A 66-year-old man was referred to our hospital for treatment of his thoracic eso

Question

A 66-year-old man was referred to our hospital for treatment of his thoracic esophageal cancer An irregularly elevated lesion occupied the middle thoracic esophagus, and biopsy specimens from the lesion showed well-differentiated squamous cell carcinoma. Computed tomography revealed wall thickening in the middle thoracic esophagus and swelling of a middle thoracic para-esophageal lymph node. 18F-fluorodeox Font Size e positron emission tomography computed tomography revealed high uptake at the tumor and lymph node. We diagnosed the cancer as clinical stage lIB according to the Union for International Cancer Control (UICC) classification. The patient underwent neoadjuvant chemotherapy consisting of 80 mg/m cisplatin on day 1 and 800 mg/m 5-fluorouracil on days 1-5. On day 5, however, the patient's serum creatinine level had increased to 7.83 mg/ml. We diagnosed grade 4 acute renal failure based on the Common Terminology Criteria for Adverse Events, after which chemotherapy was stopped, and the patient was administered hemodialysis without delay. On day 36, we performed a renal biopsy, and the specimen contained 24 glomeruli, 3 of which were sclerotic. Light microscopy showed no mesangial proliferation. There was diffuse moderate interstitial infiltration of lymphocytes with tubulitis, mild interstitial fibrosis, and mild arteriolar sclerosis Tubular casts without macrophagic reactions were seen. The patient's renal function was expected to recover, but after 2 months of hemodialysis it had not. We therefore decided to resume treatment of his esophageal cancer while continuing hemodailysis. At that time, the patient was suffering from congestive heart failure and interstitial pneumonia, so we administered definitive radiotherapy (60 Gy). It is 48 months since the radiotherapy, and the patient is currently alive without recurrence of his esophageal cancer 0 9 1. What chemotherapeutic drug that most likely triggered the impaired renal function? 2. Explain the mechanism of action of the 2 drugs administered for cancer treatment. 3. Based on the drugs action, describe what cells are mostly targeted? 4. Which one of the 10 hallmarks of cancer do both the drugs target the most?

Explanation / Answer

Cisplatin is one of the nephrotoxity drug which has lead to impaired renal function.It affects oxidative function,DNA damage and inflammation in the cells.

2)Cisplatin

This drug interferes the DNA replication >destroys proliferating cells>DNA repair occurs >if this does not occurred or reversed>apoptosis

2)F fluorouracil

It inhibits the thimidylaye synthase>limits enzyme>stops pyrimidine nucleotide synthesis>kills cancer cell

3)These (Cisplatin & 5 fluoracil) drugs targets the cells of neck .It kills the rapidly dividing cells.This drug is very effective in esophageal cancer.

4)Hallmarks ( trait) they target on the tissue and metastasis of the cells (Apoptosis).They resist their programmed cell deat.It also controls the growth of cells. If Growth factor is stimulated. it will produce new cells

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