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hem/onc > Principles of Oncology- part 2 > Flashcards

Principles of Oncology- part 2 Flashcards

1
Q

Conversely, when the clinical goal is palliation, careful attention to minimizing the _____ becomes a significant goal

A

toxicity of potentially toxic treatments

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2
Q

What are the 4 types of cancer treatments. Most cancer treatments are _____

A

Surgery
Radiation therapy
Chemotherapy
Biologic therapy

Some combination of the above treatments

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3
Q

Surgery and radiation therapy are considered ____ treatments

A

local

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4
Q

Chemotherapy and biologic therapy are usually _____ treatments.

A

systemic

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5
Q

_____ is the most effective means of treating cancer

A

surgery

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6
Q

Name some reasons surgery is used

A

Cancer prevention (prophylactic mastectomy/colectomy)
Diagnosis
Staging
Treatment (for both localized and metastatic disease)
Palliation

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7
Q

____ of cancer patients cured by surgery

A

40%

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8
Q

Even if the surgery is not curable, name some benefits of surgery

A

Local control of tumor

Preservation of organ function

Debulking for subsequent treatments

Palliative/Supportive care
-Placement of lines
-Control of effusions and ascites
-Removal of adhesions/strictures
-Reconstructive surgery

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9
Q

What is the main goal of radiation therapy?

A

deprive cancer cells of their cell division potential

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10
Q

** Radiation causes breaks in DNA that prevent replication and generates _____ from cell water that damages cell membranes, proteins, and organelles

A

hydroxyl radicals

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11
Q

Cancer cells are not as ??? repairing the damage caused by radiation resulting in differential ____ killing

A

efficient as normal cells in

cancer cell

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12
Q

Name some factors that influence the development of systemic effects

A

volume of tissue irradiated

dose fractionation

radiation fields

individual susceptibility

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13
Q

____, ____ and _____ are features that make a particular cell more sensitive or more resistant to the biologic effects of radiation

A

total absorbed dose

number of fractions (delivering radiation in repeated doses to maximize exposure during cell division)

time of treatment

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14
Q

Type of radiation: ______ with focused beams of radiation generated at a distance and aimed at the tumor within the patient

A

teletherapy

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15
Q

Type of radiation: ______ with radionuclides targeted in some fashion to a site of tumor……radioactive iodine for thyroid cancer

A

systemic therapy

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16
Q

Type of radiation: ______ with encapsulated/sealed sources of radiation implanted directly into or adjacent to tumor tissues

A

brachytherapy

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17
Q

What type of radiation is the most common? With ____ or _____ photons

A

teletherapy

x-ray or gamma ray photons

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18
Q

What is a common way to treat prostate cancer? What type of radiation?

A

brachytherapy

insert radioactive encapsulated rods into the prostate

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19
Q

Radiation therapy is used in a curative manner in what types of cancer?

A

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

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20
Q

Radiation therapy is used in a palliative manner for ???

A

Relief of bone pain from metastatic disease, control of brain metastases, reversal of spinal cord compression and superior vena caval obstruction, shrinkage of painful masses, and opening of threatened airways.

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21
Q

What are some systemic toxic effects associated with radiation therapy?

A

fatigue, anorexia, nausea, and vomiting,

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22
Q

______ include mucositis, skin erythema (ulceration in severe cases), and bone marrow toxicity.

A

acute toxicities associated with radiation

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23
Q

Radiation carcinogenesis with secondary malignancy; pericarditis; myocardial infarction; thyroid failure; cataracts; lung fibrosis; arteritis; spinal cord transection are all examples of _____

A

chronic toxicities associated with radiation

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24
Q

______ use of extreme cold to sterilize lesions in certain sites

A

cyrosurgery

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25
Q

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

A

radiofrequency ablation

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26
Q

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

aka target vascular supply of the tumor

A

chemoembolization

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27
Q

Name the 4 broad categories of chemotherapy

A

Conventional cytotoxic chemotherapy agents
Targeted agents
Hormonal therapies
Biologic therapies

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28
Q

Types of chemo: ______ mainly target DNA structure or segregation of DNA as chromosomes in mitosis

A

Conventional cytotoxic chemotherapy agents

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29
Q

Types of chemo _____-: designed and developed to interact with a defined molecular target important in either maintaining the malignant state or selectively expressed by the tumor cells.

A

targeted agents

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30
Q

types of chemo: ______ work on the biochemical pathways underlying estrogen and androgen function

A

hormonal therapies

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31
Q

types of chemotherapy: ______ Have a particular target or may have the capacity to regulate growth of tumor cells or induce a host immune response to kill tumor cells.

A

biologic therapies

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32
Q

The usefulness of a drug is determined by ?????

A

therapeutic effect vs toxic effect to the host

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33
Q

The _____ is the degree of separation between toxic and therapeutic doses.

A

therapeutic index

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34
Q

Unfortunately chemotherapy agents have a _____ therapeutic index

A

narrow

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35
Q

Chemotherapy can either ______ or _______

A

They can induce cancer cell death

They can induce cancer cell differentiation or dormancy with loss of tumor cell replicative potential and reacquisition of phenotypic properties resembling normal cells.

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36
Q

Name the 2 antimetabolites

A

Methotrexate

5-fluorouracil (5-FU)

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37
Q

**_______ MOA causes DNA damage indirectly, through misincorporation into DNA, abnormal timing or progression through DNA synthesis, or altered function of pyrimidine and purine biosynthetic enzymes

A

Antimetabolites:
Methotrexate, 5-fluorouracil (5-FU)

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38
Q

**antimetabolites: ______ prevents thymidine formation (required for DNA replication)

A

5-fluorouracil

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39
Q

**antimetabolites:_______ competes and counteracts folic acid, causing folic acid deficiency in cancer cell and cell death

A

methotrexate

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40
Q

**What are the toxic manifestations of antimetabolites?

A

stomatitis, diarrhea, and myelosuppression

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41
Q

**Name the mitotic spindle inhibitors. What the toxic manifestations?

A

Vincristine, Vinblastine
Paclitaxel

alopecia, neuropathy (especially in the hands and feet), and myelosuppression.

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42
Q

What are the Alkylating Agents?

A

Cyclophosphamide
Chlorambucil
Cisplatin

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43
Q

**______ MOA break down, either spontaneously or after normal organ or tumor cell metabolism, to reactive intermediates that covalently modify bases in DNA

A

Alkylating Agents

44
Q

**What the toxic effects of Cisplatin?

A

neuro-toxicity (stocking-glove), hearing loss, renal failure

45
Q

What is stocking glove neurotoxicity?

A

distal to proximal neuropathy in the hands

46
Q

**_______ 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.

A

Antitumor antibiotics

Doxorubicin (Anthracyclines)

47
Q

**What is the toxic effect of Doxorubicin (Anthracyclines)?

A

cardiotoxicity, arrthrymias and heart failure

48
Q

Which chemotherapy agent is nicknamed “the red devil”? Why?

A

Doxorubicin (Anthracyclines) because it is physically a red liquid and causes cardiotoxicity

49
Q

**_____ MOA 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

A

Topoisomerase inhibitor

Etoposide

50
Q

** What is the toxic effect of Etoposide?

A

transient side effects but may lead to secondary leukemia with high doses

51
Q

**How do you treat neutropenia caused by bone marrow suppression? When does it have the greater effect?

A

Filgrastim: colony stimulating factors

Stimulate the production of neutrophils, monocytes, and eosinophils.

peaks levels of neutrophils in 24 hours

52
Q

bleeding gums, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site. Are all SE of _______.

A

Filgrastim, pegfilgrastim and sargramostim

53
Q

**What is the treatment for anemia caused by bone marrow toxicity?

A

Transfusion; Epogen (erythropoiesis-stimulating agent)

54
Q

**What is the treatment for thrombocytopenia caused by bone marrow toxicity?

A

monitoring

should be getting blood work every week

55
Q

**_____ is the MC SE of chemotherapy. What is the treatment?

A

Nausea

Ondansetron (anti-emetic)

56
Q

_______ is oral soreness and ulcerations (along with the severe diarrhea). What is the treatment?

A

Mucositis

“Magic” Mouthwash
diphenhydramine, lidocaine, Maalox

57
Q

Drugs most commonly associated with causing mucositis in the mouth and the gastrointestinal tract are ????? name 3

A

cytarabine
5-FU
methotrexate

58
Q

_____ is a common chemo toxicity and is especially with tx with 5FU infusions. What is the treatment?

A

diarrhea

1st- Loperamide (antimotility drug) (Imodium)
2nd- Octerotide (somatostatin analogue) or opiate-based preparations if no response to Loperamide

59
Q

______ manifests as painful palms or soles accompanied by erythema, progressing to blistering desquamation and ulceration in its worst forms. What is the treatment for the blank and broad category?

A

Acral erythema

Broad category: Skin toxicity

Supportive care; cold packs; sun protection

60
Q

What is the treatment for chemo associated alopecia?

A

Psychological support
- “chemo caps”
- reduce scalp temp - very controversial

61
Q

_____ refers to the disorders that accompany benign or malignant tumors but are not directly related to mass effect or invasion.

A

Paraneoplastic syndromes

62
Q

Neoplastic cells can produce a variety of products that stimulate ????? responses. 5 organ systems

A

hormonal, hematologic, dermatologic, renal and neurologic

63
Q

paraneoplastic syndromes usually manifest as _____, _____, ____ or _______

A

Endocrine
Metabolic
Hematologic
Neuromuscular

64
Q

Why are the paraneoplastic syndromes clinically important?

A
  1. can provide early clue of cancer
  2. the toxic effect of the syndrome may be a more urgent threat to the pt’s life
  3. treatment of the cancer should result in a resolution of the paraneoplastic syndrome
65
Q

Name some common endocrine paraneoplastic syndromes?

A

hypercalcemia
hypoglycemia
gonadotropin secretion
cushing’s syndrome
SIADH

66
Q

Name some common hematologic paraneoplastic syndromes?

A

coagulopathy

erythroyctosis- points to kidney or liver cancer

67
Q

Name some common neurologic paraneoplastic syndromes? What type of cancer are they related to ?

A

Lambert-Eaton syndrome

Subacute cerebellar syndrome

Small Cell Lung Cancer (SCLC)

68
Q

**neurologic paraneoplastic syndromes that is characterized by muscle weakness of the limbs

A

Lambert-Eaton syndrome

69
Q

**neurologic paraneoplastic syndromes that is characterized by dizziness, nausea, vertigo, tremor, and sometimes dysphagia and blurry vision

A

Subacute cerebellar syndrome

69
Q

Name some common dermatologic paraneoplastic syndromes?

A

Dermatomyositis

Acanthosis Nigricans

70
Q

**dermatologic paraneoplastic syndromes that is characterized a system disorder causing inflammation of the muscles and skin, as well as joints, lungs, esophagus and heart. What cancers does it point to?

A

Dermatomyositis

SCLC, NSCLC

71
Q

**dermatologic paraneoplastic syndromes that is characterized thickening of mucous membranes/skin and it presents with brownish discoloration. What cancers does it point to?

A

Acanthosis Nigricans

GI adenocarcinomas

Side note: Can occur with diabetes/obesity, typically in fold of neck, under breast

72
Q

What is a neutropenic fever defined as?

A

recurrent temperatures above 38’C or a single temperature above 38.3’C in the presence of neutropenia

neutrophil count (ANC) less than 500 cells/mL

73
Q

neutropenic fever is commonly the result of _______, not ______

A

chemotherapy NOT the underlying cancer

74
Q

vague and mild initially, but may rapidly progress to sepsis and death
Symptoms also vary based on site of infection and source of infection
Infectious agents may be viral, fungal or bacterial

What am I?

A

neutropenic fever

75
Q

**T/F: All immunocompromised pts should have a rectal exam as part of their PE work up

A

FALSE!!

It is an ABSOLUTE CI to perform a rectal exam on an immunocompromised pt!!

76
Q

What should be part of a dx workup with a pt who is suspected of having neutropenic fever?

A

cultures (skin, blood, urine, sputum and stool)

CXR

CBC with diff, CMP, coag panel and UA

77
Q

**What is the empiric treatment for a neutropenic fever? When should treatment be started?

A

Ceftazidime, Cefipime or Imipenem for antipseudomonal coverage
Aminoglycoside to cover gram – bacteria
Vancomycin to cover MRSA

All three!

start AFTER the culture is taken!!

78
Q

Back pain at the level of the tumor mass, which may be aggravated by lying down, weight bearing, sneezing, or coughing
Mix of nerve root and spinal cord symptoms

What am I?
What is the dx tool of choice?

A

spinal cord compression

MRI

79
Q

What is the usually worsening of symptoms that is common to see with a spinal cord compression?

A

LE weakness
hyperreflexia
motor/sensory loss
loss of reflexes
loss of bowel/bladder
paraplegia

80
Q

What is the treatment for spinal cord compression?

A

High dose IV corticosteroids
Surgical decompression
Radiation

81
Q

What are the 3 mechanisms that can cause hypercalcemia

A

Systemic effects of tumor-released proteins

Direct osteolysis of bone by tumor

Increased absorption of calcium due to increased active metabolite of Vitamin D

82
Q

What is the MC cause of hypercalcemia?

A

a parathyroid hormone-related peptide secreted by the cancer cells

83
Q

If hypercalcemia due to cancer is present, what does this indicate?

A

marker of advanced cancer

median survival range of 1-3 months

84
Q

What are the top 3 cancers associated with hypercalcemia?

A

myeloma, breast carcinoma, and non-small cell lung carcinoma (NSCLC)

85
Q

polydipsia, polyuria, generalized weakness, lethargy, anorexia, N/V, constipation, abdominal pain, AMS and psychosis

What am I?
What is the treatment?

A

hypercalcemia

Hydration and forced diuresis
and bisphosphonates

86
Q

zoledronic acid or pamidronate IV are in the drug class ______. When are they commonly used?

A

Bisphosphonates

treatment of hypercalcemia

87
Q

What is second line treatment for hypercalcemia? If that still doesnt work, use ______

A

2nd- Calcitonin

alternative: Hemodialysis-> will be the definitive treatment

88
Q

Hypercalcemia labs will show elevated _____ and ______

A

Total serum calcium level

ionized calcium levels

89
Q

What will the EKG show a pt with hypercalcemia?

A

may show shortened QT, ST depression and AV blocks

90
Q

______ is a clinical syndrome that occurs 1-3 days following radiochemotherapy of most commonly hematologic malignancies. Especially _____

A

Tumor Lysis Syndrome

Especially Burkitt lymphoma

91
Q

_____ is a massive release of cellular material including nucleic acids, proteins, phosphorus, and potassium. If both the metabolism and excretion of these breakdown products are impaired, hyperuricemia, hyperphosphatemia, and hyperkalemia will develop abruptly.

A

Tumor Lysis Syndrome

92
Q

What is the pt at a huge risk for following Tumor Lysis Syndrome? Why?

A

Acute kidney injury may then develop from the crystallization and deposition of uric acid and calcium phosphate within the renal tubules further exacerbating the hyperphosphatemia and hyperkalemia.

93
Q

**In Tumor Lysis Syndrome, combination of hyperkalemia and hypocalcemia, development of _____ may occur

A

fatal cardiac arrhythmias

94
Q

**Patient may present with lethargy, N/V, cloudy urine, and neuromuscular irritability, muscular spasm, seizure and altered mentation associated with hypocalcemia.

What am I?
What is the treatment?

A

Tumor Lysis Syndrome

includes IV hydration and correction of electrolyte abnormalities
May require emergency hemodialysis

95
Q

**What does the EKG show in a pt with tumor lysis syndrome?

A

may show peaked T waves of hyperkalemia, as well as arrhythmias

96
Q

**____ and _____ most commonly caused by lung and breast cancers

A

Pleural and pericardial effusions

97
Q

**_____ associated with ovarian, colorectal, stomach, and pancreatic cancers.

A

Malignant ascites

98
Q

**fatigue, chest heaviness, dyspnea, palpitations, cough and syncope
Tachycardia, narrowed pulse pressure, hypotension, distended neck veins, muffled heart sounds, and pulsus paradoxus

What am I?
What is the dx tool of choice?
What is the treatment of choice?

A

Pericardial Effusion / Cardiac Tamponade

Transthoracic echocardiogram

echo-guided percutaneous pericardiocentesis under local anesthesia

99
Q

What other dx tools can you use to dx Pericardial Effusion/Cardiac Tamponade?

A

Chest x-ray may demonstrate an enlarged cardiac silhouette and pleural effusion

EKG may show sinus tachycardia, low QRS voltage and electrical alternans

**Transthoracic echocardiogram is diagnostic tool of choice

100
Q

_____ is caused by malignancies such as compression of the vessel wall by right upper lobe tumors or thymoma and/or mediastinal lymphadenopathy

A

Superior Vena Cava Syndrome

101
Q

What is the MC malignancy that causes SVCS?

A

bronchogenic carcinoma

102
Q

gradual onset of dyspnea, chest pain, cough and, facial and arm swelling; cerebral edema is rare
Distended neck, arm and chest veins, nonpitting edema of the neck, arm swelling, tongue and facial swelling and cyanosis

What am I?
What is the dx tool of choice?
What is the treatment?

A

SVC syndrome

Chest CT with contrast is diagnostic test of choice

**steroids
**Intravascular stenting
chemotherapy
radiation

103
Q

What is Virchow’s triad?

A

Vessel wall injury
stasis
hypercoagulability

104
Q

hx of dyspnea, fever, cough, DOE, pleuritic chest pain, leg pain or swelling, and rarely hemoptysis
include low-grade fever, tachypnea, tachycardia, pleural rub and unilateral lower extremity swelling

What am I?
What is the dx tool of choice?
What is the treatment?

A

DVT/PE

Chest CT with contrast or V/Q scan

IV heparin or lovenox immediately then follow up with DOAC

105
Q

When is thrombolytic therapy necessary?

A

When the patient is tanking and their life in crisis

aka when systolic is below 90

106
Q
A

hem/onc (14 decks)

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