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What are the most common forms of cancer?
What are the stages of carcinogenesis?
What is initiation in carcinogenesis?
- Exposure of normal cells to carcinogenic substances producing genetic damage that, if not repaired, results in irreversible cellular mutations.
- Mutated cells have an altered response to their environment and a selective growth advantage, giving them the potential to develop into clonal populations of neoplastic cells.
What is promotion in carcinogenesis?
- Carcinogens or other factors alter the environment to favor growth of the mutated cell population over normal cells.
- This is reversible.
What is conversion in carcinogenesis?
- The mutated cell becomes cancerous
- This could take 5-20yrs
What is progression in carcinogenesis?
- Further genetic changes lead to increased cell proliferation.
- The critical elements of this phase include tumor invasion into local tissues and the development of metastases
What are protooncogenes?
Normal genes that are genetically altered through point mutation, chromosomal rearrangement, or gene amplification and consequently activate the oncogene
What are oncogenes?
- Produce either excessive amounts of the normal gene product or an abnormal gene product resulting in dysregulation of normal cell growth and proliferation
- EGFR family [ErbB-1 (EGFR), HER-2, her-3, and HER-4]
What are tumor suppressor genes?
- Regulate and inhibit inappropriate cellular growth and proliferation
- BRCA1 & BRCA2
What type of cancer is HER-1 responsible for?
- Head and neck
What type of cancer is HER-2 responsible for?
- Salivary gland
What type of cancer is HER-3 responsible for?
- Other carcinomas
What type of cancer is HER-4 responsible for?
- Childhood medulloblastoma
What type of cancer is BCR-ABL responsible for?
Chronic myelogenous leukemia
What type of cancer is K-RAS responsible for?
- Pancreatic binding cancers
What type of cancer is faulty retinoblastoma responsible for?
- Small cell lung
What is the most common genetic change associated with cancer?
What type of cancer is p53 associated with?
What type of cancer is BRCA1 associated with?
What type of cancer is BRCA2 associated with?
What can be done to help prevent cancer?
- Lifestyle modifications:
- eat more fruits and vegetables (antioxidants)
- use sunscreen
- quit smoking
- HPV vaccine
- antioxidants (alpha tocopherol, beta carotine)
- Aspirin/NSAIDs (maybe...for colon cancer)
What antioxidant increases risk of lung cancer if taken by smokers?
What screenings should be performed to detect cancer, and when should they be done?
- Clinical breast exam - 20
- Pap test - sexual activity, but NLT 21
- Mammogram - 40
- DRE (prostate) - 40
- PSA (prostate) - 40
- Colonoscopy - 50
What are the levels on the ECOG scale for performance status?
- 0: fully active
- 1: restricted in strenuous activity
- 2: out of bed >50%, able to provide self-care
- 3: in bed >50%, only limited self-care
- 4: bedridden, completely disabled, no self-care
What are the trends of the Karnofsky scale for performance status?
- 0% - dead
- 20% - very sick, hospitalization necessary, requires active supportive treatment
- 50% - requires considerable assistance and frequent medical care
- 80% - normal activity with effort, some signs or symptoms of disease present
- 100% - no complaints or evidence of disease
What are the characteristics of a "good" chemo drug?
- Low toxicity
What are the common and acute toxicities associated with chemo drugs?
- Alopecia - most disturbing for the pt
- NV - most disturbing for the pt
- Myelosuppression (neutropenia, thrombocytopenia, anemia) - most worrisome for the provider
What are the organ specific toxicities associated with chemo drugs?
- Cardiac toxicity
- Pulmonary toxicity
- Bladder - hemorrhagic cystitis
- Peripheral neuropathy
What chemo drug is associated with nephrotoxicity?
What chemo drug is associated with cardiac toxicity?
What chemo drug is associated with pulmonary toxicity?
What chemo drug is associated with hemorrhagic cystitis (bladder toxicity)?
Cyclophosphamide (at high doses)
What chemo drug is associated with myelosuppression?
What chemo drug is associated with peripheral neuropathy?
Vincristine and other Vinca Alkaloids
What drug used in chemo is responsible for a puffy face?
What are the possible long-term complications of chemo?
- Secondary leukemia
What is curative care?
- analytical and rationalistic
- based on diagnoses
- scientific and biomedical
- aimed at disease process
- views patients as parts
- based on "hard"sciences
- impersonal care
- death is seen as failure
What is palliative care?
- based on symptoms
- humanistic and interpersonal
- aimed at comfort
- views patient as a whole
- based on "soft" social sciences
- individualized care
- death accepted as normal