(SYNOPTIC) Cancer Metastases Flashcards by Jimmy Salon

Q

What is a metastasis?

A

Secondary involvement of cancer spreading across the body

Cells within metastases resemble the 1y tumour

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Q

What are the main routes of metastatic spread?

A

(1) Lymphatic system

(2) Haematogenous spread
- via blood

(3) Transcoelomic
- through body walls into abdominal/ chest cavities

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Q

What is the process of carbohydrate interactions in disease pathways of metastatic cancers?

A

(1) Leukocyte captures chemo-attractants
(2) Leukocyte rolls
(3) Rolling slows
(4) Leukocyte adhesion to endothelium
(5) Transmigration + release of chemo-attractants into tissue

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Q

What is lymphatic spread?

A

Follows lymphatic system

Lymphadenopathy

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Q

What is lymphadenopathy?

A

Spread + growth of cancer cells/ reactive hyperplasia

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Q

What is haematagenous spread?

A

Spread of metastases via circulatory system

Veins more readily invaded than arteries

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Q

What will a cancer metastases invasion of the inferior vena cava likely cause?

A

Lung metastases

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Q

What is transcoelomic spread?

A

Spread of metastases across peritoneal cavity

Often associate with fluid buildup

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Q

Name two types of cancer metastases that have arisen from transcoelomic spread?

A

(1) Ovarian cancer - across peritoneum

(2) Lung cancer - across pleural cavity

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Bladder

A

Bone
Liver
Lung

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Breast

A

Bone
Brain
Liver
Lung

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Colon

A

Liver
Lung
Peritoneum

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Kidney

A

Adrenal gland
Bone
Brain
Liver
Lung

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Lung

A

Adrenal gland
Bone
Brain
Liver
Other lung

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Melanoma (skin)

A

Bone
Brain
Liver
Lung
Skin
Muscle

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Ovary

A

Liver
Lung
Peritoneum

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Q

State the likely location of cancer metastases based on the location of the primary cancer.

Prostate

A

Adrenal gland
Liver
Bone
Lung

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Q

How are metastases diagnosed?

A

CT Scans
X-ray
Tumour markers
Biopsy
Cytology

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Q

What is the pharmacological symptomatic treatment of bone metastases?

A

Bisphosphonates

To reduce calcium

As bone metastases are often linked to hypercalcaemia

Q

How is spinal cord compression, due to bone metastases, treated?

A

Dexamethasone with PPI cover

Radiotherapy to bone

Pain relief + laxatives

Q

What is the pharmacological treatment of brain metastases?

A

Dexamethasone + PPI

Often causes seizures - anti-epileptics

Q

What is the pharmacological treatment of lung metastases?

A

Dexamethasone + PPI

Salbutamol to open airways (if required)

May require tranexamic acid to reduce bleeding

Q

What is the pharmacological treatment of liver metastases for symptomatic relief?

A

Dexamethasone
- useful for pain

Drain ascites

Q

What is primary chemotherapy resistance?

A

Intrinsic resistance to chemotherapy, regardless of drug exposure

What is acquired chemotherapy resistance?

Natural selection of tumour cells that are sensitive to chemotherapy drug die, but this does not affect the tumour as a whole

What are some mechanisms of metastases resistance?

- efficient repair to damaged DNA - decreased intracellular activation - increased intracellular breakdown - bypass biochemical pathways - overproduction of blocked enzyme - changes to receptor

What is a cellular mechanism of defence, of a cancer cell, to alkylating agents?

Efficient repair to damaged DNA

What is a cellular mechanism of defence, of a cancer cell, to methotrexate?

(1) Decreased uptake by cell (2) Bypass biochemical pathways (3) Gene amplification/ overproduction of blocked enzyme

What is a cellular mechanism of defence, of a cancer cell, to doxorubicin?

Decreased uptake by cell

What is a cellular mechanism of defence, of a cancer cell, to vinca alkaloids?

Increased drug efflux

What is a cellular mechanism of defence, of a cancer cell, to anthracyclines?

Increased drug efflux

What is a cellular mechanism of defence, of a cancer cell, to 5-fluorouracil?

Decreased intracellular activation

What is a cellular mechanism of defence, of a cancer cell, to cytarabine?

Increased intracellular breakdown

What is an oncogene?

Gene that gains function when mutated

What is a tumour suppression gene?

Gene that loses function when mutated

What is EGFR, with regard to cancer?

Oncogene

What does mutated EGFR do, with regard to cancer?

Promotion of angiogenesis

What is p53?

Tumour suppressor gene Mutated p53 suppresses apoptosis

What is PGP?

p-glycoprotein Increases drug efflux from a cell

What does upregulation of MDR1 gene do?

Codes for PGP Indirectly increases drug efflux from a cell

What is the MoA of cisplatin?

Forms crosslinks with purine bases on DNA Interferes with DNA repair mechanisms Induces apoptosis

Which receptor influences cisplatin uptake in a cell?

CTR1

What is 5-fluorouracil?

Antimetabolite chemotherapy drug Metabolites inhibit thymidylate synthetase - stops DNA synthesis

How does resistance to 5-fluorouracil occur?

Decreased intracellular activation of 5-FU to active metabolite

What does methotrexate inhibit?

DHFR

What effect is an overexpression of DHFR likely to have on methotrexate efficacy?

Cancer cell resistance to methotrexate

With regard to chemotherapy, what is FEC?

3 complementary chemotherapy drugs F - Fluorouracil - inhibits thymidylate synthetase - stops DNA synthesis E - Epirubicin - forms a complex with DNA C - Cyclophosphamide - forms DNA + RNA crosslinks