CANCER PT 4

Adjuvant Chemotherapy

It is started after initial treatment with either surgery or radiation therapy

Neoadjuvant chemotherapy

Refers to the preoperative use of chemotherapy to reduce the bulk and lower stage of a tumor making it amenable to surgery even to possible cure with subsequent local therapy

ALKYLATING AGENTS

Non-phase specific and basically act on performed nucleic acids by creating defects in tumor DNA. They cause cross-linking of DNA strands, which can permanently interfere with replication and transcription

● prevent cell division by damaging DNA effective in all phases of cycle

NITROGEN MUSTARDS (MECHLORETHAMINE)

First drug used in chemo ● Used to treat cancer of the blood or cancer of the bone marrow

. Mechlorethamine, chlorambucil, cyclophosphamide, melphalan and ifosfamide

NITROSOUREAS (CARMUSTINE)

can cross the blood-brain barrier (BBB)

Ex. Carmustine, streptozocin, lomustine

ALKYL SULFONATES (BUSULFAN)

damage the DNA ladder ● inhibit DNA and RNA ladder, can cross BBB

. Streptozocin, lomustine

ANTIMETABOLITE AGENTS

Phase - specific, working best in the S phase and having little effect in G0. ● These are the most commonly used drugs to treat cancer. The oldest type of chemo medicine

CYTOTOXIC ANTIBIOTICS

Derived from various species of streptomyces and are generally too toxic to be used as antibacterial agents

Disrupt DNA replication and RNA transcription

1. Actinomycin 2. Doxorubicin 3. Bleomycin 4. Mithramycin

VINCA ALKALOIDS

Phase-specific acting during mitosis, they bind to a specific protein that promote chromosome migration during mitosis and serves as a conduit for neurotransmitter transport along axons

Vincristine ● Vinblastin

ETOPOSIDE (VP-16)

Acts in all phases of the cell cycle, causing breaks in DNA and metaphase arrest

● Inhibits the enzyme topoisomerase II, which aids in DNA unwinding, and by doing so causes DNA strands to break.

Prednisone

main hormone used for corticosteroids

CORTICOSTEROIDS

Phase specific (G1); acts by binding to specific intracellular receptors, repressing transcription of memory RNA and thereby altering cellular function and growth

Cisplatin

● An organic drug containing platinum and chlorine atoms

TOPOISOMERASE I

interferes with DNA synthesis by inhibiting the enzyme topoisomerase I

irinotecan (camptosar) ● Topotecan (Hycamtin)

TOPOISOMERASE II

inhibits type II topoisomerase activity resulting in the breaks of DNA

Doxorubicin (Adriamycin) ● Teniposide (Vumon) ● Etoposide (VePesid)

IMMUNOSTIMULANTS

It enhances the body's immune system when it is exhausted from fighting after prolonged invasion or fighting a specific pathogen or cancer cell ● To boost immune system

INTERFERON

has antiviral, anticancer, immunostimulant action. These are drugs naturally produces and released by cells after viral infection

● interferon alfa-2a (roferon-A) ● Interferon alfa-2b (Intron-A)

INTERLEUKINS

stimulate immune function by increasing the activity of natural killer cells and platelets ● Drug: ● Aldesleukin (proleukin)

T- CELL AND B- CELL MODULATOR

stimulates B cells which then stimulates antibody formation, enhances T- cell activity and increases the activity and proliferation of monocytes and macrophages

. BONE MARROW TRANSPLANT

Accepted treatment to stimulate a non- functional marrow or to replace marrow. ● Primary treatment modality in leukemia.

HORMONE THERAPY

Used as an adjunct to other types of CA therapy ● It can slow tumor growth or prevent reoccurrence

PHOTOFRIN

an intravenous dose of photosensitizing compound, which is selectively retained in higher concentrations of malignant tissue

DUCTAL CARCINOMA IN SITU (DCIS)

characterized by the proliferation of cancer cells in the milk ducts without invasion to surrounding tissues

LOBULAR CARCINOMA IN SITU (LCIS)

characterized by proliferation of cells within the breast lobules.

MRM = Modified Radical mastectomy

Remove entire breast and most axillary lymph nodes ○ Modified = preserve pectoral muscles

Grade 1 tumor

Score of 3,4,5 in scarff bloom richardson grading

Grade 2 tumor (moderately differentiated)

Score of 6 or 7 in scarff bloom richardson grading

Grade 3 tumor (poorly differentiated)

Score of 8 or 9 in scarff bloom richardson grading

Tissue Expanders

A temporary device is placed on the chest wall deep to the pectoralis major muscle.

Transverse Rectus Abdominis Muscle Flap

Musculocutaneous flap (muscle, skin fat, blood supply) is transposed from abdomen to the mastectomy site

Latissimus Dorsi Muscle Free Flap

The flap originates from the flat, triangular muscle running from the upper vertebral column to the arm.

Nipple-Areola Reconstruction

Is the making of a nipple/areola shape in a reconstructed breast. Done as one of the last stages of breast reconstruction

PROSTATE CANCER

The 2nd leading cause of death in males ● A malignant tumor of the prostate gland ● 80% of cases diagnosed after age 50 or as early as age 50. ● Fertility is not a factor

TURP (Transurethral Resection of the Prostate)

surgical intervention for prostate cancer

40

DRE at what recommended age

UTERINE CANCER

CANCER OF THE ENDOMETRIUM ● The most common gynecologic CA ● Usually AdenoCA

0 - inner lining of the uterus

I- inner lining to the endometrium

II- uterus and cervix

III- outside of the uterus, vagina, lymph nodes

IV - spread to the bowel, bladder, abdomen or other organs

Stages of Endometrial Cancer

0

1

2

3

4

CLASS 1 NORMAL

CLASS 2 INFLAMMATION (repeated after 3 months)

CLASS 3 MILD TO MODERATE DYSPLASIA (repeated within 3 weeks) CLASS 4 PROBABLY MALIGNANT (BIOPSY)

CLASS 5 MALIGNANT

Pap Smear Result

Class 1 , 2, 3, 4, 5

LIVER CANCER

A rare form of cancer with a high mortality rate ● 90% arise from the liver parenchymal cells (hepatoma) ● Some originate from the intrahepatic bile duct (cholangioma)

Primary

brain tumor that originates from cells & structures within the brain

Secondary

tumors that develop from the outside of the brain

5-15mmHg

Normal ICP

MUCOSA - inner lining, absorbs water and nutrients

SUBMUCOSA - connective tissue containing blood vessels and nerves

MUSCULARIS - smooth muscle layers that move and make bowel contents

SEROSA - outer layer that supports and anchor the colon

4 Main Linings in the colon

tumor is limited to bowel wall

Duke's Classification: A

extension of tumor to all layers

Duke's Classification: B

metastases of tumor to regional lymph nodes

Duke's Classification: C

- lymph node metastases, ulcerated carcinoma, distant metastasis

Duke's Classification: D

Segmental resection with anastomosis

removal of the tumor and portions of the bowel on either side of the growth, as well as the blood vessels and lymphatic nodes.

Abdominoperineal resection with permanent colostomy

removal of the tumor and a portion of the sigmoid and all of the rectum and anal sphincter

Temporary colostomy

followed by segmental resection and anastomosis and subsequent reanastomosis of the colostomy allowing initial bowel decompression and bowel prep before resection

Permanent colostomy

for palliation of unresectable obstructive lesions

HODGKIN'S LYMPHOMA

A type of lymphoma which is a cancer originating from white blood cells called lymphocytes

REED STERNBERG CELLS

HODGKIN'S LYMPHOMA is chracterized by the presence of an abnormal cell called