Cancer Flashcards

1
Q

What is the pathogenesis of leukaemia?

A

Mutation of early haematopoietic progenitors, leading to excessive production of progenitors which replace normal bone marrow tissue. Loss of function erythrocytes, thrombocytes and leukocytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can leukaemia be classified?

A

Acute or Chronic

Myeloid or Lymphoblastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is acute myeloid leukaemia?

A

Clonal proliferation of precursor cells which give rise to myeloid cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of acute myeloid leukaemia?

A

Pancytopaenia

  • thrombocytopaenia: easy bruising
  • neutropaenia: recurrent infection, slow wound healing
  • anaemia: fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is acute myeloid leukaemia diagnosed?

A

Anaemia that is normocytic and normochromic
Very low platelet count
Low leukocyte count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the principle of leukaemia treatment?

A
  1. Chemotherapy to induce remission
  2. Consolidation to destroy remaining leukaemia
  3. Maintenance to remain in remission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is haematopoietic stem cell transplant considered?

A
  1. Younger patients
  2. When there is a suitable donor
  3. First or second remission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is acute lymphoblastic leukaemia?

A

Clonal proliferation of stem cells of the lymphoid lineage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms of acute lymphoid leukaemia?

A

Splenomegaly
Hepatomegaly
*Due to excessive B and T lymphocyte progenitor formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between acute and chronic leukaemia?

A

Acute is more aggressive; chronic develops more slowly

Acute prevents blood stem cells from maturing, chronic prevents the development of mature/maturing blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is chronic myeloid leukaemia?

A

Myeloproliferative neoplasm categorised by the abnormal proliferation of mature/maturing granulocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the symptoms of chronic myeloid leukaemia?

A

Slow onset –> some patients are asymptomatic
Splenomegaly
Elevated WBC and platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Philadelphia gene?

A

BCR region from chromosome 22 and ABL region from chromosome 9 undergo a fusion reaction to form the Philadelphia gene. This results in a tyrosine kinase signalling protein that is always “on”, resulting in uncontrolled cell divison.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatment of Chronic Myeloid Leukaemia?

A

Tyrosine Kinase Inhibitor: Imatinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imatinib MOA?

A

Competitively inhibits BCR-ABL tyrosine kinase by blocking the ATP binding site, preventing the conformation switch to the active form. this blocks the proliferation and induces apoptosis of BCR-ABL positive cell lines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Imatinib ADR?

A
ADR usually arise during a few months of treatment.
Neutropaenia, thrombocytopaenia
Gastrointestinal bleed
Nausea, vomiting --> take with food
Diarrhoea --> loperamide
Maculopapular rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should be monitored prior to initiating imatinib?

A
Full blood count
Serum creatinine
Urea, electrolytes
Liver function test
TSH
INR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How often should patients taking imatinib be monitored?

A

Weekly for the first month
Biweekly for the second month
Every 2-3 weeks thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drugs interact with imatinib?

A

Imatinib is a CYP3A4, 2C9, 2D6 and 2C19 inhibitor, thus reacts with any drugs that are inducers or inhibitors of these enzymes.
Carbamezapine: CYP3A4 inducer
Azole antifungal: CYP3A4 inhibitor
Warfarin: metabolised by CYP2C9 and 3A4

20
Q

What is lymphoma?

A

Chronic malignancy of mature lymphocytes

21
Q

What is Hodgkin lymphoma?

A

Malignancy wherein Hodgkin Reed-Sternberg cells (a type of B cell) are mixed in with non-neoplastic cells

22
Q

What is the difference between Hodgkin and Non-Hodgkin lymphoma?

A

Hodgkin Lymphoma is diagnosed by the presence of Reed-Sternberg cells. Hodgkin lymphoma also typically begins in the upper body, Non-Hodgkin lymphoma begins anywhere/

23
Q

What are the symptoms of Hodgkin’s lymphoma?

A
Asymptomatic lymphadenopathy
B symptoms
- fever
- night sweats
- unintentional weight loss
24
Q

How is Hodgkin’s Lymphoma staged?

A

Stage 1: single node
Stage 2: two nodes on one side of the diaphragm
Stage 3: bilateral nodes
Stage 4: extranodal (i.e. nodes on other parts of the body)

25
What are the treatment options for Hodgkin Lymphoma?
Multi agent chemotherapy - ABVD - BEACOPP Radiation therapy
26
What is the best treatment option for early-stage Hodgkin lymphoma?
ABVD: doxorubicin, bleomycin, vincristine, darcapazine
27
What is the best treatment for late-stage Hodgkin lymphoma?
BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone
28
When is radiation therapy considered in Hodgkin's lymphoma?
Poor prognosis | Risk of relapse
29
What is Non-hodgkin lymphoma?
Haematological malignancy arising from lymphocytes (B, T, NK)
30
What are the subtypes of non-hodgkin lymphoma?
Aggressive/highly aggressie | Indolent
31
What are the symptoms associated with aggressive NHL?
Fever, night sweats Weight loss Rapidly growing mass
32
What are the symptoms associated with indolent NHL?
Waxing/waning lymphadenopathy Hepatomegaly Splenomegaly Cytopaenia (loss of functional blood cells)
33
What is the treatment of NHL?
R-CHOP: - rituximab - cyclophosphamide - doxorubicin - vincristine - prednisone
34
Why is chemotherapy administered in cycles?
Chemotherapy only attacks cells that are currently dividing. By the time cancer is detected, those cells have stopped dividing and are in the G0 phase. Thus, chemotherapy is administered in a cycles to target cancer when it is dividing. Intermittent cycles also allow normal tissues time to recover.
35
Rituximab MOA
rituximab is a monoclonal antibody that binds to transmembrane antigen CD20 to initiate cell lysis. This is done via 4 mechanisms: 1. Antigen-dependent cell cytotoxicity 2. Antigen-dependent cell phagocytosis 3. Complement-dependent cytotoxicity 4. Apoptosis
36
How are chemotherapy doses calculated?
Body surface area: | root of height*weight over 3600
37
What premedications are given for rituximab?
Loratadine and paracetamol to prevent hypersensitivity, for pain relief and to reduce infusion-related reactions.
38
What happens if patients have rituximab-induced infusion reactions?
Treat symptoms of infusion reaction then administer at a reduced infusion rate.
39
Rituximab ADR?
Serious infection Infusion-related hypersensitivity reactions CV AEs: exacerbation of angina, arrythmia, heart failure
40
Cyclophosphamide MOA?
Alkylating agent, adds alkyl group to nucleic acids, proteins and amino acids, preventing strand separation by cross-linking DNA.
41
Cyclophosphamide ADR?
``` Haemorrhagic cystitis (bleeding from bladder) Treat with fluids (unless fluid restricted) and MESNA. ```
42
Doxorubucin MOA?
Anthracycline antibiotic, causes cell fragmentation by inhibiting DNA and RNA synthesis
43
Doxorubicin ADR?
Cardiotoxicity Hand-foot syndrome Dehydration
44
Vincristine MOA?
Vinca alkaloid, inhibits production of spindle fibres therefore inhibits mitosis in cancer cells.
45
Vincristine ADR?
Constipation due to autonomic neuropathy | Treat with prophylactic laxatives
46
Vincristine must be administered...
...via IV
47
Prednisone MOA?
Glucocorticoid, reduces the number of circulating lymphocytes, eosinophils and monocytes and decreases inflammation.