Patho And Pharm Of Neoplasia Flashcards
What is a neoplasm?
Abnormal mass of tissue, growth exceeds and is uncoordinated with normal tissues
Neoplasm is also referred to as a new growth.
What does the term ‘tumor’ refer to?
A non-specific term meaning lump or swelling
Often synonymous with neoplasm.
Define cancer.
Any malignant neoplasm or tumor
Cancer indicates a more severe, invasive type of neoplasm.
What is metastasis?
Discontinuous spread of a malignant neoplasm to distant sites
What is the cell type origin of carcinoma?
Epithelial origin
Examples include basal cell carcinoma and breast carcinoma.
What is the cell type origin of sarcoma?
Connective tissue or muscle
Examples include osteosarcoma and Kaposi’s sarcoma.
Which cell types are involved in leukemias and lymphomas?
Immune cells
Examples include Hodgkin’s lymphoma and acute myelogenous leukemia (AML).
Identify traditional treatments for neoplasia.
- Surgery
- Radiation
- Chemotherapy
List new methods of cancer treatment.
- Target cell pathways
- Stem cell transplantation
- Angiogenesis inhibition
- Gene therapy
- Cancer vaccines
What is primary chemotherapy?
Primary treatment is chemotherapy
What is the goal of chemotherapy in advanced disease?
Limit spread, improve quality of life (QOL)
What is neoadjuvant chemotherapy?
Chemotherapy induced to reduce tumor size prior to and after surgery
What is the purpose of adjuvant chemotherapy?
Reduce incidence and resurgence of tumor after surgery
What are the goals of chemotherapy?
- Disease-free survival (DFS)
- Overall survival (OS)
How can chemotherapy be administered?
- Intravascular (peripheral vs central lines)
- Oral
- Topical
- Intra cavity
What are common general toxicities of cytotoxic drugs?
- Nausea & Vomiting
- Bone marrow depression
- Alopecia
- Oligospermia, impotence, ↓ ovulation
- Abortion, fetal death, teratogenicity
- Carcinogenicity
- Hyperuricemia
- Immunosuppression
True or False: Cancer cells have normal mechanisms for suppressing cell growth.
False
What are cell cycle specific agents (CCS)?
Act against specific proteins involved in cell cycle progression
Examples include 5-FU, paclitaxel, vinblastine.
What are cell cycle nonspecific agents (CCNS)?
Effect not reliant on cell cycle progression
Examples include mitomycin, platinum analogs, doxorubicin.
What is the purpose of combination drug therapy?
Negates the effects of resistances of the different drugs
What is primary resistance in cancer treatment?
Mutations prevent the drug from working (e.g., p53)
Define acquired resistance in cancer treatment.
Drug treatment selects for resistant strains
What do alkylating agents do?
Transfer alkyl group to target (DNA), making it inactive
What are antimetabolites?
Inhibit DNA synthesis (folate pathway)
What are natural products in cancer treatment?
Plant-derived agents and their derivatives
What are antitumor antibiotics?
Bacterial and fungal derived agents
What are hormonal agents used for in cancer treatment?
Either hormones or inhibitors of hormonal signaling
What are miscellaneous agents in cancer treatment?
Do not fit in other groups, include inhibitors and monoclonal antibodies
What is the largest and most diverse class of anti-neoplastic drugs?
Alkylating Agents
* Either alkylate DNA or interfere by crosslinking (platinum compounds)
List the alkylating agents groups:
Groups:
* Nitrogen Mustards
Cyclophosphamide, Chlorambucil
* Nitrosureas
Carmustine, lomustine, streptozocin
* Alkyl Sulfonate
Busulfan
* Platinum Analogs
Cisplatin, carboplatin
What is the mechanism of action of cyclophosphamide?
Most commonly used alkylating agent for various neoplastic conditions
What is the slowest acting and least toxic alkylating agent?
Chlorambucil
What is the primary use of nitrosoureas?
Meningeal/Brain tumors
Adverse Effects:
* Delayed bone marrow suppression
* Visceral fibrosis, renal damage
What is a common use of cisplatin?
Testicular cancer (85%-95% curative)
Key Cisplatin Facts
Administered IV
* Highly bound to plasma proteins
* Concentrates in kidney, intestine, testes
* Poorly penetrates BBB
* Slowly excreted in urine
List common adverse effects of cisplatin.
- Emesis
- Nephrotoxicity
- Peripheral neuropathy
- Ototoxicity
What is methotrexate used for?
Methotrexate is a folate antagonist
* Inhibits dihydrofolate reductase (DHFR) and interferes with DNA/RNA synthesis
Cytotoxic actions of Methotrexate
- Predominant on bone marrow
- Ulceration of intestinal mucosa
- Crosses placenta interferes with embryogenesis
*fetal malformations and death
Immunosupressive action of Methotrexate
Prevents clonal expansion of B & T lymphocytes
Anti-Inflammatory action of methotrexate
Interferes with release of inflammatory cytokines
What do purine antagonists interfere with?
Nucleic acid synthesis
* 6-Mercaptopurine (6-MP), 6-Thioguanine, Azathioprine
What are the main uses of pyrimidine antagonists?
Stomach, colon, breast, ovarian, liver cancers
* 5 Fluorouracil (5-FU), cytarabine, gemcitabine
What is the mechanism of action of vinca alkaloids?
Block tubulin polymerization leading to dissolution of mitoticspindle and cell death
What do taxanes do in cancer treatment?
Stabilize mitotic spindle so the cell cannot depolymerize and eventually lead to cell death
What is the mechanism of action of antitumor antibiotics?
Intercalation in DNA, blocking DNA & RNA synthesis
What are corticosteroids used for in cancer treatment?
Leukemias and lymphomas
prednisolone
What is the role of selective estrogen receptor modulators (SERM) like tamoxifen?
Block estrogen effects in breast cancer
What is the primary goal of cancer treatment?
Remission, suppression, or no treatment
What constitutes a cure (Remission)
- Repeated maximally tolerated individual dosing
- Given as frequently as tolerated in carefully timed cycles
Micellaneous Agents: What are ibs? Are they the same as MABs?
If there is an ib, it means that it is going to inhibit tyrosine kinase growth factors. Not the same as MABs
List the strategies to reduce cancer risk.
- Avoid tobacco
- Maintain healthy weight
- Regular physical activity
- Eat healthy
- Limit alcohol consumption
- Protect your skin
- Know your family history
- Have regular checkups
What drug treats all forms of cancer?
Trick question, no drug treats all cancers.
* every case is a little bit different
