Cancer

Question 1

Briefly describe the phases of the cell cycle

Answer 1

G0: resting phase - cells are not in the process of cell division
G1: relatively dormant with some RNA and protein synthesis
S: synthesis phase = DNA is synthesized, and RNA and protein synthesis continues
G2: some RNA synthesized
M: mitosis (cell division)

Question 2

Cells are most sensitive to radiation in the _______ phases

Cells are least sensitive to radiation in the ____ phase

Answer 2

Most sensitive to radiation: M and G2 phases

Least sensitive to radiation: S phase

Question 3

Explain the rationale for use of cell-specific and non cell-specific medications

Answer 3

Increased likelihood of medications to target cells in all phases of the cell cycle

Question 4

Clinical manifestations of chemotherapy is governed by ____________________.

Answer 4

Negative clinical manifestations are governed by the mitotic rate of tissue - i.e. rapidly dividing cells such as mucosa and bone marrow are affected first so the early manifestations are hair loss, nausea, vomiting, etc. vs. slowly proliferating tissue e.g. bone, kidney manifest late responses

Question 5

Benign or malignant?

well differentiated cells

Answer 5

Benign

Question 6

Benign or malignant?

angiogenesis with rapid rate of growth

Answer 6

malignant

Question 7

Benign or malignant?

metastasis

Answer 7

malignant

Question 8

Benign or malignant?

encapsulated tumor

Answer 8

benign

Question 9

Benign or malignant?

general effects such as anemia, weakness, weight loss

Answer 9

malignant

Question 10

Benign or malignant?

tumor grows at periphery and sends out processes that infiltrate surrounding tissue

Answer 10

malignant

Question 11

Benign or malignant?

usually no tissue damage unless its location interferes with blood flow

Answer 11

benign

Question 12

Explain where cancer pain may arise from

Answer 12

pain: from tumor pressing on nerves of blood vessels, tumor releasing lytic enzymes that directly injure cells, or tumor related pain in space-limiting compartments

Question 13

Explain the etiology of cachexia that occurs in cancer

Answer 13

general fat and protein wasting due to anorexia, poor digestion, increased metabolic rate, or changes in metabolism e.g. selective trapping of nutrients by growing tumor cells

Question 14

Explain how anemia occurs in cancer

Answer 14

due to bleeding, depression of bone marrow from chemo/radiation treatment, or nutritional deficits

Question 15

Explain what causes fatigue in cancer

Answer 15

poor nutrition, protein malabsorption, inadequate tissue perfusion (due to anemia)

Question 16

Explain what causes effusion in serous cavities in cancer

Answer 16

impaired lymph flow from the serous cavity (obstruction) or erosion by tumor into the cavity

Question 17

What are the 5 main clinical manifestations of cancer?

Answer 17

FCAPE:
Fatigue
Cachexia
Anemia
Pain
Effusion

Question 18

What are the classes of chemotherapeutic drugs? Identify if they are cycle specific or non-specific

Answer 18

Alkylating agents: non-specific e.g. cisplatin, chlorambucil
Antimetabolites: S-phase specific e.g. methotrexate, imuran, cytosine, 5-FU
Mitotic inhibitors: M-phase specific e.g. vinblastine, vincristine, taxol
Antineoplastic antibiotics: non-specific e.g. adriaMYCIN, actinoMYCIN, bleoMYCIN
- bleomycin is M and G2 specific

Question 19

Explain how alkylating agents work

Answer 19

inactivates DNA –> halts cancer cell replication (similar action to radiation)

Question 20

Explain how antimetabolites work

Answer 20

interfere with DNA synthesis by mimicking cellular metabolites that the cell incorporates into the cell DNA –> immediate cell death

Question 21

Explain how mitotic inhibitors work

Answer 21

impact spindling in mitosis - interrupts cell replication

Question 22

Explain how antineoplastic antibiotics work

Answer 22

modify DNA function and interferes with RNA transcription –> cells die immediately or with cell division

Question 23

Explain how hormones work as treatment in cancer therapy

Answer 23

alter cellular environment making it less desirable for survival/replication; stimulates DIFFERENTIATION

Question 24

What are the phases of cancer development?

Answer 24

Initiation - DNA mutation
Promotion - factors cause replication of mutated cells
Progression - rapid multiplying of cancer cells with metastasis

Question 25

List the complications of cancer

Answer 25

DPT SHIPS
DIC: concurrent clotting and fibrinolysis
Pericardial effusion and cardiac tamponade
Tumor lysis syndrome - hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia
Superior vena cava syndrome - obstruction of venous flow to upper body
Hypercalcemia - destruction of bone by mets
Infection - due to myelosuppression (neutropenia) and immunosuppression of tumor
Paraneoplastic syndrome: as result of release of hormones by cancer cells e.g. SIADH, ACTH, insulin, etc.
Spinal cord compression: due to vertebral collapse from mets

Question 26

The 2 essential characteristics of cancer

Answer 26

proliferation/rapid growth

differentiation - poor

Question 27

Tumor spreads by 2 ways

Answer 27

invasion or metastasis (direct extension, lymphatic spread, or dissemination by the blood stream)

Question 28

The most frequent symptom of cancer and cancer treatment

Answer 28

fatigue

Question 29

Pain is associated with early/late (?) stages of cancer

Answer 29

late

Question 30

Cancer treatment usually involves some combination of ____________________

Answer 30

surgery, radiation, chemotherapy, immunotherapy

Question 31

Clinical manifestations in acute leukemia

Answer 31

AH CHILS
Anemia - due to WBC production inhibiting RBC and Plt production
Hypermetabolism - due to WBC production
CNS - abnormal WBC infiltrating CNS and increased intracranial pressure
Hyperuricemia - uric acid released with cell destruction
Infections - severe due to high count of immature WBC’s unable to fight infection
Lymphadenopathy - due to many WBC; hyperactivity in bone marrow causes bone pain
Splenohepatomegaly - due to many WBC