Lecture 1 Flashcards
Intro Oncology
What is the incidence and prevalence of cancer in Canada ?
2 in 5 people will receive the cancer diagnosis in their lifetime
What are the characteristics of cancer ?
-Uncontrolled Proliferation
-Cellular Changes : unfunctional cell from its origin
- Local Invasion
- Metastasis
How do we call solid tumour : epithelial cells ?
Carcinoma and Adenocarcinoma
What is the suffix for connective tissue tumours ?
ends with “sarcoma”
What is glioblastoma ?
solid tumour of neural tissue - glial tissue
What is astrocytoma?
solid tumour of neural tissue - astrocytes
What is the tumor of germ cells ?
germinomas
List all the liquid malignant tumours ?
Leukemia, lymphoma and multiple myeloma
What is the process of carcinogenesis ?
Initiation
Promotion
Conversion
Progression
What are the common types of genetic mutations that cause cancer ?
BRCA1/BRCA2 mutation - germline
TP53 - tumour suppressor
What are the possible causes of somatic cancer ?
UV radiation
Chemicals ( alcohol, smoking, asbestos)
Viruses ( HPV, Epstein Barr Virus)
Chance - genetic mutations
What is the difference between germline and somatic mutations ?
Germline : hereditary, in all cells \
Somatic : some cells, needs a biopsy
What are the characteristics of an oncogenes ?
gene to cause cancer , leads to excessive genetic product and breaks the regular cycle and growth of a cell
What are proto ocogenes ?
normal genes that can change to be oncogenes
What is special about TP 53 ?
tumor suppressor genes that is difficult to treat
Name the hallmark of cancer ?
sustain proliferative
resisting cell death
induce angiogenesis
enabling replicative immortality
invasion and metastasis
evading suppressors
What are the emerging hallmarks and enabling characteristics ?
phenotype plasticity
non mutational epigenetic reprogramming
senescent cells
microbiomes
What is the difference between distant and local metastases ?
Local - >lymphatic
distant –> brain, lung, bone, liver
What are cancer prevention ?
reduce exposure to carcinogens
prevent infections
healthy and cancer free lifestyles
What is the highest preventable causes to cancer ?
Physical inactivity
What are cancer screening process ?
7 Warnings
bowel movements
sore that does heal
unusual bleeding
wart/mole
nagging cough
What are cancer early diagnosis ?
Mammogram –> breast
FIT ( fecal) –> colon
PAP –>cervical
What is the HPV vaccine ?
HPV is a common STI and associated with multiple cancer type
What is the efficacy of HPV vaccine in cancer prevention ?
vaccination before 17 yo leads to 90% reduction of cervical cancer
How is HPV vaccine provided in Canada ?
publicly funded up until 26 yo
What are the potential features of cancer to exploit for cure / slow the disease ?
killing ( dividing cells)
targeted (signalling and transduction )
immunotherapies (body immune system)
Endocrine ( hormone dependent)
angiogenesis inhibitors
Cancer diagnosis
History and physical exam (Palpations , meds, carcinogens, general health)
lab test results ( regular or tumour markers)
screening test results
Biopsy / surgical resection
What is a tumour grade ?
looking at the histology to provide a prognosis by the pathologist
What is the main purpose of Imaging ?
Xray, U/S and CT scan is to CONFIRM the presence of a mass and get an idea if it is typical of malignant
What is the mitotic activity ?
growth rate
Ki67
how aggressive is the cancer and how likely is the chemotherapy to respond
What is Ki67 ?
protein in the dividing cells and is a marker for growth fraction
What are the common biomarkers within cancer cells that the pathologist can test ?
cytogenetics, mutations and antigens
What is cytogenetics ?
changes in the chromosomes
What is the main difference between prognostic and predictive ?
prognostic is without tx –> helps to fins how aggressive the tumor is
predictive biomarker : looks at the therapy efficacy
When do we use serum markers for staging cancer ?
in testicular cancer
What is the TNM staging ?
Tumour
nodes
metastases
What is remission ?
the complete response to the chemotherapy
What is induction ?
Start of the antineoplastic
What is consolidation ?
Sustaining of remission
What is maintenance ?
Prolonging remission
What is the scale to measure how the tx will impact the pt daily life and how fit the patient is ?
Performance ECOG
0n–> fully active and able to carry dailyactivities
Which of the following is a potential challenge when determining if a cancer patient is disease-free?
Presence of undetectable microscopic disease (micrometastases)
What does “5-year disease-free survival” refer to in cancer therapy?
The patient is alive and no detectable cancer is present after 5 years of treatment
What are the treatment goals ?
Cure
Extension of Life (Prolonging Survival)
Improved Quality of Life
Palliation
When a cure is not possible, what is the primary goal of cancer treatment?
Prolonging survival time and improving quality of life
What does “progression-free survival” (PFS) refer to in cancer trials?
The number/proportion of patients who are still alive and free of disease progression
What does “overall survival” (OS) refer to in cancer treatment trials?
The proportion of patients still alive at a specified time, regardless of the cause of death
How is overall survival (OS) different from progression-free survival (PFS)?
OS accounts for death from any cause, while PFS only considers disease progression.
What does the term “dose-limiting toxicity” refer to in the context of antineoplastic therapy?
The specific toxic effects that prevent further increases in drug dosage
Which of the following dosing methods is commonly used for cytotoxic chemotherapy?
Body surface area (BSA) dosing
The dosing of Carboplatin is often adjusted based on which formula?
Calvert formula
Why are cytotoxic agents typically administered in cycles (e.g., every 14, 21, or 28 days)?
To give the body time to recover from the toxic effects of treatment
Flat dosing is most commonly associated with which type of antineoplastic agents?
Oral targeted agents
What is the primary difference between the dosing schedules of traditional cytotoxic agents and oral targeted therapie
Oral targeted therapies are often administered daily for several consecutive days, while cytotoxic agents are administered cyclically
Which of the following is true about monoclonal antibodies used in cancer therapy?
They are given cyclically with chemotherapy and have a very long half-life
Which of the following is a key reason for using drugs with different mechanisms of action (MOA) in combination therapies?
To enhance cell kill by targeting different pathways or stages of the cell cycle
Why is it important for each drug in a combination therapy to have a distinct toxicity profile?
To avoid overlapping toxicities and reduce the overall risk of severe side effects
What is the purpose of adding “rescue” agents in combination therapy regimens?
To protect or repair normal cells from the toxic effects of the primary drugs
A 48-year-old female with small cell lung cancer is prescribed etoposide. The recommended dose is 100 mg/m² of BSA daily for 3 days in a 21-day cycle.
Patient Details:
Weight: 60 kg
Height: 160 cm
BSA=1.63m2
Doseperday=163mg
A 62-year-old female with breast cancer is prescribed doxorubicin. The recommended dose is 60 mg/m² of BSA every 21 days.
Patient Details:
Weight: 70 kg
Height: 165 cm
BSA≈1.79m 2
Dose=107.4mg
What is the definition of a Complete Response (CR) in oncology?
Disappearance of all lesions and no evidence of new disease
Which response category indicates that a patient’s disease has worsened?
Progressive Disease (PD)
A patient with a lung tumor shows a 25% decrease in tumor size and no new lesions. How is this response categorized?
Stable Disease (SD)
If a patient’s tumor increases by 15% in size but does not develop any new lesions, how should this be classified?
Stable Disease (SD)
Which of the following best describes a Partial Response (PR) to treatment?
The tumor decreases in size by at least 30% with no new lesions
A 60-year-old female with ovarian cancer was treated with chemotherapy. After 4 cycles, follow-up imaging shows a 35% reduction in the size of her tumors and no new lesions.
How would you classify this response to treatment?
This response would be classified as a Partial Response (PR) because the tumor size has decreased by at least 30% and there are no new lesions. The reduction in tumor size meets the criteria for PR.
A 45-year-old male with metastatic melanoma shows a 50% increase in the size of his primary tumor and has developed new lesions in his liver after 6 months of immunotherapy.
How should this response be classified?
This response should be classified as Progressive Disease (PD) because there is at least a 20% increase in tumor size and the development of new lesions. Both criteria for PD are met.
Which of the following is a direct result of myelosuppression caused by cytotoxic agents?
Neutropenia, amenia, thrombocytopenia
What is a common gastrointestinal toxicity associated with cytotoxic agents?
Mucositis
Neurotoxicities from cytotoxic agents can affect which of the following systems?
Central, peripheral, and autonomic nervous systems
Which of the following cytotoxic agent toxicities is usually reversible?
Alopecia
Which antineoplastics medications is known for N/V ?
Cisplatin , alkylating agent
Which antineoplastics medications is known for pulmonary toxicity ?
Bleomycin - unique and interact with DNA base pairs
Which antineoplastics medications is known for myelosuppression ?
Etoposide - topoisomerase inhibitor
How often should Joe’s platelet count be monitored when receiving etoposide to manage the risk of thrombocytopenia?
Every 21 days prior chemo
For a patient undergoing chemotherapy with potential myelosuppression, which of the following is a critical sign of infection that should prompt immediate medical attention?
Fever
Joe has started a chemotherapy regimen including cisplatin and etoposide. He reports feeling nauseous and has vomited several times in the past week.
What supportive care measures should be taken to manage Joe’s nausea and vomiting?
Joe should be provided with antinauseants, such as 5-HT3 receptor antagonists (e.g., ondansetron) or NK1 receptor antagonists (e.g., aprepitant).
Joe is experiencing symptoms of bruising and bleeding easily, and his recent platelet count indicates thrombocytopenia.
How should Joe’s thrombocytopenia be managed to minimize the risk of bleeding complications?
Joe should be advised to avoid activities that increase the risk of bleeding or bruising, such as contact sports or trauma. Regular monitoring of platelet counts is essential to detect significant drops. If necessary, treatments like platelet transfusions or dose adjustments of etoposide may be considered. Educating Joe about recognizing and reporting signs of bleeding or unusual bruising is important for early intervention.
What is a characteristic of dosing for small molecule targeted therapies (“NIBS”)?
Flat dosing with potential adjustments for organ dysfunction
May have rest days also
Which of the following best describes the dosing for monoclonal antibodies?
Administered IV cyclically, with doses based on BSA, weight, or flat dosing
NIBS are typically what type of medds ?
Oral targeted tx - tyrosine kinase inhibitors “nibs”
Cancer cells can continue to divide despite messages to rest, stop, and/or differentiate. This hallmark of cancer is referred to as:
evading growth suppressors
