Oncology Week 1 Dr. Manion’s Lecture Basics of Oncology 101 – Flashcards
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True/false: There is no therapeutic levels of chemo.
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True. Chemo is dosed to toxicity
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How is chemo dosed?
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To toxicity
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Who selects the chemo regimen?
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Medical oncologists (vs. I.D. where pharmacists usually select the regimen)
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What is the pharmacist's role?
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Toxicity management Medication Safety Patient education
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Cancer is the #1 killer of what demographic?
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Americans under 85 years old
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What are the 4 biggest cancer killers?
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Prostate Breast Lung Colorectal
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What is the disconnect/oddity with the 4 biggest killers?
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There is screening available!
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What are the 4 parts of carcinogenesis?
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Initiation Promotion Conversion (transformation) Progression
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What is carcinogenesis?
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Beginning of cancer, process by which cancer starts
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Define Proliferation
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Dividing and making new cells
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Define Differentiation
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What a cell wants to be when it grows up. Process by which the cell gets to the end functional unit
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Define Hyperplasia
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Growth in number of cells
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Define Hypertrophy
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Growth in size of cell
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Define Dysplasia
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Don't function properly
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Define Anaplasia
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de-differentiation (lack of differentiation)
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Define Neoplastic
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new growth (benign, malignant)
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Who are the key players in cancer treatment?
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Medical Oncologist Radiation-Oncologist Surgical Oncologist Chemo-competent-RN Nurse Navigator Dietician (RD) Social worker (MSW)
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What are the 7 deadly signs of tumors/cancer in adults?
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1.) Change in BM/bladder habits 2.) Non-healing sore 3.) Unusual bleeding/discharge 4.) Palpable lump (especially breast tissue) 5.) Difficulty swallowing/indigestion 6.) Change in wart/mole 7.) Hoarseness (chronic) cough
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Most tumors are palpable at what size?
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1-2cm
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When are most tumors palpable?
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When disease burden shows up.
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At what tumor size does disease burden typically show up?
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1-2 cm
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What is done most of the time when a tumor is found?
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Biopsy
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What are the three types of biopsies?
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Core Needle Aspirate
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How are tumors named?
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Based on tissue origin (epithelial, nerve, connective, and lymph) plus "oma" Also benign vs. malignant
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What are the imaging tests used for tumors?
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CT MRI PET Ultrasound
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Which scan is metabolically active?
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PET scan
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Why is the metabolically active PET scan important?
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Shows rapid cell turnover/reproduction as seen in cancer
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What is margin status?
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Describes what is left after surgical removal of tumor
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How is staging used?
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To determine treatment and prognosis.
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What does TNM stand for?
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Tumor size Nodal involvement Metastatic presence
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What is TNM used for?
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Solid tumors
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What is WHO used for?
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Brain cancers
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What is a part of the WHO staging?
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Grades 1-4, indicated benign vs. malignant
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What are the "other" cancers (not solid tumors or brain cancers) in staging?
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Small cell lung and hematologic disease
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How are the "other" cancers staged?
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Limited vs. Extensive
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What is cellular grading?
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Level of differentiation...how much does it look like the parent tissue
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What are the two primary ways in which progression takes place?
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Hematologic and lymphatic
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What are some other, non-primary ways in which cancer progresses?
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CSF and peritoneal cavity spread
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Describe the genetic endeavors for pathophysiology?
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What is the molecular picture of a specific tumor? Can we PERSONALIZE the medicine? Looking for common mutations and Identifying masses of common mutations
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What are the treatment principles in oncology?
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1.) Dose-dense chemotherapy 2.) Combination chemotherapy 3.) Neo-adjuvant chemotherapy 4.) Adjuvant Chemotherapy 5.) Dose-capping chemotherapy 6.) Sequencing
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What is a cycle?
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A round of chemo
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What is a day?
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Treatment day during a given cycle
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What is dose?
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Amount given based on BSA, Weight, CrCL, AUC, etc.
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What are ADLs?
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Activities of daily living
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What is a 0 in ECOG?
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No restrictions in ADLs
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What is a 1 in ECOG?
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ADLs intact, able to carry out physically light work, able to work in moderation
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What is a 2 in ECOG?
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50% of the time up and moving, ADLs intact, unable to work
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WHat is a 3 in ECOG?
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50% of the time confined to bed or chair, severe limitations in ADLs
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What is a 4 in ECOG?
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Confined to bed or chair at all times
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What is a 5 in ECOG?
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Dead
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What are three treatment options?
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Surgery Radiation Chemotherapy
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What are 3 chemotherapy types?
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Biologic Cytotoxic Targeted
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What is a basic principle that explains chemo's side effects?
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Chemo works to destroy fast growing cells
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What are some common unwanted targets of chemo (think fast growing cells)?
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Blood cells, specifically WBCs Hair GI tract Skin
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What may be necessary because of side effects?
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Dose reductions
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What is NCI-CTCAE?
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A commonly used scale to determine GRADE of chemotherapy/treatment SIDE EFFECTS
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What are some other general toxicities?
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1.) Secondary malignancies 2.) Infertility 3.) Extravasation 4.) Infusion Reactions 5.) Cost
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True/false: Most cancer drugs have one hallmark side effect?
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True
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True/false: Bone marrow can have 3 side effects because of different cell lines.
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True. But the drug usually targets one type of blood cell though
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What are the general categories of side effects?
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1.) Bone marrow 2.) Mucositis 3.) Nausea 4.) Alopecia 5.) Organ toxicity 6.) Infusion reaction
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What are some unique thoughts on giving chemotherapy, in regards to ASCO/ONS Administration Guidelines?
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1.) Staffing 2.) Charting 3.) Practice standards 4.) Ordering 5.) Drug prep 6.) Patient consent and education 7.) Administration 8.) Monitoring and assessment
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What are 5 Resources for cancer?
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1.) National Comprehensive Cancer Network (NCCN) 2.) American Society of Clinical Oncology (ASCO) 3.) Chemocare.com 4.) Lexicomp 5.) Institution specific resources 6.) Primary literature
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Explain about National Comprehensive Cancer Network (NCCN).
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Free guidelines you will use extensively Sometimes do not put doses Need to sign up for free
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Explain about American Society of Clinical Oncology (ASCO)
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Outpatient guidelines Standards of practice/quality New research, treatments, and care Man Journal of Clinical Oncolofy (JCO) No need to sign up
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Explain about Chemocare.com
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Drug-specific side effects Run by the Cleveland Clinic
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What are 4 primary literatures for cancer resources?
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1.) Journal of Clinical Oncology 2.) New England Journal of Medicine 3.) Journal of Hematology and Oncology 4.) Journal of Supportive Care and Community Oncology
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In what setting is most chemotherapy research done?
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In the metastatic setting
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What is a Complete Response (CR) in RECIST?
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All target lesions are gone, maintains for 1 month
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What is a Partial Response (PR)in RECIST ?
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In Reference to baseline lesion size, 30% decrease in size
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What is Stable Disease (SD) in RECIST?
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Does not qualify for either PR or PD. Can shrink up to 29.9% and grow up to 19.9%
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What is Progressive Disease (PD)in RECIST ?
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In reference to baseline lesion size, 20% increase in size
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When analyzing oncology literature, what does OS stand for?
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overall survival
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When analyzing oncology literature, what does DFS stand for?
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disease free survival
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When analyzing oncology literature, what does PFS stand for?
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progression free survival
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When analyzing oncology literature, what does CR stand for?
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complete response (no evidence within 1 month of tx)
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When analyzing oncology literature, what does PR stand for?
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partial response (30% or greater decrease in tumor size)
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When analyzing oncology literature, what is stable disease?
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no growth or shrinkage during/after tx
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When analyzing oncology literature, what is a cure?
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maintenance of CR, no risk of relapse, survival stats back to normal population
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What is a Kaplan-Meier Curve?
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A time response curve (time to progression)
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What is considered the point of no return?
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Conversion
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What are two considerations of silent tumors?
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Not as many symptoms Present with larger tumors
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What is the only reason to leave positive margin in surgery?
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Quality of life in a palliative setting
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A high grade tumor has what level of differentiation?
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low level of differentiation (can transform more readily)
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A low grade tumor has what level of differentiation?
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High level of differentiation
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What is micrometastatic?
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Little seeds throughout the body that may not show up on scans. Give systemic treatment
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Tumors grow how?
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Exponential, logarithmic growth. NOT LINEAR
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What happens when treatment decreases size of tumor?
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Eventually immune system recognizes not normal
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Historical or Traditional Chemotherapy
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"Hitting the curve"
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What is modern treatment?
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Looking for specific receptors on cells to target
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Is dose-capping evidence-based?
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Not much evidence! Treat to true BSA!
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***How many cycles of treatment?
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6???
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****How many days is a cycle?
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21 days?????
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At what point in the ECOG scale do we not give chemo?
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Typically 3 onward
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If the cancer comes back within 6 months, what is it?
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Refractory (resistant)
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What happens if the cancer is refractory?
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May not give the initial treatment again
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If cancer comes back after 6 months, the disease is what?
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Recurrent
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What happens if the disease is recurrent?
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MAY give the initial treatment again
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True/false: NCCN has guidelines for almost all cancers.
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True
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True/false: NCCN has guidelines for almost all cancers.
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True
