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CANCER INTRODUCTION Flashcards

1
Q

which gender has most cancer overall

A

male

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2
Q

what is cancer

A 
uncontrolled cell proliferation 
loss of natural apoptotic control 
decreased differntiation 
invasion 
ability to establish atypical environments 
loss of tissue organisation
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3
Q

How does cancer occur (3)

A

genomic instability
mutations
epigenetics

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4
Q

genes which can cause cancer

A

overexpression of oncogenes RAS or MYC,

faulty TSGs e.g. BRCA, p53

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5
Q

whats endogenous mutagenesis

A

chemical instability of DNA/ errors in replication

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6
Q

what can cause endogenous mutagenesis

A

oxygen free radicals produced in metabolism

lifetime exposure to oestrogen

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7
Q

other thing which can cause cancer- think more external

A

chemical carcinogens e.g. tabacco, environmental pollutants, alcohol
physical agenst such as UV or X-Rays
viruses and bactera e.g. HPV, H.pylori

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8
Q

what is epigenetics

A

means of altering the activity of genes by changing how compact or relaxed DNA is

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9
Q

effect of methylation

A

compacts DNA= reduced gene expression

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10
Q

effect of acetylation

A

relaxes- increases expression

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11
Q

ways proteins can cause cancer?

A

mutations

too much, too little, wrong place, less stable, more stable

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12
Q

what makes certain cells more prone to cancer?

A

as mutations occur in the S phase its more likley to occur in rapidly dividing cells e.g. epithelial lining of the gut
cells such as glial cells typically inhabit the g0 phase but can be stimulated to enter into division

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13
Q

what type of cells never divide?

A

myocardial

so unlikely to be cancer

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14
Q

4 classifications of cancer

A

Histopathology
grade
stage
metastasis

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15
Q

how to determine histopathology?

A

microscopic examination by biopsy

establishes origin of the disease and what type of cancer it is.

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16
Q

explain the grade of cancer? what makes it low or high grade? speed of growth?

A

low: well differentiated- look like normal cells, slow growth
high: less like normal cells, aggressive fast growth

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17
Q

what is staging? how do we present this?

A 
how much of the disease is present 
TNM
tumour size
nodal envolvement 
metastases
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18
Q

TNM meaning and values

A

Tumour size 1-4, the bigger the side the higher the number
Nodal involvement 0 if local and 1 if <4 nodes and 2 if >4 nodes
Metastases either 0 or 1 if its gone into a different organ space- must be same cells as in primary tumour

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19
Q

3 ways of metastasis?

A

direct invasion- direct penentration through tissue
lymphatic spread
blood stream

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20
Q

generic presentation of cancer

A

lump
unexplained bleeding
weight loss

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21
Q

specific signs of cancer

A

chest pain

change in bowel habit

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22
Q

4 things that are used to confirm diagnosis

A

X-ray
biopsy
biomarkers
CT/PET

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23
Q

2 types of cancer surgery

A

palliative- to improve QOL

curative

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24
Q

what is curative surgery? would this be the only treatment?

A

primary tumour removal- no as high risk of relapse, probably chemotherapy

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25
how would the tumours margins be classed as 0
in surgery the surgeon will take a sample from around the tumour, if no tissues found here the margins are 0
26
how do you qualify for palliative surgery? examples?
reasonable prognosis 3-6 months | e/g/ bowel obstruction
27
what can be used in place of surgery if the patient isnt fit enough?
radical radiotherapy- curative
28
what ways can radiotheapy be given in relation to surgery?
reduce size prioir to surgery adjuvant: to consolivate surgery with chemo palliative: to relieve symptoms of incurable disease
29
which type of radiotherapy is most common?
external beam radiotherapy
30
examples of external beam radiotherapy
Xray, electron, proton
31
what is stereotactic radiosurgery
cyber knife, avoids effects on surrounding tissue
32
what is total body irridiation?
fully ablate bone marrow before stem cell transplants
33
advantages of proton beam radiotherapy
reduces amount of RT administered to surrounding tissues, able to calculate it specifically to hit the tumour useful for tissues which dont regenerate well
34
examples of internal radiotherapy
liquid radioiodine selective internal radiation therapy (beads) solid sources of RT INTRACAVITY interstitial- into tumour, stays forever and delivers radiation for 6-12 months
35
would an interstitial seed of RT make the person radioactive?
no, works locally
36
endogenous radiosensitiser?
oxygen: binds to breaks in DNA rendering them unfixable= cell death
37
exogenous radiosensitiser?
chemoradiotherapy e.g. cisplatin gemcitabine temozolomide, capecitabine, cetuximab
38
acute side effects of chemo?
rapidly dividing cells targetted: alopecia, N&V, indigestion, mucositis, taste disturbance, oesophagitis, diarrhoea, cystisis
39
late effects of chemo?
slowly dividing cells | fibrosis, breathlessness, lymphodema, bladder/ bowel incontinence, vaginal stemosis, sterility
40
when do acute side effects of RT present/ go away?
1-2 weeks into RT lasts for 3-4 weeks after
41
skin reactions in RT can be made worse by which risk factors?
older, smoking, alcohol, malnutrition, obesity
42
how to treat skin reactions? grades 1-4
grade1: moisturiser 2: m+ HYDROCORTISONE OR INSTILLAGEL 3: M, increase HC potency, dressings 4: consult
43
managing oral hygiene on radiotherapy? | pain pf mouth?
``` mucositis socium chloride/ bicarbonate, diflam stop smoking brush BD pain: mist paracetamol ```
44
how to manage RT associated N&V
5-HT3 receptor antagonist from 24 hours prior and 24 hours after treatment ondansetrn or metoclopramide/ domperidone
45
low risk cancers for RT induced N&V? if prophylaxis used?
breast, head and neck, limb, brain, no prophylaxis used
46
treating cystitis from RT
antibiotics
47
treating diarrhoea from ABs
loperamide
48
what is SACT
systemic anti cancer chemotherapy
49
exampls of SACT
targetted agents cytotoxic traditional chemo immunotherapy CAR-Ts
50
what do cytotoxic agents affect
all cells- depends on cell cycle stage in some
51
what must you do before giving targeted chemo?
establish expression of target, ensure to monitor for resistance
52
how does cytotoxic ?
interfered with cell cycle | kills cells and healthy cells
53
side effects of cytotoxic chemo
bone marrow suppression, N&V, alopecia, peripheral neyropathy
54
example of cytotoxic chemotherapy
capecitabine, flurouracil prodrug
55
capecitabine flurouracil MOA
antimetabolite, interfered with DNA replication enzymes | prevents thymidine production and halts DNA replication
56
which types of cytotoxic chemo is associated with peripheral neuropathy
platinums and taxanes
57
is alopecia and N&V seen with all cytotoxic drugs?
no, not all | N&V depends on emetogenicity of t he drug
58
how do targetted agents work | examples
disrupt ssignalling pathways which allows cancer cells to proliferate TKIs mAbs
59
what is gefitinib, what does it treat? | toxicities?
EGFR inhibitor, lung cancer, skin can give acneiform rash due to EGFR expression in the skin GI disturbance
60
Cetuximab MOA | treats?
EGFR inhibitor needs RAS wild type treats RAS wild type colorectal cancer, cant use if mutated RAS
61
side effects of Cetiximab
acneform rash like TKI but no GI disturbances | hypersensitivity
62
what is a targeted cytotoxic agent?
combines two MOAs to increase efficacy and reduce toxicity | binds due to target and then releases cytotoxic agent
63
example of a targeted cytotoxic agent
trastuzumab HER2 receptor
64
trastuzumab MOA
HER-2 receptor specific delivers a cytotoxic moiety as well binds to HER2 cells only then releases= specific
65
what does immunotherapy utilise
T cells/ the immune cells
66
T cells normal role, how does cancer stop them?
they seek and destroy | cancer can express PD-1 which normally prevents autoimmune activity, but cancer uses it so T- cells cannot destroy them
67
how can we use immunotherapy to stop cancer deactivative T-cells using the PD-1 ligand?
PD-1 checkpoint inhibitor
68
toxicities of PD-1 checkpoint inhibitor?
autoimmune like conditions colitis pneumonitis hepatitis
69
what is ATMP
advanced therapy medicinal products
70
example of ATMPs (advanced therapy medicinal products )
A gene therapy medicinal product A somatic cell therapy medicinal product A tissue engineered product
71
example of a ATMP
CAR-T
72
what does CAR-T treat? how are they made?
``` leukaemia T-cells taken from patient engineered to recognise cancer cells cultured to increase number returned into patient to destroy cancer ```
73
risk of using CAR-T cells
risk cytokine storm which can be life threatening
74
example of surgery RT and CT being used? give drug names
breast cancer surgery to remove primary tumour if caught early adjuvant chemo for micro metastases radiotherapy for unclear margins at chest calls 1 year of trastuzumab or herceptin if HER+]5 YEARS OF ENDOCRINE THERAPY IF HORMONE RECEPTOR +VE E.G. TAMOXIFEN

patient MCQ (22 decks)

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