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36 Cards in this Set

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CANCER

What is the subclinical or latent phase of the cancer?
The time from the inception of a cancer (transformation of a single cell) to the time that the tumro becomes clinically detectable (one billion cells)

During this period it is impossible to detect
CANCER

What is tumor cell heterogeneity?
Tumor cells are very different from one another even though cancer cells look similar under the microscope.
CANCER

What is the tumor growth fraction?
The dividing cells / total cell number
CANCER

What are the four steps in the metastatic process?
1. clonal evolution
2. intravasation
3. extravasation
4. growth in the distant metastatic sites.

Most often occurs in the subclinical or latent phase of the cancer
CANCER

What does the stage of the cancer tell us?
Stage of cancer indicates the extent of disease at the time of diagnosis and determines the prognosis and treatment.
CANCER

All staging systems are reduced to three basic stages:
1. CA localized to organ of origin
2. CA localized to organ of origin with spread to regional draining lymph nodes
3. disseminated disease
CANCER

How does resisitance to CA occur?
It occurs as a chance, spontaneous event.
CANCER

Can we currently target the antineoplastic drug to the CA cell?
NO!!!
CANCER

What is the Skipper Hypothesis?
The ability of chemotherapy to cure CA is inversely proportional to the tumor burden.
CANCER

What are five examples of chemocurable CA's (that never develop resistance to chemotherapy);
1. disseminated testicular CA
2. some lymphomas
3. some leukemia's
4. Hodgkin's disease
CANCER

Five toxicities due to effect of chemotherapy on normal dividing cells?
1. transient myelosuppression
2. temporary hair loss
3. transient GI toxicity (damage to nL dividng cells of oral and GI mucosa)
4. sterility (effect of drug on dividing germ cell epithelium
5. second neoplasms due to the mutagenic effect of the drug on normal cells.
CANCER

When does hair loss occur?
2-3 wks after the first administration of the drug
CANCER

When does myelosuppression occur?
7-14 days following drug adminstration
CANCER

When do sore mouth and diarrhea occur?
1 week following treatment with chemotherapy
CANCER

When does nausea and vomiting occur?
12-24 hrs after first treatment
CANCER

When does the bodies bone marrow start getting back to normal?

So when do blood counts recover?
Around 21 days

Blood counts recover: between 21-28 days.
CANCER

What drugs cause cardiac toxicity?
Antracyclines
CANCER

What drug causes pulmonary toxicity?
Bleomycin
CANCER

What drug causes nephrotoxicity?
cis-DDP
CANCER

What is the most important test to run on a patient receiving chemotherapy?
Absolute neutrophil count

This is because segmented neutrophils and bands (immature neutrophils) are very important to fighting off bacterial infections.
CANCER

Are there any acute toxic effects of chemotherapy?
NO
CANCER

Is the fall in platelets and WBC's acute when using chemotherapy? Explain
No, it is not acute.

This is because the effect of chemotherapy is not on the formed elements of the blood but on the precursor cells in the bone marrow which are dividing. When chemotherapy is given the production of precursor cells or the platelets and the WBC's is temporarily halted but the circulating platelets and WBC's are not affected. It take about 1 week to see a decrease in production of PMN and platelets and bone marrow is back to normal about the third week following chemotherapy.
CANCER
VIP VIP VIP

What is the formula for the absolute neutrophil count:

Why is the ANC so important?
ANC = total white count x (fraction of PMN + fraction of bands)

ANC is important because if it fails below 500 you are at an increased risk of infection from bacteria in the gut. Bacteremia can occur. So any patient with a fever and ANC < 500 must be hospitalized and given broad spectrum antibiotics.
CANCER

Which count is more affected in chemotherapy: PMN or platelets?
PMN

but if platelets fall below 20,000 (rare) patient is at increased risk for hemorrhage and platelet transfusions are given.
CANCER

How can you reduce the severity of myelosuppression when administering chemotherapy?
Severity can be lessened with the use of granulocyte colony stimulating factor (G-CSF). This drug should be given 24hrs after each chemotherapy is given.

This drug will lessen myelosuppression but will not effect thrombocytopenia.
CANCER

What is another drug that causes pulmonary toxicity?
BCNU
CANCER

If cumulative toxicity reversible or irreversible?
Irreversible
CANCER2

In general, what does the stage of the cancer tell us?
The extent of disease at the time of diagnosis
CANCER2

What is used to determine the stage of a cancer?
1. PE
2. blood tests
3. imaging studies
CANCER2

Who gets chemotherapy?
1. someone with a cancer removed but who is believed to be at high risk of recurrance

2. someone with metastatic disease

3. someone with a large tumor burden before going into surgery so as to cause cytoreduction.
CANCER2

What is the log kill hypothesis?
Log Kill Hypothesis

The killing of CA cells by the chemotherapy durgs follows first order kinetics. The same fraction of CA cells is killed with each administration of chemotherapy (so we need multiple cycles of the drugs)
CANCER2

What is the fractional cell kill?
The fraction of cells killed with each administration of drugs. (it is never 100%)
CANCER2

Can tumor regrowth in between cycles of chemotherapy occur?
YES
CANCER2

What are the five rules for creating a combination therapy?
Combo therapy
1. each individual drug in the combo should have acitivity against the disease
2. the drugs should have non-overlapping toxicities (except for hairloss and myelosuppression, NV)
3. combine drugs with different MOA's
4. combine cell-cycle specific and cell-cycle non-specific drugs
5. drugs should be given at a maximally tolerated dose and schedule since there is a relationship between response rate and dose of chemotherapy administered. (Goldie-coleman hypothesis)
CANCER2
VIP

Indicate how the Goldie-Coleman hypothesis supports the administration of chemotherapy to patients who have had a CA removed but are at risk of recurrence at a later date.
If patients are at risk for recurrence chemotherapy must be administered initially so as to kill any micromets while they are still chemo-sensitive.
CANCER2

In staging of CA's, do all CA grow from stage 1 to 2 to 3, etc?
NO!! There is no orderly progression of stages. Can go from 1 to metastasis!