Cell Cycle and Cancer Chemotherapy Quiz

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Questions and Answers

Which phase of the cell cycle is characterized by the synthesis of DNA?

G2 phase

M phase

S phase (correct)

G0 phase

What primarily regulates the cell cycle to prevent excessive proliferation of normal cells?

Proto-oncogenes and cell division signals

Tumor suppressor genes and proto-oncogenes (correct)

External growth factors and cytokines

Apoptosis and cellular aging mechanisms

What is a characteristic feature of cancer cells in terms of growth signals?

They are highly regulated by apoptosis

They become less dependent on external stimulatory signals (correct)

They have a limited replication potential

They require external growth factors for proliferation

What is the result of an imbalance between stimulatory and inhibitory growth signals during carcinogenesis?

Transformation of normal cells into cancer cells Signup and view all the answers

What is the role of telomerase in cancer cell proliferation?

It enables cancer cells to proliferate endlessly Signup and view all the answers

What is the primary function of alkylating agents in chemotherapy?

To cross-link DNA strands Signup and view all the answers

Which of the following is classified as an antimetabolite in chemotherapy?

Methotrexate Signup and view all the answers

How do phase-specific agents in chemotherapy work?

They target specific phases of the cell cycle Signup and view all the answers

What type of therapy does Tamoxifen represent?

Endocrine therapy Signup and view all the answers

Which chemotherapy drug is a topoisomerase inhibitor?

Bleomycin Signup and view all the answers

What is the main action of antitumor antibiotics such as Doxorubicin?

Membrane lipid peroxidation Signup and view all the answers

In which phase of the cell cycle do vinca alkaloids exert their effect?

M phase Signup and view all the answers

Which component does NOT represent a type of systemic therapy?

Surgical excision Signup and view all the answers

What is the primary function of Gonadotropin-releasing hormone (GnRH) agonists like leuprolide?

To treat prostate cancer Signup and view all the answers

Which of the following is NOT a standard treatment for chemotherapy-induced nausea and vomiting (CINV)?

Oxycodone Signup and view all the answers

What is the purpose of administering G-CSF in chemotherapy patients?

To stimulate neutrophil production Signup and view all the answers

What is the main reason for administering glucocorticoids like prednisone in cancer treatment?

To reduce inflammation Signup and view all the answers

Which treatment is recommended to manage fever or neutropenia in cancer patients?

Broad-spectrum intravenous antibiotics Signup and view all the answers

What is a significant factor contributing to the decline in breast cancer incidence from 1999 through 2004?

Decreased use of hormone-replacement therapy Signup and view all the answers

Breast cancer most commonly arises from which structures in the breast?

Ducts and lobules Signup and view all the answers

Which of the following agents is NOT considered a miscellaneous anticancer agent?

Dexamethasone Signup and view all the answers

Which of the following types of breast cancer is classified as invasive?

Invasive lobular carcinoma (ILC) Signup and view all the answers

What is considered a significant risk factor for breast cancer related to personal history?

Family history of breast cancer (first-degree relatives) Signup and view all the answers

What symptom is most commonly identified during the early stages of breast cancer?

Painless lump Signup and view all the answers

What radiological examination is performed to confirm the abnormality after a mass is palpated?

Mammogram Signup and view all the answers

Which combination of factors is primarily assessed to determine the stage of breast cancer?

Size of the tumor, positive lymph nodes, and extent of disease Signup and view all the answers

Which of the following is NOT a common symptom of metastatic breast cancer?

Skin rash on the breast Signup and view all the answers

How does early menarche influence the risk of breast cancer?

By leading to prolonged estrogen exposure Signup and view all the answers

What is the role of a bone scan in the diagnosis of breast cancer?

To evaluate for metastatic disease Signup and view all the answers

What is the most common type of invasive breast cancer?

Invasive Ductal Carcinoma (IDC) Signup and view all the answers

Which stage of breast cancer has the best prognosis?

Stage I Signup and view all the answers

What differentiates inflammatory breast cancer from other types?

It presents with skin changes resembling cellulitis. Signup and view all the answers

Which treatment is described as being administered before surgery?

Neoadjuvant therapy Signup and view all the answers

What is the 5-year survival rate for stage IV breast cancer?

Approximately 26% Signup and view all the answers

Which of the following is NOT a modality of breast cancer treatment?

Folic acid therapy Signup and view all the answers

What is indicated by a breast that has the appearance of an orange peel?

Inflammatory breast cancer Signup and view all the answers

How is stage II breast cancer characterized in terms of tumor and lymph nodes?

Small tumors with lymph node involvement Signup and view all the answers

Which of the following is a common toxicity associated with Doxorubicin?

Alopecia Signup and view all the answers

What is the mechanism of action of Cyclophosphamide?

Inhibition of DNA synthesis through cross-linking Signup and view all the answers

What type of therapy is Trastuzumab classified as?

Monoclonal antibody Signup and view all the answers

Which agent should be premedicated with dexamethasone and H1 and H2 blockers to avoid hypersensitivity reactions?

Paclitaxel Signup and view all the answers

Which of the following toxicities is associated with the use of Tamoxifen?

Pulmonary embolism Signup and view all the answers

For which group of patients is Aromatase Inhibitors (AIs) specifically indicated?

Postmenopausal women Signup and view all the answers

What is a typical regimen for HER2 positive tumors?

Doxorubicin followed by Trastuzumab and Paclitaxel Signup and view all the answers

What is the primary effect of Luteinizing hormone-releasing hormone (LH-RH) agonists?

Ovarian suppression Signup and view all the answers

Signup and view all the answers

Study Notes

Clinical Pharmacy I, PP904, Lecture 9: Supportive Care of Oncological Diseases

This lecture covers supportive care of oncological diseases.
The lecturer is Dr. Nashwa Eltantawy, a lecturer of Clinical Pharmacy at the Egyptian Chinese University.
Office hours are Monday, 12:00 PM - 2:00 PM.

Marks Distribution

Periodical Exam: 20 marks
Practical Project: 10 marks
Lab Evaluation: 5 marks
Practical (OSCE): 10 marks
Practical Final Exam: 15 marks
Final Written Exam: 75 marks
Oral Exam: 15 marks
Total: 150 marks

Course Outline

Introduction to clinical Pharmacy facilities
Clinical Case presentation
Clinical laboratory data and physical examination
Therapeutic planning
Drug-related problems
Medication errors & Reconciliation
Special care populations (geriatric, pediatric)
Special care populations (pregnancy, Hepatic)
Supportive care of oncological diseases
Supportive care of blood disorders
Supportive care of nutritional deficiencies
Medication Therapy management services

Cancer

Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells.
Cancer cells do not respond to normal processes of cell growth, proliferation, and survival.
They cannot carry out the physiological functions of normal cells.
Cancer cells metastasize (invade adjacent normal tissues and travel through the blood or lymph to establish new tumors at a distant site).
Cancer cells stimulate the formation of new blood vessels (angiogenesis).
Cancer cells have endless replication potential.
Cancer is related to various factors including sex, age, race, genetic predisposition, exposure to environmental carcinogens (ionizing radiation, chemical carcinogens in tobacco smoke, azo dyes, aflatoxins, asbestos, benzene), viruses (chronic infection with HBV and HCV, HIV, human papillomavirus, Epstein-Barr virus (EBV)), and oncogenes.

Pathophysiology of normal cells (Growth and Proliferation)

Signal transduction coordinates and integrates cellular signaling processes.
Growth factors bind to receptors.
This activates a series of enzymes in the cell.
It stimulates cell signaling pathways.
This controls gene transcription, which encodes proteins regulating cell growth and proliferation.

Pathophysiology: Malignant Transformation

Cancer is a genetic disease.
Damage to cellular DNA results in mutations leading to oncogenes and loss/inactivation of tumor suppressor genes.
Oncogenes are genes whose overactivity leads to cancer development.
Proto-oncogenes are normal genes.
Genetic alterations (chromosomal translocations, deletions, insertions, point mutations) can transform proto-oncogenes into oncogenes.
Abnormal forms or excessive quantities of stimulatory proteins disrupt normal cell growth signaling pathways.
This leads to excessive growth and proliferation, resulting in malignant transformation.

Pathophysiology: Gene Mutation

Substitution, insertion, and deletion are types of gene mutations.
A change in one DNA nucleotide base results in a completely different amino acid sequence.

Pathophysiology: Tumor Suppressor Genes & DNA Repair Genes

Tumor suppressor genes encode proteins that suppress inappropriate cell division or growth.
Deletions or mutations in tumor suppressor genes can cause inappropriate cell division or growth
DNA repair genes encode proteins correcting errors arising during DNA duplication.
Mutations in DNA repair genes cause accumulation of genetic changes and cancer progression.
Cancer development is a multistep process involving multiple genetic mutations (activation of oncogenes and loss/inactivation of tumor suppressor genes).

Pathophysiology: Transformation of a single normal cell

The transformation of a normal cell into a cancer cell is an initial event.
Environmental factors (lifestyle, diet, sexual behavior), medical therapies (cytotoxic chemotherapy, immunosuppressive or radiation therapy), and hereditary factors (genetics) contribute to this.

Pathophysiology: Tumors

Tumors can arise from epithelial, connective (muscle, bone, cartilage), lymphoid, or nerve tissue.
Benign tumors are encapsulated and localized.
The suffix "-oma" is added to the name of the cell type.
Malignant cells are categorized based on their origin: carcinomas (epithelial cells), sarcomas (muscle or connective tissue), adenocarcinomas (glandular tissue), leukemias (bone marrow), lymphomas (lymphoid tissue).

Tumor Characteristics

Benign tumors are encapsulated, localized, indolent, seldom metastasize, and rarely recur.
Malignant tumors are invasive, spread to other locations even if the primary tumor is removed, have loss of structure and function (anaplasia), and can metastasize, rendering cancer incurable once metastasized.

Diagnosis and Staging of Cancer

Various tests are performed based on initial diagnosis.
Laboratory tests (CBC, LDH, renal/liver function), radiologic scans (X-rays, CT scans, MRI, PET), biopsy of tissue/bone marrow, and genetic analysis are used.
Tumor markers may also be considered.

Cancer Staging

Staging of the disease is done before treatment and determines the extent/spread of the disease.
Staging is performed for solid tumors.
The TNM system is used for staging breast cancers (evaluating tumor size [T], lymph node status [N], metastasis [M]).

Warning Signs of Childhood Cancer

Continued unexplained weight loss.
Headaches with vomiting, early morning/night.
Increased swelling or pain in bones, joints, back, legs.
Lump/mass in abdomen, neck, chest, pelvis, armpits.
Development of excessive bruising, bleeding, rash.
Constant infections.
Whitish color behind the pupil, persistent nausea, vomiting.
Constant tiredness, noticeable paleness.
Vision changes, sudden occurrence and persistence.
Recurrent fevers of unknown origin.

Clinical Presentation

Initial signs and symptoms of malignant disease vary and depend on histology/diagnosis, location (including metastases), and tumor size.
Commonly presented symptoms: non-specific complaints (weight loss, unexplained anemia, malaise, lethargy, pain; specific localizing symptoms such as bleeding, ulcer, cough/hoarseness, painful lump; painless lump).

Treatment

Cancer is treated with surgery, radiation, and systemic therapies (chemotherapy, targeted therapy, hormone therapy, etc.).
Surgery is used for localized tumors (removal of tumor plus margin of normal tissue).
Radiation therapy is used for solid tumors based on different factors like tissue type and therapy intent. Radiation may be given before or after surgery (neoadjuvant or adjuvant).
Systemic therapy (chemotherapy) is used for widespread metastatic disease or recurrence after initial treatment. Different types exist: chemotherapy, targeted therapy, endocrine therapy, and biological response modifiers (e.g. hormones).

Chemotherapy

Chemotherapy (cytotoxic therapy) targets rapidly dividing cells by damaging DNA, interfering with DNA synthesis, or inhibiting cell division.
Agents can be targeted to a specific phase or any phase of the cell cycle.
Some examples of anticancer drugs: alkylating agents, antimetabolites, natural products, antitumor antibiotics, hormones, miscellaneous agents.
Treatments involving Doxorubicin have different mechanisms and common side effects: myelosuppression, nausea/vomiting, alopecia, and cardiomyopathy.
Treatments involving Cyclophosphamide have different mechanisms and common side effects: myelosuppression, nausea/vomiting, alopecia, and risk of secondary leukemias.
Treatments involving Paclitaxel have side effects such as myelosuppression, nausea/vomiting, and hypersensitivity reactions.
Treatments involving Trastuzumab have a mechanism of targeting the extracellular HER2 protein commonly used in lymph node- +ve disease and common side effect is cardiotoxicity.

Hormonal Therapy

Hormone therapy is given to patients with ER- and/or PR+ve disease.
It can include SERMs (selective estrogen receptor modulators), LH-RH agonists(luteinizing hormones releasing hormones), and AIs (aromatase inhibitors)
Tamoxifen is a SERM used in both premenopausal and postmenopausal women and has side effects like hot flashes, vaginal discharge, thrombosis, pulmonary embolism, and strokes.
LH-RH agonists (e.g., leuprolide) are used in premenopausal patients.
Aromatase inhibitors (e.g., anastrozole, letrozole, exemestane) are used in postmenopausal patients to inhibit estrogen production.

Breast Cancer (Incidence, Prevalence, Epidemiology, Risk Factors)

Breast cancer is the most common malignancy in women, second to lung cancer in mortality.
It develops from breast tissues like ducts and lobules.
Can affect men as well.
Incidence has decreased since 1999 due to reduced hormone therapy use.
Early diagnosis leads to higher survival rates.
Risk factors include gender (female>male), personal/family history of breast cancer, benign breast changes (atypical hyperplasia), early menarche/late menopause, late first pregnancy, advancing age, long-term hormone replacement therapy use, prior chest wall irradiation, obesity, and high-fat diets.

Breast Cancer (Pathophysiology, Clinical Presentation, Diagnosis)

The breast consists of fat, muscle, ducts, and lobules.
Common types are: ductal carcinoma, invasive ductal carcinoma, DCIS, lobular carcinoma/ILC/LCIS.
Other types: Inflammatory, tubular/medullary carcinomas, sarcomas.
Common clinical presentation: painless lump (more common), non-specific complaints (weight loss, anemia, malaise, lethargy, pain), some specific symptoms (specific localizing symptom; non-healing ulcer, minor symptoms like cough/hoarseness).
Diagnosis: physical examination to identify a lump/abnormality in breast. Mammogram, breast ultrasound, biopsy, and radiologic exams (CT scan, bone scan/chest/pelvis) are used to diagnose metastatic disease.

Breast Cancer (Types of Breast Cancer and Staging)

Treatment depends on disease stage.
Staging determines the size of the tumor, extent of positive lymph nodes, and presence of metastases.
Histological types: invasive disease (IDC most common, ILC is second), noninvasive (in situ disease – DCIS and LCIS).
Inflammatory breast cancer (IBC) is the most aggressive.
The time to develop a palpable or mammographically detectable mass varies, with IBC developing in weeks.

Breast Cancer (Cancer Staging for Breast Cancer)

Staging in breast cancer uses a TNM system where T is the tumor size, N is lymph node involvement, and M is presence of metastasis.
Different stages of breast cancer have different prognoses. Stage I has a ~98% 5-year survival rate, while stage IV has ~26% 5-year survival rate.

Breast Cancer (Overview of Treatment, Local Treatment, Systemic Therapy, Adjuvant)

Treatment involves multiple modalities like surgery, radiation therapy, hormonal therapy, chemotherapy, and biologic therapies.
Local treatment (surgery and radiation): Surgery is the definitive treatment for early-stage breast cancer. Modified radical mastectomy removes the entire breast along with axillary lymph nodes, preserving pectoralis muscles. Radiation is sometimes prescribed for tumors larger than 5 cm or patients with >4 positive lymph nodes or positive margins. Neoadjuvant chemotherapy may shrink the tumor for breast-conserving procedures.
Systemic therapy (chemotherapy, hormonal, biologic therapies): This is used to treat systemic disease or recurrence. Lymph node negative disease with favorable prognostic factors (hormone-positive disease): hormonal therapy without chemotherapy is an option. Lymph node negative disease with poor prognostic factors (hormone-negative disease): chemotherapy may be used with or without trastuzumab. Lymph node-positive disease and tumors larger than 1cm: systemic therapy (chemotherapy and often hormonal therapy) is considered.
Different regimens, such as combining anthracyclines, alkylating agents, and fluorouracil, are used for adjuvant chemotherapy. If the patient also has HER2-positive disease, trastuzumab is commonly included in the treatment.

Symptom Control & Chemotherapy Toxicity

Chemotherapy-induced nausea and vomiting is managed using serotonin antagonists.
Opiates and NSAIDs are used to manage pain.
Bone marrow suppression and related complications (infections, neutropenia, and thrombocytopenia) are managed with antibiotics, blood transfusions if needed, and prophylactic measures.
Specific side effects of doxorubicin include cardiomyopathy, those of cyclophosphamide include risk of secondary leukemias, and those of paclitaxel include myelosuppression and hypersensitivity reactions and cardiotoxicity.

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Test your knowledge on the phases of the cell cycle, cancer cell characteristics, and various chemotherapy drugs. This quiz covers key concepts including DNA synthesis, growth signal regulation, and the mechanisms of action of different cancer treatments. Explore the relationships between cellular processes and pharmacological interventions in oncology.