Heme/Onc - mostly cancer stuff Flashcards
Name 2 alkylating agents (oncology).
cyclophosphamide
cisplatin
Name 2 antimetabolites (oncology).
methotrexate
fluorouracil
Name a selective estrogen receptor modulator (oncology).
tamoxifen
Name an aromatase inhibitor drug(oncology).
anastrozole
Name a GnRH analog (oncology).
leuprolide
Name a biologic response modifier drug (oncology).
interferon alpha
Name 2 antimicrotubule drugs (oncology).
vinca alkaloid vincristine
paclitaxel
Name 2 enzyme inhibitor drugs (oncology).
irinotecan
imatinib
Name a targeted therapy drug (oncology).
imatinib
Name a monoclonal antibody drug (oncology).
bevacizumab
Name 2 antimicrobial drugs (oncology).
doxorubicin
bleomycin
Name 4 causes of acquired platelet disorder.
- drugs
- uremia
- myeloproliferative disorder/myelodysplastic syndrome
- cardiac bypass
Name 9 drugs that can cause acquired platelet dysfunction.
- aspirin
- NSAIDs
- glycoprotein IIb/IIIa inhibitor e.g. abciximab
- thienopyridines e.g. clopidogrel, ticlopidine
- dipyridamole
- SSRIs e.g. fluoxetine
- omega-3 fatty acids
- penicillin
- alcohol
What drug treats specifically metastatic colorectal cancer?
bevacizumab
What drug treats colon & rectal carcinoma?
irinotecan
What drug treats estrogen-receptor-positive breast cancer?
tamoxifen
What drug treats hormone-dependent breast cancer?
anastrozole
What drug treats prostate cancer and also has some effect in treating breast cancer?
leuprolide
What drug treats CML?
imatinib
What does alpha interferon treat?
blood cancers
What does bleomycin treat?
testicular cancer
Define neoplasia.
abnormal, uncontrolled growth of tissue, functioning autonomously and outside of regulation by surrounding tissues
(Path. Made Ridic. Simple p15)
Define carcinoma in situ.
Severe dysplasia involving the entire thickness of an epithelial layer. It is not malignant because it has not yet broken through the basement membrane of the epithelial tissue.
(Path. Ridic. Simple p 16)
Define dysplasia.
A premalignant lesion. Dysplastic tissue shows disordered and immature growth with accompanying genetic and functional alterations that have the potential to become malignant without treatment. OFTEN REVERSIBLE IF THE CAUSATIVE STIMULUS IS REMOVED.
(Path. Ridic. Simple p16)
What drug treats advanced ovarian cancer, metastatic breast cancer, and non-small cell lung cancer?
paclitaxel
Define metaplasia.
Reversible change from one type of fully mature cell to a different type of mature cell that is not normally found in the tissue involved.
(Path Ridic. Simple p1)
Define paraneoplastic syndrome.
Symptom complex in cancer patient not attributable to local tumor effects or overproduction of factors normally produced by the tissue of origin of the tumor. For example, hypercalcemia in a patient with lung cancer is a paraneoplastic syndrome, while hypercalcemia in a patient with a parathyroid adenoma is NOT.
(Path. Ridic. Simple p28)
Define adjuvant therapy.
When chemotherapy is used as a supplemental treatment to attack micrometastases FOLLOWING surgery and radiation treatment, it is called adjuvant chemotherapy.
(Lipp. p482)
Define neoadjuvant therapy.
Chemotherapy given PRIOR to the surgical procedure in an attempt to shrink the cancer is referred to as neoadjuvant chemotherapy.
(Lipp. p482)
Define anaplasia.
Cells lack any evidence of differentiation!
–variation in size and shape of cells and nuclei
–extremely dark nucleus due to increase in DNA
–nucleus takes up more space in cell compared to normal cell
–clumpy chromatin
–large nucleoli
–increased mitoses
–loss of polarity of cell and/or nuclei
–central necrosis (esp. in malignant tumors when they outgrow their blood supply)
(Path. Ridic. Simple p15)
Define oncogene.
Genes derived from mutations in proto-oncogenes.
Oncogenes encode oncoproteins, which are devoid of important regulatory elements and do not depend on growth factors or other external signals!
(Path. Ridic. Simple p19)
Define tumor suppressor gene.
Suppressor genes keep cell growth in check, suppressing abnormal cellular growth and actively counteracting growth stimulus as appropriate. (Path. Ridic. Simple p 19, 20)
Disruption of BOTH COPIES is necessary for dysregulation of cell growth. (22)
What are the top three cancers in terms of NEW CASES in 2010 for males?
prostate
lung/bronchus
colon/rectum
(Pat, Antoinette)
What are the top three cancers in terms of NEW CASES in 2010 for females?
breast
lung/bronchus
colon/rectum
(Pat, Antoinette)
What are the top three cancers in terms of DEATHS in 2010 for males?
lung/bronchus
prostate
colon/rectum
(Pat, Antoinette)
What are the top three cancers in terms of DEATHS in 2010 for females?
lung/bronchus
breast
colon/rectum
(Pat, Antoinette)
Describe in general the TNM staging system.
T: describes the primary tumor
N: describes whether or not the cancer has reached nearby lymph nodes
M: whether there are distant metastases
(cancerstaging.org, the link provided in CURRENT)
Name the three pathways of metastasis.
- Seeding of body cavities
- Lymphatic spread
- Hematogenous spread
(Path. Ridic. Simple p18)
Define remission.
A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.
cancer.gov
Define prognosis.
A prognosis is an estimate of the likely course and outcome of a disease. The prognosis of a patient diagnosed with cancer is often viewed as the chance that the disease will be treated successfully and that the patient will recover.
cancer.gov
Define cure.
A cure means that treatment has successfully eradicated all traces of a person’s cancer, and the cancer will never recur (return). A cure does not mean, however, that the person will never have cancer again. It is possible that another cancer, even the same type of cancer, will develop in the person’s body at some point in the future.
cancer.gov
Define invasive carcinoma.
Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
cancer.gov
Name 7 paraneoplastic syndromes.
- Cushing syndrome
- carcinoid syndrome
- hypercalcemia
- hyponatremia/SIADH
- ectopic hormone production
- Lambert-Eaton myasthenic syndrome
- hypercoaguability (Trousseau sign)
What is Cushing syndrome? S/S?
Excessive corticosteroids
- -Central obesity, muscle wasting, thin skin, hirsutism, purple striae.
- -Psychological changes.
- -Osteoporosis, hypertension, poor wound healing.
- -Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia, hypokalemia.
What is carcinoid syndrome?
Carcinoid syndrome occurs in patients with carcinoid tumors (<10%), usually small bowel carcinoid tumors. 90% of those who get carcinoid syndrome have hepatic metastases.
Carcinoid syndrome is caused by tumor secretion of hormonal mediators. The manifestations include –facial flushing
- -edema of the head and neck (especially with bronchial carcinoid)
- -abdominal cramps and diarrhea
- -bronchospasm
- -cardiac lesions
- -telangiectases
Name causes of hypercalcemia as a paraneoplastic syndrome.
- ovary, kidney, lung cancers
- multiple myeloma
- lymphoma
SIADH can be a paraneoplastic syndrome of several different malignancies, but especially which?
small cell lung cancer
What is Trousseau syndrome?
Trousseau syndrome is an ACQUIRED COAGULOPATHY presenting as MIGRATORY THROMBOPHLEBITIS often in a setting of underlying MALIGNANCY. Both the arterial and venous vasculature can be affected and can lead to devastating complications such as pulmonary embolism, stroke, limb necrosis, and organ ischemia.
(Fitzpatrick ch. 153)
How is Trousseau syndrome treated?
low-molecular weight heparin is the treatment of choice
Fitzpatrick ch. 153
With which cancers in particular is Trousseau syndrome associated?
lung, pancreatic
What is Lambert-Eaton myasthenic syndrome?
muscle weakness where power steadily increases with sustained contraction
Current ch 24
With which cancer type is Lambert-Eaton myasthenic syndrome most frequently associated?
small cell carcinoma of lung
Current ch 24
How is Lambert-Eaton myasthenic syndrome treated?
Treatment with plasmapheresis and immunosuppressive drug therapy (e.g. prednisone) may lead to improvement, in addition to therapy aimed at tumor when present.
Current ch 24
What is the emergent treatment for spinal cord compression?
corticosteroids (DEXAMETHASONE)
emergent surgery (biopsy, decompression)
radiation therapy
Why is spinal cord compression an oncologic emergency?
Because the probability of reversing neurologic symptoms largely depends on the duration of symptoms. Patients who are treated promptly after symptoms appear may have partial or complete return of function.
What is the main presenting symptom of spinal cord compression?
back pain that is worse at night or when laying down, with bilateral “radicular” style pain
What is superior vena cava syndrome?
Partial or complete obstruction of the superior vena cava that is usually secondary to neoplastic or inflammatory processes in the superior mediastinum.
What are the symptoms of superior vena cava syndrome?
- -Swelling of the neck, face and upper extremities.
- -Dilated veins over the upper chest and neck.
- -Symptoms are often perceived as congestion and present as headache, dizziness, visual disturbances, stupor, syncope, or cough.
- -Symptoms are particularly exacerbated when the patient is supine or bends over.
- -Brawny edema of the face, neck, and arms occurs later
- -Cyanosis of these areas then appears.
What is the urgent treatment for superior vena cava syndrome?
Urgent treatment for neoplasm consists of (1) cautious use of intravenous diuretics and (2) mediastinal irradiation, starting within 24 hours, with a treatment plan designed to give a high daily dose but a short total course of therapy to rapidly shrink the local tumor.
A stent could also be placed.
Why is superior vena cava syndrome an oncologic emergency?
A high degree of obstruction of rapid onset secondary to cancer is often fatal in a few days or weeks because of increased intracranial pressure and cerebral hemorrhage, but treatment of the tumor with radiation and chemotherapeutic drugs may result in significant palliation.
When is hyperuricemia/tumor lysis syndrome most likely to occur?
Tumor lysis syndrome (TLS) is seen most commonly following treatment of hematologic malignancies, such as acute lymphoblastic leukemia and Burkitt lymphoma. However, TLS can develop from any tumor highly sensitive to chemotherapy.
What causes tumor lysis syndrome?
TLS is caused by the massive release of cellular material including nucleic acids, proteins, phosphorus, and potassium. If both the metabolism and excretion of these breakdown products are impaired, hyperuricemia, hyperphosphatemia, and hyperkalemia will develop abruptly.
Why is tumor lysis syndrome/hyperuricemia an oncologic emergency?
Acute kidney injury may develop from the crystallization and deposition of uric acid and calcium phosphate within the renal tubules further exacerbating the hyperphosphatemia and hyperkalemia.
What is the most important factor in management of tumor lysis syndrome for all patients regardless of risk factors?
Prevention is the most important factor in the management of TLS. Published guidelines for TLS management include aggressive hydration prior to initiation of chemotherapy as well as during and after completion of the chemotherapy. Administration of fluid helps keep urine flowing and facilitates excretion of uric acid and phosphorus.
What is done for patients at moderate risk of developing tumor lysis syndrome?
ALLOPURINOL (which blocks the enzyme xanthine oxidase and therefore the formation of uric acid from purine breakdown) should be given before starting chemotherapy
What is done for patients at high risk of developing tumor lysis syndrome?
RASBURICASE is given intravenously for 1–7 days
What are the symptoms of hypercalcemia?
constipation and polyuria
nausea, vomiting, anorexia, peptic ulcer disease
renal colic, and hematuria from nephrolithiasis
How is malignant hypercalcemia treated?
IV fluids
Bisphosphanate
Define polycythemia.
The term polycythemia means increased cellular components in peripheral blood—RBCs, WBCs, and platelets—but in common practice is used to describe increased red cells or erythrocytosis. Polycythemia can be primary, due to malignant transformation of a hematopoietic stem cell (called polycythemia vera), or can be secondary to an event outside the bone marrow driving erythropoiesis.
Define aplasia.
Aplasia means failure to develop. E.g aplastic anemia is a condition of bone marrow failure in which the bone marrow becomes hypoplastic, fails to produce mature blood cells, and pancytopenia develops.
Define anisocytosis.
red blood cells are of unequal sizes - some big, some small, some normal, etc.
Define poikilocytosis.
when RBCs are abnormally shaped. Examples:
spherocyte
ovalocyte
sickle cell
acanthocytosis (jagged projections from surface)
schistocyte (RBC fragment)
Define anemia.
hematocrit is < 41% in males or < 36% in females
Define pancytopenia.
decreased RBCs, WBCs, and platelets
