Learning Cards- Gettys Oncology Handouts N205 Hacc

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Ablation- removal of tissue from the surface by vaporization

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Absolute Neutrophil Count ANC- the real number of WBC that are neutrophils. Referenced a lot in oncology

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Adjuvant therapy- use of treatment with no evidence of metastases. Used after primary surgical treatment

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Aplastic anemia- anemia caused by deficiency of RBC production due to bone marrow disorders. Could be due to cancer or treatment

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apoptosis- programmed cell death according to the genetic limitation of the lifespan of a cell. Important in limiting the growth of tumors

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Bands- an immature developing leukocyte in the circulating blood. This is indication of a problem- either infection or other

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b-cell - b-lymphocyte/ originates in the bone marrow. Precursor to a plasma cell. Protects against bacterial infection, lymphocytes that transform into plasma cells and secrete anitbodies

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Blast cell- an immature form of a blood cell (erythroblast, lymphoblast)

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CA-125 - an antigen produced by epithelial tissues. Tumor marker for epithelial cancers especially ovarian cancer. Lots of false posatives, non-specific

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Cancer in SITU- early-stage cancer. Before the invasion of surrounding tissue. USually implies total cancer removal with surgical incision

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Carcinogenesis- the transformation of normal cells into cancer cells. The process of initiation, promotion, and progression.

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CEA- carcinoembryonic antigen. Tumor marker for colon cancer and other abdominal cancers.

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CINV- chemotherapy induced nausea vomiting.
Seen in the charts a lot. Radiation induced.

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cytoprotective medications- administered immediately before RT or chemo to prevent severe reactions to the drug. Protects the organs

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Cytokines- proteins secreted by various cell types and involved in cell-to-cell communication. Include colony stimulating factors, interferons, and lymphokines.

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Debulking- surgically remove as much tumor as possible. Usually for pain management. Sometimes done before chemo to increase effectiveness.

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differentiation- the process where a cell changes in structure and function as it matures

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well-differentiated- cancer cells that closely resemble the tissure of origin. young cells. Easier to treat.

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undifferentiated(anaplasia)- reverting to a less developed state, the loss of structural organization or differentiation of cell, and useful function of a cell.

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EGFR- epidermal growth factor receptor- a growth factor that has been found to stimulate cancer cells. Especially in the colon. i

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erythropoetin- a horomone secreted by the kidneys to stimulate bone marrow to make RBC

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extravasation-leakage or infiltration of a vesicent chemotherapy agent into local tissue. Can result in tendon and nerve damage and may progress 6 months after incident

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FIGO- staging- International Federation of Gynecology and Obstetrics

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GCSF- Granulocyte Colony Stimulating Factor- a hematopoietic growth factor that works by encouraging the bone marrow to produce more WBC. Growth factors are proteins.

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Graft vs Host(GVHD)- bone marrow of the donor contains antigens not matched to the recipients antigens. Antigens begin attacking body cells.

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HER2- Human Eipdermal growth factor Receptor 2- makes breast cancer more aggressive but there are drugs specific and work well with it.

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Metastasis- the spread of cells from a primary tumor via the lymphatic system or circulatory system to distant body parts where such cells give rise to tumor mass. Cancer will look like cells from original site

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Metastatic disease- when cancer metastasized in a patient

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mucositis- inflammation of ANY mucus membranes

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Nadir- the period of time when cancer treatment medications have their most profound effects on the bone marrow. RBC, WBC at their lowest when in Nadir.

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neoplasm- an abnormal mass of cells typically exhibiting progressive and uncontrolled growth. Classifies by the cell type from which they originate and their biologic behavior. Can be benign or malignant

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neutropenia- low neutrophil count. <500. Life threatening. Neutropenic Precautions implemented.

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oncogene- pieces of genetic information located in the cell. Carcinogens may activate oncogenes and alter the regulatory mechanisms of the cell.

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palliative- therapy designed to reduce intensity of symptoms but not intended to produce a cure.

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PAP- prostatic acid phosphates

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Plasma cell- a cell that originates from B-cell lymphocytes and secretes an antibody

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PSA- prostatic serum antigen- blood test to test for prostate cancer. Tumor marker.

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Rescue agents- administered subsequently to chemo or RT to counteract effects of the medication/treatment (ex- granulocyte colony stimulating factors). Given to help rescue bone marrow and stimulate it to produce

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staging- classification of disease progression. In general, lower stages are more localized. HIgher stages involve metastasis. Specific staging depends on type of cancer.

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Stem cell- a cell with unlimited reproductive capacity. Stem cells have the potential to develop into several different types of mature cells. All blood cells originate from a stem cell.

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Stomatitis- inflammation of the mouth. Including lips tongue, and mucous membranes.

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t-cells : originate from stem cells. monitors the immune system. Acts directly on antigens to distory them

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tumor marker- a product produced by a cancer cell or in response to the presence of cancer which may be released into the circulation or may remain associated with the cancer cell

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VEGF- vascular endothelial growth factor- a substance made by cells that stimulates new blood vessel formation

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Vesicant- any agent that has potential to cause blistering or tissue necrosis when extravasated. Not all chemo cause tissue damage

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Xerostomia- dry mouth- usually caused by salivary impairment caused by cancer treatment. Andriomycin is one.

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irritant-tissue damage drug, not as bad as vesicant, but still as bad. Feneragan.

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Medications given before, during, and after chemo- ativan, benedryl, decadron, protonix, reglan, zofran

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ativan(lorazepam)- for anxiety and anticipatory N/V
IVP PO

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benadryl (diphenhydramine) antihistamine, for hypersensativity

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decadron(dexamethasone)- steriod L/A- prekemo N/V inflammation
IVP PO

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Protonix(pantoprazole)- PPI, used with steroids to protect stomach
IVP PO

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Reglan(metoclopramide)- antiemetic, speeds stomach, used in prechemo
PO IV

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Zofran(ondansetron) or Aloxi(palonosetron)- antiemetics N/V
IM PO SL IVPD IVP(2-4 mg)

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colony stimulating factors(growth factors) (rescue agents) - aranesp, epogen, neulasta, neupogen, neumega, sargramostim

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aranesp (darbopoetin alpha)- RBC stimulation, renal failure usually

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epogen or procrit (epoetin alpha)- stimulate RBC
SQ

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Neulasta (pegfilgrastim)- aids Neutrophils
SQ

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Neupogen (filgrastim)- neutrophils
SQ

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Neumega (oprelvelkin) - stimulates platelets
SQ

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Sargramostim (Leukine)- bone marrow recovery of all counts and is given with bone marrow transplant IV

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medications for hypercalcemia- aredia, didronel, zometa, sensipar

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aredia (pamidronate) - hypercalcemia, very potent, give only 1/month.
IVPB

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Didronel (etidronate)- hypercalcemia. Less potent than aredia
PO

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zometa (zoledromic acid) potent monthly med, hypercalcemia
IV

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sensipar (cinacalcet) used for parathyroid cancer only, to handle hypercalcemia, it decreases bone reabsorption (often they have bone metastasis)

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meds used for cancer pain- dilaudid, fentanyl, morphine, oxycodone, oxymorphone, percocet, vicodin, toradol (only non-narcotic)

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dilaudid (hydromorphone)- narcotic, IV (drip or bolus), or PO

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Fentanyl- duragesic patch (change every 5 days and needs fat to absorb), Actiq (PO) lollipop, IV (PCA), rare ones are- Fentora (Buccal) and Ionsys (transdermal)

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MS Contin- LA PO taken w or wo pain q12h for chronic long term pain. DO NOT CRUSH

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Roxanol- RA Morphine

MSIR- instant release morphine (liquid 20mg/ml)
used for break through pain

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oxycodone- stronger than morphine-
oxycontin - LA
oxyIR - pill
oxyFAST - liquid for brk thru

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oxymorphone- opana- not used, new, expensive

Back 37

Percocet- oxycodone with APAP
PO
vicodin (hydrocodone) PO

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toradol (ketorolac) - NSAID
PO IV IM
for 5 days max, highly effective in PO pain, hard on the stomach

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Narcan (naloxone)- will bind with any narcotic in blood stream. Antidote to opiates

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antidiarrheal medications- imodium, lomotil, sandostatin, sandostatin LAR depot

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Imodium (loperamide) - OTC PO very effective with diarrhea

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Lomotil (diphenoxylate and atropine) - antidiarrheal, liquid or pill Rx

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Sandostatin (octreotide) (SC IV) for large amount of diarrheal stools. RA $$. Stop when stools form

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Sandostatin LAR depot- IM used to treat very severe diarrhea or GI endocrine tumors. $$ LA

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Antiemetics- Aloxi, Emend, Kytril, Phenergan, Zofran

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Aloxi (palonosetron) - 5HT3 antagonist LA, IV every 7 days
antiemetics given 30 minutes prior to chemo

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Emend (aprepitant)- NK1 agonist antiemetic

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Kytril (granisetron- PO/IV and Patch) 5HT3, $$, not used often. Patch is new and useful Sancuso- antiemetic used for 5 days and start the day before chemo

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Phenergan (promethazine)- PO IV antiemetic

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Zofran- 5HT3 antagonist SA, cheaper than kytril

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Cesamet- (nabilone) man made form of cannibus

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anti-infectives- cephalosporins, activated protein c, anti-fungal, cyclic lipopeptide, fluroquinolone, glycylycline, oxazolidinones, anti-viral, carbapenems,

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xigris- given in ICU for severe sepsis to reduce mortality, given IV

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antifungals- usually on skin or in mouth
caspofungin, diflucan, eraxis, mycamine, nystatin, v-fend

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cubicin (daptomycin) for skin infections. cyclic lipopeptide antibacterial agents

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fluroquinolone- antibiotics avelox, cipro

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glycylycline- skin antibiotic tygacil (tigecycline)

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oxazolidinones- linezolid (zyvox) anti infective

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anti-viral (like shingles) acyclovir, ganciclovir

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gelclair- oral protectant against mucocitis, chemo protective agent

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megace (800mg/20ml) anti neoplastic oral chemo agent. normally used to encourage hunger (which is a SE)

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Elitek (rasburicase)- new med that makes uric acid water soluble so it can pass easier. Acid created from lysed cancer cells

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methylnatrexone (relistor)- opiod antagonist

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neutropenic precautions- when ANC <500
IV antibiotics STAT without cultures.
Avoid anything invasive
Wear mask in room if sick

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pancytopenic- all encompassing low cell counts
also- thrombocytopenic, leukopenic, anemic, neutropenic

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Pan- contains everything
Neut- Neutrophil
Carcin- Cancer
Leuk- leukocyte, white

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Immuno- immune, immunity
Adeno- gland
Myelo- bone marrow
-penia- defficiency

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-cytosis- blood cell condition
-blast germ or bud
-poiesis production
-emia blood condition

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-oma tumor
-plasia formation
-genesis creation
-blastoma neoplasm composed of immature cancer cells

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adenocarcinoma- cancerous tumor of the gland
hyperplasia- excessive proliferation of normal cells

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carcinogen- any substance or agent that produces cancer or increases risk of cancer

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leukopenia- abnormal decrease in WBC below 5000/mm3
erythropoiesis- formation of RBC

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carcinogenesis- transformation of normal cells into cancer often result of damage by viral, chemical, or radioactive

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granulocytosis- abnormal increase in number of granulocytes in the blood

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eosinophils kill parasites they are also phagocytes to some degree
they help regulate other immune cell functions( CD4+ T cell, B cell, mast cell, neutrophil).

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eosinophils are involved in the destruction of tumor cells

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Basophils release histamine when injured, Basophils and other leukocytes release prostaglandins. that contribute to increased blood flow at the site of the infection.

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granulocytosis- abnormal increase of granulocytes in the blood

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adenoma- benign tumor made of epithelial cells usually arrainged like a gland

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myelosuppresion- inhibition of bone marrow function
thrombocytopenia- abnormal decrease in platelets

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Common cancer chemo medication usually given with Benedryl is Taxol

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Ativan- IVP dilute and give direct IV
Benedryl- IVP dilute with 10ml NSS; IVPB dilute in 50 ml NSS over 15 mins

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Dilaudid and Morphine can be given IVP or IVPB

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Phenergan is IVPB ONLY!!
must be mixed in 50 ml bag and administered over at least 15 minutes

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Zofran IVP IVPB
doses greater than 4mg are usually administered IVPB