oncology 2 Flashcards
what can increase person’s perception of pain?
depression and anxiety
opioid rotation
a balance between analgesia and side effects might be achieved by changing to an equivalent dose of an alternative opioid
cancer pain - biophysical agents
- relieve some of the symptoms associated with cancer but do not treat the cancer
cancer related fatigue CRF
is a distressing, persistent, and subjective sense of tiredness or
exhaustion related to cancer or cancer treatment (unknown
mechanisms).
paraneoplastic syndrome
when tumors produce signs and symptoms (not direct effects of either the tumor or its metastases) at a site distant from the
tumor or its metastasized sites.
primary prevention for cancer
- Epigenetics - screening to identify high-risk people and subsequent reduction or elimination of modifiable risk factors.
- Nutrigenomics - prevent cancer through the impact of nutrition on gene structure and
stability. - Chemoprevention - The use of agents to inhibit and reverse cancer, has focused on diet
derived agents. - Cancer vaccine*
secondary prevention for cancer
aimed at preventing morbidity and mortality uses:
- screening,
- early detection
-prompt treatment
tertiary prevention for cancer
Focuses on managing symptoms, limiting complications, and
preventing disability associated with cancer or its treatment
useful tests for early detection
o Laboratory values
o Radiography
o Endoscopy
o Isotope scan
o CT scan
o Mammography
o MRI
o Biopsy
diagnosis - biologic tumor markers
- substances produced and
secreted by tumor cells. - may be found in the blood serum.
- tumor marker is not diagnostic itself but can signal malignancies
anti-neoplastic treatment
curative and palliative
curative: intent to cute
palliative: provides symptomatic relief
*Neoadjuvant (before definitive surgical intervention) treatment with chemotherapy or radiotherapy to shrink the primary tumor or
provide local or systemic control
diagnosis - molecular profiling
- the use of cancer biomarkers to determine cancer aggressiveness, treatment, and risk prediction
G1
checkpoint to stop the cell
cycle if the DNA is damaged
G2
another checkpoint
- most sensitive to radiation therapy
when is chemotherapy most effective?
during DNA synthesis and mitosis
irradiation therapy
* what do post op doses do?
to shrink a tumor, making it operable, while preventing further spread of the disease during
surgery.
- postoperative doses prevent
residual cancer cells from multiplying or metastasizing
cell kill hypothesis
Each round of chemo will kill a certain % of cancerous cells (e.g., 90% were killed with 10% survive)
growth fraction
The % of proliferating cells relative to total neoplastic cell population
- decreasing as a tumor gets larger
in what stage are cells most sensitive to radiation therapy?
g2
what is the mechanism of irradiation therapy?
Destroy the dividing cancer cells by destroying hydrogen bonds between DNA strands within the cancer cells.
cytotoxic strategy - general principles of chemo
- limit cell proliferation by killing or stopping growth cancerous cells.
- inhibit DNA/RNA synthesis & directly inhibit cell division (mitosis).
- affect cancerous cells to a greater extent than normal cells.
chemotherapy
- particularly useful in the treatment of widespread
or metastatic disease. - systemic drugs travel throughout the body rather than
remain confined to a specific area. - usually intermittent to allow bone marrow recovery
diagnostic methods
1) tissue biopsy
2) biologic tumor markers
3) molecular profiling
neoadjuvant treatment - antineoplastic treatment
before definitive surgical intervention
- shrink the tumor with chemo or radiation therapy to obtain local or systemic control
adjuvant treatment- antineoplastic treatment
1) surgically remove the primary tumor
2) adjuvant therapy {chemo and radiation}
3) long term hormonal therapy ~5 yrs
in what stage are cells resistant to chemo and radiation therapy?
g0
when is irradiation therapy used?
used preoperatively to shrink a tumor
radiation therapy delivery types
- external beam
- sealed source: xrays and gamma
- unsealed source
chemotherapy primary mechanism
interferes with synthesis of DNA in growth phase cells
* does not kill all cells (cell-kill hypothesis)
* intermittent to help with bone marrow recovery
If a patient has a tumor in the pancreas, what would be the most common site of pain referral for this tumor?
Shoulder, midthoracic, or low back
Cells are most sensitive to radiation therapy in the _____ phase
g2
What is the last step in the mitotic cycle before cell division?
g2
Which chemotherapy agents bind to DNA and prevent DNA replication?
Alkylating agents
Tamoxifen in an antiestrogen hormonal agent is used in to block estrogen receptors in tumor cells that require estrogen to thrive.
breast cancer
Monoclonal antibodies may be especially effective in treating certain cancers because these drugs
bind to antigens on the surface of a particular type of cancer cells.
A relatively new strategy for treating certain tumors is to prevent the formation of new blood vessels, thus impairing tumor growth by starving the tumor of oxygen and nutrients. Drugs that use this strategy are known as .
angiogenesis inhibitors
Most cancer chemotherapy agents exert severe and potentially toxic side effects because
most of these drugs do not discriminate between healthy tissues and cancerous cells.
Some of the newer cancer chemotherapy agents (e.g., cytokines) are called biological therapies or biological response modifiers because they
encourage the body’s immune system to fight cancerous cells.
The drug subclass of cytarabine is antimetabolites. What is the mechanism of action of cytarabine?
Inhibit DNA and RNA synthesis
Which of the following healthcare professionals determines the delivery method and dosage of radiation therapy to be provided to a patient?
Radiation oncologist
Which of the following therapy options is considered as nonpharmacologic modality for cancer pain?
Relaxation training
Which of the following concepts describe the theory that each round of chemotherapy will affect a certain percentage of cancerous cells and the chemotherapeutic regimen can never completely eliminate the tumor?
Cell kill hypothesis
Tumor lysis syndrome (TLS) is a serious complication of chemotherapy that has significant adverse effects on the .
kidney
A 37-year-old female has breast cancer. She is receiving FAC chemotherapy: Fluorouracil, doxorubicin (Adriamycin), Cyclophosphamide (Cytoxan). (Please answer the following questions from 15-18) 15. What is the drug class of Fluorouracil?
Antimetabolites
What is the trade name of doxorubicin?
Adriamycin
What is the drug class of Cyclophosphamide (Cytoxan)?
Alkylating Agents
What are the common adverse effects of Cyclophosphamide (Cytoxan)?
All the above
A 68-year-old man presents with a history of chronic cough, weight loss, and hemoptysis. Chest X-ray reveals a mass in the right lung. A biopsy confirms the diagnosis of non-small cell lung cancer.
Question:
Given the patient’s diagnosis, which of the following imaging studies would be most appropriate to stage the tumor and assess for metastasis?
Positron emission tomography (PET) scan
Follow-up Case:
The patient in the previous case receives chemotherapy, which includes a combination of agents such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).
Question:
To help the patient recover from chemotherapy-induced neutropenia, which of the following medications might the physician consider?
Granulocyte colony-stimulating factor (G-CSF)
