Oncology and Chemotherapy (Exam III) Andy's Cards Flashcards
What are tissue changes seen in cancer cells?
- Number of cells increases (hyperplasia).
- Organization changes (dysplasia)
What is the progression from normal cells to cancerous cells?
Characteristics of Cancer Cells
- Less specialized
- Can ignore pre-programmed apoptosis signals
- Abnormally influence normal cells (ex. make normal cells form blood vessels which feed a tumor)
- Can evade the immune system
What are the three “drivers” that increase the proliferation of cancer cells?
-
Proto-oncogenes
Involved in normal cell growth and division
Become cancer-causing…allow cells to grow and survive -
Tumor suppressor genes
Alterations allow genes to divide uncontrollably -
DNA repair genes
Incorrect damage repair; cause other mutations
How many types of cancers are there?
More than 100
Where do basal cell cancers originate from?
Basal layer of the epidermis
Where do squamous cell cancers originate from?
Epithelial cells:
- Beneath skin
- GI tract
- Bladder
Where do adenocarcinoma’s originate from?
- Mucous producing cells
- Gland tissue (breast, prostate)
Where do sarcoma’s originate from?
Bone and soft tissue
Where do leukemia’s originate from?
Bone marrow
Where do lymphoma’s originate from?
Lymphocytes
These tend to build up on lymph nodes and lymph vessels.
What are some problems in cancer screenings?
- Can cause problems: Colonoscopy perforation
- Can have false-positives
- Can have false-negatives
Screenings are working if statistics show:
- More early-stage cancers found
- Less late-stage cancers found
- Less deaths occur
What is absolute risk?
Absolute risk
- How many people get “x” in a certain period.
Ex. If 4 people out of a group of 100,000 get “x” then risk is 4 in 100,000
Explain relative risk.
% of people in exposed group that develop cancer
vs.
% of people in unexposed group with diagnosis.
Give an example of a relative risk that is greater than 1.
Smoking
Smoking increases risk relative to the rest of the population.
Give an example of a relative risk that is less than 1.
Exercise
Exercise decreases risk relative to the rest of the population.
What cancer screenings are typically standard now?
- Colonoscopy
- Mammograms
- Pap Smears
What are the factors measured in tumor staging?
- T: size/extent of primary tumor
- N: # of nearby lymph nodes which are +
- M: is there metastasis
The staging is done at diagnosis. No later evaluation.
What would a tumor measurement of TX mean?
- TX: tumor cannot be measured.
What would a tumor measurement of T0 mean?
- T0: tumor cannot be found.
What would a tumor measurement of T1 - 4 mean?
- T1= least invasive
- T4 = most invasive
What does NX mean?
NX: cancer in nearby lymph nodes cannot be measured.
What does N0 mean?
N0: no cancer in nearby lymph nodes.
What does N 1-3 mean in regards to tumor staging?
N1 = limited cancer found in regional lymph nodes
N3 = cancer is all up in these lymph nodes
How is metastasis measured in the tumor staging system?
- MX:cannot be measured.
- M0: has not spread to other parts of the body.
- M1: has spread to other parts of the body.
What are other staging systems?
- In situ: abnormal cells are present but have not spread to nearby tissue
- Localized: limited to place where it started; no sign of spread
- Regional: has spread to nearby lymph nodes, tissues, or organs
- Distant: spread to distant parts of body
- Unknown: not enough information to figure out the stage
For median survival of 6 months or less what two factors are more important that type of cancer?
- Functional status
- Laboratory values
What factors are associated with a survival rate that is 6 months or less?
What type of cancers will frequently radiate to the bone?
- Breast
- Lungs
- Kidney
- Prostate
Osteolytic, osteoblastic or both lesions
What can be helpful in treating cancer metastasis to the bone?
- Radiotherapy/chemotherapy
- NSAID +/- opioids
- Vertebroplasty
Hormonal therapy is often helpful for what types of cancer?
Breast
Lung
Kidney
Prostate
Why does cancer typically cause pain?
- Invasion of tumor into tissues innervated by afferent neurons
- Directly invades nerve plexus
Pain is mostly d/t cancer itself not treatment
WHO “Cancer Pain Stepladder”
- Prompt administration
- On schedule; not prn
- Add antianxiety drugs as necessary
- 80-90% effective (simple things can go a long way)
Common nerve blocks used to treat cancer patients
- Celiac plexus for unresectable pancreatic cancer, hepatic cancer, or gastric cancer
- Intercostal nerves for rib metastasis
- Lumbar sympathetic ganglion for pelvic tumors
What areas are anesthetized with a celiac plexus block?
- Sympathetic fibers of T5-T12
- Parasympathetic celiac plexus fibers
For what types of cancer are celiac plexus blocks typically performed?
Unresectable:
- Pancreatic
- Hepatic
- Gastric
What injection is used with a neurolytic celiac plexus block?
How long does this typically last?
Isopropyl alcohol
Destruction of nerves typically lasts 3-6 months.
What is the principal benefit of continuous infusion via catheters for cancer pain?
- ↓ systemic side effects
- Technique and equipment very available.
What is the principal benefits of continuous infusion via catheters for cancer pain?
- ↓ systemic side effects
- Technique and equipment very available.
Chemotherapy target cells in different phases of their ________.
- Cell cycle
How do alkylating agents work?
Whats an example of an alkylating agent?
Cisplatin (Nitrosurea)
- Damage cell DNA in all phases of the cell cycle.
What is a severe side effect of alkylating agents?
Dose-dependent cause of leukemia 5-10 years after treatment.
What types of cancers do antimetabolites treat?
- Breast
- Ovary
- Intestines
- Leukemias
How do antimetabolites work?
Interfere with DNA and RNA
What are two examples of antimetabolites?
- Methotrexate
- 5-Fluorouracil
How do Anti-tumor antibiotics treat cancer?
- Interfere with DNA copying enzymes
What are examples of anti-tumor antibiotics?
-cins
Doxorubicin, bleomycin, etc
What type of cancer drugs have life-time dosing limits?
Why is this?
Anti-tumor antibiotics because they permanently damage cardiac tissue in large doses.
Which chemotherapy increases the risk of a second cancer developing?
Topoisomerase Inhibitors
Which chemotherapeutic agent damages cells in all phases through the prevention of protein synthesis?
Mitotic Inhibitors
Which chemotherapeutic class may cause peripheral neuropathy?
Mitotic inhibitors
(-Taxels and vincristine, vinblastine, etc.)
What cells are most likely to be damaged due to chemotherapy?
- Bone marrow
- Hair follicles
- GI tract (including mouth)
- Reproductive systems
What drug can inhibit hormonal contraceptives?
And thus result in unexpected baby’s.
Aprepitant (neurokinin 1 antagonist)
How does marijuana treat nausea/vomiting?
Depresses CNS vomiting center
What is radiation’s effects on the peripheral vascular system?
Coagulopathy
6x increase!
What is radiation’s effects on tissues afflicted by head and neck cancers?
- ↓ Thyroid function
- Carotid artery disease
- Possible airway issues
What is radiation’s effects on the chest wall and/or breasts?
- Pericarditis
- Cardiomyopathy
- Valvulopathies
- Dysrhythmias
What is the possible effect of radiation on the lungs??
Radiation pneumonitis
What chemotherapeutic agent is known to cause cardiomyopathy?
Adriamycin
What chemotherapeutic agent is known to cause pulmonary toxicity?
Bleomycin
What chemotherapeutic agents are known to cause peripheral neuropathy?
- Cisplatin
- Vincristine (mitotic inhibitor)
What preoperative abnormalities might be seen in a cancer patient?
- ↓ RBCs
- ↓ WBCs
- ↓ PLTs
- ↑ Ca⁺⁺
Why is hypercalcemia common in cancer?
Many drugs are toxic to bone marrow thus causing breakdown and releasing Ca⁺⁺ into the bloodstream.
What test is useful for testing for adrenal insufficiency?
ACTH stimulation test
Why is adrenal insufficiency often seen in cancer patients?
Steroid treatments
Why is tumor resection a risk factor for tumor recurrence?
- Tumor cells can spread into blood stream
- Residue remains behind
- Localized spread via lymphatics
Why is inflammation and surgical stress bad for cancer patients?
Surgical stress → elevation COX expression → PG’s and thromboxanes → promoted cell survival and cancer cell growth
How long can inflammation and stress last post surgery?
weeks
β adrenergic receptors at the sites of tumor growth will upregulate cancer cell active via nerve fiber delivery of _______.
norepinephrine
What drug class directly stimulates cancer cell proliferation and invasion, inhibits leukocyte migration, and inhibits NK cell activity?
Opioids
How do volatiles adversely effect cancer patients?
- Induce chemo resistance
- Inhibit NK cells
What effects does propofol have on cancer cells?
- Decreases migration
- Promotes apoptosis
Propofol on top as always.
Long term administration of NSAIDS _______ proliferation of cancer cells.
decreases
Cancer types diagram
Flip Card
What is the major cause of lung cancer?
Tobacco smoke
3 decade lag time in cancer occurrence
What substances cause lung cancer other than tobacco?
- Asbestos
- Radon gas
What are the types of lung cancer?
- Small cell
- Non-small cell
- Carcinoid
- Mesothelioma
What are the subtypes of non-small-cell lung cancer?
NSMC Lung cancer:
- Squamous
- Adenocarcinoma
- Large cell
What type of lung cancer makes up 75-80% of cases?
Non-small cell
What is the typically origin of small cell lung cancer?
Neuroendocrine
Thus the cancer is typically metastatic on presentation
What lung cancer always recurs and is resistant to further treatment?
Small cell lung cancer
What are possible large side effects of small cell lung cancer?
- ↓ Na⁺
- Hypercortisolism
- Lambert-Eaton Syndrome
What is the name for the disease called hypercortisolism?
Cushing’s Disease
Lambert-Eaton syndrome involves symptoms that ________ as the day goes on.
improve
Myasthenia Gravis involves symptoms that ________ as the day goes on.
deteriorate
Lack of improvement with acetylcholinesterase inhibitors and extreme sensitivity to non-depolarizing neuromuscular blockers are characteristics of what disease?
Lambert-Eaton Syndrome
What tumor type is mostly benign and has great (>90%) 5 year survival rates?
Neuroendocrine tumors
Carcinoid syndrome usually results from tumor originating from where?
GI tract
What are characteristics of Carcinoid Syndrome?
- Tumor secretion of serotonin, histamine, PG’s, tachykinins, kallikrein
- Hemodynamic collapse unresponsive to pressors
- Coronary artery spasm
How is carcinoid syndrome treated?
Octreotide & Somatostatin
These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.
What type of lung cancer has a 5-year survival rate that greatly improves with surgery?
Non-small cell lung cancer
- 10% w/o surgery
- 40% w/ surgery
Squamous cell lung cancers grow to a large size but _______ late.
metastasize
What are possible consequences of squamous cancer’s large growth?
Mass Effect:
- Hemoptysis
- Obstructive PNA
- Superior Vena Cava syndrome
What is the most common subtype of non-small cell lung cancers?
Adenocarcinomas
Adenocarcinomas will typically metastasize ______.
earlier
What two hormones are typically secreted by adenocarcinomas?
- Growth Hormone
- ACTH
What is the least common non-small cell lung cancer subtype?
What should be known about its metastatic characteristics?
- Large cell
- Metastasizes rapidly
NSAIDs can induce acute respiratory failure when combined with what chemotherapeutic?
Cisplatin
What factors can help predict one lung desaturation?
- High % of V/Q to operative lung on the preoperative V/Q scan.
- Poor PaO₂ during two lung ventilation
- Right sided thoracotomy
What is the formula for predicted post-operative FEV₁ ?
A patient has had a right upper and right middle lobectomy done. The patients preoperative FEV₁ was 60%. What is the predicted post-operative FEV₁ ?
ppoFEV₁ = 60 x (1 - 23.8/100)
ppoFEV₁ = 45.72%
What anticoagulative drug class requires discontinuation 7 days prior to surgery?
- -grel drugs ( P2Y12 Inhibitors)
- Ticagrelor
Clopidogrel, prasugrel, etc
Flip card to see anticoagulative medication hold times.
How many dermatomes are typically covered via a paravertebral block?
4-6 dermatomes
What are contraindications for paravertebral blocks?
- Site infection
- Empyema
- Paravertebral tumor
- Kyphoscoliosis
A paravertebral block at ___ is necessary for a sternotomy.
T4
A paravertebral block at ___ is necessary for a thoracotomy.
T6
A paravertebral block at ___ is necessary for abdominal procedures.
T10
What is required for intercostal nerve block?
Blockade 2 dermatomes above and 2 dermatomes below incision.
What are indications for intercostal nerve block?
- Thorax surgery
- Upper abdomen surgery
- Mastectomy
What are disadvantages associated with intercostal nerve block?
- Pneumothorax
- LA toxicity (especially if multiple levels are blocked).
Flip for intercostal nerve block pictures.
