Cancer treatment

Question 1

what does radiation do

Answer 1

kills rapidly dividing tumor cells including tumor cells in adjacent tissues

Question 2

what does chemo do

Answer 2

kills rapidly dividing cells

Question 3

what does hormone therapy do

Answer 3

inhibits the growth and survival of hormone dependent tumor cells

Question 4

what does targeted therapy do

Answer 4

specifically inhibit processes required for tumor cell grwowth

Question 5

what does immunotherapy do

Answer 5

recruits immune system to attack tumor cells

Question 6

what is the toxicity scale

Answer 6

1= mild
2= mod
3= severe
4= disabling/life threat
5= death

Question 7

what is myelosuppresion (treatment side effect)

Answer 7

-can result from cancer itself or chemo/radiation
-suppress all diff cell types in the myeloid line
-WBC (focus on neutrophils), platelets, RBC

-most common dose-limiting toxicity
-onset depends on lifespan of blood cells
-drug, dose regimen specific

Question 8

what is neutropenia

Answer 8

side effect of tx
-due to radiation or chemo which destroys cells that grow at a fast rate
-can’t eat fresh fruit, have fllowers and cant leave their room because of the risk of contamination

management:
=wash hands, minimize exposure from sick people and crowds

side effect: bone pain

Question 9

what is thrombocytopenia

Answer 9

low levels of platelets
-normal: 150,,000-350,000
-consider fall risk and muscle trauma (resistance exercise)
-CV: therapy contraindicated of values <50,000 bc at risk of bleeding so be careful with plyos and resistance training

-watch for: incraesed bruising, prolonged bleeind gimt,e concomitant medications

they should not be on bed rest
-treatment: platelet transfusions

Question 10

what is anemia

Answer 10

-fatigue and cardiac symptoms
-risk factors: tx, malignancy, age, hemoglobin level, comobriditiea
-CV: <7-8

management:
-RBC infusions
-erthropoetic stimulating agents: increase risk of blood clot

Question 11

what is alopecia

Answer 11

loss of hair-scalp first
-onset 1-2 weeks, max 3 weeks
-reversible; growth 2-3 months
-risk varies by class

lowest: hormones, targeted agents
low/mod: antimetablites, platinum agents
high: class alklyating agents
very hihg: taxanes

Question 12

what is diarrhea

Answer 12

-muscosa of GI tract has a high cell turnover rate
-lose a lot of body water

chronic:
-occurs more than 24 hours after treament
-watch for dehyrations and hypovolumia
-treat ewith anti diarrheals

Question 13

what is breakthrough nausea

Answer 13

occurs despite appropriate emetic prophylaxis therapy

Question 14

what is refractory nausea

Answer 14

occurs despite prophylaxis and breakthrouhg emesis treatment

Question 15

what is chemo brain

Answer 15

-found in up to 75% of paitents
-subtle shifts in cog function
-may be seen early or late
-mechanism unknown

effects:
-difficulty concenrtating, handling performing multiple tasks, short term memoruy

Question 16

what are grades 1-2 toxicity

Answer 16

-accepted by oncology providers
most common
-dose reduction not warranted

Question 17

what are grades 3-4 toxciity

Answer 17

-hold doses to permit recovery
-reduce subsequent doses
-prevention important if possible
-impariments are likely permanent

Question 18

what do taxanes do

Answer 18

-interfere with mitosis
-bind to stabilized microtubules interfering with disaessmebly

Question 19

what do vinka alkaloids do

Answer 19

-interefre with mitosis
-inhibit microtubule assembly

Question 20

what are the side effects of taxanes and vinka alkaloids

Answer 20

-peripheral neuropathy
-motor and/or sensory impairments
-stocking and glove: symmetric pareesthesia
-motor nerve impairment that leads to…. loss of DTR and ataxia, paralysis, foot and wrist drop, irreversible or minimallt reversible

-cardiotoxicity: aryyhtmias, hypotension, HF

Question 21

what are alkylating agents mechanism of action

Answer 21

-prevent cell division by cross linking DNA strands (S phase)
-cell continues to synthesize other cell things like RNA and protein and imablance occurs and the cell dies (G1/G2)

Question 22

what are the side effects of alkylating agents

Answer 22

1. myelosuppression: primary dose limiting toxicity like leukopenia
2. hemorhagic cystitis: common in poor hydrated or renal disease, manifest as hematuria
3. cardiotoxitity; decline in LV systolic function
4. neurotoxicity; encephalopathy= cerebellar ataxia, confusion, hallucinations

Question 23

what is anthracycline

Answer 23

-prevents cell division by intercalation between DNA pairs (S phase)
-inhibits DNA replication

side effects: cardiotoxiity
acute: arryhytmias and pericarditis
chronic: congestive cardiomyopathy and HF

Question 24

talk about doxorubicin and HF risk

Answer 24

HF risk increases with escalating dose of doxorubicin

Question 25

what is doxorubicin

Answer 25

red devil
-can cause hand-foot syndrome

signs/symp:
-erythema and swelling
-dyesthesia painful itching and burning
-blistering

triggers are cold environment

Question 26

what is HER2

Answer 26

-growth promoting protein
-receptors are overexpressed in some breast cancers
-cancers tend to grow and spread faster than other breast cancers
-binds to HER2 receptor preventing receptor activation and slows growth

Question 27

talk about anti-estrogen agents in hormone therapy

Answer 27

-aromatase inhibitos; block aromatase, an enzyme that catalyzes estrogen formation
-anastrozole: side effects are hot flashes, joint paint, osteoporosis

Ar is not helpful is someone is triple negative

Question 28

talk about anti-estrogens

Answer 28

-selectie estrogen-receptor modulator
-tamoxifen: impacts receptor on tumor and can have side effects like thromobembolic events and hot flashes

Question 29

what do antiandrogens do

Answer 29

decrease testosterone synthesis

Question 30

what do lutenizing hormone releasing hormone agonists do

Answer 30

increase testosterone followed by suppression

Question 31

how does radiation work

Answer 31

-isolates tumor
-damages the DNA of exposed tissue
-cancerous cells have reduced ability to repair
-XRT beams are targeted to tumor to increase the absorbed dose
-non selectivre

Question 32

what are the goals of radiation

Answer 32

-cure
-slow CA progression
-shrink tumor for palliation
-shrink tumor for surgery

Question 33

what is brachytherapy

Answer 33

-internal radiotherapy
-seeds are placed inside or next to area of tumor
-small enough to limit the exposure of the surrounding tissue

Question 34

what are some side effects of radiation theapy

Answer 34

-toxicity
-immunosuprression
-skin changes: fraigle, burn,
-GI changes: vomit, diarrhea=impaired nuturion, protein deficitency, muscle breakdown
-fatigue

-Avascular necrosis
-radiation myelitis

Question 35

what is avascular necrosis

Answer 35

-loss of blood supply to an area resulting in necrosis of tissue
most common hip
symptoms: pain with WB, ache in groin and thigh

Question 36

what is radiation myelitis

Answer 36

-radiation may damage small blood vessels in the spinal column resulting in loss o f blood flow, necrosis and demylenation
-time of onset 4-12 months after
-symptoms are sensory dysfunction and weak

Question 37

talk about a bone marrow transplant

Answer 37

process is induction of chemo/rad > transplant > engraftment
side effect: graft vs host diasease