Patho And Pharm Of Neoplasia

Question 1

What is a neoplasm?

Answer 1

Abnormal mass of tissue, growth exceeds and is uncoordinated with normal tissues

Neoplasm is also referred to as a new growth.

Question 2

What does the term ‘tumor’ refer to?

Answer 2

A non-specific term meaning lump or swelling

Often synonymous with neoplasm.

Question 3

Define cancer.

Answer 3

Any malignant neoplasm or tumor

Cancer indicates a more severe, invasive type of neoplasm.

Question 4

What is metastasis?

Answer 4

Discontinuous spread of a malignant neoplasm to distant sites

Question 5

What is the cell type origin of carcinoma?

Answer 5

Epithelial origin

Examples include basal cell carcinoma and breast carcinoma.

Question 6

What is the cell type origin of sarcoma?

Answer 6

Connective tissue or muscle

Examples include osteosarcoma and Kaposi’s sarcoma.

Question 7

Which cell types are involved in leukemias and lymphomas?

Answer 7

Immune cells

Examples include Hodgkin’s lymphoma and acute myelogenous leukemia (AML).

Question 8

Identify traditional treatments for neoplasia.

Answer 8

• Surgery
• Radiation
• Chemotherapy

Question 9

List new methods of cancer treatment.

Answer 9

• Target cell pathways
• Stem cell transplantation
• Angiogenesis inhibition
• Gene therapy
• Cancer vaccines

Question 10

What is primary chemotherapy?

Answer 10

Primary treatment is chemotherapy

Question 11

What is the goal of chemotherapy in advanced disease?

Answer 11

Limit spread, improve quality of life (QOL)

Question 12

What is neoadjuvant chemotherapy?

Answer 12

Chemotherapy induced to reduce tumor size prior to and after surgery

Question 13

What is the purpose of adjuvant chemotherapy?

Answer 13

Reduce incidence and resurgence of tumor after surgery

Question 14

What are the goals of chemotherapy?

Answer 14

• Disease-free survival (DFS)
• Overall survival (OS)

Question 15

How can chemotherapy be administered?

Answer 15

• Intravascular (peripheral vs central lines)
• Oral
• Topical
• Intra cavity

Question 16

What are common general toxicities of cytotoxic drugs?

Answer 16

• Nausea & Vomiting
• Bone marrow depression
• Alopecia
• Oligospermia, impotence, ↓ ovulation
• Abortion, fetal death, teratogenicity
• Carcinogenicity
• Hyperuricemia
• Immunosuppression

Question 17

True or False: Cancer cells have normal mechanisms for suppressing cell growth.

Answer 17

False

Question 18

What are cell cycle specific agents (CCS)?

Answer 18

Act against specific proteins involved in cell cycle progression

Examples include 5-FU, paclitaxel, vinblastine.

Question 19

What are cell cycle nonspecific agents (CCNS)?

Answer 19

Effect not reliant on cell cycle progression

Examples include mitomycin, platinum analogs, doxorubicin.

Question 20

What is the purpose of combination drug therapy?

Answer 20

Negates the effects of resistances of the different drugs

Question 21

What is primary resistance in cancer treatment?

Answer 21

Mutations prevent the drug from working (e.g., p53)

Question 22

Define acquired resistance in cancer treatment.

Answer 22

Drug treatment selects for resistant strains

Question 23

What do alkylating agents do?

Answer 23

Transfer alkyl group to target (DNA), making it inactive

Question 24

What are antimetabolites?

Answer 24

Inhibit DNA synthesis (folate pathway)

Question 25

What are natural products in cancer treatment?

Answer 25

Plant-derived agents and their derivatives

Question 26

What are antitumor antibiotics?

Answer 26

Bacterial and fungal derived agents

Question 27

What are hormonal agents used for in cancer treatment?

Answer 27

Either hormones or inhibitors of hormonal signaling

Question 28

What are miscellaneous agents in cancer treatment?

Answer 28

Do not fit in other groups, include inhibitors and monoclonal antibodies

Question 29

What is the largest and most diverse class of anti-neoplastic drugs?

Answer 29

Alkylating Agents * Either alkylate DNA or interfere by crosslinking (platinum compounds)

Question 30

List the alkylating agents groups:

Answer 30

Groups: * Nitrogen Mustards *Cyclophosphamide, Chlorambucil* * Nitrosureas *Carmustine, lomustine, streptozocin* * Alkyl Sulfonate *Busulfan* * Platinum Analogs *Cisplatin, carboplatin*

Question 31

What is the mechanism of action of cyclophosphamide?

Answer 31

Most commonly used alkylating agent for various neoplastic conditions

Question 32

What is the slowest acting and least toxic alkylating agent?

Answer 32

Chlorambucil

Question 33

What is the primary use of nitrosoureas?

Answer 33

Meningeal/Brain tumors Adverse Effects: * Delayed bone marrow suppression * Visceral fibrosis, renal damage

Question 34

What is a common use of cisplatin?

Answer 34

Testicular cancer (85%-95% curative)

Question 35

Key Cisplatin Facts

Answer 35

Administered IV * Highly bound to plasma proteins * Concentrates in kidney, intestine, testes * Poorly penetrates BBB * Slowly excreted in urine

Question 36

List common adverse effects of cisplatin.

Answer 36

* Emesis * Nephrotoxicity * Peripheral neuropathy * Ototoxicity

Question 37

What is methotrexate used for?

Answer 37

Methotrexate is a folate antagonist * Inhibits dihydrofolate reductase (DHFR) and interferes with DNA/RNA synthesis

Question 38

Cytotoxic actions of Methotrexate

Answer 38

* Predominant on bone marrow * Ulceration of intestinal mucosa * Crosses placenta interferes with embryogenesis *fetal malformations and death

Question 39

Immunosupressive action of Methotrexate

Answer 39

Prevents clonal expansion of B & T lymphocytes

Question 40

Anti-Inflammatory action of methotrexate

Answer 40

Interferes with release of inflammatory cytokines

Question 41

What do purine antagonists interfere with?

Answer 41

Nucleic acid synthesis * 6-Mercaptopurine (6-MP), 6-Thioguanine, Azathioprine

Question 42

What are the main uses of pyrimidine antagonists?

Answer 42

Stomach, colon, breast, ovarian, liver cancers * 5 Fluorouracil (5-FU), cytarabine, gemcitabine

Question 43

What is the mechanism of action of vinca alkaloids?

Answer 43

Block tubulin polymerization leading to dissolution of mitoticspindle and cell death

Question 44

What do taxanes do in cancer treatment?

Answer 44

Stabilize mitotic spindle so the cell cannot depolymerize and eventually lead to cell death

Question 45

What is the mechanism of action of antitumor antibiotics?

Answer 45

Intercalation in DNA, blocking DNA & RNA synthesis

Question 46

What are corticosteroids used for in cancer treatment?

Answer 46

Leukemias and lymphomas *prednisolone*

Question 47

What is the role of selective estrogen receptor modulators (SERM) like tamoxifen?

Answer 47

Block estrogen effects in breast cancer

Question 48

What is the primary goal of cancer treatment?

Answer 48

Remission, suppression, or no treatment

Question 49

What constitutes a cure (Remission)

Answer 49

* Repeated maximally tolerated individual dosing * Given as frequently as tolerated in carefully timed cycles

Question 50

Micellaneous Agents: What are ibs? Are they the same as MABs?

Answer 50

If there is an ib, it means that it is going to inhibit tyrosine kinase growth factors. Not the same as MABs

Question 51

List the strategies to reduce cancer risk.

Answer 51

* Avoid tobacco * Maintain healthy weight * Regular physical activity * Eat healthy * Limit alcohol consumption * Protect your skin * Know your family history * Have regular checkups

Question 52

What drug treats all forms of cancer?

Answer 52

Trick question, no drug treats all cancers. * *every case is a little bit different*