(2) Cancer Pharmacology and pregnancy Flashcards
(98 cards)
1
Q
What is the second leading cause of death in the US
A
cancer
2
Q
What is characteristic of cancer
A
uncontrolled cell replication of the body’s own cells
3
Q
What is a tumor
A
an abnormal growth of new tissue arising from uncontrolled cellular proliferation that has no physiological function
4
Q
what is a neoplasm
A
a new growth
5
Q
What is a malignancy
A
a cancer with invasive properties, more life threatening that non-malignant cancers
6
Q
What is benign
A
non-invasive, less life threatening than a malignancy
7
Q
what is metastisize
A
when a tumor has pieces that break off and spread to other parts of the body
8
Q
What is the most common type of oral cancer
A
squamous cell carcinoma (epithelial)
9
Q
how many people per year are diagnosed with oral cancer
A
30,000
10
Q
how many people die each year from oral cancer
A
8,000
11
Q
What is the population at most risk for oral cancer
A
people over 40 men 2x more likely than women African americans more likely those who smoke and drink (both is higher than either alone) people with HPV-16 and HPV-18
12
Q
What is the link between HPV and oral cancer
A
HPV infects epithelial cells (which are prominent in the oral cavity) smoking and drinking alcohol promotes HPV invasion
13
Q
Which is more likely to be cancerous leukoplakia or erythroplakia
A
erythroplakia
14
Q
if a oral lesion doesn’t resolve after ________ it should be reevaluated and considered for a biopsy
A
2 weeks
15
Q
When should a dental exam be performed in relation to cancer treatment
A
at least 1 month before the start of cancer treatment to permit adequate healing from any invasive oral procedure
16
Q
what affect do chemotherapeutic drugs have on wound healing
A
they impair wound healing
17
Q
do chemotherapeutic drugs cause xerostomia
A
the often do
18
Q
What are the three main approaches to cancer treatment?
A
surgical excision
irradiation
chemotherapy
19
Q
What is chemotherapy
A
the pharmacological approach to cancer treatment
20
Q
what makes chemotherapy so complicated
A
the cancer cells are mammilian cells and are very similar to healthy cells
21
Q
What are the 4 characteristics of cancer cells that differ from normal healthy cells
A
1 - uncontrolled proliferation
2 - Dedifferentiation of cells
3 - invasiveness
4 - metastisis
22
Q
What are the two types of cells that normally prevent cells from being cancerous
A
proto-oncogenes
tumor supressing genes
23
Q
What is an oncogene
A
a gene which has potential to cause cancer (the mutated form of a proto-oncogene)
24
Q
What is a tumor suppressor gene
A
a gene that protects the cell from becoming cancerous (when mutated it loses that ability)
25
What are the mechanisms by which cancer cells have uncontrolled proliferation?
1. resistance to apoptosis
2. Telomerase expression
3. Angiogenesis
4. Loss of cell cycle stop points
5. increased responsiveness to growth factors
26
What does dedifferentiation of cancer cells mean
that the cells are poorly differentiated, the cells are no longer specific to a certain function.
27
Is more differentiation or less differentiation indicative of more advanced cancer and thus a worse prognosis
less "poorly" differentiated cells are associated with more advanced cancers and have a worse prognosis
28
What does the cancer characteristic of invasiveness mean?
cancer cells lose responsiveness to region specific growth cues, this allows them to grow in other locations. They also begin secreting enzymes which break down the extracellular matrix and allow the tumor to spread
29
What is metastasis
when cells break off from a tumor, travel to a different location and form secondary tumors.
30
What does the TNM stand for in calculated risk in cancers
```
T = Tumor
N = Node
M = Metastasis
```
31
What are the different T values in the TNM cancer staging
T0 = No evidence of tumor
Localized = Tumor is confined to primary site of origin
Extension (not T4) = tumor has extended beyond the site of origin but not to specified T4 locations
32
What are the locations into which if a tumor extends (in the oral region) the tumor is classified as T4a
```
Through bone
To deep/extrinsic muscles of the tongue
Maxillary sinus
Skin of Face
Medial Pterygoid
Hard palate
```
33
What are the locations into which if a tumor extends (in the oral region) the tumor is classified as T4b
```
Encases the Internal Carotid artery
skull base
pterygoid plates
massicator space
lateral pterygoid muscle
lateral nasopharynx
```
34
What is the relative prognosis for a T1-3 cancer and a T4 cancer
the higher the T value the worse the prognosis (T4 is worse than T1-3)
35
What are the different N values in the TNM cancer staging
```
N0 = no lymph node metastasis
N1 = metastasis (<3cm) into a single ipsilateral node
N2a = Metastasis (> 3cm, < 6cm) in a single ipsilateral node
N2b = metastasis (< 6cm) in multiple ipsilateral nodes
N2c = metastasis (<6cm) in bilateral nodes
N3 = Metastasis in any node > 6 cm
```
36
If you have a cytotoxic cancer drugs that at a given dose is known to kill 99% of cancer cells. and you start with 100 billion cancer cells. How many cells will remain after treatment
1 billion
| 1% survives, 1% of 100 billion is 1 billion
37
why is the idea of leaving some cancerous cells (in cancer therapy) different than leaving some bacterial cells (in antibiotic therapy)
because leftover bacterial cells following antibiotic treatment can be cleaned up by the bodies immune system. cancer cells cannot be
38
what is the goal of cytotoxic cancer treatment drugs
to get the number of cancer cells as close zero as possible
39
why is early treatment of a tumor more successful
because early on the tumor has fewer cells so it is easier to get the total number closer to zero
40
What is adjuvant chemotherapy and why is it more successful than chemotherapy alone
adjuvant chemotherapy is when chemotherapy follows surgical removal of a tumor, or radiation. is it more successful because a large number of tumor cells have been removed. the smaller the number of cells remaining = easier to get close to zero cells with chemotherapy
41
What is the level of detection for cancer (how many cells does the tumor have when it first becomes detectable)
approximately 10^9
42
What happens if you stop chemotherapy when the cancer is no longer visible
you have left 10^9 cancer cells and they will continue to duplicate and to spread and the cancer will grow to detectable levels again
43
Why are so many rounds of chemotherapy often needed to cure (approx 0 cells) cancer
because there is regrowth of the tumor between chemo courses (you kill two logs of cells, then 1 log regrows before the next course begins)
44
What are the three types of cells typically found in a tumor
Group A = continuously dividing cells
Group B = not currently dividing but are capable
Group C = cells incapable of cell division
45
What is important to know about Group A cells in a tumor
they are continuously dividing
they are the most susceptible to chemotherapy
they only make up about 5% of cells
46
What is important to know about Group B cells in a tumor
they aren't currently divinding, which makes them more difficult to treat with chemo, but they are capable of dividing in the future
47
What is the most common target of current anticancer drugs
rapidly dividing cells
48
what is the negative side effect of anticancer drugs attacking the rapidly dividing cells of cancer
they also attack the rapidly dividing cells of the body and cause
- bone marrow toxicity
- impaired wound healing
- loss of hair
- damage to GI epithelium
- Depression of growth in children
- sterility
- teratogenicity in pregnant females
49
What is combination therapy with anticancer drugs and why is it done
it is the use of several chemotherapy drugs with different mechanisms of action and thus different toxicities together. it is done because it is more effective and because it helps prevent chemotherapy resistance in the cancer
50
with chemotherapy Is it better to perform high doses for a short period of time or small doses given continuously
high doses for short periods of time with time in between for recovery
51
What are the chemotherapy drugs involved in the CHOP combination therapy
```
C = Cyclophosphamide
H = Hydroxydaunorubicin
O = Oncovin
P = Prednisone
```
52
What are the 8 main types of chemotherapeutic drugs
1. alkylating agents
2. antimetabolites (folate antagonists)
3. antimetabolistes (Base analogs)
4. cytotoxic antibodies
5. plant derivatives
6. hormones/antagonists
7. kinase inhibitors
8. Monoclonal antibodies
53
What is the most commonly used alkylating agent in cancer therapy
cyclophosphamide
54
what is the mechanism of action for anticancer alkylating drugs
they form intra and inter chain crosslinks with DNA bases (this doesn't allow DNA to replicate and form a proper double stranded helix)
55
What types of cells are affected by the alkylating agent cyclophosphamide
both rapidly proliferating and non-proliferating cells (cell cycle non-specific)
56
Is cyclophosphamide a progrug
yes, it is activated by the p450 enzymes of the liver
57
what is the major toxicity of alkylating drugs
myelosuppresion (suppression of bone marrow and blood cell formation)
58
What is the most commonly used antimetabolite anticancer drug
methotrexate
59
What is the function of folates in many reactions
it acts as a coenzyme to metabolism of amino acids and DNA
60
What is methotrexate in relation to folates
it is a folate antagonist (prevents folates from acting as a coenzyme in metabolic reactions)
61
What are the side effects of methotrexate
- myelosuppression
- GI toxicity
- Nephrotoxicity
62
What is Leucovorin
a drug often given in combination with methotrexate because it can rescue cells from methotrexate toxicity
63
What are the antimetabolite drugs that act as base analogs
```
5 - fluorouracil
Cytarabine
6-Mercaptopurine
6- thioguanine
pentostatin
azathioprine
```
64
What makes base analogs good cancer treating drugs
they interfere with the copying of DNA
65
what cells do base analogs target
those rapidly dividing
66
What are the two most common cytotoxic antibiotics used in cancer treatment
Doxorubicin (Adriamycin)
| Bleomycin
67
What is the mechanism of action for Doxorubicin (adriamycin)
Topoisomerase 2 inhibitor (inhibits DNA replication and RNA synthesis)
68
what are the main unwanted effects of taking the cytotoxic antiobiotic doxorubicin (adriamycin)
```
nausea
vomiting
hair loss
myelosuppression
cardiotoxicity (high dose)
```
69
What is the mechanism of action for bleomycin (the cytotoxic antibiotic) used in cancer treatment
causes single (mostly, some double) strand breaks in DNA
70
what drug is commonly used to treat squamous cell cancer in the head, neck and esophagus
bleomycin
71
What is the most common plant derivative used in cancer chemotherapy
Paclitaxel (taxol) (from yew tree bark)
72
what is the method of action of the plan derivative paclitaxel (taxol)
stabilizes or freezes microtubule assembly (thus inhibiting mitosis)
73
What types of cancers is the plant derivative paclitaxel (taxol) used for
breast and ovarian cancers
74
what are the main unwanted effects of paclitaxel (taxol)
```
myelosuppression
hair loss
GI disturbance
neurotoxicity (peripheral neuropathy)
hypersensitive reactions are fairly common
```
75
What is the most common hormone given in the treatment of cancers
prednisone
76
what type of hormone is prednisone
a glucocorticoid
77
what is the method of action of prednisone in cancer treatment
prevents lymphocyte proliferation
78
what type of cancers is prednisone used to treat
leukemias
| also used as palliative care in other cancers, mediates nausea and vomiting
79
what is the main unwanted effect of prednisone treatment for cancers
causes cushings syndrome
80
What is the main hormone antagonist used in cancer treatment
tamoxifen
81
what is the method of action of tamoxifen (hormone antagonist)
estrogen receptor antagonist
82
for what types of cancers if tamoxifen used to treat
breast cancers that respond to estrogen
83
what is the main side effect of tamoxifen treatment of cancers
menopause like symptoms
84
What is the most commonly used monoclonal antibody used in the treatment of cancers
bevacizumab (avastin)
85
What is the method of action for the monoclonal antibody bevacizumab (avastin)
binds VEGF, blocks angiogenesis
86
What is the most common protein kinase inhibitor used in cancer treatment
Imatinib (Gleevec)
87
what is the method of action for Imatinib (gleevec) as a protein kinase inhibitor of cancer treatment
it inhibits Bcr/Abl kinase (a product of chromosome translocation in the philidelphia chromosome)
88
what type of cancer is the protein kinase inhibitor imatinib (gleevec) used to treat
chronic Myeloid leukemia (due to the philidelphia chromosome)
89
what are the main unwanted effects of imatinib (gleevec)
GI effects and fatigue (minimal for chemo)
90
What drug is given to manage emesis in patients receiving chemo
Ondansentron
91
what drugs are given to manage the myelosuppression in patients receiving chemo
Erythropoetin - stimulates RBC development, helps recover
| Filgrastim - human G-CSF, stimulates differentiation of hematopoeitic cells
92
What is primary resistance in a tumor
when a tumor is resistant to the drug the first time that it is given
93
what is acquired resistance in a tumor
tumor is initially susceptible to the drug but then becomes resistant
94
What are the two mechanisms by which tumors become resistant to chemo drugs
adaptation or mutation
95
What are resistance mechanisms cancer cells use to become resistant to chemo drugs
- decreased drug accumulation (increase outbound transporters, decrease inbound transporters)
- insufficient drug activation
- increased drug inactivation
- use of alternate metabolic pathways
- induction of rapid cell repair mechanisms
- mutations in the drug target
96
What are the three things that must happen for a drug to be effective against cancer
1. drug must reach the cell
2. drug must enter the cell in the phase in which the drug is active
3. tumor can't be resistant to the drug
97
what is the future of chemotherapy
getting the patients own immune system to attack the cancerous cells
98
What is the FDA pregnancy regulation
no longer using pregnancy categories due to confusion. the FDA believes that a narrative structure is best
