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reproductive > PHARM: Ovarian and Bladder Cancer > Flashcards

PHARM: Ovarian and Bladder Cancer Flashcards

1
Q

What protein is usually elevated in most ovarian cancer cells and change in blood level is a marker for drug efficacy or tumor proliferation?

A

CA-125

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2
Q

What is the most common type of bladder cancer?

A

superficial transitional cell carcinomas

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3
Q

How do superficial transitional cell carcinomas present?

A

hematuria (leads to an early presentation)

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4
Q

What cells become cancerous in transitional cell carcinomas? Why?

A

transformation of the cells lining the urothelial surface; these are cells that remain in contact with high concentrations of chemicals

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5
Q

Where is stage Ta bladder cancer located?

A

confined to epithelium (mucosa)

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6
Q

Where is stage T1 bladder cancer located?

A

invades sub-epithelial CT (lamina propria)

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7
Q

Where is stage T2a/T2b bladder cancer located?

A

invades superficial/deep muscle

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8
Q

Where is stage T3a/T3b bladder cancer?

A

microscopically/macroscopically invading perivesicle fat

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9
Q

Where is stage T4a/T4b bladder cancer located?

A

tumor invades surrounding organs/pelvis or abdominal wall

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10
Q

What is the treatment for locally confined ovarian cancer?

A

intra-peritoneal instillation of cisplatin provides for juxtaposition of high concentrations of chemotherapeutic in direct contact with the spreading cancer cells

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11
Q

How does intra-peritoneal chemotherapy work?

A
  • Patients receive a 1-2L instilled volume that is retained for up to 2 hr, then drained off.
  • During this time supine patients rotate from side-to-side to ensure adequate coverage of peritoneal surfaces.
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12
Q

You do you treat “superficial” bladder cancer?

A

treated by trans-urethral resection of the bladder cancer (TURBC) + intravesical instillation of a high concentration of chemotherapeutic (ex. mitomycin or BCG for >1 yr) to eradicate any transformed cells that remain

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13
Q

How do you treat bladder cancer that has “progressed”?

A

chemo-radiation or conventional systemic chemotherapy are employed

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14
Q

What is the last line therapy for bladder cancer?

A

total cystectomy and subsequent lifestyle changes

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15
Q

What is a big risk of TURBC?

A

if you penetrate too deep in the bladder tissue, you may compromise retention of drug in the bladder lumen and significantly increase the potential for drug systematization

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16
Q

Why might women with late stage ovarian cancer elect to get intra-peritoneal chemotherapy?

A

troublesome ascites may lead them to elect intraperitoneal drug instillations in a palliative mode to decrease the rate of build up of the ascites.

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17
Q

What is the chemo combination for stage 1-2 ovarian cancer?

A

carboplatin- or cisplatin-based regimen usually including cyclophosphamide and/or doxorubicin

18
Q

What is the chemo conbination for stages 3-4 ovarian cancer?

A

carboplatin or cisplatin with paclitaxel

19
Q

MOA: Forms DNA intrastrand crosslinks and adducts

A

Cisplatin and carboplatin

20
Q

MOA: Pro-drug of active alkylating moiety

A

Cyclophosphamide

21
Q

MOA: Intercalator, free radical generator, topo II inhibitor

A

Doxorubicin

22
Q

MOA: Microtubule stabilizer inhibiting depolymerization

A

Paclitaxel

23
Q

TOXICITY: Allergic reactions; dose related myelosuppression, cumulative anemia; dose-related N/V.

A

carboplatin

24
Q

TOXICITY: Allergic reactions; dose related severe nephrotoxicity, myelosuppression and N/V. Significant ototoxicity (tinnitus and deafness) reported in children

A

Cisplatin

25
Q

TOXICITY: Blood dyscrasias→ anemia and infection; renal compromise; hemorrhagic cystitis; N/V, rashes; amenorrhea/infertility; pulmonary fibrosis

A

Cyclophosphamide

26
Q

TOXICITY: Myelosuppression, CHF, hepatic disease, secondary malignancies, extravasational necrosis; N/V

A

Doxorubicin

27
Q

TOXICITY: hypersensitivity; myelosuppression; myalgia and arthralgia

A

paclitaxel

28
Q

Which of the ovarian cancer drugs leads to blood chemistry dyscrasia (elevated hepatic enzymes, BUN, and creatinine)?

A

carboplatin

29
Q

With which ovarian cancer drug must you monitor the patient for secondary malignancies?

A

cyclophosphamide

30
Q

What are the drugs used to treat bladder cancer?

A 
Bacillus Calmette-Guerin (BCG)
Cisplatin
Doxorubicin
MItomycin C
Thiotepa
31
Q

How is BCG administered?

A

(instilled and held 1-2 hours, 6X/week)

32
Q

MOA: Polyfunctional alkylator with loss of aziridine (alkylator) moiety. The remaining moiety, diethylenethiophosphoramide forms DNA interstrand cross-links.

A

Thiotepa

33
Q

MOA: Mono- and bi-functional alkylating agent

A

Mitomycin C

34
Q

MOA: Intercalator, free radical generator, topo II inhibitor

A

Doxorubicin

35
Q

MOA: Forms DNA intrastrand crosslinks and adducts (bladder cancer drug)

A

cisplatin

36
Q

MOA: Binds to urothelial cells, attracts APCs and ultimately leads to the production of a host of immune system effector cells, such as cytotoxic T-Lymphocytes (CTLs) and Natural Killer (NK) cells.

A

Bacillus Calmette-Guerin

37
Q

What bladder cancer drug has an effect that lasts days to months? (potential for “boosters”)

A

Bacillus Calmette-Guerin

38
Q

TOXICITY: Pancytopenia (IV); when used IVe leads to chemical cystitis, contact dermatitis (palmar and plantar erythemas if contact made with instillate solution or void volume)

A

Mitomycin C

39
Q

TOXICITY: Pancytopenia (IV); when used IVe you expect dysuria, urinary retention, chemical/hemorrhagic cystitis; renal dysfunction

A

Thiotepa

40
Q

TOXICITY: pulmonary infiltrates (dyspnea and unproductive cough)

A

Mitomycin C

41
Q

Which bladder cancer drug is a lipophillic, small molecular weight drug that can easily penetrate urotehilal tissue?

A

thiotepa

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