Introduction to Oncology

1. Cancer
a. Ongoing proliferation of abnormal cells that are metabolically active
2. Treatment options
a. Surgery
i. Most useful for localized solid organ tumors
ii. Physical removal of the tumor or to reduce the size
iii. Margins
1. Positive – there is cancerous tissue remaining
2. Negative – cancer was removed in entirety
b. Radiation
i. Can be palliative or curative
ii. Causes cell death through DNA damage by oxygen-free radicals
iii. Radiation is measured in Gray (Gy) units
1. 1 Gy = 1 J per kg tissue
c. Pharmaceutic (aka chemotherapy)
d. Terminology
i. Neoadjuvant – chemotherapy administered prior to surgery
ii. Adjuvant – chemotherapy administered after surgery/radiation
3. Tumor locations
a. Solid organ tumors
i. Originate in the organs
b. Hematologic malignancies
i. Originate in the blood/blood-forming organs (bone marrow, lymph nodes)
4. Chemotherapy classes
a. Cytotoxic
i. Cell-cycle specific
1. Work at a specific stage in the cell cycle
2. Typically administered as continuous infusion to catch cancer cell in
specific phase and maximize killing effect
ii. Noncell-cycle specific
1. Work throughout the entire cell cycle
2. Administered as shorter infusions
b. Biologic targeted
i. Large monoclonal antibodies – target extracellular cell surface receptors
1. Ex: rituximab, bevacizumab
ii. Small molecules (oral agents) – target intracellular pathways
1. TKIs (dasatinib, imatinib)
c. Hormonal
i. For tumors that are hormonally active (breast cancer, prostate cancer)
ii. Ex: SERMs, LHRH agonists/antagonists
d. Immunotherapy
i. Agents that imitate or influence the body’s natural immune system
 ii. Ex: interferons, interleukins
5. Chemotherapy dosing
a. Amount of tumor cell killing is dose-dependent
b. Amount of side effects is also dose-dependent
c. Cycles
i. Allows for effective doses while decreasing adverse effects and allowing the
body time to recover from a cycle
6. Chemotherapy adverse events
a. Chemotherapy medications mostly affect rapidly proliferating cells
i. Mucous membranes, skin, hair, GI, bone marrow
b. Myelosuppression – most common dose-limiting adverse effect