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Year 2 > Cancer: Chemotherapy and Radiotherapy > Flashcards

Cancer: Chemotherapy and Radiotherapy Flashcards

1
Q

What is chemotherapy?

A

Cytotoxic drugs used to destroy rapidly proliferating cells by interfering with cell division and is used in the treatment of cancer because it can travel via the bloodstream to treat cancer anywhere in the body. It generally has a low target-specificity.

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2
Q

How does chemotherapy work?

A

Binds to DNA, inhibits enzymes or disrupts the mitotic spindle and mimicks DNA building blocks.

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3
Q

In which circumstances can chemotherapy be targeted?

A

A key feature of cancer cells is the inability to repair DNA damage.

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4
Q

What are the drawbacks of chemotherapy?

A

Does not discriminate and targets cells with a high proliferative ability, especially the cells of the intestinal lining with a high replacement rate.

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5
Q

Which cells are affected in chemotherapy?

A

Bone marrow: leads to anaemia, thrombocytopenia
Intestinal cells: leads to vomiting and GI upset
Hair root cells: causing alopecia
Skin cells: leads to photosensitivity or rashes or pigmentation

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6
Q

What are the types of chemotherapy side effects?

A

Acute and long-term

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7
Q

What is a vesicant?

A

Chemical drug that can cause severe chemical burns and tissue damage. Chemotherapy is a vesicant which causes toxicitiy of the heart, lungs, CNS and endocrine system

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8
Q

What are the common side effects of chemotherapy?

A

Acute toxicity which is self limiting due to normal cells ability to repair
Long term toxicity which is incurable and leads to end organ damage

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9
Q

What are the types of acute toxicity in chemotherapy?

A

Myelosuppression, alopecia and GI toxicities with vomiting and headaches. Cognitive impairments such as confusion and memory loss

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10
Q

What are the long term toxicities of chemotherapy?

A

Infertility, early menopause, fatigue, hearing loss, heart failure

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11
Q

What is radical treatment?

A

Curative treatment

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12
Q

What is SACT?

A

Drug treatment to control or treat cancer which includes surgery, radiotherapy and chemotherapy and targeted treatment.

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13
Q

What effects does chemotherapy have on the organs?

A

Injection of the cytotoxic drug can contain high calcium levels such as anthracyclines which result in heart failure long term
May be lung damage,
Liver steatosis because chemo drugs are lipophilic and taken up
Kidney damage due to the breakdown of the cytotoxic drugs

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14
Q

What are the common side effects of chemotherapy?

A

Extravasation of the drug, alopecia, stomatitis, stimulation of vomiting centre in CNS. C

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15
Q

What is the primary cancer treatments?

A

Surgery to remove tumour only in a specific location
Radiotherapy to kill cancer cells only in the area that it is aimed at
Chemotherapy has systemic cytotoxic effects on cancer cells and travels throughout the body via the bloodstream

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16
Q

What is multimodality treatment?

A

Using more than one type of treatment to treat cancer.

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17
Q

What are the types of chemotherapy?

A

Curative
Adjuvant
Neoadjuvant
Palliative

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18
Q

What is curative chemotherapy?

A

Chemotherapy administered to obtain full cancer remission in the patient, typically used in the treatment of acute lymphocytic leukemia. Typically has an induction phase to destroy any cancer cells and later a consolidation phase to remove any remaining cancer cells.

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19
Q

What is adjuvant chemotherapy?

A

Given after a primary treatment such as surgery or radiotherapy to increase the length of cancer remission. This is beneficial because following removal of a tumour, information about the cancer spread and characteristics can make adjuvant treatment highly tailored to the patient. This is typically done for breast cancer.

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20
Q

What is neoadjuvant chemotherapy?

A

Treatment given to reduce the size of the tumour prior to the primary treatment to increase the likelihood of surgery success and assess the effect of cancer therapy on the disease for bladder cancer and breast cancer.

21
Q

What is palliative chemotherapy?

A

Intent is to improve quality of patient life, such as pain relief, stress from the illness regardless of diagnosis which is common in solid tumours. Used for pancreatic cancer, breast cancer and non-small cell lung cancer

22
Q

What is radiotherapy?

A

The use of localised ionising radiation to cause DNA damage to cells as a treatment of cancer via direct or indirect methods.

23
Q

What are the types of radiotherapy?

A

External radiotherapy and internal radiotherapy

24
Q

What is external radiotherapy?

A

Machine called external beam directs ionising radiation to the body.

25
Q

What are the types of external beam?

A

Conventional external beam
Stereotactic radiation
Particle radiation
3D Conformal radiotherapy

26
Q

How does radiation damage occur?

A

Via rexoygenation where radiation causes loss of electrons from cell which reacts with oxygen to form a superoxide radical that causes DNA damage.

27
Q

What is conventional external beam?

A

2D beams deliver high energy X rays using medical linear accelerator to tumour but high dose is limited by effect on healthy tissue.

28
Q

What is Stereotatic radiation?

A

Focused angles of different beams of radiation localised to the tumour in a short amount of time with a lower dose so less effect on surrounding tissue. Only ideal for smaller tumours.

29
Q

What is particle radiation?

A

Consists of a beam of protons, neutrons and electrons directed to tumour which reduces energy deposited to surrounding tissue

30
Q

What is 3D Conformal radiotherapy?

A

Multiple radiation beams are directed to conform to tumour shape using a multileaf collimator/

31
Q

What is indirect radiotherapy?

A

Ionising radiotherapy is targeted to the water surrounding cancer cells and causes free radicals to form which react with oxygen to form superoxide radicals that cause DNA damage.

32
Q

What is direct radiotherapy?

A

Ionising radiotherapy is targeted directly to cancer cells and causes double stranded DNA break, ideally during the end of the M phase of cancer cells when it is most susceptible to DNA damage. This is done in segments via fractionation.

33
Q

What is fractionation?

A

Providing radiotherapy over the course of many days because cancer cells are in different stages of division. This ensures normal cells that are damaged have enough time to repair and that most cancer cells are damaged enough to prevent repopulation by non-damaged cells.

34
Q

What is brachytherapy?

A

Internal radiotherapy which inserts radiation source inside or close to tumour site to deliver higher dose treatments. This requires high tumour accessibility and clear demarcation.

35
Q

What is pre-operative XRT?

A

Radiotherapy given before surgery which decreases extensiveness of surgery and distant metasasis due to surgery, makes microscopic cancers more radiosensitive. Also creates a smaller treatment portal (extent in bloodstream). It can make previously unsecetable tumours become resectable.

36
Q

What are the drawbacks of pre-operative XRT?

A

Reduces wound healing rate and lower safe dose.

37
Q

What is post-operative XRT?

A

Providing radiotherapy after surgery which means a greater dose can be given dependent on the residual tumour burden, allows surgical staging (tumour can be assessed post-surgery) and improves healing and make surgical resection easier.

38
Q

What are the drawbacks of post-operative XRT?

A

Delay in providing post-operative treaments if there are healing problems and potential distant metastasis due to manipulation

39
Q

What are the acute side effects of radiotherapy?

A

Occurs during treatment depending on area treated:
Damage to epithelial surfaces causing skin to become pink and sore
Mouth, throat and stomach sores
INfertility due to sensitivity of gonads to radiation
Intestinal discomfort

40
Q

What are the late side effects of radiotherapy?

A

Occurs weeks-> months after treatment
Tissue fibrosis
Dry eyes and mouth
Hair loss
Lymphaedema

41
Q

How can cancer cells become resistant to chemo drugs?

A

Contain the MDR-1 gene, which codes for P-glycoprotein for increased efflux of drugs to protect the brain. Increases resistance to alkaloids, anthracyclines and epipodophyllotoxins.

42
Q

What is the role of topoisomerase?

A

Relaxing of DNA supercoils to break and reattach for DNA replication for the topology of DNA

43
Q

What is anthracycline?

A

Anti-tumour drug which inhibits topoisomerase
Inihibits DNA helicase activity by intercalating between the DNA bases
Induces ROS production to induce apoptosis

44
Q

What is the action of anti-metabolites?

A

Inhibits DNA and RNA synthesis by targeting thymidylate synthase which catalyses dUMP -> dTMP and Methylene THF -> DHF.

45
Q

Which nucleotide is most affected by action of anti-metabolite?

A

Thymine nucleotide which is produced from the methylene THF donated a methyl group to uracil -> thymine

46
Q

What are the methods of cancer resistance to drugs?

A

Primary drug resistance
Secondary drug resistance

47
Q

What is stage?

A

Extent of cancer spread. This is commonly in the

48
Q

What are the invasive diagnostic procedures for cancer?

A

Colonoscopy, bronchoscopy and laparoscopy.

49
Q

What are the biochemical investigations?

A

Protein and electrolytes
Liver enzymes
Tumour markers such as PSA (prostate specific antigen) and HCG

Year 2 (247 decks)

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