Principles of Oncology- part 2 Flashcards
Conversely, when the clinical goal is palliation, careful attention to minimizing the _____ becomes a significant goal
toxicity of potentially toxic treatments
What are the 4 types of cancer treatments. Most cancer treatments are _____
Surgery
Radiation therapy
Chemotherapy
Biologic therapy
Some combination of the above treatments
Surgery and radiation therapy are considered ____ treatments
local
Chemotherapy and biologic therapy are usually _____ treatments.
systemic
_____ is the most effective means of treating cancer
surgery
Name some reasons surgery is used
Cancer prevention (prophylactic mastectomy/colectomy)
Diagnosis
Staging
Treatment (for both localized and metastatic disease)
Palliation
____ of cancer patients cured by surgery
40%
Even if the surgery is not curable, name some benefits of surgery
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
What is the main goal of radiation therapy?
deprive cancer cells of their cell division potential
** Radiation causes breaks in DNA that prevent replication and generates _____ from cell water that damages cell membranes, proteins, and organelles
hydroxyl radicals
Cancer cells are not as ??? repairing the damage caused by radiation resulting in differential ____ killing
efficient as normal cells in
cancer cell
Name some factors that influence the development of systemic effects
volume of tissue irradiated
dose fractionation
radiation fields
individual susceptibility
____, ____ and _____ are features that make a particular cell more sensitive or more resistant to the biologic effects of radiation
total absorbed dose
number of fractions (delivering radiation in repeated doses to maximize exposure during cell division)
time of treatment
Type of radiation: ______ with focused beams of radiation generated at a distance and aimed at the tumor within the patient
teletherapy
Type of radiation: ______ with radionuclides targeted in some fashion to a site of tumor……radioactive iodine for thyroid cancer
systemic therapy
Type of radiation: ______ with encapsulated/sealed sources of radiation implanted directly into or adjacent to tumor tissues
brachytherapy
What type of radiation is the most common? With ____ or _____ photons
teletherapy
x-ray or gamma ray photons
What is a common way to treat prostate cancer? What type of radiation?
brachytherapy
insert radioactive encapsulated rods into the prostate
Radiation therapy is used in a curative manner in what types of cancer?
Breast cancer, Hodgkin’s disease, head and neck cancer, prostate cancer, and gynecologic cancers.
Radiation therapy is used in a palliative manner for ???
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.
What are some systemic toxic effects associated with radiation therapy?
fatigue, anorexia, nausea, and vomiting,
______ include mucositis, skin erythema (ulceration in severe cases), and bone marrow toxicity.
acute toxicities associated with radiation
Radiation carcinogenesis with secondary malignancy; pericarditis; myocardial infarction; thyroid failure; cataracts; lung fibrosis; arteritis; spinal cord transection are all examples of _____
chronic toxicities associated with radiation
______ use of extreme cold to sterilize lesions in certain sites
cyrosurgery
_______ focused microwave radiation to induce thermal injury within a volume of tissue
radiofrequency ablation
_________ Infusion of chemotherapeutic agents directly into the target area via vascular catheters
aka target vascular supply of the tumor
chemoembolization
Name the 4 broad categories of chemotherapy
Conventional cytotoxic chemotherapy agents
Targeted agents
Hormonal therapies
Biologic therapies
Types of chemo: ______ mainly target DNA structure or segregation of DNA as chromosomes in mitosis
Conventional cytotoxic chemotherapy agents
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.
targeted agents
types of chemo: ______ work on the biochemical pathways underlying estrogen and androgen function
hormonal therapies
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.
biologic therapies
The usefulness of a drug is determined by ?????
therapeutic effect vs toxic effect to the host
The _____ is the degree of separation between toxic and therapeutic doses.
therapeutic index
Unfortunately chemotherapy agents have a _____ therapeutic index
narrow
Chemotherapy can either ______ or _______
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.
Name the 2 antimetabolites
Methotrexate
5-fluorouracil (5-FU)
**_______ 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
Antimetabolites:
Methotrexate, 5-fluorouracil (5-FU)
**antimetabolites: ______ prevents thymidine formation (required for DNA replication)
5-fluorouracil
**antimetabolites:_______ competes and counteracts folic acid, causing folic acid deficiency in cancer cell and cell death
methotrexate
**What are the toxic manifestations of antimetabolites?
stomatitis, diarrhea, and myelosuppression
**Name the mitotic spindle inhibitors. What the toxic manifestations?
Vincristine, Vinblastine
Paclitaxel
alopecia, neuropathy (especially in the hands and feet), and myelosuppression.
What are the Alkylating Agents?
Cyclophosphamide
Chlorambucil
Cisplatin