Cancer and Chemotherapy Flashcards
What is the definition of cancer?
A group of diseases characterised by abnormal cell growth through which cells my acquire potential to metastasise from the site of origin to other sites in the body.
What is tumour growth dependent on?
Delivery of nutrients and oxygen via increased vascular supply (angiogenesis).
What are some of the modifiable risk factors for cancer?
Smoking, body weight, physical activity, diet, UV radiation.
What are some non-modifiable risk factors for cancer?
Pollution, genetics, hormonal factors.
What are some red flag symptoms for cancer?
Bleeding, bruising, lumps, swelling, appetite loss, swallowing difficulties.
Why is chemo given in cycles?
Since chemo only targets dividing cells, some normal cells will be impacted and some non-dividing cancer cells won’t be impacted. The break means that by the next cycle, some of these cancer cells will now be dividing. Also, normal cells impacted by chemo repair damage more effectively than cancer cells, so while they may fully repair in this break, cancer cell damage builds up without causing permanent damage to normal cells.
What are the common side effects of chemotherapy?
Weakness
Fatigue
Thrombocytopenia and anaemia Immunosuppression
Nausea and vomiting
Hair loss
Diarrhoea and constipation
Nerve damage.
What can dexamethasone also be used for in palliative care?
Appetite loss.
What can be given to alleviate chemotherapy-induced pain?
Opioids. Usually morphine. Can be taken prn or preventatively plus oral morphine for breakthrough pain. Can cause constipation.
What can be given to alleviate opioid-induced constipation?
Osmotic laxative (lactulose, movicol, laxido) or stimulant (senna, docusate, bisacodyl). NOT bulk forming.
What is neutropenic sepsis?
Sepsis caused by low neutrophil count, usually due to immunosuppressant treatment such as chemotherapy.
Why is paracetamol not recommended in chemotherapy patients?
Paracetamol is an analgesic and an antipyretic, so can mask symptoms of infection such as pain and fever.
Which opioid is least likely to cause nausea?
Fentanyl.
What test should be done if sepsis is suspected?
NEWS2
What does NEWS2 score measure?
CROPS T
C - Level of consciousness or new-onset confusion.
R- Respiratory rate
O - Oxygen saturation
P- Pulse rate.
S- Systolic blood pressure.
T - Temperature
What is the criteria for neutropenic sepsis?
Neutrophil count of 0.5x10^9/L or lower
plus either
temperature of 38C or higher
other signs or symptoms consistent with sepsis.
What should be given when sepsis confirmed?
BUFALO:
Blood tests - cultures, FBC, urea and electrolytes, CRP.
Urine - monitor urine output.
Fluids - IV fluids.
Antibiotics - broad-spectrum IV antibiotics.
Lactate - monitor lactate.
Oxygen - high flow oxygen.
What is first line antibiotic treatment for sepsis:
Piperacillin with tazobactam IV 4.5g every 8 hours.
When should a person be switched from IV to oral antibiotics:
After 48 hours if possible, based on COMS criteria:
C - clinical improvement observed.
O - oral route not compromised.
M- markers show trend towards normal. Apyrexial for 24 hours all but one of HR, RR, BP, and WCC normal.
S - specific indication/deep-seated infection? If so, speak to microbiology before switching.
What are the benefits of switching from IV to oral antibiotics?
Cheaper
Patient can go home.
Lower risk of infection.
Lower risk of phlebitis.
Narrower spectrum based on blood cultures.
What can be given to alleviate chemotherapy-induced nausea and vomiting?
Metoclopramide - dopamine and serotonin receptor antagonist.
Dexamethasone - steroid.
