pathology of neoplasia

explain what a neoplasia is?

uncontrollable and abnormal growth of cells and tissues

what is a carcinoma

a cancer type that develops in the epithelial cells

what is a bone sarcoma

a cancer type that starts in the bones

what is a lymphoma

cancer type that starts in the lymph glands

what is a myeloma?

cancer type that starts in the plasma cells

what is leukemia

cancer type that starts in the white blood cells

what is the most common form of brain cancer

glioma which is the cancer of the glial cells

what are some characteristics of a benign tumor?

unlikely to move to other pars of the body and effect other tissues

enclosed in a capsule

what characterizes a malignant tumor?

abnormal and unstable growth of cells that can spread to other parts of the body and metastasize

what happens in the g1 phase of cell cycle?

cell grows physically and copies its organelles

what happens in s phase of the cell cycle?

cell synthesizes a copy of its DNA

what happens in the g2 phase of the cell cycle

cell grows more and reorganizes the structure for the cell ready for mitosis, also double checks for any duplicated chromosomes

where is the first checkpoint in the cell cycle?

transition between g1 and s phase

where is the second check point in the cell cycle?

transition between g2 and m

where is the final checkpoint in the cell cycle?

between metaphase and anaphase of the mitotic phase of the cell cycle

what check point is the rate limiting step in the cell cycle? and what does it check for?

g1, checks for cell size, nutrients, DNA damage, growth factors

what does the g2 checkpoint look out for?

check to see if the cell has enough cytoplasm and phospholipids. also check for DNA damage and assess if it can be repaired or not?

what does the final checkpoint look out for?

check to see if chromosomes are in the correct place before division takes place

what are proto oncogenes?

these are normal genes that aren’t usually harmful but when mutated or overexpressed can turn onto oncogenes e.g MYC

what do the hallmarks of cancer tell us

they explain how cancer cells exist and survive

what are the 6 hallmarks of cancer?

sustaining proliferative signaling

evading growth suppressors

activating invasion and metastasis

enabling replicative immortality

inducing angiogenesis

resisting cell death

what grade of cells are more aggresive?

grade 3

how are tumors graded in terms of their characteristics?

the less differentiated a cell is the more aggressive it is, higher the grade.

what are anaplastic tumors?

cells that have no differentiation, highly aggressive and have unusual size and shape

what is the tnm scoring system based on?

size of tumor, degree of nodal involvement, metastases

how would a cancer be describes as in stage 0

early cancer that is only present in a layer of cells in which it started

how would a cancer be describes as in stage 1,2,3

increase in stage from 1,3 could indicate a increase in size of the tumor, or possible nodule involvement, near the primary tumor

how would a cancer be describes as in stage 4

this is when a cancer has metastases into another organ, secondary cancer.

why are performance status criteria used?

used to asses how a patients disease is progressing and how the cancer affect their daily activities. this is important in deciding appropriate treatment

based on the ECOG scale, at what grade would you not treat a patients with chemotherapy.

2 onwards

what is adjuvant treatment in chemotherapy

a course of chemo given to patient with no evidence of residual cancer, after surgery or radiotherapy given to flush out any potential cancer

what is neoadjuvant chemo treatment

chemo given to downsize a tumor before surgery or radiotherapy

what is maintenance chemo treatment?

long term, low dose chemo given to help keep cancer from returning or to control its growth in patient that have reached remission

what is palliative chemo treatment?

chemo given to control the symptoms of cancer or prolong life

what does the term induction mean in chemo?

high dose of chemo given to induce complete remission in hematological cancers

what does the term consolidation mean in chemo?

repetition of the induction regime with the intention of increasing cure rates or prolong remission in hematological cancers

what does the term intensification mean in chemo?

chemotherapy after complete remission at high doses to increase cure and remission duration. use for hematological cancers.

what does the term salvage mean in chemo?

treatment given when cancer has relapse. maybe be palliative. used for hematological cancers.

what are some common principles of combined chemo that need to be considerd.

using chemo drugs that have different toxicity profiles

using pulsed treatment to allow healthy cells to recover

use drugs that are known to be effective as single agents

there are not clinically important drug interactions as saving px life is more important- risk/benefit

at what interval is chemo usually given and why?

at 3 weekly intervals as this is how long it takes for bone marrow and epithelial lining cells to recover from chemo.

what is the proportional kill effect?

a given dose of chemo kills a consonant proportion of tumor cells so tumor cell number decreases in a logarithmic fashion

what are 4 factors that can affect the response to chemo?

dose intensity, tumor burden, drug resistance, patient specific factors( age, other medical conditions)

what class of drugs effect the m phase of the cell cycle?

taxanes and the vincalkaloids

what class of drugs effect the s phase of the cell cycle?

antimetabolites

what is cross resistance and how does this happen?

resistance to multiple structurally unrelated compounds due to the exposure of tumor to a single agent

what order kinetics do cell death via chemo follow?

1st order

what can happen if paclitaxel is administered before carboplatin?

increase myelosuppression

reduction of paclitaxel clearance

what is the R-CHOP regime comprised of?

rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone

what is the BEP regime comprised of ?

bleomycin, etoposide, cisplatin

what is BEP used to treat?

testicular cancer

what markers are raised in tumors?

AFP

HCG

LDH

what is the treatment for cytokine release syndrome?

steroids, NSAIDS, IL inhibitors

what is tumor lysis syndrome?

contents of cells are released which causes electrolytes imbalances

what are some treatment options for Tumor lysis prevention?

hydration, steroids

allopurinol and rasburicase to prevent uric acid formation

in px with febrile neutropenia( temperature above 38 degrees) what should be started ASAP

start broad spectrum antibiotic within an hour and assess NEWS

in terms of extravasation, how her drugs classed?

vesicants

irritants

non vesicants

what two types of skin reaction are associated with cetuximab?

ACNE and rash

what can be give prophylactically to reduce the chance of infusion related reactions?

paracetamol, chlorphenamine( antihistamines), steriods

what can be given to treat tumor induced hypercalcemia?

iv fluids, bisphosphonates and denosumab