General Flashcards
How does Folate accelerate cancer cell growth?
Folate provides substrates for DNA synthesis and accelerates cancer cell proliferation and Tumor expanstion
Cancer Staging
T: grade reflects the size and extent of the tumor
N: grade is for the extent of spread to local lymph
M: grade indicates the presence or absences of distant metastasis
Number: 0 to each letter indicates the size or extent of the primary cancer and extent of cancer spread
Grade
measures how abnormal the cancer cell looks under microscope (differentiation)
-ones that look abnormal or more differentiated and tend to grow and spread fast
Grades
Gx: grade cannot be assessed
G1: Well differentiated (Low grade)
G2: moderately differentiated (intermediated)
G3: poorly differentiated (high grade)
G4: undifferentiated (high grade)
Grade -Primary Tumor (t)
Tx: tumor cannot be visible by imaging
To: No evidence of tumor
Ts: carcinoma in situ (CIS) abnormal cells are present but not spread to neighboring tissues
T1: Tumor not palpable or visible imaging
T2: tumor confirmed by primary cancer site
T3: tumor extends neighboring cancer sites
T4: metastatic disease
Grade: Lymph Node (N)
NX: regional lymph nodes cannot be evaluated
N0 no regional lymph node involvement
N1-N3: Involvement of regional lymph nodes (number of lymph notes indicates extent of spread)
Distant Metastasis (M)
Grade:
Mx: distent metastatic cannot be evaluated
M0: No distant metasis
M1: Distant metastasis present
3 stages of cancer cachexia
- precachexia -wt loss, anorexia, progression depends on cancer type and stage.
- Cachexia = wt loss of > 5% over 6 months, BMI < 20 with > 2% weight loss, sarcopenia and > 2% weight loss, reduced food intake
- Refractory cachexia-active metabolism, management of weight loss not possible , ve;ry advanced, unresponsive to cancer tx
Energy needs
Cancer Repletion (weight gain): 30-35 kcals/Kg
cancer, inactive (nonstressed): 25-30 kcals/Kg
Cancer, hypermetabolic (stressed): 35 kcals/Kg
Sepsis: 25-30 kcals/Kg
BMT: 30-35 kcals/Kg
What are functional foods?
Whole foods along with fortified, enrich or enhanced foods that have a potentially beneficial diet on a regular basis at effective levels based on significant standards of evidence
example: Flaxseed: omega 3 FA, amino acid, soluble and insoluble fiber
Tumor Burden or Tumor Load
Definition: the size of the tumor or the amount of cancer in the body
Effects on response: As tumor mass increase in size its growth rate can slow thus reducing effectiveness of cancer treatment
Tumor growth rate
Definition: the proportion of cancer cells within the tumor that are growing and dividing to form a new cancer cell
Effects on response: Growing tumors usually are more responsive to treatment
Drug Resistance
Definition: the failure of cancer cells to respond to a drug used to kill or weaken them
effects on response: cancer cells may be resistant at the beginning of treatment or may develop resistance after exposure to treatment
Cancer therapy approaches:
Prevention
preventative surgery
Adjuvant therapy
Definitive therapy
Neoadjuvant therapy
Palliation
Prophylactic therapy
Cancer Therapy Approach: Prevention
Goal: use of medicines or other agents to reduce the risk of cancer or delay its development
Examples: hormone therapy (antiestrogen agent) to reduce the risk of breast Ca in a women who are at high risk, Immunization
Cancer Therapy approach: Preventative surgery
Goals: use surgery to reduce the risk of cancer or delay its development
Example: Total colectomy
Cancer therapy approach: adjuvant therapy
Goals: use of additional cancer treatment after the primary therapy to reduce the risk of cancer recurrence and to decrease the incidence
Example:
Chemo given after lobectomy for tx of lung Ca
Chemo, hormone therapy and monoclonal antibody therapy given after lumpectomy after Breast Ca tx
Cancer therapy approach: Definitive therapy
Goals: Use of radiation therapy as the primary tx modality with or without chemo
example:
Radiation therapy of prostate cancer
Cancer therapy approach: Neoadjuvant therpay
Goals: use of 1 or more tx modalities before the primary therapy to reduce the size of the primary tumor, improve the effectiveness of the surgery and decrease the incidence of metastatic disease
example: Chemo and external beam radiation therapy given before esophagectomy to treat Esophageal Ca (chemo before surgery)
Cancer therapy approach: Palliation
Goals: use of Ca treatment modalities when disease cure and control cannot be achieved to relieve side effects and symptoms caused by Ca and other illnesses to improve QOL
Cancer therapy approach: Prophylactic therapy
Goals: use of radiation therapy to relieve symptoms such as pain bleeding, obstruction
Example: Whole brain irradiation
5 phases of cell cycle
G0: resting phase
G1 (post mitotic phase) - cells begin the 1st phase of reproduction by synthesizing protein and RNA necessary for cell death
S: Synthesis phase- DNA is synthesized
G2: (premeiotic phase) cells prepare to divide
M: (mitotic phase); cells growth and protein production stops cellular energy is focused on the orderly division into 2 daughter cells
Chemo Agents used
(cell cycle nonspecific)
Classified according to their mechanism of action and effect on cell reproduction.
Cell cycle nonspecific agents (are drugs that damage cell in all phases)
include:
- Alkylating agents
- Antitumor agents
- Antibiotic agents
- Hormone
- Nitrosources
Chemo agents used
(Cell cycle specific)
-Antimetabolites (synthesis phase)
-Camptohecins (synthesis phase)
-Plant Alkaid’s and taxanes (mitosis phase)
-Miscellaneous agents (various phases)
3 important facts in the delivery of the different chemo agents include:
-frequency of cycle (daily, weekly, every 14, 21 days)
-length of cycle (lasting minutes, days, years)
-number of cycles (determine by research and clinical trials)
cell cycle nonspecific drug: Alkylating agents
cell cycles nonspecific agents: active throughout the cell cycle
Mechanism of action: interfere with DNA . base causing break in DNA helix strands and thus preventing DNA replication and transcriptions of RNA
Bendasmustine (treande)
-Alkylating agent
-route: IV
Indication: CLL, NHL, B celll
side effects: mild N/V, fatigue, hypersensitivity infusion, TLS
Busulfan (myleran)
-Alkylating agent
-route: IV
-Indication: Chronic CML, SCT
-side effects: N/V/D, mucositis, adrenal insuff.
Carboplatin (paraplatin)
-Alkylating agent
-route: IV
indication: breast, bladder, cervix, endometrium, esophagus, germ HN, lung
side effects: N/V, renal toxicity, peripheral neuropathy, Taste change
