Cancer Therapies Flashcards

1
Q

What are the roles of surgery in the management of cancer?

A
  • Biopsy for histological diagnosis
  • Laparoscopic staging
  • Curative intent
  • Palliative debulking, stabilization of fractures
  • Prophylactically in BRCA/FAP
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2
Q

Outline how RT kills cancerous cells

A

Use of ionizing radiation to produce free radicles which damage DNA to kill tumour cells

Normal cells are better at repairing this damage than cancer cells so recover before the next dose

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3
Q

Define neoadjuvant chemo

A

Agent before definitive Tx, shrink, optimise outcomes

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4
Q

Define primary therapy chemo

A

Sole treatment

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5
Q

Define adjuvant chemo

A

After Tx

Reduce the chance of relapse after surgery

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6
Q

Define palliative chemo

A

Provide relief from symptomatic metastatic disease and possible prolong survival

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7
Q

What is an alkylating agent?

A

Cancer therapy drug class

Antiproliferative drugs that bind via alkyl groups to DNA causing damage

e.g. cyclophosphamide, chlorambucil, busulfan

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8
Q

What is an antimetabolite?

A

Cancer therapy drug class

Act as building blocks of DNA/RNA, when this happens copies cannot be made

e.g. methotrexate, 5-fluorouracil (Inhibits thymidylate synthesis (enzyme required for thymidine)

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9
Q

What is a vinca alkaloid?

A

Cancer therapy drug class

Inhibits function of microtubules

e.g. vincristine (SE - pins + needles), vinblastine

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10
Q

What is an anti-tumour antibiotic?

A

Cancer therapy drug class

Changing the DNA inside the Ca cell to keep them from growing/multiplying

e.g. dactinomycin, mitomycin (form adducts with DNA)

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11
Q

What is a monoclonal Ab?

A

Cancer therapy drug class - immunotherapy

Bind to cell surface Ag = block downstream signaling = arresting cell prolif

  • HER2 inhib (herceptin/trastuzumab) = breast/gastric Ca
  • VEGR (vascular ep growth receptor) inhib (bevacizumab) = ovarian/bowel Ca
  • EGFR (ep GF receptor) inhib (panitumumab) = bowel Ca

SE = skin toxicity, hair gwroth disorders, pruritus, fatigue, D&N, HTN, proteinuria, GI perf

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12
Q

What are the possible side effects from cancer therapies?

A
  • Brain = chemo brain, peripheral neuropathy, fatigue
  • Hair = alopecia
  • Lungs = pneumonitis, PE
  • Liver = deranged LFTs
  • Kidneys = AKI, electrolyte disturbances
  • Repro = impaired fertility, decreased libido, prem menopause
  • Heart/blood = cardiomyopathy, myelosuppression
  • Bladder = haemorrhagic cystitis
  • GI = dirrahoea, constipation
  • Skin = PPE, rash, nail ridging/loss
  • Injection site = hardens, phlebitis, tracking, extravasation

Neutropenia = most commonly 10-14d after chemo
- neutropenic sepsis

Tumour cell lysis = gout, hyperK, hypoCa, urate nephropathy, ca-phos nephropathy

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13
Q

What are the principles of combination chemo?

A

Increases tumour cell killing

Offers broader range of drug activity

Prevents/slows development of new drug resistant cells

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14
Q

What early reactions are seen when giving radiotherapy?

A
  • tiredness
  • mucositis (head, neck)
  • N+V (stomach, liver, brain)
  • diarrhoea (abo, pelvic)
  • dysphagia (thoracic)
  • cystitis (pelvic)
  • BM suppression
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15
Q

What late reactions are seen when giving radiotherapy?

A

CNS

  • somnolence
  • spinal cord myopathy
  • brachial plexopathy
  • reduced IQ (<6yrs olds)

Lung
- pneumonitis

GI

  • xerostomia
  • benign strictures
  • radiation proctitis

GU

  • urinary frequency
  • decreased fertility
  • vaginal stenosis + dyspareunia
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16
Q

What are immune checkpoint inhibitors?

A

MAb that bind, blocking checkpoint proteins from binding their partner proteins, preventing ‘off’ signal being sent, allowing T cells to kill Ca cells

  • PD-L1/PD-1 inhibitors = nivolumab (melanoma, lung, renal Ca)
  • CTLA4 inhibitor = imipilumumab (melanoma)

SE = inflam, increased immune activity, abdo pain, diarrhoea, blood/mucus stool, ileus, dermatitis, pruritis, rash, hepatitis, neuropathy

17
Q

What are the types of radiotherapy?

A
  • Direct = DNA damage, death
  • Indirect = free radicals, DNA damage, death

Types
• External
• Brachytherapy - prostate/cervical Ca
• Systemic - injection, swallowed

18
Q

What medications are given alongside chemotherapy and why?

A

Cotrimoxazol - prophylactic Abx

Aciclovir - prophylactic antiviral

Allopurinol - prevent increased uric acid levels

19
Q

What should be performed before offering potentially curative surgery?

A

PET scan - looking for mets