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Flashcards in day 1 oncology Deck (63):
1

Most common types of cancer?

Breast, prostate, lung, colon, lymphoma

2

Most common cancer deaths?

Lung, colon, breast, prostate, pancreas

3

What is cancer?

• Disease caused by accumulated mutations in DNA that alter cell function
this gives cancer cells growth advantages over nml cells

4

Why is cancer bad?

As cancers grow they invade other areas/ organs of the body
becomes a burden which causes organ failure/ death

5

What is a primary tumor

original mass of cancer cells of solid tumor in a body orgam

6

benign tumors

are abnormal tumor growth but is not as invasive or fatal as malignant

7

How is cancer treated?

localized therapy treatment
systemic therapies (2)

8

2 types of localized therapy treatments?

• Surgery
• Radiation

9

3 types of chemotherapy

– Traditional chemo
monoclonal antibodies
targeted angents

10

What is immunomodulation

Stem cell transplantation

11

What are 3 goals if treating with surgery?

– Hope for complete removal of tumor
sometime remove tumor/organ
remove troublesome metastases
cant use in hematologic malignancies

12

What is radiation therapy

alone or combo therapy with surgery or chemo
exposes the patients to radioactive energy that destroys cancer cells

13

Chemotherapy involves what?

Involves use of drugs with various MOA that disrupts cancer cell functions
IV or oral

14

Why is chemotherapy used?

Many types of chemo target mechanisms of cell function that block cancer cell growth and division
most active against rapidly growing tumors that have active growth mechanics

15

Traditional chemotherapy targets what?

mechanics of cell divisions
DNA, RNA, spindle fiber formation

16

newer chemotherapy targets what?

Newer target specific proteins that are required for various cancer cell functions

17

Principles of cancer chemotherapy-- Log cell kinetics

– A given treatment kills a constant fraction of cells
subsequent doses reduce the cancer burden proportionally over time
more cells killed= the higher chance for cure

18

Principles of cancer chemotherapy-- Gompertzian model

Growth fraction of a tumor is not constant
growth fraction decreases as tumor gets larger
results in decrease number of cells susceptible to chemo

19

1st line primary therapy

Used in advanced cancer cases in which other treatments would not be effective

20

Neoadjuvant chemotherapy

Used prior to the use of local therapies to improve their effect by reducing the size of the tumor

21

Adjuvant chemotherapy

Used after local therapies to improve their long term effect by eliminating any remaining undetected cancer cells

22

Dose density is what?

Giving repeated doses of multiple chemotherapy agents over a period of time
regular exposure gives a wave like approach to killing cancer cells over time

23

Definition of cure

a sustained cancer free period

24

Defition of control

reduce cancer burden
prevent extension of cancer
extend survival
cure unlikely

25

Definition of palliation?

reduce symptoms of disease
improve QOL
prolong survival
cure not likely

26

Defition of remission?

when we cant detect cancer we call this REMISSION. if remission last about 5 yrs we call it a cure BUT doesnt mean the cancer cant come back

27

4 responses to treatment?

complete remission
cure
partial response
treatment failure/progression of disease

28

How do you determine the response of treatment

Physical exam
tests: xray, CT scan, MRI
blood tests
tumor markers/ proteins in blood

29

Mutations within cancer cells could?

– Block chemo actions
block uptake of chemo into the cells
facilitate excessive transport of drug back out of the cell

30

Difference between primary and acquired resistance to chemotherapy

primary= cancer was never susceptable to the chemo
acquired= cancer changed and no longer responds

31

Chemotherapy resistances

mutations
drug interactions could decrease exposure to chemo within the patients body
Calculated dose does not match pts body characteristics (obese pt)

32

What are the 3 treatment options if primary treatment is unsuccessful?

salvage treatment--> giving second line agent
stem cell transplant
investigational therapies

33

What are the 2 types of stem cell transplant?

autologous SCT
allogenic SCT

34

Autologous SCT

high dose chemo followed by reinfusion of patients own stem cells

35

Allogenic SCT

completely changing the pts immune system—give them stem cells from a healthy donor

36

2 targets of new chemotherapy

• Tyrosine kinase
growth factor receptors

37

3 targets of traditional chemotherapy?

• DNA/RNA
mechanics of cell division
DNA polymerase

38

Alkalating agents are what?

groups of molecules that trasfer an alkalating group to other molecules
disrupt normal DNA structure by altering atomic interactions and prevents use of DNA as a blueprint for cell division

39

What do alkalating agents target?

sulfydryl, amino, hydroxyl
phosphate group on DNA

40

What are some examples of alkalating agents?

Lomustine
Cyclophosphamide
Mechlorethamine
Bendamustine
Melphalan
Temozolomide
Thiotepa
Dacarbazine
Procarbazine

41

What are the uses of alkalating agents?

Cyclophosphamide: breast CA, lymphoma, leukemia, myeloma
melphalan: myeloma
procarbazine: lymphoma

42

Mechanisms that reduce susceptibility to alkalayting agents

– Increase repair of damaged DNA
decrease transport of alkalating agent into cell

43

Common Adverse effects of alkalating agents

– Bone marrow toxicity
mucositis
N/V
sterility
tissue damage following extravasation
risk of secondary malignancies

44

MOA of platinum analogs

binding DNA and form intra and interstrand crosslinks
bind to cytoplasmic and nuclear proteins required for cell function

45

3 examples of platinum analogs

Cisplatin
Carboplatin
Oxaliplatin

46

uses of platinum analogs

• Cisplatin and carboplatin- lung, esophagus, ovary, head, neck, bladder
oxaliplatin- more commonly used for colorectal

47

Adverse effects of Cisplatin

renal toxicity,
N/V
anemia
ototoxicity

48

carboplatin adverse effect

myelosuppression

49

oxaliplatin adverse effects (3)

neurotoxicity, diarrhea, myelosuppression

50

What is antimetabolite?

Antimetabolites are molecules that substitute for actual components of metabolic process
*inhibits cell processes that produce components of DNA
**S phase specific

51

examples of antimetabolites?

methotrexate
5-FU
6-MP
Fludarabine
Gemcitabine
cytarabine
capecitabine

52

Uses of antimetabolites

• Methotrexate: leukemia, lymphoma, breast CA, RA
pemetrexed- lung CA
5-FU- colorectal, breast CA
cytarabine- leukemia, lymphoma
gem- pancreas, bladder, breast
capecitabine- breast cancer

53

Leucovorin

no anticancer action
reduced form of folic acid
mimics action of tetrahydrofolate

54

2 key uses of Leucovorin

– Reduce methotrexate toxicity by rescuing normal cells
increase 5-FU activity against colon cancer

55

Adverse effects of animetabolites

Methotrexate: diarrhea, mucositis, myelosupprssion
pemetrexed- rash, diarrhea, PPE
5-FU- diarrhea, mucositis, myelosupprssion
cytarabine- N/V, pulmonary toxicity
gem- diarrhea, N/V, myelosupprssion
capecitabine- PPE N/V, diarrhea

56

What is palmar plantar erythrodysesthesia treated with?

dexamethazone

57

Chemo derived from natural products

– Vinca alkaloids
taxanes
epipodophyllotoxins
camptothecins

58

MOA of vinca alkaloids

Inhibit tubulin polymerization required for microtubule assembly
blocks cell division during metaphases and causes cell death

59

Uses of vinca alkaloids

• Vincristine: leukemia, lymphoma, rhabdomyosarcoma
vinblastin- germ cell cancer, leukemia, lymphoma
vinorelbine- lung breast ovary

60

Adverse effects of vinca alkaloids

• Alopecia
• Neurotoxicity
constipation
myelosuppression
vesicant action of extravasation

61

MOA of taxanes

Act by promoting microtubule formation
prevents spindle fibers from retracting
blocks completion of cell division causing cell death

62

Uses of taxanes

• Paclitaxel: ovary, lung, prostate, breast
cabazitaxel- prostate
ixabepilone- breast

63

adverse effects of taxanes

• Myelosuppression
• Hypersensitivity reactions
peripheral neuropathy
fluid retention