Cancer Treatment

Question 1

What is chemotherapy toxicity and how is it quantified?

Answer 1

chemo kills any rapidly dividing cells so it can cause a whole host of problems and can be medication dependent
Quantifying toxicity is by the following
1-mild
2-moderate
3-severe
4-disabling
5-death

Question 2

What is a common issue with pt and reporting chemotherapy toxicity and what is two major toxicities that PT should be on the lookout for?

Answer 2

Pts often do not metion their side effects because they dont want to stop what is helping heal them

peripheral motor/ sensory neuropathy

Question 3

What is myelosuppression?

Answer 3

Myelosuppression can affect all the cell types in the myeloid line which originate in the bone marrow
white blood cells- immune deficient
platelets- bleeding risk
red blood cells- risk of anemia
most common does limiting toxicity

Question 4

What is neutropenia and what are the associated precautions

Answer 4

Decrease in neutrophils which protect agains infection
management: must wash hands and minimize exposure from sick people and large crowds

Question 5

What is Thrombocytopenia and what should a PT watch for?

Answer 5

thrombocytopenia- low level of platelets
increase risk of bleeding consider fall risk, muscle trauma

watch for:
increased bruising/petechiae
prolonged bleeding times
concomitant medications (anticoagulants)

Question 6

What is a critical value of thrombocytopenia?

Answer 6

low platelet level of 10-20,000

Question 7

What is Anemia, SS, and Critical Value?

Answer 7

decreased RBC decreased oxygen carrying capacity
SS: fatigue/cardiac symptoms
Critical value <7-8

Question 8

What is alopecia

Answer 8

loss of scalp hair from chemotherapy since it attacks rapidly dividing cells
onset 1-2 weeks but is reversible

Question 9

What should be recognized if a patient has diarrhea?

Answer 9

the pt is at risk for dehydration hypovolemic hypotensive

Question 10

What are the different types of Nausea/Vomiting associated with chemo

Answer 10

acute, delayed, anticipatory, breakthrough, refractory

Question 11

Define Cancer Related Fatigue?

Answer 11

CRF- distressing, persistant, subjective sense of physical, emotional, cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activities and interferes with usual functioning

it is not relieved by rest

Question 12

Explain the prevalence of chemo brain and how it impacts an individual

Answer 12

found in 75% of pt
may be seen early or late mechanism unknown it is not related to anemia, fatigue, or depression
Effect:
difficulty concentrating, performing multiple tasks, short term memory

Question 13

What are some key facts about toxicity

Answer 13

-every pt has toxicity
no one gets all toxicities

grade1-2 most common
grade 3-4- MD may hold dose reduce addition doses

Question 14

Describe what phase and what 2 toxicities are correlated with taxanes & vinca alkaloids (vincristine)

Answer 14

interferes with M phase cell reproduction
side effects:
peripheral neuropathy- distal to proximal stocking glove
loss of DTR, paralysis, irreversible
Cardiotoxicity- arrhythmia- bradycardia, hypotension, heart failure

Question 15

Describe what phase and what 4 toxicities occur with Alkylating Agents

Answer 15

Interferes with S phase- DNA replication preventing cross linking DNA strands

Side Effects:
-myelosuppression- decreased myeloid line WBC Platelets RBC
-hemorrhagic Cystitis- more common in poorly dehydrated appears as hematuria
-cardiotoxicity- declines in LV systolic function
Neurotoxicity- cerebellar ataxia, mental confusion, complete visual hallucinations

Question 16

Describe what phase and what toxicity occurs with anthracycline the “rubicins”

Answer 16

interferes with s phase- prevents cell division between base pairs DNA replication

side effect
Cardiotoxicity: acute- arrhythmia chronic- heart failure

Question 17

What is there a high risk of when a pt is taking Doxorubicin?

Answer 17

Heart Failure

Question 18

Explain HER 2 and what HER 2 antibodies do in relation to a certain cancer?

Answer 18

HER 2 is a growth promoting protein common in breast cancer then spread faster and grow most common in breast cancer
HER 2 antibodies- binds to HER2 receptor preventing the receptor from activating slowing the growth

Question 19

Is radiation therapy selective?

Answer 19

no radiation therapy works by damaging the DNA of exposed tissue it is non selective` thus will impact nearby fast dividing cells
the goal is to cure slow cancer progression, shrink palliation

Question 20

Brachytherapy is internal radiotherapy ____ and ____ for multiple types of cancer ____, ___, ___, ___.

Answer 20

localized and precise
prostate, cervical, breast, skin

Question 21

What are the 6 common side effects for Radiation Therapy?

Answer 21

1. immunosuppression
2. skin changes
3. gastrointestinal changes
4. Fatigue- may resolve when radiation is complete or last 6 months to one year post radiation
5. avascular necrosis- loss of blood supply to an area resulting in necrosis of tissue
6. Radiation myelitis

Question 22

Define Radiation myelitis and how it may present?

Answer 22

radiation myelitis- radiation may damage small blood vessels in the spinal column resulting in loss of blood flow, necrosis and demyelination
symptoms include sensory dysfunction and motor weakness can present like a spinal cord injury