Week 5- Oncology (pt 3) Flashcards
Major chemotherapeutic agents that induce binding within DNA strands and prevent DNA function and replication
Alkylating agents
Major chemotherapeutic agents that are structurally similar to endogenous metabolites and compete with these compounds during DNA/RNA biosynthesis
Antimetabolites
Primary mechanisms of antimetabolites
(1) Mimic the active ingredients or (2) other constituents needed for DNA synthesis and replication
True or false: Antibiotics are incorporated into the DNA strand between base pairs
True
Antibiotics may also induce the formation of _________, leading to DNA strand breakage
Free radicals
Major chemotherapeutic agents that disrupt the normal function of the spindle apparatus (mitotic spindle) and prevent the cell from dividing and proliferating
Antimicrotubule (microtubule-targeting) agents
Major chemotherapeutic agents that disrupt cellular mitosis by bind to the microtubule and inhibit microtubules assembly or disassembly
Antimicrotubule (microtubule-targeting) agents
__________ catalyzes the cutting and re-ligating of DNA strands during the unwinding/rewinding process of DNA replication
Topoisomerase
The ___________ render the cell unable to replicate
Topoisomerase inhibitors
True or false: All forms of cancer are hormone sensitive, because they tend to be exacerbated by certain hormones and attenuated by others
False
(several– not all)
Major chemotherapeutic agents that mimic or block (antagonize) the effects of sex hormones to treat certain hormone-sensitive forms of cancer
Anticancer hormones
Two mechanisms of anticancer hormones
(1) Direct inhibitory effects on cancerous cells or (2) by negative feedback mechanisms that decrease the endogenous hormonal stimulation of the tumor
Also known as heavy metal compounds
Platinum coordination complexes
Major chemotherapeutic agents that form strong cross-links between and within DNA strands, thereby preventing DNA translation and replication
Platinum coordination complexes
True or false: There are agents that bind to targets on or in cancer cells and transmit intracellular signals resulting in cell death, deliver chemotherapeutic agents to the disease site, or prevent cell growth and proliferation
True
Chemotherapeutic agents that stimulate the immune mechanisms by increasing proliferation and activity of immune cellsthat destroyabnormal cell proliferation (cancercells) without harming normal cells
Cytokines
Insidious cancer cells synthesize a glycoprotein that is inserted into the cell’s __________ and effectively ___________ drugs from the cancer
Membrane
Expels
_____________ produce enzymes and specific and specific substances that __________ drugs within the cancer cell
Insidious cancer cells
Inactivate
True or false: Insidious cancer cells develop mechanisms that destroy DNA damaged by drugs
False
(repair… not destroy)
True or false: Insidious cancer modify the structure or function of drug receptors so that the drug is unable to bind to receptor
True
Many agents are ______ and _________
Systemic
Nonspecific
Normal cells most at risk for damage are those that normally have ______________.
High mitotic rates
Antineoplastic drugs typically have a very _____ therapeutic index (TI)
Low
True or false: Some side effects of chemotherapy can be treated with other drugs
True
The most noticeable and distressing adverse effect of chemotherapy
Alopecia
Actively growing hear or hair in the ________ phase is very susceptible to chemo
Anagen
True or false: Hair is not the most rapidly proliferating cell population in the body
False
(it is)
Alopecia typically occurs within 1-3 weeks and is usually _________
Temporary
__________ of hair is 2-3 months after termination of treatment
Regrowth
True or false: Experience with alopecia may vary; ranging from thinning of hair to complete loss of hair, including eyelashes, eyebrows, and body hair
True
True or false: Cells of the oral cavity and GI tract normally divide slowly
False
(quickly– not slowly)
Ulcerations or damage of the mucous cells lining the GI tract
Mucositis
Abdominal pain, bloating, nausea/vomiting, diarrhea, constipation
Mucositis
This side effects occurs 1-2 hours, peaks at 4-10 hours, and lasts 12-24 hours after administration (1-5 days after platinum-based agents)
Chemotherapy-induced nausea (CINV)
The inhibition of bone marrow cells
Myelosuppression
Fewer red cells —> ?
Fewer white cells (leukopenia) —-> ?
Fewer platelets –> ?
Anemia
Infections and fever
Bleeding
Reduced number of neutrophils
Neutropenia
Effects of prolonged neutropenia
-Severe and life threatening infections
-Fungal infections become more likely
-Gram positive bacteria are seen most often
-Gram negative bacteria are the cause of most serious infections, with a higher mortality
Persistent, distressing, subjective sense of physical, emotional, and/or cognitive tiredness related to cancer or cancer treatment that is not relieved by rest and is disproportional with recent activity
Fatigue
True or false: Fatigue interferes with a person’s ability to perform daily tasks and reduce quality of life
True
True or false: Fatigue peaks within a few weeks after therapy
False
(days– not weeks)
Manifestation of cardiomyopathy
-Heart failure
-Reduced left ventricular ejection fraction
-Arrhythmias
-Myocarditis
-Myocardial ischemia/infarction
-Pericarditis
Symptoms to this chemotherapy adverse effect are bronchospasm, fibrosis, or pneumonitis
Pulmonary toxicity
True or false: Symptoms of pulmonary toxicity occur within a few months of starting treatment
True
__________ can occur years after completion of treatment (think of pulmonary toxicity)
Fibrosis
True or false: Risk of pulmonary toxicity is increased with advancing age, tobacco use, concomitant irradiation, and accumulated dose
True
Many chemo agents, antibiotics, and other drugs used in cancer treatment are metabolized and excreted by the ________
Kidneys
Cytotoxic drugs destroy malignant cells —> ? —> kidneys are unable to tolerate the sudden load
Releasing large amounts of intracellular ions and metabolic byproducts
Manefistations of TLS
Hyperkalemia (potassium)
Hyperuricemia (uric acid)
Hyperphosphatemia (phosphate) –> hypocalcemia
True or false: Damage to the liver can also change the metabolism of other chemotherapy drugs or medications used for other purposes, increasing toxicities
True
The synthesis of fatty acids and retention of lipids in hepatocytes
Steatosis
A distinctive and potentially fatal form of hepatic injury that occurs predominantly, if not only, after drug or toxin exposure
Sinusoidal obstruction syndrome (SOS)
A toxicity-related injury of peripheral neurons
Chemotherapy induced peripheral neuropathy (CIPN)
Symptoms of CIPN
Numbness, tingling, burning of hands/feet that will progress in a distal to proximal pattern as neuropathy becomes more severe
Weakness and/or cramping of distal muscles, decreased balance, gait instability, and decreased fine motor coordination
Symptoms may include Neurovascular complications, headaches, focal neurologic deficits, generalized neurologic decline with cognitive impairment, seizure activity, spinal cord damage with myelopathy, cortical atrophy, and white matter abnormalities
CNS toxicity
3 types of Immunotherapy
Cytokines
Adjuvants
Monoclonal antibodies
Boosts immune responses against tumors through the administration of immunomodulatory factors
Immunotherapy
True or false: A method of adoptive cell therapy in immunotherapy is isolating T cells from within or around a tumor, ex vivo expand these cells with IL-2, and infuse them back into the patient
True
Also known as bone marrow transplantation
Hematopoietic cell transplantation
True or false: High does of chemo/radiation are not toxic to bone marrow
False
(they are toxic)
Type of immunotherapy that destroys specific cancer cells without disturbing healthy cells
Targeted therapy
Large, complex, Y-shaped molecules that bind to specific antigens on the surface of some cells and can destroy cancer cells
Monoclonal antibodies (mAbs)
This enzyme can block other enzymes and receptors involved in cancer cell growth and proliferation
Tyrosine kinase enzyme
True or false: Tumor cells can survive without oxygen and other nutrients transported by the blood
False
(they cannot survive)
These block the formation of new blood vessels supplying cancer cells
Angiogenesis inhibitors
This type of therapy can help treat breast or prostate cancer
Hormonal therapy
These block the ability of estrogen to stimulate tumor growth in estrogen positive tumors
Selective estrogen receptor modifiers (SERMs)
True or false: Palliative treatment occurs when curative measures are no longer possible or available
True
Examples of palliative care
-Radiation
-Chemotherapy
-Physical therapy (e.g., physical agents, exercise, positioning, relaxation techniques, biofeedback, or manual therapy)
-Medications
-Acupuncture
-Chiropractic care
-Alternative medicine (e.g., homeopathic and naturopathic treatment)
-Hospice care
Sometimes referred to as integrative medicine, energy medicine, or bioenergetics
Complementary and alternative medicine
Examples of complementary and alternative medicine
-Acupuncture
-Reike
-BodyTalk
-Hypnosis
-Mind body techniques
-Massage
-Music
-Tai Chi
-Qi gong
-Yoga
-Meditation
Prognosis is influenced by…
-Type of cancer
-Stage and grade of disease at diagnosis
-Availability of effective treatment
-Response to treatment
-Other factors related to lifestyle such as smoking, alcohol consumption, diet, nutrition, and exercise
True or false: The earlier cancers are found, the harder treatment may be, and the lesser likelihood of a cure
False
(simpler treatment, greater likelihood)
True or false: Prognosis is great for anyone with advanced, disseminated cancer
False
(poor… not great)
True or false: The terms survival and cure do not always portray the functional status of a cancer survivor
True
Term that may be used when all signs of the disease have disappeared after treatment but before the end of 5 years occurs and there are no signs of the disease using current tests
No evidence of disease
Term used if response is maintained for a long period of time
Durable remission
A person who is alive and without evidence of disease for at least 5 years after diagnosis
Cured
Disease-free Survival, Event-free Survival, Progression-free Survival, Complete Response, Stable Disease, Near-complete Response, Partial Response, Progressive Disease are terms used to describe…
Cancer treatment outcomes
True or false: Cancer diagnosis is considered a death sentence
False
(not anymore)
True or false: Many people considered cured are left with physical limitations and movement dysfunctions that interfere with their daily lives
True
Exercise plays an important role in cancer _________and __________ the side effects of cancer treatment and promoting improved health among cancer survivors
Prevention
Ameliorating
True or false: PTs working with oncology patients are encouraged to evaluate the research to find the best choice of exercise for a specific cancer
True
A ___________ lifestyle is a risk factor for several of the most common types of cancer
Sedentary
________ minutes of _____________ physical activity at least ______ days/week will reduce the risk of cancer
30-60
Moderate to vigorous
5 days / week
Type, frequency, duration, and intensity of exercise should be individualized on the basis of:
-Age
-Previous fitness level
-Type of cancer and treatment
-Presence of any additional comorbidities
During a screening and assessment, a therapist will…
-Take a detailed history of treatment
-Examine lab results
-Distinguish between fatigue and deconditioning and fatigue from medical interventions
During exercise, the therapist should always…
-Monitor oxygen saturation with pulse oximetry
-Evaluate pulse rate
-Breathing frequency
-Blood pressure before, during, and after treatment session
-Watch for early signs of cardiopulmonary complications
Each year approximately ________ children in the US are diagnosed with cancer
8400
With recent advances in treatment, ____% of these children will survive ____ years or more
79
5
_________ is the second leading cause of death among children between 1 and 14 years of age
Cancer
________ is one of the most common pediatric malignancies
Leukemia
The term ________ refers to the damaging effects of surgery, radiation, and chemotherapy on nonmalignant tissues, as well as to the social, emotional, and economic consequences of survival
Late effects
True or false: Late effects have been identified in almost every organ system
True
Surgery and radiation involving the ____________ system have been associated with defects such as kyphosis, scoliosis, and spinal shortening
Musculoskeletal
Finally, the child who has received radiation or chemotherapy has a 10-fold _________ chance of developing a second malignancy than a child who has never had cancer
Greater
Which chemotherapy agents bind to DNA and prevent DNA replication?
-Antimetabolites
-Alkylating agents
-Microtubule targeting agents
-Topoisomerase inhibitors
Alkylating agents
Tamoxifen in an antiestrogen hormonal agent is used in __________ to block estrogen receptors in tumor cells that require estrogen to thrive.
-Colorectal cancer
-Bone cancer
-Breast cancer
-Lung cancer
Breast cancer
Monoclonal antibodies may be especially effective in treating certain cancers because these drugs
-create a strong alkyl reaction with the DNA molecule.
-directly inhibit the topoisomerase enzyme responsible for DNA synthesis.
-bind to antigens on the surface of a particular type of cancer cells.
-directly inhibit the mitotic apparatus that is responsible for controlling cell division (mitosis).
Bind to antigens on the surface of a particular type of cancer cells.
A relatively new strategy for treating certain tumors is to prevent the formation of new blood vessels, thus impairing tumor growth by starving the tumor of oxygen and nutrients. Drugs that use this strategy are known as ______________.
-Topoisomerase inhibitors
-Aromatase inhibitors
-Angiogenesis inhibitors
-Antimetabolites
Angiogenesis inhibitors
Most cancer chemotherapy agents exert severe and potentially toxic side effects because
-these drugs have a high therapeutic index (TI).
-most of these drugs are not approved by the FDA.
-most of these drugs do not discriminate between healthy tissues and cancerous cells.
-these drugs all have extremely long half-lives, and tend to accumulate in the body for an extended period of time.
most of these drugs do not discriminate between healthy tissues and cancerous cells.
Some of the newer cancer chemotherapy agents (e.g., cytokines) are called biological therapies or biological response modifiers because they
-form strong alkyl bonds within the DNA of the cancerous cell.
- act as false nucleic acid precursors during DNA biosynthesis.
- encourage the body’s immune system to fight cancerous cells.
-encourage the mitotic apparatus to function more effectively.
Encourage the body’s immune system to fight cancerous cells.
The drug subclass of cytarabine is antimetabolites. What is the mechanism of action of cytarabine?
-Disrupt the normal function of the spindle apparatus (mitotic spindle) and prevent the cell from dividing and proliferating
-Inhibit topoisomerase during the unwinding/rewinding process of DNA replication
-Inhibit DNA and RNA synthesis
-Inhibit tyrosine kinase receptors
Inhibit DNA and RNA synthesis
Which of the following therapy options is considered as nonpharmacologic modality for cancer pain?
-Chemotherapy
-Relaxation therapy
-Steroids
-Opioid analgesics
Relaxation therapy
Tumor lysis syndrome (TLS) is a serious complication of chemotherapy that has significant adverse effects on the ____________.
-Liver
-Kidney
-Bone marrow
-Nerves
Kidney
Drug class for Fluorouracil
Antimetabolite
