Cancer Therapy Flashcards

Question

Define radical radiotherapy

Answer 1

Radiotherapy used to treat cancer as part of curative strategy - neoadjuvant - adjuvant - definitive

Answer 2

``` Symptom control - not aiming to cure Lower dose so reduced side effects Spinal cord compression Pain caused by bone mets SVCO ```

Answer 3

``` Depends on area treated Fatigue Hair loss Dysphagia, sore throat, oral mucositis Low blood counts N+V Erythema Cystitis Sterilisation Radiotherapy dermatitis ```

Answer 4

``` Skin - pigmentation - necrosis - telangiectasia - ulceration Bone - necrosis - fracture Mouth - ulceration - xerostomia Eyes - cataracts Lung - fibrosis Hear - cardiomyopathy - pericadiafibrosis Gonads - infertility - menopause Bowel - strictures - ulcers ```

Answer 5

Melanoma | Renal cell cancers

Answer 6

Mucosal surfaces - Head and neck squamous cell - Anus and rectal cancers

Answer 7

Alkylating agents - form covalent bonds with DNA to impede replication - depression of bone marrow function, GI upset, increased risk of non-lymphocytic leukaemia Antimetabolites - block one or more metabolic pathways involved in DNA synthesis - pyrimidine analogues - fluorouracil - purine analogues - tigouanine - depression of bone marrow function, GI epithelial damage, nephrotoxicity, teratogenicity Cytotoxic antibodies - prevent cell division by different mechanisms - doxorubicin - prevents DNA unzipping - dactinomycin - interferes with RNA polymerase - bleomycin - degrades fully formed DNA - N+V, myelosuppression, hair loss, fevers, muccositis, pulmonary fibrosis

Answer 8

Drugs antagonise or suppress hormonal action o Glucocorticoids e.g. prednisolone, dexamethasone – inhibit lymphocyte proliferation o Oestrogens and anti-androgens – used to suppress growth of prostate tumours o Anti-oestrogens, e.g. Tamoxifen – competes at oestrogen receptors in breast cancer tissue, preventing oestrogen uptake and therefore reducing rate of tumour growth o Adrenal hormone synthesis inhibitors (aromatase inhibitors) – used in post-menopausal breast cancer to inhibit sex hormone synthesis o Progestogens – useful for endometrial neoplasms and renal tumours o Gonadotrophin releasing hormone analogues/antagonists – act to inhibit gonadotrophin release, preventing its action on tumours and therefore inhibiting tumour growth in advanced breast cancers in pre-menopausal women and prostate cancers o Somatostatin analogues – relieve symptoms of neuroendocrine tumours, · Monoclonal antibodies – used for targeted treatment of specific cancers o Can cause hypotension, chills and fevers, hypersensitivity · Protein kinase inhibitors – inhibit protein kinases, e.g. tyrosine, which transduce growth signals in rapidly dividing cells

Answer 9

Nausea and vomiting o Domperidone or metoclopramide in low level nausea and vomiting o Serotonin antagonists (ondansetron) – better for severe nausea and vomiting · Extravasation – inflammation caused by leak of white cells into tissue compartments. Seen as pain, redness, blotching and blistering, in serious cases can lead to skin necrosis o Topical antidotes – e.g. Dimethyl sulfoxide o Debridement and grafting depending on how damaged the skin becomes · Bone marrow suppression o Monitor neutrophil counts and admit for assessment of neutropenic sepsis if neutrophils drop below 0.5x109 cells/L o Inform patients to go to A+E if they start to feel feverish or unwell during any chemo cycles o Granulocyte Colony Stimulating Factor can be given to increase circulating volume of white cells if necessary · Alopecia o Hair may remain or grow back faster if head is kept cold · Fertility – many chemotherapeutic agents lead to hypogametogenesis or infertility o Counselling on this should be given before treatment starts o Sperm/egg harvest and storage should be offered o Most chemotherapeutic agents are teratogenic, therefore females should be counselled on contraception If side effects are causing issues, reduce chemotherapy dose or wait longer between cycles

Answer 10

External beam – lasers emitting gamma radiation are fired at the tumour to damage cells, angled to avoid heathy tissues as much as possible o Curative – given in short doses over a few weeks o Palliative – large doses all at once to try to shrink tumour o May be used alongside radiosensitisers – chemotherapy which stimulates the uptake of radiation into targeted tissues to help target radiotherapy further o Side effects: tiredness, soreness/irritation, diarrhoea if near the rectum, cystitis if near the bladder, impotence, moist desquamation (especially under the breast, avoid by keeping skin clean and moisturised), lymphoedema (reduced drainage if lymph nodes are targeted) xerostomia if near salivary glands, risk of future cancer, nausea and vomiting, myelosuppression, pneumonitis if lung is affected · Brachytherapy – radiation sources placed in or near the tumour o Temporary o Permanent – uses low-dose, long half-life sources o Systemic – e.g. radioactive iodine taken orally to treat thyroid disease

Answer 11

AFP (Alpha-fetoprotein) – liver cancers and germ cell tumours (e.g. testicular cancer) · B2M (Beta-2-microglobulin) – myeloma, CLL and lymphoma · Beta-hCG – choriocarcinoma (of trophoblast cells in uterus, e.g. malignant molar pregnancy) and germ cell tumours (e.g. testicular cancer) · CA15-3 and CA27.29 – breast cancer · CA19-9 – pancreas, gall-bladder, bile duct and gastric cancers · CA125 – ovarian cancer · Calcitonin – medullary thyroid cancer · CEA (Carcinoembryonic Antigen) – colorectal cancer · CgA (Chromogranin A) – neuroendocrine tumours · Fibrin/fibrinogen in the urine – bladder cancer · Immunoglobulin levels – myeloma · LDH – melanoma, leukaemia and lymphoma · PSA – prostate cancer · Thyroglobulin – thyroid cancer

Answer 12

``` Asparagine = neurotoxicity Cisplatin = ototoxic/nephrotoxic - tx = amifostine Vincristine = peripheral neuropathy Vinblastine = myelosuppression Bleomycin = pulmonary fibrosis Doxorubicin = cardiotoxic - tx = dexrozoxane Cyclophosphamide = nephro/bladder toxic - tx = mesna = SIADH effects - tx = democlocycline Methotrexate = neprhtoxic - tx = leucovorin = myelosuppression - tx = filgrastim ```

Cancer Therapy Flashcards

(36 cards)