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Hunts 1A > Oncology part 2 > Flashcards

Oncology part 2 Flashcards

chemo and radiation drugs

1
Q

MoA of radiation

A

breaks in DNA that prevent replication and generates hydroxyl radicals from cell water that damages cell membranes, proteins, and organelles.
Damages cancer cells more because cancer cells aren’t as efficient at repairing themselves.

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2
Q

Why do systemic radiation symptoms appear despite radiation being local

A

it depends on volume of tissue, dose, where the fields are aimed at, and individual susceptibility

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3
Q

3 types of radiation and what they do

A

1)teletherapy, with focused beams of radiation generated at a distance and aimed at the tumor - xray and gamma
(2)brachytherapy, encapsulated/sealed sources of radiation implanted directly into or adjacent to tumor tissues
(3)systemic therapy, radionuclides targeted in some fashion to a site of tumor……radioactive iodine for thyroid cancer

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4
Q

What cancer can radiation CURE?

A

Breast cancer, Hodgkin’s disease, head and neck cancer, prostate cancer, and gynecologic cancers.

all gyn parts, just the prostate for males, then 2 H’s - Hodgkins and Head and neck

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5
Q

Radiation can be used for palliation for:

A

blocked airways, bone pain ,brain , spinal cord and SVC compression , shrink masses

BBB & SSS
Bone, brain, blocked airways
Spinal cord, Sup. vena cava, Shrink masses

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6
Q

What are the other localized therapies?

A

Radiofrequency, crysurgery, chemoembolizaiton.

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7
Q

What does radiofrequency ablation do

A

focused microwave radiation to induce thermal injury within a volume of tissue

local. think hot.

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8
Q

Cryosurgery

A

use of extreme cold to sterilize lesions in certain sites

local. think cold

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9
Q

Chemoembolization

A

Infusion of chemotherapeutic agents directly into the target area via vascular catheters

chemo that’s local. “embolis” is the key to remembering. an embolis of chemo would be local on the stuff around it

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10
Q

Chemotherapy mechanism

A
  • Kill cancer cells
  • increase the time until the disease progresses
  • Tumor cell -> differentiated into a normal cell

sometimes can’t kill the cancer cells and patient live longer

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11
Q

methotrexate and 5-FU

MoA, toxic, class?

A

Antimetabolites
5-fluorouracil prevents thymidine formation (required for DNA replication)

Methotrexate competes and counteracts folic acid, causing folic acid deficiency in cancer cell and cell death

Common toxic manifestations include stomatitis, diarrhea, and myelosuppression

MTX = monster truck. picture a monster truck blowing through a folic acid supplement
rem 5-FU - thymidine. it says F U to thymidine formation
Toxic - DSM

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12
Q

Vincristine, Vinblastine
Paclitaxel

A

Mitotic spindle inhibitors
Toxic: alopecia, neuropathy, and myelosuppression.

toxic - M-MAN (man is toxic)

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13
Q

Cyclophosphamide
Chlorambucil
Cisplatin

A

– neuro-toxicity (stocking-glove), hearing loss, renal failure
Alkylating Agents
cell cycle phase–nonspecific agents

Break down to reactive intermediates that covalently modify bases in DNA, then perform cross-linkage of DNA strands. Looks like breaks in DNA

Stocking glove, hearing loss, renal fail
*picture someone with gloves covering their ears + renal

C’s = in orgo, a ‘c’ is carbon. for alkyl group

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14
Q

Doxorubicin

A

Produced by bacteria that in nature appear to provide a chemical defense against other hostile microorganisms.
As a class they bind to DNA directly and can frequently undergo electron transfer reactions to generate free radicals in close proximity to DNA, leading to DNA damage in the form of single-strand breaks or cross-links

-cardio toxicity

DOC
D: Doxorubicin
O: oxidative stress (free radicals)
C: Cardiotoxic

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15
Q

Etoposide

A

Topoisomerase inhibitor

  • inhibits DNA synthesis by forming a complex with topoisomerase II and DNA, causing breaks in DNA, which prevents the mitotic phase of cell division, causing cell death
    Toxic: secondary leukemia with high doses

TBL
Top - forms complex with and inhibits
Breaks DNA
Leukemia

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16
Q

Filgrastim, pegfilgrastim, sargramostim

A

used to treat neutropenia, a toxic SE of chemo
Colony stimulating factors (CSF)
Takes 24 h to induce peak neutrophils
Stimulate neutrophils, monocytes, and eosinophils
SE: allergies, warmth, blister, burn, numb, bleeding gums, ulcer

stimulates MEN in 24 h
SE: hot, bleed, numb

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17
Q

Epogen

A

Treats anemia in chemo toxicity (stimulates erythrocytes)

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18
Q

Ondansetron

A

treats nausea, chemo SE

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19
Q

Magic mouthwash

A

diphenhydramine, lidocaine, Maalox
Treats mouth sores (mucositis), chemo toxicity

Warlock Maalox has a caine and casts benadryl

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20
Q

Drugs MC mucositis in mouth and GI (mouth ulcer&diarrhea)

A

cytarabine,5-FU, and methotrexate

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21
Q

Loperamide is used to treat what
And b/c of what form of chemo

A

treat diarrhea chemo toxicicity
esp from 5FU
antimotility

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22
Q

Octerotide

A

Octerotide (somatostatin analogue) or opiate-based preparations if no response to Loperamide

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23
Q

Cold packs and sun protection

A

treat skin toxicity chemo

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24
Q

What does skin toxicity from chemo look like

A

-Hyperpigmentation, alopecia, photosensitivity, nail changes, acral erythema, and generalized rashes.

  • Acral erythema manifests as painful palms or soles accompanied by erythema, progressing to blistering desquamation and ulceration in its worst forms.

dark, hairless, nails, blister and rash, burn easy
Painful red–>blister and shed–> ulcer

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25
Q

Chemo caps

A

Reduce scalp for alopecia, very controversial. should just give psychological support

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26
Q

Chemo routine blood

A

CBC, CMP, PT/aPTT

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27
Q

3 reasons why paraneoplastic syndrome are clinically important

A
  • early clue
  • the metabolic effects of tumor on other tissues can be more toxic than the cancer itself
  • paraneoplastic syndrome should go away when the cancer does and vice versa
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28
Q

Hypercalcemia

A

endocrine paraneoplastic syndrome
- non small cell lung cancer, Breast, Renal cell, Adrenal, Prostate
Usually due to parathyroid hormone related peptide

L: Lung cancer
A: Adrenal gland tumors
R: Renal cell carcinoma
P: Prostate cancer
+
B: Breast cancer

29
Q

Hypoglycemia

A

Hepatocellular carcinoma (impaired gluconeogenesis)

30
Q

Gonadotropin secretion

A

small cell lung carcinoma

gonadotorpin is the one that regulates ovaries and testes. small cell cardinoma is the uncommon form of lung cancer

31
Q

Cushings

A

SCLC, Adrenal, Thymoma
ectopic production of ACTH by tumor

-cushings causes fat pads, moon face, buffalo hump, apple shape body. its from being exposed to steroids too long

S: Small cell lung cancer (SCLC)
A: Adrenal tumors
T: Thymoma
ACTH: Ectopic production of ACTH by the tumor

32
Q

SIADH

A

NSCLC, SCLC (both types of lung cancer)

-ectopic production of vasopressin by tumor

33
Q

Coagulopathy

A

Breast, GI, prostate
Paraneoplastic syndrome

B(GI) Big PC (prostate, coag)

34
Q

Erythrocytosis

A

Erythrocytosis - due to ectopic production of erythropoietin
Renal, Hepatocellular

H: Hepatocellular cancer
E: Erythrocytosis
R: Renal cancer
EPO: Ectopic production of erythropoietin

35
Q

Lambert-Eaton syndrome

A

neurologic paraneo.
immune mediated
characterized by muscle weakness of the limbs
SCLC

Lame: Refers to muscle weakness (lameness)
Bert
Eats: Refers to Eaton
Small Cell Lung Cancer (SCLC)

36
Q

Subacute cerebellae syndrome

A

immune mediated cerebellar degeneration
SCLC
Characterized by dizziness, nausea, vertigo, tremor, and sometimes dysphagia and blurry vision

Submarine: Subacute
Captain: Cerebellar
Trembling: tremor
Small: Small cell lung cancer (SCLC)
Dizzy: Dizziness
Boat: Blurry vision, Nausea, Vertigo

37
Q

Dermatomyositis

A

SCLC, NSCLC ( both types of lung)
A system disorder causing inflammation of the muscles and skin, as well as joints, lungs, esophagus and heart

paraneoplastic syndrome

Dermy’s HELL J&M”

Breaking it down:

Dermy: Dermatomyositis
H: Heart
E: Esophagus
L: Lungs (SCLC, NSCLC)
L: Lungs again for emphasis

J Joints
M: Muscles

38
Q

Acanthosis Nigricans

A

Acanthosis Nigricans - thickening of skin/brownish discoloration
Can occur with diabetes/obesity, typically in fold of neck, under breast
More likely to also involve the mucous membranes with cancer
GI adenocarcinomas

Fatties chew GUM
G: GI adenocarcinomas
U: Under fold (under fold of breast and neck. think of gum being stuck under tables)
M: Mucous membranes (involvement with cancer)

39
Q

Whats the point of surgery

A
  • CURES 40% of cancer patients
  • most effective at treating cancer
  • can also palliate, stage, diagnose, treat
40
Q

MC form of radiation therapy

A

Teletherapy

41
Q

Whats the point of radiation therapy

A

deprives cells of their division potential

42
Q

Radiation Toxicity looks like:

A
  • systemic effects: FATIGUE, anorexia,N/V
  • Acute toxicities:mucositis, skin erythema (ulceration in severe cases), and BM toxicity.
  • Chronic toxicities:
    Radiation carcinogenesis with secondary malignancy; pericarditis; myocardial infarction; thyroid failure; cataracts; lung fibrosis; arteritis; spinal cord transection

more cancer, MI, pericarditis, thyroid, cataracts, lung scarring, arteritis, spinal cord issue

43
Q

Categories for chemo

A

Conventional cytotoxic: try to hurt the DNA
Targeted: molecular target design
Hormonal: estrogen and androgen function
Biologic: Boost immune system or regulate tumor growth

44
Q

Paraneoplastic syndromes - endocrine

A

hypercalcemia, hypoglycemia, gonadotropin, cushings, siadh

45
Q

paraneoplastic syndromes - hematologic

A

coagulopathy, erythrocytosis

46
Q

Paraneoplastic syndrome - neuologic

A

lambert eaton syndrome, subacute cerebellar syndrome

47
Q

Paraneoplastic syndrome - dermatologic

A

Dermatocyositis, acanthosis nigricans

48
Q

Oncologic complications

A

Neutropenic fever, spinal cord compression, hypercalcemia, tumor lysis syndrome, effusions, SVC syndrome, thromboembolic event

49
Q

Neutropenic Fever

A

Recurrent above 38 C, or single above 38.3 C while ANC less than 500

Can be an infection thats viral fungal or bacterial. vague and mild b/c not enough WBC to show sx. then rapid sepsis and death.

Etiology - CMV, HSV, VZV, Klebsiella, Pseudomonas, E coli, H flu, staph strep
Fungal - yeast, aspergillosis

DUE TO CHEMO

50
Q

Neutropenic fever sites of infection

A

central venous access catheter, skin, mouth, sinus, chest or lung, abdomen, perianal region, and CNS. NO DIGITAL RECTAL EXAM

51
Q

Neutropenic fever tx

A

Ceftazidime, cefipime, imipenem
Aminoglycoside
Vancomycin

aminoglycoside = streptomycin, gentomycin

52
Q

Neutropenic fever dx

A

Cultures from all lumens, skin, sinuses, blood, urine, sputum, stool
CXR but could be normal b/c not enough WBC
CBC, CMP, coag, UA

its an invisible infection that you can only find via culture. so your hunting in every possible site it could be before the patient dies.

53
Q

Spinal Cord Compression

A
  • Back pain at the level of the tumor mass, aggrivated by bearing down, supine
  • nerve sx
  • Progression of LE weakness, hyperreflexia, motor sensory loss, loss of reflexes, loss bowel/bladder fx, and lastly paraplegia
54
Q

Spinal Cord compression tx & dx

A

MRI,
IV corticosteroids, surigcal decompression, radiate the lesion

55
Q

Read only

hypercalcemia MoA

A

Hypercalcemia is caused by one of three mechanisms:
Systemic effects of tumor-released proteins
Direct osteolysis of bone by tumor
Increased absorption of calcium due to increased active metabolite of Vitamin D
Most commonly caused by a parathyroid hormone-related peptide secreted by the cancer cells
This activates the parathyroid hormone receptor, stimulating osteoclastic activity and promoting renal reabsorption of calcium
Usually a marker of advanced cancer, with median survival ranging from 1 to 3 months

56
Q

Hypercalcemia etiology and presentation

A
  • Happens to 20-30% cancer patients
  • MC: NSCLC, myeoloma, breast
  • thirsty, polyuria, AMS, lethargy, psychosis, CONSTIPATION, abdominal pain

Urine NOT cloudy which separates it from tumor lysis

57
Q

Hypercalcemia Dx

A

total serum ca AND ionized ca are elevated
EKG: short QT, ST depression, AV block

58
Q

Hypercalcemia treatment

A

1line. hydration, diuresis
bisphosphonates (zoledronic, pamidronate)
2 line. Calcitonin
Hemodialysis definitive

59
Q

Tumor Lysis Syndrome Etiology

A
  • 1 to 3 days following radiochemotherapy, usually hematologic type cancer
  • Release of nucleuic acids, proteins, phosphorus, potassium
  • If can’t metabolize/excrete, hyperuricemia, hyperphosphatemia, hyperkalemia
  • AKI from deposition of uric acid and calcium in the renal tubules which makes K and phos worse
60
Q

Tumor Lysis Syndrome clinical presentation

&dx, tx

A
  • fatal cardiac arrhythmias
  • lethargic, N/V, CLOUDY URINE, MSK spasm, seizure
  • peaked T waves on EKG
    -IV hydration, correct electrolyte abnormalities
    +- emergency hemodialysis
61
Q

Pleural effusion MC cause

A

lung and breast

62
Q

pericardial effusions MC cause

A

lung and breast cancer

63
Q

Malignant ascites MC cause (effusion)

A

ovarian, colon, stomach, pancreas

Everything in abdomen except liver, spleen, prostate

64
Q

Pericardial effusion/Cardiac tamponade

A
  • Fatigue, chest heaviness, dyspnea, palpitations, cough, syncope
    -rate of accumulation and distensibility of the sac determines the degree of hemodynamic instability.
  • PE: tachyc, dec. pulse pressure, low BP, distended neck veins, muffled heart sounds, pulse paradoxus
65
Q

Pericardial Effusion/Cardiac Tamponade Dx Tx

Dx, Tx

A
  • Chest XRAY enlarged cardiac silhouette and pleural effusion
  • EKG- sinus tachy, low QRS voltage
    - transthoracic echocardiogram is diagnositc tool of choice
  • Tx of choice is echo- guided percutaenous pericardiocentesis under local anaesthesia
66
Q

MC cause of SVC

A

Bronchogenic carcinoma

67
Q

SVC clinical presentation

A

dyspnea, chest pain, cough, facial and arm swelling, cerebral edema rare
-distended neck, arm and chest veins, nonpitting edema of the neck, arm swelling, tongue and facial swelling and cyanosis

-CXR shows widened mediastinum
- CHEST CT W/ CONTRAST DIAGNOSTIC TEST OF CHOICE

Compare: cardiac tamp was CXray and echo. xray showed enlarged cardiac silhouette

Why w/ contrast? Want to visualize blockage

68
Q

SCV syndrome treatment

A

glucocorticoids to decrease edema, intravascular stenting to get around mass
chemo and radiation

69
Q

Thromboembolic event

clinical present, dx, tx

A

-hypercoag state
PE: fever, pleural rub, unilateral lower extremity swelling
Spiral chest CT with contrast or V/Q scan to CONFIRM dx

tx - Anticoagulation heparin or lmwh, thrombolytic therapy maybe

Hunts 1A (18 decks)

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