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Y4 Cancer > Basics Of Systemic Treatment > Flashcards

Basics Of Systemic Treatment Flashcards

1
Q

How does traditional chemotherapy work ?

A

Systemic drug used to kill cancer cells by causing lethal cytotoxicity or apoptosis.

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2
Q

Where can chemotherapy be used ?

A

Primary chemotherapy - induction of remission
Neo-adjuvant - treat/shrink cancer before surgery
Adjuvant - after surgery to kill any remaining cells
Maintenance lower doses to prolong remission
Palliative - improve cancer symptoms

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3
Q

What are some benefits of targeted therapy over chemotherapy ?

A

More specific
Better tolerated
Can be given for longer periods

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4
Q

What is an example of a small molecule agent ( targeted therapy ) ?

A

Tyrosine kinase inhibitor - imatinib

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5
Q

How are biologic therapies used in cancer management ?

A

Usually monoclonal antibodies against cell surface or circulating antigens

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6
Q

In what cancers are hormonal agents useful ?

A

Breast
Prostate

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7
Q

When can hormonal agents be used in breast cancer and what is given ?

A

When the cancer is oestrogen positive
Selective oestrogen receptor modulators or aromatase inhibitors

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8
Q

What hormonal therapy can be given for prostate cancer ?

A

Androgen deprivation therapy - GnRH agonists or antagonists

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9
Q

When does Alopecia occur in cancer management ?

A

Usually 7-10 days after chemotherapy

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10
Q

What causes nausea and vomiting in cancer management ?

A

Traditional chemotherapy

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11
Q

What are some management options for nausea and vomiting due to chemotherapy ?

A

Ondansetron
Olanzapine
Dexamethasone

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12
Q

When does neutropenia occur in cancer management ?

A

Traditional systemic agents

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13
Q

When is neutropenia an emergency after chemotherapy ?

A

Associated with a fever - neutropenic sepsis

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14
Q

What can cause oral mucositis ?

A

Traditional chemo
Radiotherapy

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15
Q

What is oral mucositis ?

A

Acute inflammation or ulceration of the oral or oropharyngeal mucosal membranes which can interfere with eating, swallowing or speech due to pain or discomfort.

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16
Q

Which medications are associated with peripheral neuropathy ?

A

Traditional chemo - platinum therapies and microtubule inhibitors

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17
Q

How can chemo induced peripheral neuropathy be managed ?

A

Consider dose adjustment
Gabapentin or duloxetine

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18
Q

What are some cancer treatments associated with secondary cancers ?

A

Chemotherapy - alkylating agents, platinum agents, topoisomerase inhibitors
Targeted therapies - SSC of the skin

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19
Q

How do alkylating agents work ?

A

Cell cycle non specific drugs which contain alkyl groups that form reactive molecular species that interact with and cross link with DNA. This halts DNA replication.

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20
Q

What is an example of an alkylating agent ?
( and its indications )

A

Cyclophosphamide
ALL, CLL, Hodgkin’s and non-Hodgkin’s, myeloma, breast, ovary, Wilma tumour

21
Q

What are some side effects of cyclophosphamide ?

A

Alopecia
Nausea and vomiting
Diarrhoea
Myelosuppression
Haemorrhagic cystitis

22
Q

What are some examples of microtubule inhibitors ?

A

Vincristine
Docetaxel and paclitaxel

23
Q

What are some indications for vincristine ?

A

Hodgkin and other lymphomas
Wilson tumour
Rhabdomyosarcoma
Neuroblastoma

24
Q

What are some side effects of vincristine ?

A

Neurotoxicity
Peripheral neuropathy
Myelosuppression

25
Q

What are the indications of docetaxel ?

A

Breast
Non small cell lung cancer
Ovarian cancer
Bladder
Head and neck cancer

26
Q

what are some side effects of docetaxel ?

A

Hypersensitivity
Neutropenia
Peripheral neuropathy

27
Q

What are some examples of platinum agents ?
( +Indications )

A

Cisplatin, Carboplatin and oxaliplatin
Testicular
Ovarian
Bladder

28
Q

What are some side effects of platinum agents ?

A

Peripheral neuropathy
Ototoxicity
Nephrotoxicity
Nausea and vomiting
Myelosuppression

29
Q

What is an example of selective oestrogen receptor modulators ( + indications ) ?

A

Tamoxifen
Oestrogen responsive breast cancer

30
Q

What are some side effects of tamoxifen ?

A

Hot flushes
Vaginal bleeding
DVT
Endometrial hyperplasia and malignancy

31
Q

What are some aromatase inhibitors ?

A

Anastrozole and letrozole

32
Q

What are the indications for aromatase inhibitors ?

A

Oestrogen positive breast cancer in postmenopausal women

33
Q

What are some side effects of aromatase inhibitors ?

A

Hot flashes
Reduced bone mineral density
Arthralgia

34
Q

What is an example of a monoclonal antibody in cancer management ?

A

Herceptin

35
Q

When can herceptin be used in breast cancer management ?

A

HER-2 positive

36
Q

What are some side effects of herceptin ?

A

Cardiotoxicity
Reduction in left ventricular ejection fraction

37
Q

What is an indication of imatinib ?

A

Chronic myeloid leukaemia

38
Q

What are some side effects of imatinib ?

A

Myelosuppression
Hepatotoxicity
Fluid retention

39
Q

Which cancers can be treated with hydroxyurea ?

A

Head and neck
CML
Melanoma
Ovarian
Myeloproliferative

40
Q

What cancers can bleomycin be used for ?

A

Testicular
Lymphomas

41
Q

What are some side effects of bleomycin ?

A

Pulmonary toxicity - Pneumonitis and fibrosis

42
Q

What can Rituximab be used for ?

A

Non-Hodgkin’s
B cell lymphoma

43
Q

What is radiation ?

A

Released when an unstable higher energy atom configuration changes into a more stable lower energy configuration.
Uses X ray waves

44
Q

What happens at the level of tissue in the process of killing a cancer using radiation ?

A

Repair - cancer cells can’t repair between the fractions of radiation
Repopulation - radiation damages the tumour cells ability to repopulate
Re-assortment - the radiation will catch cells in different phases of the cell cycle ( different fractions will catch cells in more vulnerable phases of the cycle )
Re-oxygenation - indirect damage

45
Q

In palliative setting when is radiation used ?

A

Bone mets
Lung mets
Brain mets
Spinal cord compression
SVC obstruction

46
Q

What are some side effects of radiation therapy ?

A

Fatigue
Sun - burnt appearance
Dry skin
Hair loss
Mucositis
Cough
Pneumonitis
Dysphagia
Nausea and vomiting
diarrhoea
Headache
Marrow suppression

47
Q

What are some WHO principles of screening ?

A

Important health problem
There should be a treatment
Facilities should be available
Latent stage of disease
Test or exam for the disease
Test should be acceptable to public
Agreed policy for who to treat

48
Q

What is the purpose of staging ?

A

Assessment of local disease
Assessment of distant disease

This determines operability and choice of treatment

Y4 Cancer (12 decks)

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