Medical Oncology Flashcards
Fine Needle aspiration for diagnosis of what cancers?
carcinomas specifically squamous cells…
bad for seeing tissue architecture
core biopsy
adequate for almost all cancers..but takes the longest
excisional biopsy for diagnosis of what cancers and how we do it?
take out the whole suspected area
good for melanomas and lymphoma diagnosis
liquid biopsy mechanism and why its used?
tumor cell DNA products in the blood stream so get those
allows for longitudinal monitoring of the cancer
will a late stage tumor have a high or low growth fraction?
will actually have a low growth fraction because its slowing down and becoming hypoxic
how do administer non stage specific drugs?
can give in one big bolus dose
How do we administer cell cycle specific drugs?
give as continuous infusion or multiple divided doses
salvage, palliative and definitive treatment of cancer
salvage- cancer not responding to anything else
palliative- relieve symptoms
definitive- cure
how do we give ourselves ability to give high toxicity treatment?
by being able to give autologous stem cell transplant to make the cells back
neoadjuvant treatment
given before main treatment
adjuvant treatment
in addition to primary treatment
induction treatment
intense initial treatment to get handle on cancer
consolidation treatment
used to solidify remission
maintenance treatment
used to catch slow growing cells and increase disease free state
5 targets of drugs for cancer
angiogenesis surface antigens signaling pathways DNA rep and repair specific oncogenes
what cancer has a lot of angiogenesis?
kidney cancer
VHL tumor suppressor pathway in kidney cancer
VHL usually helps ubiquinate the HIF and lead to its degradation but in kidney cancer the cells become hypoxic and the VHL does not break down the HIF which means it can lead to targeting factors that increase angiogenesis…this pathway is a great target for kidney cancer drugs
what is characteristic of lymphomas that are a good drug target?
they have a lot of cell surface antigens and markers that are consistent between patients and the cancer cells..making them a nice target
explain immune checkpoint inhibition treatment
T cells and cancer cells interact at checkpoints..often cancer cells are downregulating the T cells…well if you make an antibody against the molecules involved in this cancer and T cell checkpoint then the cancer cell cannot down regulate the T cells
T cell cancer therapy
take T cells out, modify to target specific cancer cells and then reintroduce to patient
treatment for a localized cancer
likely surgery and radiation
oncologic emergencies (2)
spinal cord metastases and bowel perforation
testicular cancer treatment effectiveness
super susceptible to treatment…great numbers
why does slow growth make treatment of cancer difficult?
because a lot of treatment targets cell replication and if you are not growing you are not replicating so wont be as effective
why do we treat past remission?
because probably still some slow growing cells lingering around that do not show up clinically
ECOG performance scale and what it is used for
0-4 with 0 being low level of comorbidity and 4 being bed ridden
use this to determine what treatment and risk of toxicity we can take
4 ways people die from cancer
local effects-organ failure, brain compression
infection
VTE
systemic effects- cachexia, anorexia
