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Part 4 – PM4B Ali > (SYNOPTIC) Cancer Recap > Flashcards

(SYNOPTIC) Cancer Recap Flashcards

1
Q

What does the ‘pathobiology’ of cancer refer to?

A

How a cancer cell forms

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2
Q

What is cancer?

A

Collection of diseases

Underlying features of uncontrolled cell growth

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3
Q

How is a cancer cell formed?

A

Normal cell undergoes specific changes

Allows it to proliferate without normal limit

Spread to surrounding/ distant tissues

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4
Q

What are the hallmarks of a cancer cell?

A

(1) Growth factor independence
(2) Insensitivity to growth inhibitors
(3) Proliferation without limit
(4) Avoid apoptosis

(5) Promote angiogenesis
- Development of new blood vessels

(6) Invade and metastasise

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5
Q

What causes cancer?

A

A single cell acquiring most/ all hallmarks of cancer via multiple mutations

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6
Q

Why is cancer more prevalent in older people?

A

Developing enough mutations to progress to a cancerous cell takes time

As it requires multiple mutations to achieve most/ all hallmarks

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7
Q

What are the aims in management of cancer?

A

(1) Prevention
(2) Early detection
(3) Total eradication

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8
Q

What is the hierarchy of aims in cancer management?

A

(1) Cure
- Eradication of tumour + metastasis

(2) Remission/ mitigation
- Significant reduction in tumour load

(3) Symptomatic care/ palliation
- Treatment of secondary complications
- Relief of symptoms

(4) Terminal care
- Improve quality of life
- Optimise symptom control

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9
Q

What are the main modes of therapy in cancer?

A

(1) Surgery
(2) Chemotherapy
(3) Radiotherapy

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10
Q

When is surgery appropriate in cancer therapy?

A

(1) Well-defined solid tumour
(2) Non-vital region
(3) Non-mutilating result
(4) Resection/ reconstruction possible (e.g. gut)

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11
Q

When is chemotherapy appropriate in cancer therapy?

A

(1) Adjuvant therapy following surgery/ radiotherapy
(2) Neo-adjuvant therapy prior to surgery/ radiotherapy
(3) Widely disseminated/ metastasised
(4) Diffuse tumour

(5) Palliation
- Reduce symptoms

(6) Some primary tumours
- e.g. Hodgkins lymphoma

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12
Q

When is radiotherapy appropriate in cancer therapy?

A

(1) Diffuse but localised tumour

(2) Vital organ/ region
- Head/ neck/ CNS

(3) Adjuvant therapy
(4) Palliation

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13
Q

What is the rationale of chemotherapy?

A

Target cancerous cells during rapid proliferation

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14
Q

What is important when choosing chemotherapeutic agents for use in combination?

A

Minimal overlap in toxicity

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15
Q

Why should chemotherapy be delivered intermittently?

A

To allow for recovery of most sensitive tissues

- Rapidly dividing, e.g. bone marrow/ gut mucosa/ hair follicles

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16
Q

What are some rapidly dividing cells in the body?

A

(1) White blood cells (bone marrow)
(2) Gut mucosa
(3) Hair follicles

17
Q

How do anti-metabolites function in chemotherapy?

A

G1 Phase

- Prevent synthesis of components of DNA

18
Q

How do microtubule inhibitors function in chemotherapy?

A

G2 Phase

- Prevent cells making components needed to separate

19
Q

What are some examples of anti-metabolites?

A

(1) Methotrexate

(2) Azathioprine

20
Q

What are some examples of microtubule inhibitors?

A

Vinca alkaloids

  • Vinblastine
  • Vincristine
  • Docetaxol
21
Q

How do agents binding to DNA function in chemotherapy?

A

S Phase

- Prevent DNA synthesis

22
Q

What are some examples of agents that bind to DNA in chemotherapy?

A

(1) Alkylating agents
(2) Anti-tumour ABx
(3) Platinum compounds

23
Q

When were single chemotherapy agents used?

A

Used until early 1960s

24
Q

When was combination chemotherapy introduced?

A

1960s

25
Q

Why is combined chemotherapy used, instead of single chemotherapy?

A

(1) Increased remission
- More patients
- Longer remission period

26
Q

What is a downside of combined chemotherapy?

A

Increased side effects

27
Q

What are some potential single agent chemotherapies still used?

A

(1) Tyrosine kinase inhibitor

(2) Monoclonal Antibodies

28
Q

How can side effects of chemotherapy be minimised?

A

(1) Close monitoring
- FBCs

(2) Cycle
- Allow for marrow recovery between treatments
- Administration of stem cells to selectively enhance bone marrow proliferation

(3) Forced diuresis
- Given with nephrotoxic/ bladder-toxic drugs
- Reduce contact time + urine conc.

29
Q

What is forced diuresis, used in chemotherapy?

A

Modest over-hydration before therapy

Followed by a diuretic

30
Q

Why is forced diuresis used in chemotherapy?

A

Maintain a high urine output for at least 24hrs following therapy

Reduce urine conc. + contact time of nephro/bladder-toxic drugs

31
Q

What is an example of a drug used in forced diuresis?

A

Mannitol

Part 4 – PM4B Ali (19 decks)

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