1. Chemo Tutoring
Alaina darby

2. Introduction to chemo stuff

3. Which of the following describes carcinogenesis?
Cells do not differentiate following genetic mutation
Cells undergo altered regulation following genetic mutation
Cells continually undergo apoptosis following differentiation
Cells adhere to strict mechanisms of cell division and differentiation B

4. Which of the following is not true of cancer?
It more prevalent in old age due to accumulation of mutations
It is a single disease characterized by unrestricted cell growth
It may involve abnormal regulation of the cell cycle
It is dependent upon the mutation of proto-oncogenes B

5. Which of the following is not a path that stem cells might take?
Division into more stem cells when proliferation when more cells are needed
Dormancy when additional cells are not necessary
Differentiation into cells that are less specific to that tissue type
Death of the cell when there are more stem cells than are needed C

6. Terminally differentiated cells Embryonal stem cells
Which of the following types of cells may differentiate into the widest variety of cell types?
Adult stem cells
Terminally differentiated cells
Embryonal stem cells
Lineage stem cells C

7. Which of the following occurs at the G1 phase in mitosis?
Gene replication
Cell division
Check that DNA is replicated
Direction on which path the cell should take D

8. Tumor suppressor genes Adult stem cells
Which of the following is not a cell type that is normally found in a genome?
Proto-oncogenes
Oncogenes
Tumor suppressor genes
Adult stem cells B

9. Increase in neutrophils at site of inflammation
Which of the following is not a mechanism by which inflammation can cause cancer?
Increase in neutrophils at site of inflammation
Increase of reactive oxygen species at the site
Destruction of telomeres in cancer cells
Release of cytokines that cause cell replication C

10. Which of the following is a surface receptor that can be mutated to cause loss of growth regulation?
Ras
EGF
STAT
JAK B

11. Which of the following will be most likely to result in cancer?
Cells with some mutations that possess significant vascularization and significant telomerase activity
Cells with significant mutations that possess significant vascularization and little telomerase activity
Cells with significant mutations that possess significant vascularization and significant telomerase activity
Cells with significant mutations that possess little vascularization and significant telomerase activity A

12. Which of the following is not true of metastasis?
Angiogenesis may aid in metastasis
Certain types of cancers only circulate to specific types of tissues
Cancer cells have the ability to break through the basement membrane of tissues
Cancer cells may spread through blood or lymph B

13. Which of the following is not a hallmark of a cancer cell?
Sustained angiogenesis
Self-sufficiency in growth signals
Insensitivity to anti-growth signals
Evasion of cell signaling D

14. Which of the following is not a cause of enhanced oncogene activity?
Point mutation in the coding sequence resulting in a hyperactive protein made in normal amounts
Gene amplification resulting in the overproduction of a normal protein
Chromosome rearrangement of DNA sequence resulting in overproduction of a normal protein
Chromosome rearrangement of DNA sequence resulting in decreased transcription of a tumor suppressor gene D

15. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models is described by the following: doubling time of cancer cells is constant and death results when malignant cells reach a critical number or fraction of body weight?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws D

16. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models is described by the following: mutations randomly result in altered phenotypes that confer cellular resistance to chemotherapeutic drugs and the probability of resistant cells depends on tumor size?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws B

17. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models assumes that tumors have inherently higher mutation rate than normal cells and that progression leads to an increase in the mutation rate?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws B

18. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models is described by the following: only therapy that completely eradicates all tumor cells will be curative?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws C

19. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models concludes that cancer is entirely curable?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws D

20. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models is described by the following: tumor growth follows a non-linear curve with slowing of growth rate being due to tumor outgrowing blood and nutrient supply?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws A

21. Gompertzian Cell Growth Goldie-Coldman Hypothesis
Which of the following models is described by the following: a tumor is composed of faster-growing cells that are sensitive to therapy and slower- growing cells that are resistant?
Gompertzian Cell Growth
Goldie-Coldman Hypothesis
Norton-Simon Hypothesis
Skipper’s Laws C

22. Which of the following is an example of kinetic resistance?
Pharmacological sanctuary
Systemic non-absorption
Poor tumor vascularization
Enhanced liver metabolism C

23. Induction of alternate pathway Target molecule overproduction
Which of the following methods of cellular resistance is conferred by HER-2 cells that are treated with HER-2 antibodies?
Transport defects
Induction of alternate pathway
Target molecule overproduction
Insufficient drug activation B

24. More toxic therapies have become necessary due to resistance
Which of the following is the reason that heart failure has become more prominent as a side effect of chemotherapy in recent years?
More toxic therapies have become necessary due to resistance
Patients live long enough to have long-term effects
Chemotherapies have become more targeted to the heart
Modern therapies are longer courses of treatment B

25. Which of the following is not an absolute indication for chemotherapy?
Basal cell carcinoma
Leukemia
Brain tumor
Metastatic lung carcinoma A

26. sweatman

27. General Chemo drugs cause improvement and toxicity!
Which areas of the cell cycle each drug works…
Bleomycin: G2
Podophyllotoxins: G2 and S
Antimetabolites: S
Adjuvant = after radiation, neoadjuvant = before radiation
Use a combo for resistance!! Think about MOA’s, impacts on the other drugs’ effectiveness, spectrum of toxicity (don’t overlap)
Chemo is the main treatment for SYSTEMIC cancers
Most dugs affect rapidly dividing cells (blood, mouth and GI lining, hair)
Not all drugs kill tumors
Know how each drug differs from ideal (selective, no toxicity, eradication)
Tumor lysis syndrome causes organ toxixity… treat with allopurinol or **rasburicase
Specific vs nonspecific

29. Alkylating agents Not specific Which don’t require activation?
Chlorethyl functional group attaches to DNA (different for BCNU)
Adverse effects: CNS (ifosfamide), lungs (ALL), renal (cyclophosphamide and ifosfamide), urotoxicity via acrolein (cyclophosphamide and ifosfamide)
BCNU/CCNU: enter CNS!!
BCNU: hepatotoxicity
Dose limiting factor for cisplatin is renal insufficiency (amifostine)
Emesis… use steroids
Which don’t require activation?
Mechlorethamine, melphalan
Acrolein (MESNA)

30. antimetabolites Compare anti-folates
MTX requires polyglutamination (resistance!)
5-FU and capecitabin: cause hand & foot syndrome
MTX: rescue with leucovorin
Cytarabine is most specific for S phase

32. Topoisomerases and spindle inhibitors
Vincas block tubulin POLYMERIZATION, taxels inhibit DISASSEMBLY
Microtubules… neurotoxicity, blood disorders
Acute diarrhea with itinotecan (different mechanism)
Doxorubicin = heart!!! (also, “rub”icin… red urine)
Bleomycin = lungs!!!
Pegasparagase = pancreas!!!
Retinoids… think about Accutane