Oncology/Neoplasia

Question 1

define benign neoplasia

Answer 1

uncontrolled cell proliferation but do not infiltrate and affect the tissue of origin directly

i.e. non cancerous

Question 2

define malignant neoplasia

Answer 2

rapid and uncontrolled cell proliferation which invades the tissue of origin and can metastasize

i.e. cancerous

Question 3

what are some triggers to cancer?

Answer 3

• environment
• Immunosuppresion
• Genetics
• Hormones
• Disease

Question 4

what characteristics differentiate cancer cells from normal cells?

Answer 4

• uncontrolled proliferation
• de-differentiation (loss of function)
• invasiveness
• metasteses

Question 5

what are metastases?

Answer 5

cancer cells break away from primary cancer to form new tumours (metastatic tumours)

Question 6

what do cancer cells travel through to form metastatic tumours?

Answer 6

lymph or blood

Question 7

define solid cancers

Answer 7

abnormal mass tissues

Question 8

can we assess solid cancers in the blood?

Answer 8

yes but difficult to - dont show up in blood until they start migrating which can be slow

Question 9

define hematological cancers

Answer 9

Blood or bone marrow cancer, not a mass (“liquid cancer”)

Question 10

what assessment tools can we use to diagnose hematological cancers?

Answer 10

• CBC and diff
• blood smears
• antigen testing
• biopsy

Question 11

what are the characteristics of stage 1 cancer?

Answer 11

• No lymph involvement
• No mets
• Tumours are less than 2cm in size

Question 12

what are the characteristics of stage 2 cancer?

Answer 12

• Local lymph involvement
• No mets
• Tumours are less than 5 cm in size

Question 13

what are the characteristics of stage 3 cancer?

Answer 13

• Nodal involvement
• No mets
• Tumours greater than 5 cm in size

Question 14

what are the characteristics of stage 4 cancer?

Answer 14

• Nodal involvement
• Metastases
• Tumours greater than 5 cm in size

Question 15

what are some approaches to treatment for cancer?

Answer 15

• surgery
• radiation
• chemotherapy
• or a combination

Question 16

define neoadjuvant chemotherapy

Answer 16

chemotherapy given prior to surgery to decrease size of tumor

Question 17

define adjuvant chemotherapy

Answer 17

given after sugery or in combination with radiation

Question 18

define external beam radiation

Answer 18

uses high-energy radiation beams directed from outside the body to target and destroy cancer cells

Question 19

what types of cancers is external beam radiation most effective for?

Answer 19

• solid
• stage I
• in non-sensitive areas

Question 20

define brachytherapy

Answer 20

radiation therapy where radioactive sources are inserted into a catheter/device directly to the cancer

Question 21

define radioembolization

Answer 21

radiation therapy where radioactive beads placed in blood vessels supplying the tumour to deliver focused radiation

Question 22

define radioisotope

Answer 22

radiation therapy where radiation is delivered as a medication

Question 23

how does radioactive iodine work to treat thyroid cancer?

Answer 23

the thyroid gland has localized receptors for radioactive iodine to bind to, providing direct radiation to the gland

Question 24

what are possible side effects of radiation?

Answer 24

• Local skin irritation
• Local hair loss
• Inflammatory response around the irradiated site
• Systemic effects

Question 25

what is the goal of curative chemotherapy treatment?

Answer 25

Achieve total cure of cancer

Question 26

what is the goal of control progression chemotherapy treatment?

Answer 26

Prolong life by arresting or slowing growth of cancer cells for particular malignancies

Question 27

what is the goal of palliative chemotherapy treatment?

Answer 27

Decrease symptoms from the cancer and enance or improve quality of life

Question 28

what are the 3 main approaches of chemotherapy agents?

Answer 28

* target DNA formation/repair * target hormone processess * immunotherapy

Question 29

what drug classes fall under chemotherapy agents that target DNA formation?

Answer 29

* nitrogen mustards * antimetabolites * cytotoxic antibiotics * vinca alkaloids

Question 30

what is the MOA of nitrogen mustards?

Answer 30

React with proteins that bond together to form double helix of DNA – adds an alkyl group that causes breakage of DNA strands and eventually cell death

Question 31

what phase of the cell cycle do nitrogen mustards target?

Answer 31

they are non-cycle specific

Question 32

what are the possible side effects of nitrogen mustards?

Answer 32

can be nephrotoxic, neurotoxic or pneumotoxic

Question 33

what phase of the cell cycle do antimetabolites target?

Answer 33

S phase

Question 34

what is the MOA of antimetabolites?

Answer 34

Interfere with cellular processes to damage DNA formation by mimicking cellular processes with false substitutes

Question 35

what are the side effects of antimetabolites?

Answer 35

* cytotoxic to normally quick replicating cells (hair, GI, skin) * fever * malaise * increased risk of infection

Question 36

what is the MOA of cytotoxic antibiotics?

Answer 36

Oxidize iron → yields free radicals → oxidative stress damage to DNA strands of cancer cells

Question 37

what phase of the cell cycle do cytotoxic antibiotics target?

Answer 37

G2 and M phase

Question 38

what are some side effects of cytotoxic antibiotics?

Answer 38

* bone marrow suppression * heart muscle damage * toxicity to lungs

Question 39

what is the MOA of vinca alkaloids?

Answer 39

Disrupt assembly of microtubules

Question 40

what are some side effects of vinca alkaloids?

Answer 40

* bone marrow suppression * cardiac arrhythmias * allergic reactions

Question 41

what is the MOA of tamoxiflen?

Answer 41

Estrogen receptor antagonist (blocks receptor) to prevent estrogen-stimulating growth

Question 42

what is tamoxiflen efficacious for?

Answer 42

estrogen-positive breast cancer

Question 43

what is the MOA of estrogen-like drugs to treat cancer?

Answer 43

Estrogen receptor agonists counteract endogenous testosterone

Question 44

what are estrogen-like drugs efficacious for treating?

Answer 44

prostate cancer

Question 45

what is the MOA of immunostimulants?

Answer 45

Stimulate immune system against certain tumor cells

Question 46

name some examples of immunostimulants?

Answer 46

interferons and interleukins

Question 47

what is the MOA of monoclonal antibodies?

Answer 47

mark cancer cells to enhance and direct immune response to target cells - work like opsonins

Question 48

what is the MOA of immune "check-point" inhibitors?

Answer 48

reverse deactivation of endogenous immune response, enabling the immune system to activate and locate cancer cells

Question 49

chemotherapy typically affects which cells?

Answer 49

normally fast dividing cells like blood, GI, hair follicle, liver cells

Question 50

what is the function of hematopoetic agents?

Answer 50

stimulate formation of RBCs, WBCs, platelets to produce new cells that were being destroyed by chemotherapy

Question 51

define vesicants

Answer 51

drugs that have the potential to cause blistering, severe tissue injury or necrosis when they infiltrate into surrounding tissue

Question 52

define irritants

Answer 52

drugs that may cause inflammation (phlebitis) and/or pain at the venipuncture site or along the vein but if infiltrated, do not cause tissue necrosis

Question 53

define primary cancer cell resistance

Answer 53

no response at 1st exposure, treatment not working from the beginning

Question 54

define secondary cancer cell resistance

Answer 54

tumours adapt to therapy due to mitation or decreased permeability into the cell → decreased effectiveness of treatment

Question 55

what are the effects of cell resistance?

Answer 55

* Reduce uptake of the drug * Enhance regenerative enzyme production → repair DNA damaged from chemotherapy * Alter enzymatic function * Deactivate drug (i.e. through metabolism)

Question 56

how does high dose IV vitamin C assist in cancer tx?

Answer 56

* reducing oxidative stress * Plays a role in formation of new collagen, which may lead to a reduction in malignant infiltration * act as a carrier for H2O2 to extracellular tissue, generating free radicals that act against cancer cells

Question 57

how does vitamin D assist in cancer tx?

Answer 57

* Needed for maintaining calcium and phosphorus levels in the blood and bone formation * Important for immune system funtioning

Question 58

how does cannabis assist in cancer tx?

Answer 58

* may down-regulate and control cell invasion * manage chronic pain * promote appetite and manage nausea and vomiting

Question 59

how does turmeric assist in cancer tx?

Answer 59

shown to have anti-inflammatory and anti-oxidant effects and enhance apoptosis and anti-platelet effects