23 Questions
Which tumor marker is associated with testicular cancer and choriocarcinoma?
Beta-HCG
In which type of cancer is Chromogranin A a tumor marker?
Carcinoid tumor
What is the main target of damage in radiation therapy (XRT)?
DNA
Which cancer is associated with human papillomavirus?
Cervical cancer
Which chemotherapy agent is known for causing nephrotoxicity, neurotoxicity, and ototoxicity?
Cisplatin
Which cell cycle-specific chemotherapy agent exhibits a plateau in cell-killing ability?
5-Fluorouracil (5FU)
'Initiation' in cancer transformation involves which of the following?
Heritable alteration in genome and loss of growth regulation
What is the most important prognostic indicator for lung cancer and breast cancer devoid of systemic metastases?
Nodal status
Which cancer is the most common cause of cancer-related death in women?
Lung cancer
What is the primary role of PET (positron emission tomography) in cancer diagnosis?
Identifying metastases
What is the primary reason for false positives in PET scans for cancer diagnosis?
Inflammatory disease
Which type of cells need the MHC complex to attack tumors?
Cytotoxic T cells
What can independently attack tumor cells without the need for the MHC complex?
Natural killer cells
What are the most common causes of false negatives in PET scans for cancer diagnosis?
Slow-growing tumors
Which drug inhibits thymidylate synthetase, resulting in purine and DNA synthesis inhibition?
Etoposide
Which drug is a DNA intercalator and forms O2 radicals, causing cardiomyopathy at total doses exceeding 500 mg/m2?
Doxorubicin
Which chromosome is involved in cell cycle regulation and movement?
APC
Which gene is involved in apoptosis (programmed cell death)?
bcl
Which syndrome is associated with patients getting benign hamartomas (skin, mucus membranes, GI tract) and increased risk for cancer (usually thyroid, breast, and endometrial cancer)?
Cowden syndrome
Which gene defect is associated with patients getting childhood sarcomas, breast cancer, brain tumors, leukemia, and adrenal cancer?
p53
Which carcinoma usually does not spread to bone?
Colon carcinoma
Which phase of clinical trials focuses on long-term side effects and efficacy of the therapy?
Phase IV
Which type of therapy is administered after other therapy has been used?
Adjuvant therapy
Study Notes
- Levamisole: anthelmintic drug, thought to stimulate immune system against cancer
- Methotrexate: inhibits dihydrofolate reductase (DHFR), causing purine and DNA synthesis inhibition; side effects include renal toxicity and radiation recall
- Leucovorin (folinic acid): reverses methotrexate effects by re-supplying folate
- 5-Fluorouracil (5FU): inhibits thymidylate synthetase, resulting in purine and DNA synthesis inhibition; leucovorin increases its toxicity
- Doxorubicin (Adriamycin): DNA intercalator, forms O2 radicals; cardiomyopathy is a heart toxicity secondary to O2 radicals at total doses exceeding 500 mg/m2
- Etoposide (VP-16): inhibits topoisomerase; least myelosuppression from this drug is seen with bleomycin, vincristine, busulfan, and cisplatin
- Three main groups of cancer: epithelial tumors (ectoderm), sarcomas (mesoderm), and adenocarcinoma (endoderm)
- Tumor suppressor genes: inhibit cell cycle or induce apoptosis
- Retinoblastoma (Rb1): chromosome 13, involved in cell cycle regulation
- p53: chromosome 17, involved in cell cycle (normal gene induces cell cycle arrest and apoptosis; abnormal gene allows unrestrained cell growth)
- APC: chromosome 5, involved with cell cycle regulation and movement
- DCC: chromosome 18, involved in cell adhesion
- bcl: involved in apoptosis (programmed cell death)
- BRCA: involved in DNA damage/repair and cell cycle regulation
- Proto-oncogenes: ras (G protein defect), src (tyrosine kinase defect), sis (platelet-derived growth factor receptor defect), erb B (epidermal growth factor receptor defect), myc (transcription factors)
- Li–Fraumeni syndrome: defect in p53 gene, patients get childhood sarcomas, breast CA, brain tumors, leukemia, adrenal CA
- Cowden syndrome: defect in PTEN gene, patients get benign hamartomas (skin, mucus membranes, GI tract), increased risk for CA (usually thyroid, breast, and endometrial CA)
- Hereditary diffuse gastric cancer: defect in CDH1, patients are at risk for other cancers (breast, colorectal, thyroid, and ovarian)
- Colon CA: genes involved in development include APC, p53, DCC, and K-ras; APC is thought to be the initial step in the evolution of colorectal CA
- Colon CA usually does not go to bone
- Carcinogens: coal tar (larynx, skin, bronchial CA), beta-naphthylamine (urinary tract CA), benzene (leukemia), asbestos (mesothelioma)
- Cancer spread: suspicious supraclavicular nodes (neck, breast, lung, stomach), axillary node (lymphoma, breast, melanoma), periumbilical node (pancreas), ovarian metastases (stomach, colon), bone metastases (breast, prostate), skin metastases (breast, melanoma), small bowel metastases (melanoma)
- Clinical trials: Phase I (safety and dosage), Phase II (effectiveness and dosage), Phase III (superiority to existing therapy), Phase IV (long-term side effects and efficacy)
- Types of therapy: Induction (initial treatment), primary (neoadjuvant) (administration of an agent before another main therapy), adjuvant (given after other therapy is used), salvage (for tumors that fail to respond to initial chemotherapy)
- Lymph nodes: have poor barrier function, better to view them as signs of probable metastasis
- En bloc multiorgan resection can be attempted for some tumors (e.g., colon into uterus, adrenal into liver, gastric into spleen)
- Palliative surgery: for tumors causing obstruction or bleeding (colon CA), breast CA with skin or chest wall involvement
- Sentinel lymph node biopsy: no role in patients with clinically palpable nodes
- Colon metastases to the liver: 35% 5-year survival rate if successfully resected
- Prognostic indicators for survival after resection of hepatic colorectal metastases: disease-free interval > 12 months, tumor number < 3, CEA < 200, size < 5 cm, negative nodes
- Most successfully cured metastases with surgery: germ cell tumor (seminoma)
- Ovarian CA: one of the few tumors for which surgical debulking improves chemotherapy
- Curable solid tumors with chemotherapy only: Hodgkin’s and non-Hodgkin’s lymphoma
- T-cell lymphomas: HTLV-1 (skin lesions), mycosis fungoides (Sézary cells)
- HIV-related malignancies: Kaposi’s sarcoma, non-Hodgkin’s lymphoma
- V-EGF (vascular epidermal growth factor): causes angiogenesis, involved in tumor metastasis.
This quiz covers the most common types of cancer, their prevalence, and the important prognostic indicators for lung, breast, and sarcoma cancers. It also includes information about the use of PET scans for identifying metastases in cancer patients.
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