General Flashcards
cell cycle phases
interphase:
G1 - growth and prep: DNA check for damage
S - synthesis: make more DNA
G2 - prep for mitosis, grow, final check
mitosis
Please = prophase: pair up
Make = metaphase, meet in middle
Another = anaphase, spindles pull apart
Two = telophase -> NM forms again
Cells = cytokinesis
types of genes involved in cancer (like what kind can go wrong)- and which require two mutated alleles
- tumour suppressor - both alleles
- protooncogenes - one
- DNA repair genes - one
- genes for telomeres - one
EBV associated with what cancers?
diffuse large B cell lymphoma
Hodgkin lymphoma
post-transplant lymphoproliferative disorder
Burkitt’s lymphoma
nasopharyngeal
leiomyyo
gastric adenocarcinoma
HHV8 associated with what cancers?
Kaposi’s sarcoma
(primary effusion B cell lymphoma)
(plasma cell variant of castleman disease)
which syndromes involve inactivation of tumour suppressor genes?
Li-Fraumeni (P53)
NF1 and NF2
Familial retinoblastoma
Von Hippel-Lindau
Tuberous sclerosis (TSC1 or TSC2)
which syndromes involve inactivation of DNA repair genes?
fanconi anaemia
bloom syndrome
xeroderma pigmentosum
ataxia telangiectasia
leukostasis: key features
AML most likely
it so thicc, nothing can get through:
hypoxia, dyspnoea, LOC, haemorrhage bc the blasts consume coag factors
how to treat leukostasis
- hyperhydration
- hydroxyurea
- induction chemo
- w/h RBCs
TLS: key features
- high K, PO4, uric acid
- low Ca, acidosis, AKI
- causing AKI, arrhythmia, siezures, tetany
- rapid tumours: ALL >100 WCC, lymphoma esp Burkitt, renal disease
Tx of TLS
low risk = allopurinol
high risk = rasburicase - degrades uric acid to allantoin
hyperhydration
allopurinol should never be given with which drug and why?
6MP/ azathioprine:
- Azathioprine activated by conversion to 6MP
- 6MP inactivated by xanthine oxidase
- Can cause life threatening bone marrow suppression
coagulopathy esp with which cancer
APML
i. Low fibrinogen very suggestive
ii. Elevated D-dimer
iii. Reduced platelets
mediastinal compression: which cancers, and what to do?
T cell ALL (two thirds) + lymphoma
- Vena caval compression and bronchotracheal compression > facial oedema, dyspnoea and orthopnoea
- look for pericardial effusion on CXR and avoid GA
who is at high risk of feb neut?
AML
ALL induction / delayed intensification
allogeneic transplant (day-14 to day+356)
autologous transplant (day-7 to day +30)
re-induction chemotherapy for any relapse.
Rx for feb neut
- tazocin (cefepime/ceftaz if allergic)
+/- amik if sick / high risk
+/- metro for abdo stuff
+/- vanc if suspect MRSA
alklyating agents - cyclo/ifos:
- action
- cell cycle
- indications
- add alkyl groups > break DNA
- resting phase!
- solids: NHL, wilms, NB
anti-metabolites (MTX, 6-mp, ara-c):
- action
- cell cycle
- Similar structure to naturally occurring molecules in synthesis (MTX = folate, 6-MP = purine, ara-c = pyrimidine)
- S (cell growth)
MTX = ?
vom +++, hepatitis, mucositis
hyperhydration
6-MP = ?
myelosuppression, hypoglycaemia
ALL
beware allopurinol
vinca alkaloids (vinc):
- action
- cell cycle
binds tubulin inhibiting spindle formation in MITOSIS
vincristine key features
constipation
Neuropathy (peripheral sensorimotor, autonomic)
jaw pain
extravasation
NOT emetogenic with minimal BM suppression
topoisomerase inhibitors
- action
- cell cycle
disrupt topoisomerase
S (irinotecan) and G2 (etop)
etoposide = ?
2nd leukaemia
anthracyclines (doxo/dauno)
- action
- cell cycle
increase free radicals > oxidative stress
G2/M
doxo/dauno = ?
cardiomyopathy - dexrazoxane
platins (carbo/cisplat)
- action
- cell cycle
binds to dna to cause death
cell cycle non specific
carboplatin and cisplatin = ?
carboplat = anaphylaxis
cisplat = vom +++, ototox, renal tox
l-/peg-asp: how it works and key features. which part of the cycle
converts circulating l-asp, and tumour cells can’t make their own, so they die (normal cells can). G1
ALL/AML only
pancreatitis, DIC, anaphylaxis, venous thrombosis, hyperglycaemia
bleo = ?
lung fibrosis
Bulsulphan = ?
seizures
cyclo = ?
haemorrhagic cystitis (mesna), pulmonary fibrosis, infertility, HSV
ifos = ?
RTA, encephalopathy (thiamine/methylene blue)
ara - c = ?
n+v, mucositis, myelosuppression
Drugs that cause minimal/no myelosuppression (4)
o vinca alkaloids
o enzymes (asparaginase)
o bleomycin
o steroids
vincristine + intrathecal?
FATAL BITCH
meds for each part of cell cycle
G1: asp, steroids
S: anti-metabolites, irinotecan
G2: etop
M: vinca, taxanes
all: cyclophos, platins, doxo
first signs of vinc neuropathy? most comon and severe?
paraesthesia of fingertips and feet +/- muscle cramps (distal to proximal)
most common and severe = hyporeflexia
risk factors for vinc neuropathy
1) Concomitant azole antifungals
2) Pre-eexisting neurological condition such as Charcot-Marie Tooth
lung shit, think of which 4 CTx?
- MTX - penumonia
- cyclo - pneumonitis/fibrosis
- busulfan - fibrosis
- belo - fibrosis
main side effects radiotherapy
acute: N/V, dermatitis, cerebral oedema
chronic: dose-dependent 2nd cancer, neurocognitive, vascular, eyes, ears, fertility, cerebral necrosis, myelitis, endo
most to least common endocrinological complications of radiotherapy
- GH def (50%)
- Gonadotrophin deficiency or precocious puberty, females mostly (25%)
- Hyperprolactinemia
- ACTH deficiency
- Central hypothyroidism
what is radiation recall dermatitis?
inflammatory skin reaction that develops in an area of previously irradiated skin AFTER administration of certain promoting agents
what is radiation enhancement?
enhancement of the dermatological toxicity of radiation, if radiosensitizing chemotherapy administered within one week of the radiation
which is the childhood malignancy which most commonly has secondary cancers?
Hodgkin’s lymphoma (10% in 10 years) and soft-tissue sarcomas higher than that of any other childhood cancers
hodgkin’s = what 2nd cancers
ALL = what 2nd cancers
hodgkins = breast, thyroid, aml
ALL = brain, mds/aml
AVN happens in what Mx
steroids + BMT
