
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ya but usually like 20 eyars later
MINMUM of 2 years |
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tell me about hiroshima
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radiation caused cacner
Adults for acute leukemia Chids got thyroid, breast, GU, GI (more like stem cells were affected) |
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what cancers are common with accident/Occupational risk
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1. leukemia
2. lung 3. osteogenic sarcoma |
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what kind of radiation leads to thyroid cancer
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1. particulate emission
2. atomic bomb 3. nuclear power plant |
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what happens to babies if mom gets radiation
Preimplantation organogenesis Fetal period infants |
Preimplant- LETHAL
Organogenesis: implant to 9 weeks, malformations likely Fetal: 9 weeks to birth. underdeveloped reproductive organs, increased risk of leukemia, brain tumors. things that grow lots InfantsL retarded CNS, bone, teeth, eye |
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what happens to the skin with radiation
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1. red, edema, blister, hair loss
2. later: dermatitis, telangiectasia from weak vessels. change in pigmentation, impaired healing 3. Skin cancer 20+ years later (basal cell or squamous cell) |
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what happens to the BM when you have radiation
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1. Acute: lymphopenia, anemia
2. Late/Delayed: hypoplasia, preccancer, leukemia, lymphoma |
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what happens in the gonads with radiation
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sterility even at low dose, they are super sensitive
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what happens to the lungs in radiation
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Acute: ARDS, pulm edema, pulm congestion
Late: fibrosis, radiation pneumonitis, 1 lung cacner |
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what happes to the GI with radiation
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1. Acite: villa damaged- malabs diarrhea. ulcers, susceptible to infection, fluid/electrolyte imbalance
2. Late: fibrosis, ulceration |
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whats are the effects of radiation in the heart
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fibrosis, restrictive cardiomypoathy
fibrosis of pericardium acceleerated artherosclersosis ischemia |
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acute radiation syndrome is associated with what
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total body radiaiton
**can happen with low doess **MB is affected and decreased PMN in just a day or so. other blood cells also decrease. need BMT |
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after acute radiation syndrome what will we see after...
1. 1-4 hrs 2. 1 day 3. 5-14 days 4. 2-6 weeks |
1. CNS effects, vomit, death, NO lymphocytes
2. 1 day, decreased PMN 3. 5-14 days: GI- diarrhea, vomit, fluid electrolyte loss, lethal 4. 2-6 weeks: leokopenia with thrombocytopenia, hemmorage, epithelation, letha; 80% of the time |
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is an adult brain affected by radiation, what about embryo
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aDULT: NOPE
Babe: neurons, glia are killed in weeks to months |
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whats the time course of skin damages seen after radiation
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early: edema, erythema
weeks/mo- alternate pigmentation years- skin cancer |
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when do we see mucasal injury, ulcerationand fibrosis in GI after radiation
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early- mucosal
mid- ulcer late- ulcer, fibrosis |
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what is an IMMEDIATE effect of radiation
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decreased lymphocytes
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