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What are the most common forms of cancer?
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What are the stages of carcinogenesis?
- Initiation
- Promotion
- Conversion
- Progression
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What is initiation in carcinogenesis?
- Exposure of normal cells to carcinogenic substances producing genetic damage that, if not repaired, results in irreversible cellular mutations.
- Mutated cells have an altered response to their environment and a selective growth advantage, giving them the potential to develop into clonal populations of neoplastic cells.
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What is promotion in carcinogenesis?
- Carcinogens or other factors alter the environment to favor growth of the mutated cell population over normal cells.
- This is reversible.
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What is conversion in carcinogenesis?
- The mutated cell becomes cancerous
- This could take 5-20yrs
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What is progression in carcinogenesis?
- Further genetic changes lead to increased cell proliferation.
- The critical elements of this phase include tumor invasion into local tissues and the development of metastases
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What are protooncogenes?
Normal genes that are genetically altered through point mutation, chromosomal rearrangement, or gene amplification and consequently activate the oncogene
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What are oncogenes?
- Produce either excessive amounts of the normal gene product or an abnormal gene product resulting in dysregulation of normal cell growth and proliferation
- EGFR family [ErbB-1 (EGFR), HER-2, her-3, and HER-4]
- BCR-ABL
- K-RAS
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What are tumor suppressor genes?
- Regulate and inhibit inappropriate cellular growth and proliferation
- Retinoblastoma
- p53
- BRCA1 & BRCA2
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What type of cancer is HER-1 responsible for?
- Glioblastoma
- Breast
- Head and neck
- Colon
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What type of cancer is HER-2 responsible for?
- Breast
- Salivary gland
- Prostate
- Bladder
- Ovarian
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What type of cancer is HER-3 responsible for?
- Breast
- Colon
- Gastric
- Prostate
- Other carcinomas
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What type of cancer is HER-4 responsible for?
- Breast
- Prostate
- Childhood medulloblastoma
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What type of cancer is BCR-ABL responsible for?
Chronic myelogenous leukemia
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What type of cancer is K-RAS responsible for?
- Lung
- Ovarian
- Colon
- Pancreatic binding cancers
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What type of cancer is faulty retinoblastoma responsible for?
- Retinoblastoma
- Osteosarcoma
- Bladder
- Small cell lung
- Prostate
- Breast
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What is the most common genetic change associated with cancer?
p53
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What type of cancer is p53 associated with?
wide variety
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What type of cancer is BRCA1 associated with?
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What type of cancer is BRCA2 associated with?
Breast
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What can be done to help prevent cancer?
- Lifestyle modifications:
- exercise
- eat more fruits and vegetables (antioxidants)
- use sunscreen
- quit smoking
- Chemoprevention:
- HPV vaccine
- antioxidants (alpha tocopherol, beta carotine)
- Tamoxifen
- Raloxiphene
- Aspirin/NSAIDs (maybe...for colon cancer)
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What antioxidant increases risk of lung cancer if taken by smokers?
beta carotine
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What screenings should be performed to detect cancer, and when should they be done?
- Clinical breast exam - 20
- Pap test - sexual activity, but NLT 21
- Mammogram - 40
- DRE (prostate) - 40
- PSA (prostate) - 40
- Colonoscopy - 50
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What are the levels on the ECOG scale for performance status?
- 0: fully active
- 1: restricted in strenuous activity
- 2: out of bed >50%, able to provide self-care
- 3: in bed >50%, only limited self-care
- 4: bedridden, completely disabled, no self-care
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What are the trends of the Karnofsky scale for performance status?
- 0% - dead
- 20% - very sick, hospitalization necessary, requires active supportive treatment
- 50% - requires considerable assistance and frequent medical care
- 80% - normal activity with effort, some signs or symptoms of disease present
- 100% - no complaints or evidence of disease
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What are the characteristics of a "good" chemo drug?
- Effective
- Low toxicity
- Targeted
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What are the common and acute toxicities associated with chemo drugs?
- Alopecia - most disturbing for the pt
- NV - most disturbing for the pt
- Myelosuppression (neutropenia, thrombocytopenia, anemia) - most worrisome for the provider
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What are the organ specific toxicities associated with chemo drugs?
- Nephrotoxicity
- Cardiac toxicity
- Pulmonary toxicity
- Bladder - hemorrhagic cystitis
- Myelosuppression
- Peripheral neuropathy
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What chemo drug is associated with nephrotoxicity?
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What chemo drug is associated with cardiac toxicity?
Doxorubicin
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What chemo drug is associated with pulmonary toxicity?
Bleomycin
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What chemo drug is associated with hemorrhagic cystitis (bladder toxicity)?
Cyclophosphamide (at high doses)
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What chemo drug is associated with myelosuppression?
- Fluorouracil
- Mercaptopurine
- Methotrexate
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What chemo drug is associated with peripheral neuropathy?
Vincristine and other Vinca Alkaloids
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What drug used in chemo is responsible for a puffy face?
Corticosteroids
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What are the possible long-term complications of chemo?
- Sterility
- Infertility
- Secondary leukemia
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What is curative care?
- analytical and rationalistic
- based on diagnoses
- scientific and biomedical
- aimed at disease process
- views patients as parts
- based on "hard"sciences
- impersonal care
- hierarchical
- death is seen as failure
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What is palliative care?
- subjective
- based on symptoms
- humanistic and interpersonal
- aimed at comfort
- views patient as a whole
- based on "soft" social sciences
- individualized care
- interdisciplinary
- death accepted as normal
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