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NUR370 Pathophysiology and Pharmacology > Neoplasia > Flashcards

Neoplasia Flashcards

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1
Q

properties of a cancer cell

A

a. Defect in proliferation
b. Evading apoptosis
c. Angiogenesis
d. Invasion (invade local tissue)
e. Metastasis

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2
Q

benign tumours

A

grow slowly and locally, well-defined capsule, not invasive and does not metastasize, well-differentiated (resembles normal cells)

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3
Q

malignant tumours

A

grow rapidly, invades neighbouring tissues and enters blood vessels, poorly differentiated and spread distantly

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4
Q

carcinoma in situ (CIS)

A

neoplasm, lesions with all histological characteristics of cancer, but has not begun to invade local tissue

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5
Q

Name 3 angiogenic growth factors secreted by cancers causing angiogenesis

A

a. vascular endothelial GF
b. platelet derived GF
c. basic fibroblast GF

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6
Q

what are the most common sites of metastases?

A

bone, brain, lungs and liver

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7
Q

Two types of genes that can be affected by mutation are:

A
  1. proto-oncogenes - promotes growth
    = mutation turns them into tumour inducing genes
  2. tumour suppressor genes (BRCA 1 and 2) - suppresses tumour growth
    = mutation render them inactive
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8
Q

carcinoma

A

Epithelial tissue (mucous membrane of respiratory tract, GI and GU tracts)

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9
Q

adenocarcinoma

A

From ductal or glandular tissue (skin, glands)

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10
Q

sarcoma

A

Mesenchymal tissue (connective tissue, muscle, bone and fat)

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11
Q

lymphoma

A

Lymphatic tissue, the glands of the lymphatic system

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12
Q

leukemia

A

Blood-forming cells, cancers of the bone marrow

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13
Q

Classification of Cancer by Grading

A

determined by how closely cells resemble tissue of origin

Grade I - IV

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14
Q

Classification of cancer by Staging

A

based on presence of metastasis

Stage I - IV

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15
Q

Clinical manifestations of Cancer

A 
Pain
Fatigue
Cancer cachexia
Anemia
Leukopenia Thrombocytopenia
GI manifestations (ulcers, malabsorption, diarrhea, nausea)
Alopecia and skin breakdown
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16
Q

Causes of cancer include

A

environmental and lifestyle factors

genetic and epigenetic factors

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17
Q

Known risk factors of cancer

A
  • tobacco use
  • infectious agents
  • lifestyle (body weight, exercise, diet and alcohol)
  • UV radiation
  • reproductive and hormonal factors
  • environmental and occupational exposures (radiation, pollutant, chemicals)
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18
Q

Types of Lung Cancer

A
  1. Non small cell lung cancer
    a. squamous cell carcinoma
    b. adenocarcinoma
    c. large cell undifferentiated carcinoma
  2. small cell lung cancer
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19
Q

What is the prevalence of each type of lung cancer/

A

30% squamous cell
40% adenocarcinoma
10% large cell undifferentiated
20% small cell lung cancer

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20
Q

Squamous cell carcinoma

A
  • associated with cigarette smoking
  • not strong tendency to metastasize
  • often bound in cells that line main airway - bronchi
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21
Q

Adenocarcinoma

A
  • associated with scarring and fibrosis
  • starts in mucous-producing cells
  • most common type found in nonsmokers
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22
Q

Large cell undifferentiated carcinoma

A
  • correlation with cigarette smoking and environmental carcinogens
  • highly metastatic via lymphatics
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23
Q

Small cell lung cancer

A
  • associated with cigarette smoking and environmental carcinogens
  • most aggressive form of lung cancer
  • spreads easily and often metastasize by diagnosis
  • paraneoplastic syndrome
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24
Q

How is SCLC staged?

A

Limited stage - only found on one side of the chest, may include lymph nodes on same side as tumour

Extensive stage - tumour is found widely spread within the lung with the tumour to the other lung, lymph nodes on opposite side of chest and other parts of the body

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25
Paraneoplastic syndrome
- results from hormone or cytokine release by tumour - linked with development of SIADH, where increased ADH leads to reabsorption in collective ducts - dilutional hyponatremia
26
Genes associated with lung cancer
Epidermal growth factor receptors (EGFR) BRAF and ROS-1
27
Clinical manifestations of lung cancer
a. Persistent cough (key finding in most lung cancer diagnoses) b. Sputum (possibly blood tinged) c. Chest pain d. Dyspnea and possibly wheezes e. late symptoms: anorexia, fatigue, n/v, weight loss, palpable nodes
28
Diagnostic Studies for lung cancer
1. chest x-ray 2. CT scan 3. sputum samples 4. bronchoscopy 5. biopsy
29
Which types of lung cancer often involve surgical resection as treatment?
Adenocarcinoma | Squamous cell carcinoma
30
growth fraction
percentage of actively dividing cells compared to cells in resting phase i.e. ratio of proliferating cells to G0 cells
31
Early stages of tumour growth
- Exponential growth, short (constant) doubling time | - Large % of actively dividing cells because of good supply of O2 and nutrients - high growth fraction
32
Later stages of tumour growth
- Doubling time is slowed | - Decreased growth fraction as tumour outgrows blood and nutrient supply
33
Transcoelomic spread
Spread of a malignancy into body cavities via penetrating the surface of the peritoneal, pleural, pericardial or subarachnoid spaces
34
clinically detectable tumour
10^9 (1 billion) cells = 1 g mass = 1 cm diameter
35
lethal tumour
10^12 (1 trillion) cells = 1 kg mass
36
3 consequences of late detection
1. metastases likely to have formed 2. tumour less responsive to therapy 3. patient debilitated by disease and less tolerable to treatment
37
Goals of chemotherapy
a. cure b. control c. palliation
38
Factorings affecting response to cancer treatment
1. tumour burden 2. use of combination chemo 3. administration schedule (cell cycle non/specific) 4. hormone receptor status 5. dose category 6. supportive therapies and hematopoietic growth factors
39
Examples of cell cycle specific cytotoxic agents
a. antimetabolites b. mitotic inhibitors c. topoisomerase inhibitors d. hypomethylating agents
40
Examples of cell cycle nonspecific cytotoxic agents
a. alkylating agents b. platinum compounds c. antitumour antibiotics
41
Medications that target the S-phase of the cell cycle
most antimetabolites (methotrexate, fluorouracil) topoisomerase inhibitors (irinotecan, etoposide)
42
Which medication is important to give with leucovorin?
methotrexate
43
Which hormone antagonist should be prescribed only in post-menopausal women and why?
anastrozole - drug blocks enzyme called aromatase, which inhibits conversion of adrenal androgens to estrogen - premenopausal women continue to produce estrogen
44
What is the role of corticosteroids in cancer treatment?
- antiemetic - prevention of hypersensitivity reactions - prevention of edema - oncologic emergencies - cerebral edema
45
When are targeted therapies used?
when tumour expresses target molecule so that drug can bind with specific cellular molecular target to exert anti-cancer effect - blocks cell signalling - make malignant cells more visible to immune system
46
What are some common side effects of cytotoxic agents?
- hematologic toxicity (neutropenia, febrile neutropenia, anemia, thrombocytopenia) - chemotherapy induced nausea and vomiting - mucositis - diarrhea and constipation - alopecia - reproductive toxicity
47
Management of Neutropenia
prophylactic antibiotics and/or filgrastim
48
Management of Febrile Neutropenia
- hospital admission for broad spectrum IV antibiotics - may decrease doses of chemo - may use filgrastim
49
filgrastim
stimulates production and release of neutrophils from bone marrow side effect: bone pain
50
Management of Anema
- rest, conserve energy - oxygen therapy - diet, iron supplement - RBC transfusion - epoetin alpha
51
Epoetin alpha (Eprex)
stimulates bone marrow to produce RBCs side effect: hypertension
52
Management of Thrombocytopenia
a. platelet transfusion c. avoid drugs with antiplatelet activity d. watch for symptoms of occult bleeding e. ensure platelet count >100/mm3 before next chemo cycle
53
How is the chemoreceptor trigger zone (CTZ) activated?
1. vagus nerve - signals from stomach/intestine | 2. emetogenic compounds that reach CTZ via bloodstream
54
Receptors involved in vomiting response
- serotonin - neurokinin-1 - dopamine - acetylcholine - histamine
55
Acute CINV is associated with which chemical?
serotonin (5HT3)
56
Management of Mucositis
- good oral hygiene - avoid irritating substance and smoking - benzydamine (oral analgesic) - systemic antibiotics
57
Managment of diarrhea
- replace fluid/electrolytes | - antidiarrheal (loperamide)
58
Management of Constipation
- dietary - laxatives - stool softeners
59
Which drug causes hand-and-foot syndrome as a unique side effect?
fluorouracil (5-FU) and capecitabine (Xeloda)
60
What main side effect does vincristine cause?
neurotoxicity
61
Which drug causes hypersensitivity reaction?
taxanes paclitaxel (taxol)
62
Which drug causes severe diarrhea?
irinotecan (camptosar) topoisomerase I inhibitor
63
Which drug causes hemorrhagic cystitis (bladder injury)?
cyclophosphamide alkylating agent
64
Which drug causes nephrotoxicity?
cisplatin
65
Which drug can cause cardiotoxicity?
doxorubicin anthracycline (antitumour antibiotic)
66
Which drug can cause pneumonitis and pulmonary fibrosis?
bleomycin non-anthracyclines (antitumour antibiotic)

NUR370 Pathophysiology and Pharmacology (20 decks)

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