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54 Cards in this Set
- Front
- Back
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Staging
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extent or severity of an individual’s cancer based on the
extent of the primary tumor and the extent of spreading |
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Tumor Grade
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degree of abnormality of cancer cells compared with
normal cells |
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TNM System (staging)
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extent of the tumor (T), the extent of spread to lymph
nodes (N), and the presence of metastasis (M) |
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Primary (T)
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TX Primary tumor cannot be evaluated
T0 No evidence of primary tumor Tis Carcinoma in situ (early cancer that has not spread to neighboring tissue) T1, T2, T3, T4 Size and/or extent of the primary tumor |
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Regional Lymph Nodes (N)
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NX Regional lymph nodes cannot be evaluated
N0 No regional lymph node involvement (no cancer found in the lymph nodes) N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread) |
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Distant Metastasis (M)
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MX Distant metastasis cannot be evaluated
M0 No distant metastasis (cancer has not spread to other parts of the body) M1 Distant metastasis (cancer has spread to distant parts of the body) |
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Stage 0
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early cancer that is present
only in layer of cells in which it began |
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Stage I,II,III
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higher numbers more
extensive: greater tumor size and/or spread to nearby lymph nodes and/ or organs adjacent to primary tumor |
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Stage IV
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metastasis to another
organ |
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Tumor Grade
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Grade
GX Grade cannot be assessed (Undetermined grade) G1 Well-differentiated (Low grade) G2 Moderately well-differentiated (Intermediate grade) G3 Poorly differentiated (High grade) G4 Undifferentiated (High grade) |
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Biopsy (Surgery)
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A biopsy is almost always necessary to help the doctor make a diagnosis of cancer. In a biopsy, tissue is removed for examination under a microscope by a pathologist. Tissue may be removed in three ways: endoscopy, needle biopsy, or surgical biopsy.
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Needle Biopsy
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In a needle biopsy, the doctor takes a small tissue sample by inserting a needle into the abnormal (suspicious) area.
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Surgical Biopsy
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A surgical biopsy may be excisional or incisional. In an excisional biopsy, the surgeon removes the entire tumor, often with some surrounding normal tissue. In an incisional biopsy, the doctor removes just a portion of the tumor. If cancer is present, the entire tumor may be removed immediately or during another operation.
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Cryosurgery 1
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Cryosurgery is a technique for freezing and killing abnormal cells.
It is used to treat some kinds of cancer and some precancerous or noncancerous conditions, and can be used both inside the body and on the skin (early-stage basal and squamous cell carcinomas) |
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Cryosurgery 2
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Cryosurgery is an alternative to surgery for liver cancer that has
not spread, for cancer that has spread to the liver from another site, for prostate cancer confined to the prostate gland, for a precancerous condition of the cervix, and for cancerous and noncancerous tumors of the bone |
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Cryosurgery 3
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Cryosurgery may have fewer side effects than other types of
treatments, and is less expensive and requires shorter recovery times |
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Radiotherapy
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The use of ionizing radiation for the targeted destruction
of cancer cells Photons of energy - X-rays, gamma rays Radioactive implants Radioimmunotherapy - antibodies Radiosensitizers (5-fluoruracil, cisplatin)/Radioprotectors ~50% of all cancer patients receive some type of radiation therapy |
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What is Radiotherapy?
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The use of energy (ionizing radiation) to kill cancer cells by DAMAGING DNA which affects DNA REPLICATION in DIVIDING CELLS [dividing cells are more sensitive to damaging effects because replication is blocked; radiation also damages the DNA of normal non-dividing cells (creates mutations), but this damage can be repaired]
Direct damage or indirect (creates free radicals) |
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When is Radiotherapy Used?
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The use of radiation therapy in cancer treatment is extensive and has different goals, including:
Killing cancer cells Shrinking tumors Pain relief (palliative therapy) Prophylactic (ex. cranial irradiation in cases of small cell lung cancer) and solid tumors |
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When is radiotherapy given?
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BEFORE, AFTER and/or DURING (intraoperative) SURGERY
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Intra-Operative
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radiation during surgery for tumors that can’t be completely removed OR when there is a high risk of reoccurrence in nearby tissue [high dose to surgical area] ex. thyroid, colorectal, small intestine, pancreas, brain [clinical trials]
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Types of Radiation therapy?
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EXTERNAL - radiation source (X-rays [low or high energy], Gamma rays [from breakdown of elements like iridium and cobalt 60], Particle beams [fast moving subatomic particles like protons]) is outside of body; LINAC – electricity to form fast-moving subatomic particles (high-energy radiation)
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Internal Radiation Therapy
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INTERNAL - RADIATION IMPLANTS (thin wire, plastic tube, ribbon, capsule [seed])
interstitial - implant inserted into tissue (ex. head & neck, prostate, cervix, ovary, breast) intracavity - implant inserted into open space (ex. uterine, in trial bronchial, cervical, oral, rectal, tracheal) |
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Systemic Radiation Therapy
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injected or delivered orally, source usually radioactive element (ex. iodine [I131] or strontium [Sr89] – bone metastasis [Metason]); radioactive coupled antibodies [Zevalin, Bexxar] – B-cells
Ex. thyroid, non-Hodgkins lymphoma |
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Radiosurgery
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Radiosurgery - large dose radiation to destroy tumor tissue in brain - imaging used to precisely locate site and deliver radiation to small area (small tumors, metastatic tumors)
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3-D Conformal Radiation Therapy
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use of computers; 3-D image of a tumor used to design radiation beams that conform to shape a tumor
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Intensity Modulated Radiation Therapy
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varying intensities to deliver doses of radiation to different areas of the tumor
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Radiosensitizers and radioprotectors
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chemicals to modify cell's response to radiation
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neutropenia
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depletion of white blood cells leads to higher risk of infection
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Chemotherapy
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Chemotherapy is the treatment of cancer with drugs that can
destroy cancer cells. These drugs often are called "anticancer" drugs. |
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How does Chemotherapy work?
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Normal cells grow and die in a controlled way. When cancer occurs,
cells in the body that are not normal keep dividing and forming more cells without control. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying. Healthy cells are also harmed, especially those that are dividing. Harm to healthy cells is what causes side effects. |
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Goals of Chemotherapy
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Depending on the type of cancer and how advanced it is, chemotherapy
can be used for different goals: To cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells for a given period of time. To control the cancer. This is done by keeping the cancer from spreading; slowing the cancer's growth; and killing cancer cells that may have spread to other parts of the body from the original tumor. To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably. |
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Combination Therapy
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SURGERY, CHEMOTHERAPY, RADIATION
SURGERY, CHEMOTHERAPY SURGERY, RADIATION CHEMOTHERAPY, RADIATION |
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How do Anticancer drugs kill dividing cells
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MOST ANTICANCER DRUGS DISRUPT THE NORMAL CELL CYCLE - inhibition of DNA replication and repair or direct effects on mitosis
alkylating agents, nitrosoureas, antimetabolites, anthracyclines, topoisomerase and mitotic inhibitors |
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Alkylating Agents
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• among the first anticancer drugs and most widely used
• DAMAGE DNA - add “alkyl” groups to bases; cause cross-linking of DNA strands, abnormal base pairing, DNA strand breaks • cell cycle phase NONSPECIFIC • most effective in treating slow-growing cancers (ex. chronic leukemias, lymphomas, multiple myeloma … ) ex. busulfan, cisplatin, chlorambucil, cyclophospamide, mechlorethamine |
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Antimetabolites
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• interfere with DNA synthesis by replacing natural building blocks of DNA
• cell cycle phase SPECIFIC [S phase] • used in treating leukemias, tumors of breast, ovary, gastrointestinal tract … ex. 5-fluorouracil, 6-mercaptopurine, methotrexate, gemcitabine, fluarabine |
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Nitrosoureas
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• interfere with DNA replication and repair enzymes
• can cross the “blood-brain barrier” • cell cycle phase NONSPECIFIC • used to treat brain tumors, lymphomas, multiple myeloma, malignant melanoma • ex. carmustine, lomustine, streptozocin |
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Anthracyclines (Antitumor Antibiotics)
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bind to DNA and inhibit transcription
cell cycle phase NONSPECIFIC toxic effects (especially on cardiac muscle), dose limits used for a wide variety of cancers ex. doxorubicin, bleomycin, mitoxantrone |
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Mitotic Inhibitors (Plant Alkaloids)
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block mitosis or inhibit translation
work primarily during M-PHASE (mitosis) some disrupt formation of mitotic spindle taxanes (paclitaxel, docetaxel) and vinca alkaloids (vinblastine, vincristine) |
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Topoisomerase Inhibitors
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enzyme required for successful DNA replication
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Topoisomerase Inhibitors
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cell cycle phase SPECIFIC [S phase]
used to treat certain leukemias and lung, ovarian, gastrointestinal cancers ex. topotecan, irinotecan, etoposide, teniposide |
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How is Chemotherapy Given?
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INTRAVENOUS - injection into a vein; four ways of giving chemotherapy drugs directly into the vein
* Cannula – a small tube inserted into a vein in your arm or the back of your hand. * Central line – a thin, flexible tube inserted through the skin of the chest into a vein near the heart. * PICC line (a peripherally inserted central catheter) – a thin flexible tube passed into a vein in the crook of the arm and threaded through until the end of the tube lies in a vein near the heart. * Implantable port (also called a portacath) – a thin, soft plastic tube that is put into a vein. It has an opening (port) just under the skin on your chest or arm. |
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How is Chemotherapy Given? 2
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ORALLY - tablets or capsules that are swallowed, usually taken at home
INTRAMUSCULAR INJECTION - given by injection into the muscle of the leg or buttock SUBCUTANEOUS INJECTION - injection just under the skin INTRACAVITY - tube is inserted into the affected body cavity, for example the bladder; the chemotherapy is flushed in through the tube and may then be drained out again after a set period of time |
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How is Chemotherapy Given? 3
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INTRATHECAL INJECTION - given into the cerebrospinal fluid or CSF; local anesthetic to numb area of skin over your spine, needle inserted into the space between two of the spinal bones and into the CSF
CHEMOTHERAPY CREAMS - topical application; used for some types of skin cancer and cutaneous T-cell lymphoma |
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Side Effects of Chemotherapy
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* Tiredness
* Bone marrow - infection/anemia/clotting * Nausea and vomiting * Loss of appetite * Diarrhea and constipation * Mouth sores * Taste changes * Hair loss (alopecia) * Skin changes (“radiation recall”) * Nail changes * Effects on the nerves * Effects on the nervous system * Change in kidney function * Infertility * Changes in hearing * Second cancer |
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Bone Marrow
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Chemotherapy can reduce the number of blood cells produced by the bone marrow. Bone marrow is a spongy material that fills the bones and produces the cells (called stem cells) which develop into the three different types of blood cells:
* Red blood cells, which carry oxygen to all cells in the body. * White blood cells, which are essential for fighting infection. * Platelets, which help the blood to clot and control bleeding. All these cells normally stay inside the bone marrow until they are mature enough to perform their functions properly. They are then released into the bloodstream so that they can circulate around the body in the blood. TREATMENTS - Erythropoietin, G-CSF, Blood/Platelet Transfusions |
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Nausea and Vomiting
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Some, but not all, chemotherapy drugs can make you feel sick (nausea), or actually be sick (vomit). Many people have no sickness because there are now effective treatments to prevent and control it (anti-emetic drugs and steroids).
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Nervous System Effects
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Some chemotherapy drugs can affect the nerves in the hands and feet causing tingling or numbness, or a sensation of pins and needles (peripheral neuropathy). Some drugs can make patients feel anxious, restless, dizzy, sleepy or have headaches.
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How long is Chemotherapy Given?
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The length of chemotherapy treatment is determined by a variety of factors: type of cancer, the extent of cancer, the types of drugs that are given, as well as the expected toxicities of the drugs and the amount of time necessary to recover from these toxicities. Most chemotherapy treatment schedules (including the type and length of chemotherapy treatment) have been determined through clinical trials.
In general, chemotherapy treatment is given in cycles. This allows the cancer cells to be attacked but also allows the body's normal cells time to recover from the damage. Treatments vary by cycle time, duration of the cycle, frequency of the cycle, and how many cycles. |
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RSV
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transforms normal cells into cancer cells
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Oncogenes
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I. ONCOGENES - promoters of cell division
A. Functional Classes 1. growth factors (GFs, growth factor receptors (GFRs), intracellular signal transducers (ISTs, transcription factors (TFs) |
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Oncogene examples
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1. GF – EGF, GFR – EGFR, IST – ras, TF – myc
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Tumor Suppressor Genes
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A. Functional Classes
1. regulators of cell cycle checkpoints B. Mutations 1. loss of function, recessives C. Examples 1. Retinoblastoma (Rb) – sporadic vs. hereditary; two-hit hypothesis |
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Tumor Viruses
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A. RNA (Retroviruses)
1. Acutely Transforming – carry activated oncogene, ex. RSV 2. Slowly Transforming – insertional effects, ex. ALV B. DNA 1. Oncogenes – cellular TSG inactivation, ex. HPV |
