AOCNP review question with answers
the risk for significant bone marrow suppression (8) - -advanced age (>65),poor nutritional
status, preexisting autoimmune disease, DM, GI disorders, liver disease, or hematopoietic
disease, and substance abuse.
-Cancer-induced bone marrow suppression (3) - -a) dysfunctional hematopoietic cell within the
bone marrow, b) bone marrow infiltration with tumor c)general exhaustion of bone marrow
reserves
-solid tumor malignancies with the highest propensity to infiltrate the bone marrow in the
course of metastasis - -melanoma, cancer of the breast, lung, kidney and prostate
-Nitrosoureas (Carmustine, Lomustine) - -affect the pluripotent stem cell (affecting all cell
lines/cell cycle nonspecific agent) use for glioblastoma multiforme
severe myelosuppression may last up to 85 days, nadir of carmustine occurs in 26-60 days
-Radiation induced bone marrow suppression occurs when (2) - -1. treatment field involves
marrow producing tissue or with dose greater than 15 Gy
-CD 4 counts < 500/mm3 - -significant risk factor for oopotunisitic infections
-Cyclosphosphamide - myelosuppression risk - -moderate
-Paclitaxel - myelosuppression risk - -moderate
-Doxorubicin (Adriamycin) - myelosuppression risk - -alkylating agnet, may produce severe
myelosuppression, the duration only about 21 days
-Myelosupression secondary to radiation therapy peaks at - -week 3
Suppression may occur in all cell lines simultaneously rather than sequentially as seen with
chemotherapy
The recovery period also may be less predictable.
-Second malignancy : Acute leukemia - potential etiologic factor ? - -Alkylating agent, especially
with high doses or cumulative doses of antimetabolites
Antitumor antibiotics
Corticosteroids
Epipodophyllotoxins (i.e Etoposide)
-Second malignancy : Bladder cancer- potential etiologic factor ? - -radiation therapy for
prostate cancer
,-Second malignancy : Brain tumors - potential etiologic factor ? - -therapeutic radiation for
other cancer
-Second malignancy : hepatoma- potential etiologic factor ? - -Androgen therapy
-Second malignancy : Kidney cancer - potential etiologic factor ? - -Brain tumor therapies
Cisplatin, especially in treatment for testicular cancer
-Second malignancy : Leukemia - potential etiologic factor ? - -Antitumor antibiotics
Brest cancer treatment
Lymphoma treatment
Post transplant immunosuppression
Prostate cancer treatment
-Second malignancy : Lung cancer - potential etiologic factor ? - -HIV infection
Theraputic radiation for other cancers
-Second malignancy : Mesothelioma - potential etiologic factor ? - -Thoracic radiation for lung
neoplasms
-Second malignancy : Neuroectodermal tumors- potential etiologic factor ? - -Growth hormone
replacement after children cancers
Theraputic radiation for other cancers
-Second malignancy : Non-Hodgkin Lymphoma- potential etiologic factor ? - -Alkylating agent
Antimetabolites
Antitumor antibiotics
Cyclosporine
Radiation therapy
Tacrolimus
-Cumulative radiation dose in excess of ___ Gy reporrted have more signifiant risk of secondary
malignancies - -30 Gy
-Second malignancy : Thyroid cancer- potential etiologic factor ? - -Brain tumor therapies
Cisplatin based regimens
Therapeutic radiation
-In a patient with an abnormal complete blood count with all cell line diminished and without
evidence for a specific disorder and in whom an eorror in cell production suspected, which test
should be performed ? - -Bone marrow aspirations and biopsy with peripheral smear
-Gail model best use for - -general breast cancer risk assessment
estimate 5 years risk and overall lifetime risk for breast cancer
, risk factor : age, age at monarch, age at first live birth
race, number of first degree relatives with breast cancer
-the MMR pro model best use for - -hereditary colon cancer
-Claus model estimates - -breast cancer risk based on first -and second -degree relatives with
breast or ovarian cancer.
-Primary cancer prevention (definition) - -aims to reverse or inhibit cancer by modification of a
person's environment or behaviors or through pharmacologic mechanisms
-Primary cancer prevention : example - -tabacco use, smoking cessation, Sun Exposure, Diet
exercise, chemoprevention, HPV vaccine
-Secondary prevention - -screening and early detection
-Chemoprevention : negative trial - -Beta-caroten cancer prevention trial (ATBC) trial the Beta-
Caroten and retinol efficacy trial (CARET) (NCI,2003)
No benefit was seen from supplements in the men at risk for lung cancers were diagnosed
17 % more death occurred in participants taking beta-caroten and Vitamin A than in thoese
taking placeboes.
-Chemoprevention: positive trial - -Tamoxifen and Raloxifen
the prevention of invasive breast cancer after result from the breast cancer prevention trial (49
% reduction in invasive breast cancer in more than 13,000 high risk pre and post menopausal
women.
-Lung cancer screening - -annual LDCT in patients age 55-74 who are current or former smokers
(> or + to 30 packs years) and otherwise in good health.
-Colon cancer screening - -Age> 59
Colonoscopy q 10 years or
FOBT or FIT annually and flexible sigmoidoscopy q5 years (per NCCN, annual FOBT/FIT only per
ACS)
flexible sigmoidoscopy q 5 years
-Cervical cancer screening - -age 21-29
- PAP test q3 years, no HPV testing
age 30-65
- PAP test and HPV testing every 5 years (preferred ) or PAP test alone q 3 yeras
-HNPCC syndrome (Lynch syndrome) screening/risk - -80 % lifetime risk of developing colon
cancer (compared with 6% risk in general population) - yearly
60 % lifetime risk of developing endometrial cancer
the risk for significant bone marrow suppression (8) - -advanced age (>65),poor nutritional
status, preexisting autoimmune disease, DM, GI disorders, liver disease, or hematopoietic
disease, and substance abuse.
-Cancer-induced bone marrow suppression (3) - -a) dysfunctional hematopoietic cell within the
bone marrow, b) bone marrow infiltration with tumor c)general exhaustion of bone marrow
reserves
-solid tumor malignancies with the highest propensity to infiltrate the bone marrow in the
course of metastasis - -melanoma, cancer of the breast, lung, kidney and prostate
-Nitrosoureas (Carmustine, Lomustine) - -affect the pluripotent stem cell (affecting all cell
lines/cell cycle nonspecific agent) use for glioblastoma multiforme
severe myelosuppression may last up to 85 days, nadir of carmustine occurs in 26-60 days
-Radiation induced bone marrow suppression occurs when (2) - -1. treatment field involves
marrow producing tissue or with dose greater than 15 Gy
-CD 4 counts < 500/mm3 - -significant risk factor for oopotunisitic infections
-Cyclosphosphamide - myelosuppression risk - -moderate
-Paclitaxel - myelosuppression risk - -moderate
-Doxorubicin (Adriamycin) - myelosuppression risk - -alkylating agnet, may produce severe
myelosuppression, the duration only about 21 days
-Myelosupression secondary to radiation therapy peaks at - -week 3
Suppression may occur in all cell lines simultaneously rather than sequentially as seen with
chemotherapy
The recovery period also may be less predictable.
-Second malignancy : Acute leukemia - potential etiologic factor ? - -Alkylating agent, especially
with high doses or cumulative doses of antimetabolites
Antitumor antibiotics
Corticosteroids
Epipodophyllotoxins (i.e Etoposide)
-Second malignancy : Bladder cancer- potential etiologic factor ? - -radiation therapy for
prostate cancer
,-Second malignancy : Brain tumors - potential etiologic factor ? - -therapeutic radiation for
other cancer
-Second malignancy : hepatoma- potential etiologic factor ? - -Androgen therapy
-Second malignancy : Kidney cancer - potential etiologic factor ? - -Brain tumor therapies
Cisplatin, especially in treatment for testicular cancer
-Second malignancy : Leukemia - potential etiologic factor ? - -Antitumor antibiotics
Brest cancer treatment
Lymphoma treatment
Post transplant immunosuppression
Prostate cancer treatment
-Second malignancy : Lung cancer - potential etiologic factor ? - -HIV infection
Theraputic radiation for other cancers
-Second malignancy : Mesothelioma - potential etiologic factor ? - -Thoracic radiation for lung
neoplasms
-Second malignancy : Neuroectodermal tumors- potential etiologic factor ? - -Growth hormone
replacement after children cancers
Theraputic radiation for other cancers
-Second malignancy : Non-Hodgkin Lymphoma- potential etiologic factor ? - -Alkylating agent
Antimetabolites
Antitumor antibiotics
Cyclosporine
Radiation therapy
Tacrolimus
-Cumulative radiation dose in excess of ___ Gy reporrted have more signifiant risk of secondary
malignancies - -30 Gy
-Second malignancy : Thyroid cancer- potential etiologic factor ? - -Brain tumor therapies
Cisplatin based regimens
Therapeutic radiation
-In a patient with an abnormal complete blood count with all cell line diminished and without
evidence for a specific disorder and in whom an eorror in cell production suspected, which test
should be performed ? - -Bone marrow aspirations and biopsy with peripheral smear
-Gail model best use for - -general breast cancer risk assessment
estimate 5 years risk and overall lifetime risk for breast cancer
, risk factor : age, age at monarch, age at first live birth
race, number of first degree relatives with breast cancer
-the MMR pro model best use for - -hereditary colon cancer
-Claus model estimates - -breast cancer risk based on first -and second -degree relatives with
breast or ovarian cancer.
-Primary cancer prevention (definition) - -aims to reverse or inhibit cancer by modification of a
person's environment or behaviors or through pharmacologic mechanisms
-Primary cancer prevention : example - -tabacco use, smoking cessation, Sun Exposure, Diet
exercise, chemoprevention, HPV vaccine
-Secondary prevention - -screening and early detection
-Chemoprevention : negative trial - -Beta-caroten cancer prevention trial (ATBC) trial the Beta-
Caroten and retinol efficacy trial (CARET) (NCI,2003)
No benefit was seen from supplements in the men at risk for lung cancers were diagnosed
17 % more death occurred in participants taking beta-caroten and Vitamin A than in thoese
taking placeboes.
-Chemoprevention: positive trial - -Tamoxifen and Raloxifen
the prevention of invasive breast cancer after result from the breast cancer prevention trial (49
% reduction in invasive breast cancer in more than 13,000 high risk pre and post menopausal
women.
-Lung cancer screening - -annual LDCT in patients age 55-74 who are current or former smokers
(> or + to 30 packs years) and otherwise in good health.
-Colon cancer screening - -Age> 59
Colonoscopy q 10 years or
FOBT or FIT annually and flexible sigmoidoscopy q5 years (per NCCN, annual FOBT/FIT only per
ACS)
flexible sigmoidoscopy q 5 years
-Cervical cancer screening - -age 21-29
- PAP test q3 years, no HPV testing
age 30-65
- PAP test and HPV testing every 5 years (preferred ) or PAP test alone q 3 yeras
-HNPCC syndrome (Lynch syndrome) screening/risk - -80 % lifetime risk of developing colon
cancer (compared with 6% risk in general population) - yearly
60 % lifetime risk of developing endometrial cancer
