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ONS/ONCC Chemotherapy Immunotherapy Certificate, Study Guides, Projects, Research of General Surgery

Virginia State University (VSU)General Surgery

ONS/ONCC Chemotherapy Immunotherapy Certificate

Typology: Study Guides, Projects, Research

2024/2025

Available from 09/03/2024

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ONS/ONCC Chemotherapy Immunotherapy Certificate
1.Lesson 1: Foundations to Set the Stage:
2.Focusing on Cellular Structure and Function:
3.The Normal Cell Cycle: -The cell cycle refers to the ordered seres of
processes of DNA replication and mitosis, or cell division
-Cell nucleus regulates these processes by gathering and processing
complexes molecular information
4.Interphase and Mitotic Phase: Cell division produces two identical cells
through these two major phases
5.During interphase:: Cell grows and DNA is replicated through the
following three steps:
1: First growth phase (G1 or first
gap) 2: Synthesis phase (S
phase) 3:Mitotic Phse (M phase)
6.First Growth Phase (G1 or first gap): -cells increase in size
-reproduce RNA
-"quality assurance" test that the cell will be ready to synthesis DNA
-Length of time is variable, can be from hours to days
7.Synthesis Phase (S phase): -DNA replicates
-Results in the formation of identical pairs of DNA (chromatids)
-which are attached a t the centromere
-lasts 2-10 hours
8.Mitotic Phase (M phase): -Replicated chromosomes are aligned,
separated, and move into 2 new, identical daughter cells
-takes about 30-60 minutes
9.Major points of cell regulation are entry and exit from: -G1 checkpoint
-S Phase
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ONS/ONCC Chemotherapy Immunotherapy Certificate

  1. Lesson 1: Foundations to Set the Stage:
  2. Focusing on Cellular Structure and Function:
  3. The Normal Cell Cycle: -The cell cycle refers to the ordered seres of processes of DNA replication and mitosis, or cell division -Cell nucleus regulates these processes by gathering and processing complexes molecular information
  4. Interphase and Mitotic Phase: Cell division produces two identical cells through these two major phases
  5. During interphase:: Cell grows and DNA is replicated through the following three steps: 1: First growth phase (G1 or first gap) 2: Synthesis phase (S phase) 3:Mitotic Phse (M phase)
  6. First Growth Phase (G1 or first gap): -cells increase in size -reproduce RNA -"quality assurance" test that the cell will be ready to synthesis DNA -Length of time is variable, can be from hours to days
  7. Synthesis Phase (S phase): -DNA replicates -Results in the formation of identical pairs of DNA (chromatids) -which are attached a t the centromere -lasts 2-10 hours
  8. Mitotic Phase (M phase): -Replicated chromosomes are aligned, separated, and move into 2 new, identical daughter cells -takes about 30-60 minutes
  9. Major points of cell regulation are entry and exit from: -G1 checkpoint -S Phase

2 / 32 -G2 checkpoint -M phase

  1. Restriction Point: -The transition from the resting phase into an actively dividing phase (G0-G1) is a point where cellular transformation can occur -During this time, cells pass through a transition phase known as a restriction point -Extracellular growth factors trigger reentry into G1, and GF are required to send the cells past the restriction point, or the point of no return
  2. G0 Phase (resting phase): -After mitosis, cells may enter back into the G1 phase or go into a resting phase, known as G -Most cells in the human body reside in G
  3. -Exceptions to this are those that are (Resting in G0 phase): -Exceptions to this are those that are metabollically active, such as
  • granulocytes -and the epithelium of the GI tract
  1. Cell Cycling Time: Amount of time from mitosis to mitosis
  2. Cell cycle video and image: http://highered.mheducation.com/sites/0072495855/student_view0/cha p- ter2/animationhow_the_cell_cycle_works.html
  3. Check points in the Cell Cycle: Keeping it All Under Control: -The cell cycle is carefully controlled through a series of checkpoints -Variation in duplication or distribution of chromosomes during cell division can alter the genetic information passed on to daughter cells, leading to cellular dysfunction and disease, such as cancer -These checkpoints monitor for DNA integrity and control progression through mitosis
  4. Progression through the cell cycle is controlled through two proteins::
  5. cyclines (D, E, A, B)

4 / 32

  1. Locations of proteins Cyclins (D, E, A, B) and CDKs: -(G0-G1) : Cyclin D and CDK 4/ -Early S: Cyclin E and CDK 1/ -Late S: Cyclin A and CDK 1/ -G2: CDK 1/2 and cyclin A -Before M: CDK 1 and Cyclin B
  2. Inhibitory proteins: -prevent progression of the cycle when DNA damage is detected -An example of an inhibitory protein is p53 (AKA TP53)
  3. DNA Damage Checkpoints: -If DNA damage is present, cells are programmed to stop dividing or undergo apoptosis (programmed cell death) -The retinoblastoma protein (Rb), p53, and p21 are some of the most well-under- stood inhibitory proteins (IP)
  4. Inhibitory proteins p53: -Levels of this IP regulate several important target genes -Will increase when DNA damage is present -Protects against inappropriate signal proliferation -sometimes called the "suicide gene"
  5. M Phase Checkpoints: When the cells prepare to divide, the chromosomes line up in the mitotic spindle. If the chromosomes are not properly aligned, division is not allowed to continue
  6. Immunity:
  7. Cells of the Immune System:
  8. Pluripotent Stem Cell: -The cells of the immune system are created in the bome marrow from what is know as a

5 / 32 -A stem cell that can differentiate into any cell type except for extraembryotic tissue, does not yet have a function

7 / 32 -Regulatory T-cells

  1. Humoral Immunity: -B-Cells -Memory B-Cells -Plasma act to produce immunoglobulins (Igs) or antibodies
  2. B-Cell: -each one is programmed to make one specific antibody -Can recognize antigens whether they are freely circulating in the blood or attached to surface of a microbe -When dividing, can become plasma cells which will then begin secreting antibodies that are unique to that antigen
  3. Plasma Cells: -some plasma cells will undergo apoptosis -Some will go to the BM where they will continue to secrete antibodies sometimes for years
  4. Cell-Mediated Immunity: Depends upon cytotoxic T cells and helper T cells and their cyokinds -more effective against antigens within cells
  5. Regulatory T-cells AKA suppressor T-Cells: regulate the immune response to prevent autoimmune reactions and limit inflammatory responses
  6. T-Cell: -Can only recognize antigens when they are presented to them by "presenting cells" -Recognize phagocytized fragments of an antigen that are put on the surface of antigen-presenting cells
  7. Helper T-Cells (CD4+): -help other T-Cells by secreting chemicals -Help B Cells to respond -rapidly divide, in an effort to stay ahead of the antigen dividsion -some will turn into effector cells, which secrete different kinds of cytokines -respond similarly to B-Cells
  8. Cytotoxic T-Cells (CD8+): -Directly kill cells for which they are

8 / 32 activated to kill -rapidly divide, become mature cells, and start killing antigens

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  1. Proto-oncogene: -regulate normal cell growth and division -large family of genes that code for proteins and enzymes that turn on the cell cyle
  2. Oncogene: when mistakes in copies of DNA can occur, if a mutation occurs next to a proto-oncogene, it can "turn on" and become a
  3. Examples of oncogoenes: 1. EGFR or Erb-B1 (codes for an epidermal GF receptor in the receptor-tyrosine kinase family ad is associated with head and neck and colorectal cancers) -EGFR inhibitor therapies are known to cause cutaneous reactions
  4. Erb-B2 or HER2/neu (codes for an EGFR protein in the tyrosine kinase family and is associated with some breast cancers)
  5. Tumor suppressor genes: -act like brakes in a car, slowing down or stopping cell growth and division -in the presence of malignancies, they bind to DNA with intention of repairing or activating apoptosis -for it to be turned on it must be expressed or "opened" in the DNA helix so that it can be transcribed or copied
  6. p53: -"sucidie gene" -activates apoptosis when the cell is damaged beyond repair or too old to function -more than 50% of solid tumors, the gene is mutated and unable to perform its normal function
  7. Growth Signals: -cancer cells are able to find their own growth signals making them self-sufficient
  8. Signal transduction: -the communication or passage of a message telling the cell to do a biologic process, such as make a protein, divide, or make new blood vessels
  9. Signal transduction steps: 1. Messages usually sent from outside the cell where the messenger (ligand) first binds to the cell receptor which extended through the cell membrane 2.These receptors ae called receptor tyrosine kinases

11 / 32 3.To send the message through the membrane, the receptor often has to join with

13 / 32 -Examples: chemo, radiation therapy, hormone therapy, targeted therapy, or biologic therapy

14 / 32

  1. Dose density: -refers to the drug dose per unit of time -reduction of time between treatments to achieve higher concentration than in a standard treatment plan
  2. Dose intensity: -amount of drug delivered over time -smaller doses of chemotherapy given more frequently
  3. Relative dose intensity (RDI): -calculated by comparing the dose that the pt received to the planned dose of the standard regimen
  4. Oral Chemotherapy: -greater challenge to adherence because the responsibil- ity falls on the pt and caregiver
  5. Nonadherence: -pt takes too few or too many pills
  6. Overadherence: -when a pt believes a dose was missed or that "more is better", too much medication may be taken, leading to increased toxicity
  7. Factor affecting adherence: -provider relationship -side effects
  • necessity
  • routinization
  • support -lifestyle fit
  • cost -medication knowledge -pill burden -regiment complexity
  1. Lesson 2: Alkylating Agents:
  2. Alkylating Agents: -function by causing a break in the DNA helix strand, caus- ing interference with DNA replication, which results in cell death
  3. Alkylating Agent Subgroups: -Nitrogen mustards (cyclophosphamide{Cytox- in}, ifosfamide{Ifex}, bendamustine{Treanda}) -Platinum-based (cisplatin{Planitol}, carboplatin{Paraplatin}): do not possess an alkyl group
  • nitrosoureas
  1. Nitrosoureas: -subgroup of alkylating agents

16 / 32 -Carmustine (BiCNU) -Lomustine (CeeNu) -Streptozocin (Zanosar) -pulmonary monitoring recommended

  1. Carboplatin (Paraplatin): -Alkylazing agent -possibility for a hypersensitivity reaction which is rash, urticaria, erythema, pruritis, rarely bronchospasm and hypotensision -notify RN if itching, scratchy throat, difficulty breathing, rash -Blood count, particularly platelets, monitored because thrombocytopenia is a dose-limiting toxicity -Oral dosage: 1-5mg/kg/day
  2. Cisplatin (Planitol): -Alkylating agent -nephrotoxic (IV hydration 2-3 L per day) -severe N/V -ovarian and testicular
  3. Cyclophosphamide (Cytoxin): -Alkylating agent) -hemorrhagic cystitis (dysuria, hematuria, hemorrhage) -DC treatment if hemorrhagic cystitis -adequate hydration
  4. Oxaliplatin: -Alkylating agent -irritant and vesicant, extra caution with the IV site -peripheral neuropathy is a dose-limiting side effect (exacerbated by cold tempera- tures) -avoid cold drinks and foods, wearing gloves and warm shoes

17 / 32 -avoid breathing cold air

  1. Intrathecal Chemotherapy: -injects chemo directly into the subarachnoid space so it reaches the CNS -Often used to treat leukemia and lymphoma that has spread to the CNS since most IV chemo does not cross the blood-brain barrier -only MTX and cytarabine via this route -IT hydrocortisone is often given at the same time to reduce inflammation -MUST be preservative free to avoid CNS irritation
  2. Chemotherapy-Induced N/V (CINV) Risk factors: - younger -have a hx of low or no alcohol consumption -are female -hx of morning sickness -prone to motion sickness -have had chemo previously
  3. Types of CINV: -Acute: occurring within 24 hours -Delayed: from 24 hour - 5 days after -Breakthrough: Occurring despite treatment -Anticipatory: triggered by taste, odor, memories, visions, anxiety r/t chemo -Refractory: occurring despite subsequent cycles when treatment failed in earlier cycles
  4. Prevention/Treatment of hand foot syndrome: -limit exposure of hands and feet to hot water -take cool showers -avoid exposure to sources of heat, such as using saunas or sitting in the sun

19 / 32 -avoid contact with harsh chemicals used in detergents and household cleaning products -avoid activities that require you to press your hand against a hard surface -elevate your hands and feet when sitting or lying down -gently apply skin care creams to keep hands moist -wear loose-fitting, well ventilated shoes

  1. Nadir: -point at which blood cell counts are at their lowest following treatment -typically, but not always, occurs 7-10 days after the cycle is administered
  2. Neutropenia: -ANC of less than 500/mm3 or -less than 1000/mm3 with the expectation that the count will drop below 500 in the next 48 hours
  3. Neutopenia RF: -older than 65 -hx of neutropenia with previous chemo -previous chemo or radiation -hematologic malignancy, uncontrolled or advanced cancer, or lung cancer
  4. Neutropenic Fever: -temp of 38.3 or greater one time -temp of 38 lasting 1 hour
  5. Absolute Neutrophil Count: - (%segs + %bands) x (WBC) / 100
  6. Mucositis: -inflammation of the mucous membrane lining the digestive tract from mouth to anus -affects 40-100% of pts
  7. Stomatitis: -specifically inflammatory conditions of the mouth
  8. Xerostomia: -dryness of the mouth caused by damage to or dysfunction of the salivary glands

20 / 32

  1. Hypersensitivity Reaction (HSR): -body mounts an immunologic response to a foreign substance or antigen, resulting in local tissue injury
  2. IgE-mediated: -immediate (within 5 minute) HSR, present like classic allergic reactions