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68 Cards in this Set
- Front
- Back
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Most important risk factor urothelial cell carcinoma?** a. alcohol b. aromatic amines c. smoking d. old age |
smoking (4x) |
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Most common type bladder cancer ** |
transitional cell carcinoma predominant histologic subtype (90%) (10%:adenocarcinoma, squamous cell carcinoma, small cell carcinoma) |
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Most common type bladder cancer?** a. adenocarcinoma b. transitional cell carcinoma c. squamous cell carcinoma d. small cell carcinoma |
transitional cell carcinoma |
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Most common type renal cell carcinoma?** |
Clear cell RCC (75% of all RCC) most common subtype (VHL gene inactivation) |
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Most common type renal cell carcinoma?** a. papillary b. chromophobe c. clear cell d. giant cell e. adenocarcinoma |
clear cell Clear cell RCC (75% of all RCC) most common subtype (VHL gene inactivation) |
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** Sx renal cell carcinoma |
Hematuria Flank pain Palpable abdominal mass (renal mass on cT, highly vascular on CT) |
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** Sx Bladder cancer |
Painless hematuria (most common) Irritative voiding symptpoms possible > ferequency > urgency > dysuria W/ advanced disease: progressive flank or pelvic pain |
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Symptom of advanced disease in urothelial cell carcinoma**? a. palpable abdominal mass b. painless hematuria c. dysuria and urgency d. pelvic pain e. fever |
pelvic pain elim: a. x. RCC b. x. bladder cancer(UCC) but not sign advanced c. x. bladder cancer less common sx d. correct (progressive flank or pelvic pain, direct extension of disease or consequence of ureteral obstruction) e. nonspecific distractor |
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*** 1. Most common symptom UCC. 2. Most common symptom RCC. 3. Sign of advanced UCC. a. palpable abdominal mass b. painless hematuria c. dysuria and urgency d. pelvic pain e. fever |
1. painless hematuria (dysuria, hematuria less common) 2. palpable abdominal mass (+hematuria, flank pain, renal mass CT (very vascular)) 3. pelvic pain |
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** 1. A physician observes a very vascular lesino in the urinary tract. What is this most likely diagnosis? 2. Von Hippel lINDAU 3p translocation w/ chromosome 6 or 8 is associated with what? 3. 4:1 male/female ratio, average age 75 years diagnosis 4. glutathione S-transferase Mu 1 null genotype. a. BPH b. renal cell carcinoma c. urothelial cell carcinoma d. testicular cancer |
1. urothelial cell carcinoma (bladder cancer) 2. RCC 3. urothelial cell carcinoma (bladder cancer) 4. urothelial cell carcinoma (bladder cancer) |
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describe cancer generally ** |
Cancer is a complex genetic disease defined by transition of a normal cell, governed by processes that control its replication and behavior, into a cancer cell that is typified by unrestrained proliferation and dissemination, ultimately leading to a state of disease and/or death |
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hallmarks cancer ** |
> self-sufficiency in growth signals > insensitivitiy to anti-growth signals > evasion of apoptosis > limitless replicative potential > induction of angiogenesis > tissue invasion and metastasis Emerging hallmarks > immune evasino > metabolic dysregulation |
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emerging hallmarks cancer ** |
immune evasion metabolic dysregulation |
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enabling characteristics ** |
genomic instability > Important for the development of cancers as well for the resistance to treatments that can emerge during systemic therapy inflammation > Accounts for the stepwise progression of tumors and may sutain cancers by providing an inflammatory environment |
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Important for the development of cancers as well for the resistance to treatments that can emerge during systemic therapy ** |
Genomic instability |
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Accounts for the stepwise progression of tumors and may sutain cancers by providing an inflammatory environment ** |
Inflammation |
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most commonly muted gene in sporadic cancers ** |
TP 53 > associated w/ = breast and brain tumors = leukemia = sarcoma, pattern termed the Li-Fraumeni syndrome |
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Stability genes and their associated tumor types ** |
Description > responsible for the repair of errors in normal DNA replication Result mutation > Increased errors in DNA replication (mutations) introduced in oncogenes + tumor suppressor genes > malignant transformation |
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Responsible for death in more than 90% cancer patients ** |
Metastatic disease |
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Emerging hallmarks cancer ** |
distinct metabolic requirements tumor's capacity evade the body's immune response |
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enabling characteristics cancer ** |
genomic instability inlammation |
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EGFR?* |
Growth stimulating protein in lung and colon cancer |
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HER2/neu * |
breast cancer growth stimulating protein |
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RAF *
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growth stimulating protein in melanoma |
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MEK * |
Growth stimulating protein in melanoma |
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** 1. Used in cancer therapy 2. in lung and colon cancer 3. In melanoma 4. In breast cancer a. EGFR b. HER2/neu c. RAF d. MEK e. VEGF |
1. VEGF (block angiogenesis) 2. EGFR 3. RAF, MEK 4. HER2/neu |
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Classificaiton mutations in cancers *8 |
3 categories depending on functional consequence of mutations: > oncogenes > tumor suppressor genes > stability or caretaker genes |
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Oncogene ** > description > mechanism > types |
Description > convert a normal cell into a cancerous cell, including chromosomal translocations, gene amplifications, inorganic mutations Mechanism > often activate pathways important for cancer Types > CML > BCR-ABL |
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gene related to breast cancer ** |
HER2 |
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** 1. Someone with what type of cancer would benefit most from transtuzumab? 2. What is the mechanism of the drug? |
1. breast cancer 2. anti-HER2 monoclonal antibody, transtuzumab |
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** Someone with what type of cancer would benefit from drug inhibiting EGFR? |
non small cell lung cancer |
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BRAF mutation ** |
Melanoma |
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Melanoma gene * |
braf |
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Tumor suppressor genes ** > funciton > types |
function > contorl cellular replication and growth types > RB1 (retinoblastoma): mutations in both genes can result in multiple tumors including bilateral retinoblastoma > TP53: most commonly mutated gene in sporadic human cancers = deletions gene associated with breast and brain tumors, leukemia and sarcoma (Li Fraumeni syndrome) |
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** Most commonly mutated gene in sporadic human cancers |
TP53 |
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Linked to li fraumeni syndrome ** |
Mutation tummor suppresor gene, TP53 |
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Stability genes ** |
Rsponsible for the repair of errors in normal DNA replication types > mismatch repair genes > base excision repair genes > nucleotide excision repair genes |
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** Lynch syndrome is a cause of what? a. mutations in DNA mismatch repair genes b. mutation in tumor suppressor genes c. mutation in base excision repair genes d. oncogene production e. mutation in nucleotide excision repair |
mutations in DNA mismatch repair genes |
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Screening for colon cancer?** |
colnoscopy |
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Screening for cervical cancer?** |
Pap smear (papanicolau) |
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Pap smear for?** |
Cervical cancer screening |
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Colonoscopy for ?** |
Colon cancer screening |
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GI cancers are typically what type of cancer? ** |
epithelial malignancies, carcinomas with well defined pathological patterns of neoplastic transformation |
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GI cancers are typically what type of cancer? ** a. adenoma b. carcinoma c. sarcoma d. polyp like |
carcinoma epithelial malignancies, carcinomas with well defined pathological patterns of neoplastic transformation |
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Management generally of GI cancers ** |
> surgery > chemotherapy > radiation therapy |
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Additional contributors to morbidity from gI cancers ** |
> complications of malignancy: > intestinal or biliary obstruction and impaired nutrition due to anatomic and physiologic alteration of Digestive system |
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epidemiology renal cell carcinoma ** |
> 2-3% of all malignancies > 5th most common in men, 7th most common women > ~ 65k new cases in US |
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Risk factors RCC ** |
> Smoking (2x greater than non smokers) less certain risk factors: > obesity > hypertension > patients w/ end stage renal failure or polycystic kidney disease |
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** 1. Established risk factor for RCC ? 2. RF transitional cell carcinoma? a. obesity b. hypertension c. smoking d. end stage renal failure e. polycystic kidney disease f. slow acetylator N-acetyltransferase 2 (NAT2) variants |
1. smoking (2x) 2. smoking (4x), more specific for TCC: slow acetylator N-acetyltransferase 2 (NAT2) variants (+ glutathione S-transferase Mu 1 (GSTM1) |
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Risk factors bladder cancer (transitional cell caricinoma ) ** |
> More common developed countries > smoking (4x higher smokers) > occupational exposure = aromatic amines, chlorinated hydrocarbons, polycyclic aromatic hydrocarbons (20% of all bladder cancers) > 2x first degree relatives > genetic factors = slow acetylator N-acetyltransferase 2 (NAT2) variants and glutathione S-transferase Mu 1 (GSTM1)-n ull genotypes |
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** Risk factor transitional cell carcinoma? a. obesity b. hypertension c. exposure aromatic amines d. end stage renal failure |
Exposure aromatic amines |
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Most common malignant among men in the US ** |
Prostate cancer |
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Most common malignant among men in the US** a. lung cancer b. testicular cancer c. prostate cancer d. bladder cancer e. renal cell carcinoma f. skin cancer |
prostate cancer |
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Epidemiology and background prostate cancer ** |
> most common malignant among men in the US > heterogeneous disease with a diverse but often long natural history > lifetime risk developing ~ 1/6, but most men do not die of cancer > median age dx = 65 years (younger men < 40 rarely develop prostate cancer) |
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Risk factors prostate cancer ** |
> Age = African American men have greater risk developing prostate cancer compared w/ white or Hispanic men > Race > Dietary factors > genetic = BRCA1/2, Lynch syndrome, Abnormalities in homeobox B13 (HOXB13) > 1st degree relatives =5x - 10x increase risk prostate > high animal fat intake |
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What cancer is linked with BRCA1/2 mutation according to test? ** a. testicular cancer b. lung cancer c. bladder cancer d. prostate cancer e. brain cancer f. renal cell carcinoma |
prostate cancer |
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Which of the following is associated with prostate cancer most specifically according to text? ** a. exposure aromatic amines b. high fat diet c. smoking d. slow acetyaltor N-acetyltransferase 2 variant e. inactivation VHL gene |
high fat diet elim: a. x. BC b. correct c. x. RCC, BC d. x. bladder cancer e. x. RCC |
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** 1. von Hippel-Lindau syndrome 2. High fat diet 3. slow acetyaltor N-acetyltransferase 2 variant 4. BRCA1/2 mutation 5. exposure aromatic amines |
1. RCC 2. prostate cancer 3. bladder cancer 4. prostate cancer 5. bladder cancer |
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Epidemiology and background testicular cancer ** |
> Variety widely among racial groups > In US, most common cancer diagnosed men 20-40 > 5x common in white than black > increased 50% since 1975 |
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Risk factors testicular cancer ** |
> Cyptorchidism = cryptorchidism before puberty reduces risk testis cancer > Person or family history of testis cancer |
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*** 1. Affects AA much more than whites 2. Affects whites much more than AA 3. About 95% are germ cell tumors 4. von Hippel Lindau syndrome |
1. Prostate cancer 2. Testicular cancer 3. Testicular cancer 4. Renal cell carcinoma |
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*** 1. Cisplatin commonly used for what? |
1. metastatic bladder cancer, increases survival to ~ 14-15 mo, w/ 5-15% patients cured |
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1. What cisplastin used for ? ** 2. Result cisplatin ?? a. curing b. nothing c. increase survival 4-5 months d. increase survival 14-15 mo. e. increase survival 2-6 years f. increase survival 10-12 years |
1. metastatic bladder cancer 2. increase survival 14-15 mo. |
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** Patient has painless hematuria 1. Dx? 2. Assessment |
1. suspected bladder cancer 2. > office based cystoscopic evaluation > collecting urine for cytology > patients undergo transurethral resection of bladder tumor (TURBT) under anesthesia to obtain tissue for histology |
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Prognosis bladder cancer ** |
> Patients low grade low stage NMIBC do not progress to muscle invasive usually > those w/ organ contend disease w/o nodal involvement = cure rates > 50% > metastatic disease: 14-16 mos w/ systemic therapy, 5-15% long term survivors |
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**** 1. Most common malignant among men 2. About 95% germ cell tumors 3. cisplatin common treatment |
1. prostate cancer 2. testicular cancer 3. metastatic bladder cancer |
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** 1. Sx testicular cancer 2. Dx |
1. Enlarged testis, w/ or w/o pain 2. transcrotal ultrasound Inguinal orchidectomy if mass suspicious for cancer (standard dx procedure) > Transscortal orchidectomy or biopsy contraindicated b/c the risk of seeding the tumor in the scrotum and altering the pattern of spread |
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What is the standard diagnostic procedure for testicular cancer? ** a. biopsy b. transscrotal orchiectomy c. transscrotal ultrasound d. inguinal orchiectomy e. PSA lab test |
inguinal orchitectomy elim: a. x. contraindicated b/c the risk of seeding the tumor in the scrotum and altering the pattern of spread b. x. contraindicated b/c the risk of seeding the tumor in the scrotum and altering the pattern of spread c. x. whenever testis tumor suspected (Screening), not a diagnostic procedure d. correct. e. x. screening for prostate cancer, BPH |
