f-oncology

Carcinogenesis

The process by which normal cells transform into cancer cells involving stages of initiation, promotion, conversion, and progression.

Initiation

The first step of carcinogenesis where a normal cell undergoes a permanent genetic mutation caused by carcinogens like chemicals, radiation, or viruses.

Promotion

A reversible stage where initiated cells are stimulated to proliferate by promoters such as hormones or inflammation.

Conversion

Also called transformation, this is the stage when proliferating cells acquire malignant characteristics and become cancerous.

Progression

The stage where malignant cells undergo further genetic changes, gaining abilities like rapid growth, invasiveness, and metastatic potential.

Angiogenesis

The process by which cancer cells stimulate the formation of new blood vessels to supply nutrients and oxygen for tumor growth.

Apoptosis

Programmed cell death, a normal mechanism that cancer cells evade to survive despite genetic abnormalities.

TNM Staging

A system used to describe how advanced cancer is, where T is Tumor (size/growth), N is Nodes (spread to lymph nodes), and M is Metastasis (spread to distant parts).

T2 N1 M0

A breast cancer staging example where the tumor is between $2-5\,cm$, cancer has spread to nearby lymph nodes, and no distant metastasis is found.

Palliation

A treatment goal focused on relieving symptoms and improving quality of life without necessarily curing the disease.

Cell-cycle phase-specific agents

Chemotherapy drugs that target a particular phase of the cell cycle ($S$ phase or $M$ phase) and are usually given more frequently or by continuous infusion.

Cell-cycle phase-nonspecific agents

Chemotherapy drugs that kill cells regardless of their cycle phase and are typically given less frequently.

Small-molecule inhibitors

Targeted therapies, such as tyrosine kinase inhibitors, that inhibit enzymes involved in intracellular signaling pathways dysregulated in cancer.

Monoclonal antibodies

Large proteins like trastuzumab or rituximab designed to recognize specific antigens on cancer cells or immune cells to block growth signals or deliver toxins.

Immune checkpoint inhibitors

A type of immunotherapy that blocks proteins like PD-1 or CTLA-4 that prevent immune cells from attacking cancer.

CAR T-cell therapy

A treatment where a patient's T cells are genetically engineered to recognize and kill cancer cells.

Body Surface Area (BSA)

A dosing method for traditional cytotoxic chemotherapy used to estimate heart function, blood flow, and drug distribution/clearing.

P-glycoprotein

A mechanism of drug resistance where cancer cells pump drugs out of the cell.

Dose intensity

The total amount of drug given over time, determined by dose size, frequency, and total duration.

Dose density

The strategy of giving the same dose more frequently to kill more cancer cells by not allowing them time to regrow.

Prognostic biomarkers

Molecular markers that provide information about the likely course of the disease.

Predictive biomarkers

Molecular markers, such as HER2 overexpression or EGFR mutations, that indicate if a specific treatment is likely to be effective.

USP Chapter 800

Standards for handling hazardous drugs, including the use of ISO Class 5 biological safety cabinets and specific PPE for intravenous chemotherapy preparation.

Vesicants

Anticancer agents like Vincristine, Vinblastine, and Anthracyclines that can cause tissue damage and are preferred for administration via central lines.

Cure

eliminate cancer completely

Control

manage cancer as a chronic condition

Surgery

removal of tumor masses

Radiation Therapy

use of ionizing radiation to destroy cancer cells

Systemic anticancer agents

• Chemotherapy

• Targeted therapy

• Immunotherapy

Cytokines

boost immune system activity (interleukins, interferons).

Therapeutic vaccines

stimulate immune responses against tumor antigens.

Lung Cancer

• Osimertinib,

• Cisplatin,

• Pemetrexed,

• Erlotinib

Breast Cancer

• Trastuzumab,

• Tamoxifen,

• Paclitaxel

Colorectal Cancer

• Oxaliplatin,

• Bevacizumab,

• 5-FU

Prostate Cancer

• Leuprolide,

• Bicalutamide,

• Abiraterone

Flat (fixed) dosing

• Makes dosing easier and more convenient

• For oral targeted therapies and some immunotherapies

Tumor burden and cancer cell diversity

refers to the size or extent of cancer in the body. Larger tumors are often harder to treat because they contain more cancer cells with different genetic mutations.

Drug resistance

Resistance can be inherited (present from the beginning) or acquired (developed during treatment)

High-dose chemo + stem cell transplant

may increase effectiveness but also increases risk of serious side effects.

Supportive treatments

like colony-stimulating factors (CSFs) help maintain dose intensity by preventing complications like neutropenia.

Prognostic

tell us about the likely course of disease

Predictive

tell us if a treatment is likely to work

Genetic differences

can lead to toxicity or treatment failure

Comorbidities

may limit treatment choices

Doxorubicin

protect from light during storage and infusion

Dacarbazine

protect IV bag and tubing from light

Rituximab

store refrigerated, do not freeze

Bevacizumab

refrigerate; avoid shaking

Capecitabine (oral)

store at room temp, away from moisture and heat

Vesicants (can cause tissue damage)

IV only via central line preferred

• Vincristine

• Vinblastine

• Anthracyclines

PD-1, CTLA-4 inhibitors

Immune checkpoint inhibitors

Cytokines

interleukins, interferons