Anticancer Therapy Flashcards
Name 2 key components of cancer
- Uncontrolled cell proliferation
2. Ability to spready, migrate and invade
Describe 2 genes which play a significant role in cancer
- Photo-oncogene
2. Tumour Suppressor Gene
Describe 5 main cancer types
- Carcinoma (begins in skin or tissue)
- Sarcoma (begins in bone, fat, muscle, CT etc)
- Leukaemia (begins in blood forming tissue)
- Lymphoma (cancer in cells of immune system)
- Central nervous system (begins in brain or spinal cord)
Name the 8 hall marks of cancer
- Evading growth suppressors
- Avoid immune destruction
- Enabling replicative immortality
- Activating invasion and metastasis
- Inducing angiogenesis
- Resisting cell death
- Deregulating cellular energetics
- Sustaining proliferative signalling
Describe the hall mark of cancer - “Sustaining proliferative signalling”
The accelerator signals instruct cells to grow and divide chronically
Describe the hall mark of cancer - “Evading growth suppressors”
The signals to stop growing and dividing have been disabled
Describe the hall mark of cancer - “Avoiding immune destruction”
Production of signals to hold back immune cells in checks during cell replication
Describe the hall mark of cancer - “Enabling replicative immortality”
Circumventing the cellular timekeeper which typically disrupts cell division when a certain number is reached
What acts as the cellular timekeeper?
Telomere
Describe the hall mark of cancer - “Activating invasion and metastasis”
Loss of cell adhesion by epithelial mesenchymal transition
Describe the hall mark of cancer - “Inducing angiogenesis”
New blood vessel formation due to changes in growth factors
Describe the hall mark of cancer - “Resisting cell death”
Avoiding assisted suicide of rogue cells
Describe the hall mark of cancer - “Deregulating cellular energetics”
Aerobic glycolysis (cancer cells consume 20 times more glucose than normal cells)
Name 4 components of the aetiology of cancer
- Genetic predisposition
- Environmental factors
- Pre-disposing medical factors
- Immunodeficiency
Name 3 types of environmental factors which contribute to aetiology of cancer
- Lifestyle (smoking, alcohol, obesity)
- Industrial carcinogens
- Drugs / Radiation
Name 4 treatment modalities with regards to cancer
- Surgery
- Radiotherapy
- Systemic anti-cancer therapy
- Palliative and support care
Name 3 types of radiotherapy
- External beam
- Brachytherapy
- Radio-isotope therapy
Name 4 types of systemic anti-cancer treatments
- Chemotherapy
- Hormone therapy
- Immunotherapy
- Targeted therapies
What is the major aim for surgery during cancer?
Organ and functional conservation
Name 4 cancers which involve cytotoxic chemotherapy as a cure
- Breast cancer
- Leukaemia
- Lymphoma
- Lung cancer
Name 4 key types of cytotoxic agents used in chemotherapy
- Alkylating agents
- Anti metabolites
- Mitotic inhibitors
- Antibiotics
What is radiotherapy?
The use of ionising radiation to treat diseases
What is ionising radiation?
Refers to type of radiation in which absorption of energy results in ejection of one or more orbital electrons from an atom or molecule
What is the aim of radiation to treat cancer?
- Irreparably damage double-stranded DNA
- Cause this directly or indirectly
Describe the main complication of prostate cancers
90% of men with metastatic prostate cancer have bone metastases
Name 5 complications of bone metastases
- Bone marrow failure
- Pain
- Fractures
- Spinal cord compression
- Hypercalcaemia
Name 5 relevant side effects of anti cancer therapies for dentists
- Risk of infection
- Risk of bleeding
- Stomatitis
- Xerostomia
- Dysgeusia
- Mandibular osteonecrosis
What must happen with regards to oral health prior to radiation or chemotherapy?
Teeth which are non-restorable or potential problem teeth should be removed and all other teeth restored to optimum health
Name 4 main dental problems of radiotherapy
- Xerostomia
- Mucositis
- Taste alterations
- Radiation caries and osteoradionecrosis
Name 5 ways to manage dental health for a patient receiving radiotherapy
- Palliative mouth rinses
- Topical steroids
- Synthetic saliva preparations
- Topical fluoride
- Meticulous oral hygiene
Name 4 systemic side effects of chemotherapy
- Hair loss
- Cardiotoxicity
- Renal failure
- Infertility
What is the major side effect of all oncology mediations?
Stomatitis
Name 2 treatments used for invasive procedures with regards to cancer
- Antibiotic prophylaxis
2. Platelet replacement
What is the characterisation of osteonecrosis of the jaw?
- Exposed necrotic bone
- Pain
- Local swelling
Explain why there is more cases of osteonecrosis of the jaw in females
Hormone therapy and bisphosphonate treatment use is higher in females
Name 2 types of anti resorptive agents which cause jaw osteonecrosis
- Bisphosphonates (alendronate, zoledronate)
2. Rank ligand inhibitor (denosumab)
Name 3 agents which are not anti resorptive which can cause jaw osteonecrosis
- Antiangiogenic agents (sorafenib)
- Phosphorus
- Irradiation
Describe the mode of action of bisphosphonates
- Stable derivatives of inorganic pyrophosphate
- Bind hydroxyapatite crystals
- Incorporated in sites of active remodelling
- Prevent resorption by osteoclasts
- Promote osteoclast apoptosis
Describe the mode of action of denosumab
- Human monoclonal antibody to receptor activator of nuclear factor kappa B
- Inhibits development and activation of osteoclasts
- No binding to bone matrix
- Anti resorptive effects dissipated
Describe 3 components of the management of dental disease in established osteonecrosis
- Conservative treatment of teeth
- Necrotic symptomatic bone should be removed
- Extract symptomatic teeth in necrotic bone
With regards to oncology, name 3 patients dentists must be particularly cautious with
- Patients receiving chemotherapy
- Patients on bone targeted therapies
- Patients receiving or having received radiotherapy to head and neck region
