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3rd shift Topics > Oncology > Flashcards

Oncology Flashcards

1
Q

commonly associated ADR of patients undergoing chemotherapy

A

CINV

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2
Q

A group of disease characterized by uncontrolled and abnormal local cellular growth or reproduction, local
tissue invasion and distant spread to other location or
metastases

A

Cancer

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3
Q

Second cause of mortality in the United States

A

Cancer

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4
Q

growth of the tissues of the cells are malignant (reproduce on their own)

A

Cancer

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5
Q

A new and abnormal growth of tissue in some part of
the body, especially as a characteristic of cancer

A

Neoplasm

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6
Q

non-cancerous

A

benign neoplasm

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7
Q

cancer

A

malignant neoplasm

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8
Q

A multi-step process that includes initiation, promotion,
conversion and progression.

A

CARCINOGENESIS

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9
Q

exposure of normal cell to carcinogenic substances,
such as radiation, chemicals and other substances →
cellular damage → if not repaired, may lead to
irreversible mutation → promotion

A

Initiation

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10
Q
  • cellular damage can be repaired on its own
    ● if cells are not severely damaged, it can be repaired
    ● unrepaired = progress to promotion
A

initiation

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11
Q

continuous division of mutated cells → alter the environment to favor the growth of the mutated cells

A

Promotion

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12
Q

If the body recognizes the mutated cell division → ____________

A

cell toxicity or apoptosis

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13
Q

If the body failed to recognize the mutated cell division
→ _____________

A

no production of immune cells → conversion

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14
Q

mutated cells are proliferated in the body as normal cells

A

conversion

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15
Q

involves further genetic changes leading to increased cell proliferation, tumor invasion into local tissue and
development of metastases (invasion of cancer cell), ultimately resulting to cancer

A

Progression

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16
Q

Growth of both normal and cancerous cells is genetically
controlled by the balance or imbalance of _______________, _____________, and___________.

(GENETIC BASIS OF CANCER)

A

oncogene, protooncogene and tumor suppressor gene protein product

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17
Q

● Develops from protooncogene or normal genes
● Present in all cells
● Essential regulator of normal cellular function including cell cycle and mitosis

A

Oncogene

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18
Q

● If there is cell mutation, __________ may increase
proliferation of mutated cells
● when activated → sends signals to cells to multiply
further

A

oncogene

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19
Q

● Regulates or inhibits the inappropriate cellular growth
and proliferation

A

Tumor suppressor gene

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20
Q

RISK FACTORS

A
  • Environment
  • Lifestyle
  • Occupation
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21
Q

PREVENTION AND SCREENING

A
  • Breast Cancer
  • Colon/Rectal Cancer
  • Prostate Cancer
  • Cervical Cancer
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22
Q

● Annual mammogram
● Monthly SBE

A

Breast Cancer

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23
Q

● Colonoscopy
● Fecal Occult Blood Test
● Flexible Sigmoidoscopy
● Double Contrast Barium Enema

A

Colon/Rectal Cancer

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24
Q

● Prostate specific antigen (PSA)
● Digital rectal exam annually

A

Prostate Cancer

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25
Q

● Papanicolaou (Pap) test
● Pelvic exam

A

Cervical Cancer

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26
Q

○ X-ray picture of the breast
○ once a year, especially patients with history of breast cancer
○ may be done with or without symptoms

A

Annual mammogram

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27
Q

○ Look for any changes in the skin, like dimpling, and for lumps, which may feel hard or squishy
○ Best time: About 3 to 5 days after start of menstruation
■ breast is less swollen

A

Monthly SBE (self breast examination)

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28
Q

○ Especially in age 50 and above
○ camera inserted in the rectum/anus to visualize the large intestine

A

Colonoscopy

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29
Q

blood in the feces

A

Fecal Occult Blood Test

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30
Q

visualizing the lower portion of the colon (sigmoid)

A

Flexible Sigmoidoscopy

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31
Q

○ Checking for abnormalities of lower rectum, anus and prostate gland by palpation

A

Prostate Cancer (digital rectal exam annually)

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32
Q

○ Collection of sample from the surface of the cervix
○ For age 35 and above
○ a swab/small brush is inserted into the cervix/uterus to collect sample. The sample would then be subjected to microscopy for possibility of cancer progression.

A

Papanicolaou (Pap) test

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33
Q

○ Examine size, shape and position of ovaries and uterus
○ one hand/finger is inserted into the vagina, the other hand pushes down the abdomen.

A

Pelvic exam

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34
Q

Cancer treatment recommendation depends on the ___________

A

stage, severity of the cancer

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35
Q

CANCER TREATMENT

A
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Immunotherapy
  • Hormone therapy
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36
Q

● if localized, depends on the stage and patient health; used with chemotherapy and radiation therapy
● may be curative (alam kung nasaan ang cancer) or diagnostic (di alam specific location)

A

Surgery

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37
Q

● subjects an area with tumor cell growth with high ionizing
radiation to kill cancer cells; used alone or with chemotherapy
● local therapy
● Radiation therapy to kill localized cancer cell, chemotherapy to kill the remaining/escaped cancer cell

A

Radiation therapy

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38
Q

● use of drugs as treatment; most common
● kills both mutated and healthy/normal cells
○ if healthy cells are killed, bone marrow is suppressed → no formation of new immune
cells/WBC

A

Chemotherapy

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39
Q

● boosting immune system to destroy cancer
● promote formation of immune cells

A

Immunotherapy

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40
Q

● slows growth of cancer cells that uses hormone to grow

A

Hormone therapy

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41
Q

CHEMOTHERAPY

A
  • Curative
  • Adjuvant
  • Neoadjuvant
  • Palliative care
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42
Q

destroy cancer cells that have spread from primary site

A

CHEMOTHERAPY

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43
Q

● entirely free of disease
● applicable to early stages of cancer detection

A

Curative

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44
Q

● keep it from spreading
● combination of chemotherapy and radiation therapy

A

Adjuvant

45
Q

● reduces tumor burden or spare organ

A

Neoadjuvant

46
Q

● relieve of symptoms and allow individual to live comfortably
● for end stage cancer diseases
● not aiming to cure/reverse the cancer, but improve the quality of life of the patient

A

Palliative care

47
Q
  • A condition of having unusually low levels of neutrophils, a type of white blood cells, responsible for fighting infections
A

NEUTROPENIA

48
Q
  • May be caused by cancer and cancer medications, genetic conditions, viral, bacterial and parasitic infections, nutritional deficiencies such as vitamin B12, folate or copper, and autoimmune deficiencies
A

NEUTROPENIA

49
Q

no clear cause

A

Chronic idiopathic neutropenia

50
Q

● the most common dose limiting toxicity associated with traditional cytotoxic chemotherapy

A

Bone marrow suppression

50
Q

PRINCIPLES OF CHEMOTHERAPY

A
  • Bone marrow suppression
  • WBC count
  • Decrease WBC
  • risk
  • computation of ANC
  • Neutropenia
  • Febrile Neutropenia
51
Q

● normal range: 4,800 to 10,800 cells/mm3 with a circulating life span of 6 to 12 hours

A

WBC count

52
Q

● neutropenia, leucopenia or granulocytopenia; the risk is
life-threatening infection
○ neutropenia = ↓neutrophils
○ granulocytopenia = ↓neutrophils, eosinophils,
basophils
○ leucopenia = ↓granulocytes
○ these are interchangeable

A

Decrease WBC

53
Q
  • Risk increase with Absolute Neutrophil Count (ANC) less
    than __________ and the risk is greater with an ANC less
    than ___________
A

500/mm3; 100/mm3

54
Q

○ indicator if the patients can proceed with chemotherapy cycle
○ The total number of neutrophils in the WBC count

A

Absolute Neutrophil Count

55
Q

Computation of ANC

A

ANC = WBC x % granulocytes or neutrophil (segmented
neutrophil + band neutrophil)

56
Q

Before chemotherapy drug administration:

A

○ WBC: greater than 3000/mm3
○ ANC: greater than 1500/mm3
○ Platelet count: greater than 10,000/mm3

57
Q
  • An ANC of 500/mm3 or less or a count of less than 1000/mm3 with a predicted decrease to less than 500/mm3 during the next 48 hours
A

Neutropenia

58
Q
  • Neutropenia and a single oral temperature of 101ºF (38.3ºC) or more or a temperature of 100.4ºF (38ºC) or more for at least one hour
    ● ANC of less than 500/mm3 + fever
A

Febrile Neutropenia

59
Q
  • If chemotherapy administration has been delayed or the dose reduced because of prolonged neutropenia, ________________ can be considered for subsequent chemotherapy cycles as secondary prophylaxis
    ○ primary prophylaxis =_______ of the chemotherapy agent
    ○ w/ neutropenia = ________. Instead, either ↓the dose or give CSF (Filgrastim)
A

colony stimulating factor (CSF);
reduce the dose; do not proceed with chemotherapy

60
Q

Dose reduction of chemotherapy should be considered the __________, instead of a CSF, after an episode of neutropenia in patients being treated with the intent to palliate.

A

first option

61
Q

● Not recommended in patients who are neutropenic but
not febrile
● Consider in patients who are neutropenic AND febrile in
the presence of risk factors for complication (ANC < 100/mm3, pneumonia, hypotension, multiorgan dysfunction, invasive fungal infection), in addition to antibiotics to treat neutropenia in patients with these risk factors

A

Use of CSFs for Treatment of Established Neutropenia

62
Q

● An unpleasant sensory and emotional experience associated with the actual or potential tissue damage or
described in terms of such damage
● Often subjective

A

Pain

63
Q

Either somatic or visceral

A

Nociceptive Pain

64
Q

arising from skin, bone, joint, muscle, or connective tissue

A

somatic

65
Q

arising from the internal organs such as large intestine or pancreas

A

visceral

66
Q

Pain sustained by abnormal processing of sensory input
by peripheral or CNS

A

Neuropathic Pain

67
Q
  • damaged nerves, generalized pain
    ● capable of signaling the body to activate nerves at different sites
    ● more difficult to treat
A

Neuropathic Pain

68
Q

ANALGESIC MEDICATIONS

A
  • Non-opioid Analgesic
  • Opioid analgesic
  • Non-Opioid – Opioid Combination
68
Q

Pain medication should always be administered on a
schedule and not on PRN basis (t or f)

A

T

68
Q

Cancer Pain Management: preferred route of administration

A

Oral

69
Q
  • Act peripherally to inhibit the activity of prostaglandin in the pathway
    ● first line of drug for patients with mild to moderate pain
    ● reduce inflammation and pain signals
A

Non-opioid Analgesic

70
Q
  • Act centrally in the brain and at the level of the spinal cord at specific opioid receptor
    ● for moderate to severe pain
A

Opioid analgesic

71
Q

Medications that are not for pain, but they enhance the analgesic effect of other medications

A

adjuvant therapy

72
Q

adjuvant therapy

A
  • Antidepressant (Amitriptyline) and Anticonvulsant
  • Transdermal Lidocaine
  • Corticosteroid
  • Benzodiazepine, Diazepam and Lorazepam
73
Q

neuropathic pain

A

Antidepressant (Amitriptyline) and Anticonvulsant

74
Q
  • localized neuropathic pain
    ● topical anesthetic
A

Transdermal Lidocaine

75
Q

● inflammation, bone pain, or increased intracranial pressure

A

Corticosteroid

76
Q

muscle pain or muscle spasms

A

Benzodiazepine, Diazepam and Lorazepam

77
Q

Ejection or expulsion of gastric content through the mouth

A

Vomiting

78
Q
  • Awareness of discomfort that may or may not proceed to vomiting; accompanied by decreased gastric tone and
    decreased peristalsis
A

Nausea

79
Q

CLASSIFICATION of N/V BASED ON ONSET

A
  • Acute
  • Delayed
  • Anticipatory Vomiting
  • Breakthrough Vomiting
80
Q

Occurs 0 to 24 hours after chemotherapy

A

Acute

81
Q

Occurs more than 24 hours after chemotherapy

A

Delayed

82
Q

Caused by triggers, such as the sights, smells or sounds of the treatment room, even without the chemotherapy treatment yet

A

Anticipatory Vomiting

83
Q

Occurs despite prophylaxis and may require rescue therapy of other antiemetics

A

Breakthrough Vomiting

84
Q

Risk Factors for CINV

A

● Patient’s age (younger patients or younger than 50 years old)
● Female
● History of Morning Sickness
● History of Nausea and Vomiting in previous chemotherapy
● History of Alcoholism

85
Q

Risk of producing emesis.

A

Emetogenic Potential

86
Q

AC combo: Doxorubicin or
Epirubicin with Cyclophosphamide
Carboplatin ( AUC ≥ 4 )
Cisplatin
Cyclophosphamide ( > 1500
mg/m2 )
Doxorubicin ( > 50 mg/m2 )

A

HIGH

87
Q

Carboplatin ( AUC < 4 )
Cyclophosphamide ( ≤ 50
mg/m2 )
Methotrexate ( ≥ 250 mg/m2)

A

MODERATE

88
Q

Liposomal Doxorubicin
5-Fluorouracil
Methotrexate ( 50 < x < 250
mg/m2 )
Paclitaxel

A

LOW

89
Q

Methotrexate ( ≤ 50 mg/m2 )
Vinblastine
Vincristine

A

MINIMAL

90
Q

Management

A
  • Serotonin (5HT3) Receptor Antagonists
  • Corticosteroids
  • Neurokinin-1 Receptor Antagonists
  • Benzamide Analogs
  • Butyrophenone
  • Benzodiazepines
  • Cannabinoid
90
Q

Serotonin released from the gut in response to various stimuli acts on the ______ in the brainstem, initiating the vomiting reflex

A
  • chemoreceptor trigger zone (CTZ)
91
Q

Blocks serotonin receptor peripherally in the
gastrointestinal tract and centrally in the medulla

A

Serotonin (5HT3) Receptor Antagonists

92
Q

Granisetron, Ondansetron, Palonosetron, Dolasetron
(DC)

A

Serotonin (5HT3) Receptor Antagonists

93
Q

MOA: Unknown, thought to act by inhibiting prostaglandin synthesis in the cortex

A

Corticosteroids

94
Q

Dexamethasone, Methylprednisone

A

Corticosteroids

95
Q
  • Used in combination with other antiemetic drug for
    preventing acute and delayed nausea
    ● Neurokinin-1 Receptors are triggered by substance P in
    the gut, which signals brainstem to induce forceful
    expulsion of stomach contents
A

Neurokinin-1 Receptor Antagonists

96
Q

Aprepitant or Fosaprepitant

A

Neurokinin-1 Receptor Antagonists

97
Q
  • Blocks dopamine receptor in the CTZ
    ● Stimulation of cholinergic activity in the gut
    ● Increasing gut motility
    ○ This promotes gastric contents to the small
    intestine. Which in turn prevents regurgitation to
    the esophagus and mouth. Hence, prevents vomiting.
    ● Antagonizes peripheral serotonin receptor in the intestine
A

Benzamide Analogs

98
Q

Prochlorperazine, Chlorpromazine, Promethazine

A

Benzamide Analogs

99
Q

Similar to and as effective as phenothiazine

A

Butyrophenone

99
Q

antipsychotic medication with
antiemetic effects to treat transient nausea and vomiting
associated with viral infections, surgery or gastrointestinal illnesses

A

Phenothiazine

100
Q

● Minimal antiemetic activity
● Used in combination with other antiemetic
● Anterograde amnesia helps prevent anticipatory N&V
● Relief of anxiety

A

Benzodiazepines

101
Q

Lorazepam

A

Benzodiazepines

102
Q

____________ receptor in the brain and gut may mediate at least some of the antiemetic activity

A

Cannabinoid

103
Q
  • Inhibition of prostaglandin and blockade of adrenergic
A

Cannabinoid

104
Q

Heavy and long-term cannabinoid use can lead to
_______________ characterized with cyclic vomiting or repeated episodes of severe N&V

A

Cannabinoid Hyperemesis Syndrome

3rd shift Topics (12 decks)

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