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NUR370 Pathophysiology and Pharmacology > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

properties of a cancer cell

A

a. Defect in proliferation
b. Evading apoptosis
c. Angiogenesis
d. Invasion (invade local tissue)
e. Metastasis

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2
Q

benign tumours

A

grow slowly and locally, well-defined capsule, not invasive and does not metastasize, well-differentiated (resembles normal cells)

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3
Q

malignant tumours

A

grow rapidly, invades neighbouring tissues and enters blood vessels, poorly differentiated and spread distantly

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4
Q

carcinoma in situ (CIS)

A

neoplasm, lesions with all histological characteristics of cancer, but has not begun to invade local tissue

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5
Q

Name 3 angiogenic growth factors secreted by cancers causing angiogenesis

A

a. vascular endothelial GF
b. platelet derived GF
c. basic fibroblast GF

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6
Q

what are the most common sites of metastases?

A

bone, brain, lungs and liver

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7
Q

Two types of genes that can be affected by mutation are:

A
  1. proto-oncogenes - promotes growth
    = mutation turns them into tumour inducing genes
  2. tumour suppressor genes (BRCA 1 and 2) - suppresses tumour growth
    = mutation render them inactive
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8
Q

carcinoma

A

Epithelial tissue (mucous membrane of respiratory tract, GI and GU tracts)

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9
Q

adenocarcinoma

A

From ductal or glandular tissue (skin, glands)

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10
Q

sarcoma

A

Mesenchymal tissue (connective tissue, muscle, bone and fat)

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11
Q

lymphoma

A

Lymphatic tissue, the glands of the lymphatic system

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12
Q

leukemia

A

Blood-forming cells, cancers of the bone marrow

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13
Q

Classification of Cancer by Grading

A

determined by how closely cells resemble tissue of origin

Grade I - IV

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14
Q

Classification of cancer by Staging

A

based on presence of metastasis

Stage I - IV

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15
Q

Clinical manifestations of Cancer

A 
Pain
Fatigue
Cancer cachexia
Anemia
Leukopenia Thrombocytopenia
GI manifestations (ulcers, malabsorption, diarrhea, nausea)
Alopecia and skin breakdown
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16
Q

Causes of cancer include

A

environmental and lifestyle factors

genetic and epigenetic factors

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17
Q

Known risk factors of cancer

A
  • tobacco use
  • infectious agents
  • lifestyle (body weight, exercise, diet and alcohol)
  • UV radiation
  • reproductive and hormonal factors
  • environmental and occupational exposures (radiation, pollutant, chemicals)
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18
Q

Types of Lung Cancer

A
  1. Non small cell lung cancer
    a. squamous cell carcinoma
    b. adenocarcinoma
    c. large cell undifferentiated carcinoma
  2. small cell lung cancer
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19
Q

What is the prevalence of each type of lung cancer/

A

30% squamous cell
40% adenocarcinoma
10% large cell undifferentiated
20% small cell lung cancer

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20
Q

Squamous cell carcinoma

A
  • associated with cigarette smoking
  • not strong tendency to metastasize
  • often bound in cells that line main airway - bronchi
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21
Q

Adenocarcinoma

A
  • associated with scarring and fibrosis
  • starts in mucous-producing cells
  • most common type found in nonsmokers
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22
Q

Large cell undifferentiated carcinoma

A
  • correlation with cigarette smoking and environmental carcinogens
  • highly metastatic via lymphatics
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23
Q

Small cell lung cancer

A
  • associated with cigarette smoking and environmental carcinogens
  • most aggressive form of lung cancer
  • spreads easily and often metastasize by diagnosis
  • paraneoplastic syndrome
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24
Q

How is SCLC staged?

A

Limited stage - only found on one side of the chest, may include lymph nodes on same side as tumour

Extensive stage - tumour is found widely spread within the lung with the tumour to the other lung, lymph nodes on opposite side of chest and other parts of the body

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25
Q

Paraneoplastic syndrome

A
  • results from hormone or cytokine release by tumour
  • linked with development of SIADH, where increased ADH leads to reabsorption in collective ducts
  • dilutional hyponatremia
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26
Q

Genes associated with lung cancer

A

Epidermal growth factor receptors (EGFR)

BRAF and ROS-1

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27
Q

Clinical manifestations of lung cancer

A

a. Persistent cough (key finding in most lung cancer diagnoses)
b. Sputum (possibly blood tinged)
c. Chest pain
d. Dyspnea and possibly wheezes
e. late symptoms: anorexia, fatigue, n/v, weight loss, palpable nodes

28
Q

Diagnostic Studies for lung cancer

A
  1. chest x-ray
  2. CT scan
  3. sputum samples
  4. bronchoscopy
  5. biopsy
29
Q

Which types of lung cancer often involve surgical resection as treatment?

A

Adenocarcinoma

Squamous cell carcinoma

30
Q

growth fraction

A

percentage of actively dividing cells compared to cells in resting phase i.e. ratio of proliferating cells to G0 cells

31
Q

Early stages of tumour growth

A
  • Exponential growth, short (constant) doubling time

- Large % of actively dividing cells because of good supply of O2 and nutrients - high growth fraction

32
Q

Later stages of tumour growth

A
  • Doubling time is slowed

- Decreased growth fraction as tumour outgrows blood and nutrient supply

33
Q

Transcoelomic spread

A

Spread of a malignancy into body cavities via penetrating the surface of the peritoneal, pleural, pericardial or subarachnoid spaces

34
Q

clinically detectable tumour

A

10^9 (1 billion) cells = 1 g mass = 1 cm diameter

35
Q

lethal tumour

A

10^12 (1 trillion) cells = 1 kg mass

36
Q

3 consequences of late detection

A
  1. metastases likely to have formed
  2. tumour less responsive to therapy
  3. patient debilitated by disease and less tolerable to treatment
37
Q

Goals of chemotherapy

A

a. cure
b. control
c. palliation

38
Q

Factorings affecting response to cancer treatment

A
  1. tumour burden
  2. use of combination chemo
  3. administration schedule (cell cycle non/specific)
  4. hormone receptor status
  5. dose category
  6. supportive therapies and hematopoietic growth factors
39
Q

Examples of cell cycle specific cytotoxic agents

A

a. antimetabolites
b. mitotic inhibitors
c. topoisomerase inhibitors
d. hypomethylating agents

40
Q

Examples of cell cycle nonspecific cytotoxic agents

A

a. alkylating agents
b. platinum compounds
c. antitumour antibiotics

41
Q

Medications that target the S-phase of the cell cycle

A

most antimetabolites (methotrexate, fluorouracil)

topoisomerase inhibitors (irinotecan, etoposide)

42
Q

Which medication is important to give with leucovorin?

A

methotrexate

43
Q

Which hormone antagonist should be prescribed only in post-menopausal women and why?

A

anastrozole
- drug blocks enzyme called aromatase, which inhibits conversion of adrenal androgens to estrogen - premenopausal women continue to produce estrogen

44
Q

What is the role of corticosteroids in cancer treatment?

A
  • antiemetic
  • prevention of hypersensitivity reactions
  • prevention of edema
  • oncologic emergencies
  • cerebral edema
45
Q

When are targeted therapies used?

A

when tumour expresses target molecule so that drug can bind with specific cellular molecular target to exert anti-cancer effect

  • blocks cell signalling
  • make malignant cells more visible to immune system
46
Q

What are some common side effects of cytotoxic agents?

A
  • hematologic toxicity (neutropenia, febrile neutropenia, anemia, thrombocytopenia)
  • chemotherapy induced nausea and vomiting
  • mucositis
  • diarrhea and constipation
  • alopecia
  • reproductive toxicity
47
Q

Management of Neutropenia

A

prophylactic antibiotics and/or filgrastim

48
Q

Management of Febrile Neutropenia

A
  • hospital admission for broad spectrum IV antibiotics
  • may decrease doses of chemo
  • may use filgrastim
49
Q

filgrastim

A

stimulates production and release of neutrophils from bone marrow

side effect: bone pain

50
Q

Management of Anema

A
  • rest, conserve energy
  • oxygen therapy
  • diet, iron supplement
  • RBC transfusion
  • epoetin alpha
51
Q

Epoetin alpha (Eprex)

A

stimulates bone marrow to produce RBCs

side effect: hypertension

52
Q

Management of Thrombocytopenia

A

a. platelet transfusion
c. avoid drugs with antiplatelet activity
d. watch for symptoms of occult bleeding
e. ensure platelet count >100/mm3 before next chemo cycle

53
Q

How is the chemoreceptor trigger zone (CTZ) activated?

A
  1. vagus nerve - signals from stomach/intestine

2. emetogenic compounds that reach CTZ via bloodstream

54
Q

Receptors involved in vomiting response

A
  • serotonin
  • neurokinin-1
  • dopamine
  • acetylcholine
  • histamine
55
Q

Acute CINV is associated with which chemical?

A

serotonin (5HT3)

56
Q

Management of Mucositis

A
  • good oral hygiene
  • avoid irritating substance and smoking
  • benzydamine (oral analgesic)
  • systemic antibiotics
57
Q

Managment of diarrhea

A
  • replace fluid/electrolytes

- antidiarrheal (loperamide)

58
Q

Management of Constipation

A
  • dietary
  • laxatives
  • stool softeners
59
Q

Which drug causes hand-and-foot syndrome as a unique side effect?

A

fluorouracil (5-FU) and capecitabine (Xeloda)

60
Q

What main side effect does vincristine cause?

A

neurotoxicity

61
Q

Which drug causes hypersensitivity reaction?

A

taxanes

paclitaxel (taxol)

62
Q

Which drug causes severe diarrhea?

A

irinotecan (camptosar)

topoisomerase I inhibitor

63
Q

Which drug causes hemorrhagic cystitis (bladder injury)?

A

cyclophosphamide

alkylating agent

64
Q

Which drug causes nephrotoxicity?

A

cisplatin

65
Q

Which drug can cause cardiotoxicity?

A

doxorubicin

anthracycline (antitumour antibiotic)

66
Q

Which drug can cause pneumonitis and pulmonary fibrosis?

A

bleomycin

non-anthracyclines (antitumour antibiotic)

NUR370 Pathophysiology and Pharmacology (20 decks)

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