Introduction to Oncology and Cancer Prevention Flashcards


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1

Five most common types of cancer

breast, prostate, lung and bronchus, colon and rectum, melanoma of the skin

2

Most lethal type of cancer

Pancreatic

3

Cancer that kills that most people

Lung cancer

4

Most common type of cancer

Breast cancer

5

Cancer is a genetic disease caused by

  • changes to genes that control how cells function, grow, and divide
  • Knudson's double hit hypothesis; some must go wrong with both alleles

6

Genetic changes that cause cancer can happen because

  • errors that occur as cells divide (mitosis)
  • damage to DNA caused by harmful substances in the environment (tobacco smoke, UV rays)= carcinogens

7

Germline definition

occurs in the egg/sperm, can be passed onto offspring (inherited)

8

Somatic definition

occur in the body cells, are not passed to offspring (not inherited)

9

Oncogenes definition

any gene that causes cancer

10

Once oncogenes are activated it leads to

excessive amounts of normal gene product or abnormal gene product which results in dysregulation of normal cell growth and proliferation--> growth advantage for cancer cells

11

Define proto-oncogenes

normal genes that help cells grow

12

Tumor suppressor genes normal function is to

inhibit appropriate cellular growth and proliferation

(alterations lead to loss of control over normal cell growth)

13

DNA repair genes normally

repair DNA that has been damaged due to carcinogens or errors in DNA that occur during replication

(deficiencies in these genes allow for accumulation of genetic alterations)

14

Types of tumors

Solid tumors and hematologic malignancies (liquid)

15

Colorectal cancer chemoprevention

low dose Aspirin

  • 50-59 y/o
  • ASCVD risk 10%
  • 10-year life expectancy
  • low risk of bleeding

16

Breast cancer chemoprevention

  • Gail Model 5-year breast cancer risk of 1.7% or 10-year risk of 5% by IBIS/Tyrer-Cuzick
  • History of LCIS
  • 35 y/o: tamoxifen, raloxifene
  • Postmenopausal: exemestane, anastrazole

17

Breast, ovarian, uterine cancer surgical prevention

  • risk-reducing mastectomy
  • risk-reducing saplingo- oophorectomy (ovarian/uterine)

18

Warning signs of cancer

CAUTION

C- change in bowel or bladder habits

A- a sore that does not heal

U- unusual bleeding or discharge

T- thickening or lump in breast or elsewhere

I- indigestion or difficulty swallowing

O- obvious change in wart or mole

N- nagging cough or hoarseness

19

Screening for female breast cancer age 40-44 y/o

yearly mammograms are optional

20

Screening for female breast cancer age 45-54 y/o

begin yearly mammograms

21

Screening for female breast cancer age ≥ 55 y/o

mammograms every 2 years or continue yearly

22

Screening for female cervical cancer age 21-29 y/o

pap smear every 3 years

23

Screening for female cervical cancer age 30-65 y/o

pap smear + HPV DNA test every 5 years

24

Screening for female/male colon cancer age >45 (40 y/o if FH of polyps)

stool-based tests (if positive follow with colonoscopy)

  • fecal occult blood test or fecal immunochemical test (yearly)
  • stool DNA test (every 3 years)

Visual exams of colon/rectum

  • colonoscopy (10 years) GOLD STANDARD
  • sigmoidoscopy (5 years)
  • CT colonography (5 years)

25

Screening for female/male lung cancer age 55-74 y/o

annual CT scan of chest if all of the following:

  • good health
  • 30 pack-year smoking history
  • still smoking or quit smoking 15 years

26

Screening for male prostate cancer age 55 y/o

if patients opts to be tested, it involves:

  • prostate specific antigen (PSA-protein in blood) test
  • +/- digital rectal exam (DRE-feel back of wall of prostate)

27

Define tumor grading

  • description of a tumor based on how abnormal the tumor cells and the tumor tissues look under a microscope
  • indication of how quickly a tumor is likely to grow and spreads

28

Define a well-differentiated tumor

cells of tumor and organization of tumors tissue are close to those of normal cells and tissue

29

Define a poor differentiated tumor

abnormal-looking cells; may lack normal tissue structures

30

Methods of staging solid tumors (staging defines the extend of disease spread)

CT, MRI, and PET

(used to measure primary tumor and evaluate for the metastatic disease spread)

31

Solid tumor staging (non-CNS) T= size and extent of primary

T0: main tumor cannot be found

T1-4: higher the number= larger tumor or the more it has grown into nearby tissues

32

Solid tumor staging (non-CNS) N= number of nearby lymph nodes that have cancer

N0: no cancer in nearby lymph nodes

N1-3: higher number= more lymph nodes that contain cancer

33

Solid tumor staging (non-CNS) M= whether the cancer has metastasized or spread

M0:cancer has not spread to other parts of the body

M1: cancer has spread to other parts of the body

34

Process in which cancer grows and spreads (carcinogenesis)

initiation--> promotion--> conversion--> progression

(normal cell-> initiated cell-> preneoplastic lesion-> malignant tumor-> clinical cancer-> metastases)

35

What can happen in the initiation process of carcinogenesis

carcinogens, radiation, viruses, random errors during cell division

(first hit)

36

What can happen in the promotion process of carcinogenesis

activation of proto-oncogenes, inactivation of tumor suppressor genes, inactivation of genomic stability genes

(second hit)

37

Types of solid tumors

carcinoma, sarcoma, CNS

38

Types of hematologic malignancies (liquid tumors)

leukemia, lymphoma, myeloma/misc. B-cell disorders

39

Where does carcinoma tumors start

starts in epithelial tissues that cover the body, all the organs inside the body, and line the organs and body cavities

40

Where does sarcoma tumors start

starts in connective tissues (supportive tissues of the body, either hard or soft bone)

41

Where does CNS tumors start

forms in the neural cells in the brain or spinal cord

42

Where does leukemia start

starts in the bone marrow in the WBC cell line leukocytes

43

Where does lymphoma start

lymphatic system (glands, lymphocytes)

44

Where does myeloma/B-cell disorders start

starts in the plasma cells

45

Procedure sample for pathology and tumor profiling

tissue biopsy

46

What is a CT scan

series of x-rays and a computer

47

What is a MRI scan

magnetic field and computer-generated radio waves

48

What is a PET scan

special dye containing radioactive tracers

49

Define a benign tumor

tumors that tend to grow slowly and do not spread

50

Define a malignant tumor

tumors that can grow rapidly, invade and destroy nearby normal tissues, and spread throughout the body

51

Mainstay therapy in solid tumors

Remove the entire tumor

52

When would it be best to debulk a tumor (remove some but not all of cancer tumor)

when removing a entire tumor might damage an organ or the boy- c

53

How does radiation work for treatment of cancer?

uses high doses of radiation to kill cancer cells and shrink tumors by damaging their DNA **takes days or weeks of treatment before DNA is damaged enough for cancer cells to die**

54

External beam radiation

  • machine that aims radiation at the cancer
  • local treatment

55

Internal radiation

  • source of radiation is put inside the body
  • solid or liquid tumor

56

4 classes of systemic anticancer agents

cytotoxic chemotherapy, hormonal agents, small molecule inhibitors, biologic response modifiers

57

Cytotoxic chemotherapy agents

alkylating agents (cyclophosphamide)

antimicrotubule agents (paciltaxel)

antimetabolites (methotrexate)

others: epigenetic modifiers, topoisomerase inhibitors, misc. agents

58

Hormonal agents

antiandrogens/antiestrogens

LHRH/GnRH agonists or antagonists (leuprolide)

aromatase inhibitors (letrozole)

somatostatin analogues (lanreotide)

59

Small molecule inhibitors

single-or-multi-kinase inhibitors (vemurafenib)

differentiation agents (tretinoin)

histone deacetylase inhibitors (belinostat)

others: proteasome inhibitors, angiogenesis inhibitors

60

Biologic response modifiers

immune checkpoint inhibitors (ipilimumab)

monoclonal antibodies (rituximab)

interferons/interleukins, colony stimulating factors, vaccines

cellular therapy (CAR T-cells)

antibody-drug conjugates

61

What does ECOG stand for

Easter Cooperative Oncology Group

62

ECOG is standard criteria for

measuring how the disease impacts a patient's daily living abilities (performance status)

63

Grade 0-ECOG

fully active, able to carry on all pre-disease performance without restriction

64

Grade 1-ECOG

restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature , ex: light housework, office work

65

Grade 2-ECOG

ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours

66

Grade 3-ECOG

capable of only limited selfcare; confined to bed or chair more than 50% of waking hours

67

Grade 4-ECOG

completely disabled; cannot carry on any selfcare; totally confined to bed or chair

68

Treatment goals of cancer

curative intent, life extending intent, palliative intent

69

Curative intent is administered

to patients with local or regional disease

70

Life extending intent is administered to

patients with metastatic disease to slow progression of cancer and prolong survival by months to years

71

Palliative intent is given to

patients with the goal of reducing symptoms

72

What is complete response/remission (CR)

complete disappearance of all cancer without evidence of new disease for at least 1 month after treatment

73

What is partial response (PR)

25-30% or greater decrease in tumor size from baseline and no evidence of any new disease for at least 1 month

74

What is stable disease

no change in tumor size

75

What is progressive disease (PD)

20-25% increase in tumor size or development of new lesions while receiving treatment

76

What is relapse, recurrent, and/or refractory (R/R)

return of disease or the sign and symptoms of disease after a period of improvement, recurs after eradication, refractory to treatment

77

Cancer patient journey

diagnosis and workup-> staging-> treatment-> response evaluation-> monitoring-> cure or can relapse/progression

78

What is Glioma?

tumor of glial cells

79

What is a glial cell?

a non-neuronal cell of the nervous system

ex: oligodendrocytes, astrocytes, microglia, schwann cells, ependymal cells

80

Induction-terminology and goals

  • high dose combination initial therapy
  • induce a complete response

81

Consolidation- terminology and goals

  • after successful induction
  • kill undetectable disease and prolong remission

82

Neoadjuvant- terminology and goals

  • treatment before surgery
  • shrink tumor to allow for complete surgical resection

83

Adjuvant- terminology and goals

  • treatment AFTER surgery
  • destroy residual cells and prevent recurrence

84

Maintenance- terminology and goals

  • treatment continued for long period of time after response
  • prevent relapse and prolong PFS

85

Salvage- terminology and goals

  • treatment after the cancer has not responded to conventional therapies
  • induce a response

86

Palliative- terminology and goals

  • provides relief from cancer burden to patient
  • increase quality of life; inherent goal in treating metastatic (stage IV) disease