Please name 5 characteristics of a malignant tumor.
Quick aggressive growth penetration of surrounding tissue (Infiltration/Invasion and destructively)
incomplete capsule tumor not demarcated against surrounding tissue
frequent metastases (sec. tumors)
often spread along nerves, lymphatic/blood vessels
patients is increasingly deteriorating
after operation tumor often recurs
Name 6 symptoms of leukemia. 6
Fever
liver, spleen enlarged
bone pain
weight loss
nose bleeding
swollen lymph nodes
Name 4 types of leukemias. 4
Acute lymphocytic leukemia (ALL)
Acute myeloid leukemia (AML)
Chronic lymphocytic leukemia (CLL)
Chronic myeloid leukemia (CML)
Name the top 3 types of lymphoma.
Morbus Hodgkin
Indolent Non-Hodgkin lymphoma
Aggressive non-Hodgkin lymphoma
What is CHOP? 4
Combination chemotherapy used for non Hodgkin lymphoma
cyclophosphamide
Hydroxydaunorubicin
Oncovin
Prednisone
How does a tumor spread throughout the body? 3
Only few adhesive proteins of tumor cells
Therefore easy detachment and migration through body (lymphatic or blood)
Spread along nerves, lymphatic stream (lymph node metastases) and blood vessels
Surface marker of healthy cells no detection (camouflage principle)
Penetration of membrane with protein-dissolving enzymes
What do you call a tumor that has arisen from pigment cells of the skin? 2
Benign: Melanocyte nevus
Malignant: Malignant melanoma
What do you call a tumor that has arisen from lymphoid cells? 2
Benign: none
Malignant: Malignant lymphomas, lymphocytic leukemia
What do you call a tumor that has arisen from embryonic cells? 2
Benign: blastoma (hemangioblastoma)
Malignant: Blastoma (e.g. neuroblastoma, medulloblastoma, retinoblastoma)
What do you call a tumor that has arisen from striated muscle cells? 2
Benign: Rhabdomyoma
Malignant: Rhabdomyosarcoma
According to which systems a tumor is classified? 2
Systems: UICC stages and TNM classification
What does a stage 3 tumor mean according to UICC? 2
Tumor of any size
With metastases in 1-4 lymph nodes in the environment
No distant metastases
What does a tumor T1, N0, M0 mean? 2
T1: primary tumor, <2cm
N0: no infestation of adjacent lymph nodes
M0: no clinical evidence of secondary tumor
What does a tumor T3, N1, M1 mean? 2
T3: Primary tumor larger than 5 cm
N1: metastases in lymph nodes of the armpit
M1: remote metastases detectable
Please name 3 risk factors for the development of tumors. 3
Predisposition to cancer (genetically fixed)
External factors (smoking, excessive sun exposure, etc.)
Frequency of many tumors increase with age, also sex dependence
How does a tumor lead to complications? 3
Compressing hollow organs (blood vessels, bile ducts, etc.)
Secretion of coagulation promoting substances restricted perfusion of organs
Gastrointestinal tract: generating open connection to abdominal cavity (break intestinal wall) life-threatening inflammation of the peritoneum (peritonitis)
What does B symptomatology mean? 3
Combination of fever, night sweat, weight loss over 10% of body weight in 6 month
Early symptoms for tumor activity
Please name 8 therapeutic methods against solid tumors? 4
Surgery
Radiotherapy
Chemotherapy
Bone marrow and stem cell therapy
Targeted therapies
Gene therapy
Palliative and pain therapy
Supportive interventions
Complementary and alternative methods
Hormone therapy
What are the individual options to minimize the risk of a tumor disease? 4
Regular examinations
Healthy lifestyle (eg. balanced diet)
Avoid toxins (smoking, etc.)
Good UV protection
Vaccinate against Human papilloma viruses/ Hepatitis B virus
Please name 2 classic chemotherapeutic agents with their active ingredient name (INN) 2
Endoxan (Cyclophosphamid)
Taxol (Paclitaxel)
What do you mean by a targeted tumor therapy? 2
Critical metabolic processes targeted
Not as active in healthy cells, more tumor specific effect
What do you mean by immunotherapy? 2
Activation of patient´s immune system or supply anti-tumoral immune cells
Special focus on prevention and treatment of infections
What therapeutic options are there against vertebral body fractures? 1
Vertebroplasty/ Kyphoplasty
Two boreholes with liquid cement in vertebral body
Increase stability, less pain
Why does the mortality rate from breast cancer decrease in Germany
early examinations/ better screening methods
advances in therapy
Is there an ethnicity-dependent mortality rate for breast cancer? 1
Yes, higher non-Hispanic black, lower Asian pacific islander
What is a DCIS? 1
Ductal carcinoma in situ
Precancerous stage of the breast
What is a LCIS?
Lobular carcinoma in situ
Preinvasive breast carcinomas
Is the occurrence of a Mamma-Ca evenly distributed over the female breast?
If not, where is the greatest probability?
No even distribution
Upper outer quarter (55%)
Close proximity to the lymph nodes
Name causes and risk factors for breast cancer
Family history
Gene mutation
Late childbearing
Early menstruation & Late Menopause/ Obesity
Increased breast density
Prolonged use of oral contraceptives
Hormone replacement therapy after menopause
Alcohol/ tobacco
Age
What is BRCA 1 and 2?
Tumor suppressor genes
Proteins against hereditary breast cancer
What does BRCA lead to? 2
Breast cancer (mammary carcinoma)
Ovarian cancer (ovarian carcinoma)
Colon cancer (colon carcinoma)
Prostate Cancer (BRCA1)
Pancreatic Cancer (BRCA2)
Name 3 subtypes of breast cancer.
Luminal-like Breast-cancer
TNBC (triple-negative breast cancer)
HER2 positive breast cancer
Which is the most common breast cancer subtype?
Luminal-like breast cancer
What is the most difficult breast cancer subtype to cure?
TNBC
No specific treatment besides surgery and chemotherapy 2
What are the characteristics of TNBC?
Estrogen and progesterone receptor negative
HER2 negative
What is KI 67?
Protein to label dividing human cells (Proliferation-marker)
In nucleus during interphase
What leads to a poorer survival probability in breast cancer (5 topics (among others).
Nodal positive status
Mastektomie, better rate with breast keeping treatment
Late diagnosis
Name 3 columns of breast cancer therapy.
Radiation
Systemic therapy (endocrine, targeted and chemo therapy)
What are the building blocks of a systemic tumor therapy today?
Endocrine therapy
Targeted therapy
chemotherapy
What is a sentinel lymph node?
First located Lymph node starting from the tumor
Why do we look at the sentinel lymph node? 2
If negative, there is no tumor in close proximity
If positive, next lymph node is checked
What is the aim of breast tumor surgery?
Breast keeping, while cancer removed (tumor free resection margins)
Adjuvant/ neoadjuvant therapy first, if necessary surgery
What does neoadjuvant therapy mean?
Shrinking of tumor as early as possible
Tumor regresses, ideally it is completely destroyed before surgery
What are positive and negative effects of breast conserving surgery?
Negative
Delayed surgery of primary tumor/ lot removal, breast bulges, more likely local recurrence
Positive
Small scar, breast keeping, minor procedure/ short stay, breastfeeding possible afterwards
What is a side effect of taxanes?
Hair loss
Reduced with cooling cap during treatment
peripheral neuropathy, myelosup- pression, arthralgias, myalgias, and skin reactions
What is the AGO?
A consortium that searches for standards in cancer treatment
“Arbeitsgemeinschaft gynäkologische Onkologie”
Define micrometastases.
Little tumor cell formations, that form out of disseminated, remaining tumor cells
Stay inactive until reactivation to cancer
What is Her 2?
Human epidermal receptor 2
Growth factor receptor
What are the components of an antibody drug conjugate?
(Cytotoxic) Drug linked to an (monoclonal) antibody via thioether bridge
How does an antibody drug conjugate work?
Drug linked to an MAB, binding a receptor
Endocytosis in tumor cell
Release of the cytotoxin inside the cell (cleavage of thioether bridge)
What is the mode of action of an immune checkpoint inhibitor
Healthy cell presents PDL-1
T-Lymp. Recognizes it with PD-1
Same mode of action with cancer cells
Checkpoint inhibitors block the PD-1 receptor of cancer cells
What does a monoclonal Antibody consist of?
2 heavy chains
2 light chains
1 constant region (Fc)
2 epitopes (variable regions) (Fab)
What does the ingredient -xi mean in the name of a monoclonal antibody??
Chimeric MAB
Large part of variable region is non-human, constant region is human
What does the ingredient -zu in the name of a monoclonal antibody mean??
Humanized MAB
Only epitopes are non-human (binding area)
What does the ingredient -tu mean in the name of a monoclonal antibody?
Target/ Disease class
Target is tumor
What does hazard ratio mean?
The hazard ratio represents the probability of an event occurring in a certain group, compared to the control group. (eg. Death)
If >/<1 the probability if greater or smaller
Name four risks for prostate cancer.
Older age
African ethnicity
Gene changes
Name 3 common genomic alterations in prostate cancer. (+ gene examples)
PI-3-Kinase related (e.g. PTEN)
Androgen receptor related (eg. ERG)
DNA Damage repair (BRCA1/2)
Name 4 signs of prostate cancer.
Weak or interrupted flow of urine
sudden urge to urinate
frequent urination
trouble starting flow of urine
pain or burn while urinating
blood in the urine/ semen
What is the most common type of primary prostate cancer?
adenocarcinomas
Name 4 sites of metastases of prostate cancer. 4
Bone
Lung
Liver
Pleura
How does prostate cancer spread?
Local invasion
Lymphatic spread
Hematogenous metastases
What is the most common promotor for prostate cancer?
Testosterone
RASSF1a
Name the 2 major histological types of lung cancer. 2
Non small cell cancer
Small cell cancer
What is the median age at diagnosis for lung cancer?
70 years
Which ethnicities are mostly affected by lung cancer. 2
African American
White
Which lung cancer has the higher 5-year survival rate?
Non small cell lung cancer with 26%
Name 4 risk factors for lung cancer. 4
Smoking
Inherited mutation
Air pollution/ biomass Burning
Radioactive gas radon
Name 4 signs and symptoms of Lung Cancer
Cough
Dyspnoe
Hemoptysis
Weight loss 4
Drumstick fingers
What does driver mutation mean?
Changes in DNA sequences of genes, that lead to a growth advantage for the cell (growth + spread)
Name 4 common driver gene mutation for NSCLC. 4
EGFR
ALK
ROS1
KRAS
How is non small-cell lung cancer (NSCLC) subdivided?
Adenokarcinoma
Squamous cell carcinoma
Large cell carcinoma
Where do we use Cytokeratin 5/6 antibodies?
Biomarker for non-keratinizing squamous cell carcinoma, breast cancer, lung cancer
What is tyrosine kinase? 6
Enzyme used for phosphorylation of a tyrosine
Part of cell signaling, growth, division on-off switch
Very active in cancer cells inhibitor used
Where do we find therapeutic significance for targeted therapy of tyrosine kinases?
Non small-cell lung cancer
gastro intestinal stromal tumors (GIST)
CLL
Malignant melanoma
Breast cancer
Basal cell carvinoma
Name 3 important Driver Gene Mutations sites in Non-Small Cell Lung
Cancer (NSCLC) Adenocarcinoma.
What is the idea behind Immuno-checkpoint inhibitor therapy? 4
Use patient’s immune system/ boost it
Free T-cells, that are controlled (and suppressed) by check points (as well on tumor cell), by inhibiting the check points
Name 2 immune checkpoints we can control. 2
PD-1 and PD-L1 (inhibitors)
CTLA
What are characteristics of ROS1-Fusion-positive patients?
Young patients
Non smoker
More women (2/3)
No other alterations common in NSCLC
Often Adenokarzinoma up to 100%
How are non melanoma skin tumors sub-divided?
Basal cell carcinoma
Define the term incidence. 1
Occurrence/ rate of a disease in a population, per 100k people in a year
Define the term prevalence. 1
Proportion of sick people in a population, measures morbidity
What is a Basal Cell Carcinoma? 7
Most common type
In sun exposed areas
Appear as
Pearly, waxy, glossy bump
Flat, flesh colored/ brown scar
Slow growing
Metastases rare
What is a Squamous cell carcinoma (Plattenepithelcarcinom)? 7
Second most common type
Dark skinned people are more likely to develop on sun-unexposed areas
Appear as: firm, red nodule
Flat lesion with scarly, crusted surface
Faster Growth
Higher risk for metastases
What is a Melanoma?
Malignancy of melanocytes
Most dangerous and aggressive skin cancer
Anywhere on body
Most often on face or trunk (men)
Lower legs (Women)
Unexposed skin from sun in both woman and men
Any skin type affected, if dark skin: tendency to palms, soles, under fingernails and toenails
Highest rate of metastases
Name a major driver mutation in malignant melanoma. 2
BRAF, MET, c-KIT
What is a CFU baso?
Progenitor cell of basophile granulocytes
What is the function of eosinophilic granulocytes? 3
Defense against parasites (worms, lice)
Allergies
Autoimmune reaction
What is the function of neutrophils? 2
Defence against pathogens (viruses and bacteria)
What are the most common white blood cells in healthy people? 1
Neutrophils (50-65%)
What does "shift to the left" mean? 2
Proportion of Rod-nucleated granolucytes increase (normally 5%) , compared tosegment-nucleated granulocytes
Name 5 growth factors? 5
VEGF
Erythropoietin
G-CSF
PDGF
Who coined the term leukemia? 1
Rudolf Virchow, 1845
Leukós – white
haïma – blood
What are the main symptoms of Myelodysplastic syndrome MDS? 2
Anemia (hematopoiesis is disturbed – not enough healthy blood cells)
Unmatured cells in blood
What is multiple myeloma? 2
Malignant degeneration of plasma cells
Production of paraproteins (insufficient antibodies)
Belongs to B-lymphoid neoplasms or Non-Hodgkin lymphoma
Why does malignant melanoma lead to anemia? 4
Iron deficiency -> Malabsorption
Inflammation -> Interfere with blood production
Immunotherapy -> Side affects affecting blood cells
Against which diseases thalidomide (formerly Contergan) is still used today?
Multiple Myeloma
Leprosy
Name 5 risk factors for leukemia. 5
Ionizing radiation
Family background
Genetics
Health status (other diseases, etc.)
Chemicals/ toxic substances
What does CD mean in tumor biology? 6
Cluster of differentiation
Markers to identify leukocytes and their subpopulations based on cell surface
Specific to type and stage of a cell
Makers recognizable by antibodies, as well for drugs!
Analyzed in immunophenotyping
What is karyotyping? 4
Cytogenetic analysis
Examine chromosomes in cell
Check for abnormal changes (size, shape, structure, number)
With blood or bone marrow
Cultured in lab and sained
Determining treatment options and prognosis
What is minimal residual disease? 4
Remaining sick cells after leukemia treatment
Cause/ Risk for rearising cancer
Identification by PCR, NGS, flow cytometry
Intensified therapies like allogeneic stem cell transplantation
What is a CAR T-cell therapy?
Chimeric antigen receptor T-cell therapy
Immunotherapy
Own immune cells, engineered to attack cancer cells
Name 6 possible symptoms of ovarian cancer. 3
Abdominal Pain
Loss of appetite
Loss of weight
Disruption of bowel movement
increase in abdominal circumference
Disruption of menstrual period
Name 6 risk factors for Ovarial cancer. 3
Older than 50 yrs
Childlessness
Close relatives with previous disease of breast, uterine or colon ca
Severe obesity
Hormone treatment to relieve menopausal symptoms
Close realtives with ovarian cancer
What mutations can lead to Ovarial cancer? 2
Familial ovarian cancer. Gene alteration:
BRCA1
BRCA2
What is the special feature of ovarian cancer in terms of surgery?
It is part of the diagnosis and first step in therapy at the same time
What is the disadvantage of minimally invasive surgery for ovarian cancer? 1
Risk of overlooking tumor foci
carrying over cancer cells in the body
What does FIGO II mean for ovarian cancer? 1
System for classifying gynecological tumors
Tumor spread to adjacent tissue → Tumor spreading in pelvis
Which gender has a higher risk for gastric cancer? 1
male
Name 4 risk factors for gastric cancer. 4
herdeditary
blood type a
male sex
Peutz jeghers syndrom
Helicobacter pylori infection
Define “Paraneoplastic syndrome” and give an example. 4
Symptoms that are caused by a tumor but do not express locqally - sweats, fever , anorexia
How does a paraneoplastic syndrome develop? 2
Yet unclear but likely to be secondary substances secreted by a tumor or as result of antibody formation against tumor cells - cross reaction with other tissues
What is a Wilms Tumor 3
Quickly growing tumor that forms metastatses at early stage especially lungs, liver, brain
good prognosis with early therapy
What is renal involvement with renal cell carcinoma in a patient usually like? 1
only one kidney is affected
most patients do not have problems with urinary tract
How is a renal cell carcinoma discovered? 2
Ultrasound
during other examination with ultrasound
Where do metastases of a renal cell carcinoma occur? 3
Lungs
skeletal system
lymph nodes
What is the meaning of TNM?
T - Size of tumor
N- Involment of lymphnodes
M- Presence of metastases
When do symptoms of ovarian Cancer occur?
is often reffered as “silent killer“ -> symptomes often not noteable before specific stage
- Bloating
fatigue
backpain
abdominal pain
Which gene alterations are known for ovarian cancer?
BRCA1 and BRCA2 Mutations
Tp53 Mutations
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