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Cancer Care > Cancer Treatments > Flashcards

Cancer Treatments Flashcards

1
Q

What is the difference between adjuvant and neoadjuvant treatment?

A

Adjuvant is the additional therapy given with/after main treatment

Neoadjuvant is given prior to main treatment to reduce tumour size

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2
Q

What are the advantages and disadvantages of neoadjuvant therapy?

A
  • Can do more conservative surgery
  • Chemo response can predict outcome
  • May overtreat
  • Disease may progress
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3
Q

What are the advantages and disadvantages of Adjuvant therapy?

A
  • Immediate surgical removal
  • Bigger surgery may be needed
  • Can’t measure efficacy of chemo/radio before
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4
Q

What different methods of radiotherapy can be given?

A

External beam (EBRT)

Brachytherapy

Systemic (Injected/swallowed)

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5
Q

How is radiotherapy dose defined?

A

Irradiation absorbed by 1kg of tissue. Expressed in Grays (Gy)

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6
Q

Why are radiotherapy doses given in fractions?

A

Highest total dose delivered to tumour but normal tissue preferentially spared

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7
Q

What are some acute toxicities of radiotherapy?

A 
Fatigue 
Moist desquamation of the skin
Oral mucositis 
Pneumonitis 
N&V
Cytopenia can occur in whole body radiation
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8
Q

What are some long term effects of radiotherapy?

A

Secondary cancer!!

Others tend to relate to area be radiated: 
Fibrosis leading to reduced ROM
Lymphedema 
Infertility
Hypothyroidism 
Dry eyes and cataract
Atrophy
Neural or vascular damage
Endocrine side effects
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9
Q

When might radiotherapy be used in a palliative setting?

A

Palliation of symptoms e.g.
To a tumour causing spinal cord compression reducing neuropathic symptoms
To bony mets to reduce pain

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10
Q

How does radiation cause cell death?

A

Apoptosis by causing significant DNA damage

Preventing cancer cell proliferation, causing single and double stranded breaks in DNA

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11
Q

What specific head and neck radiotherapy side effects?

A 
Dysphagia
Jaw stiffness
Dry mouth
Mouth and gum sores
Hair loss
Lymphoedema 
Tooth decay
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12
Q

What are the specific side effects of chest radiotherapy?

A

Dysphagia
Dyspnoea
Radiation pneumonitis - can manifest as cough, chest pain, fevers
Radiation fibrosis - result of permanent lung scarring as a result of untreated radiation pneumonitis

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13
Q

What are some specific side effects of abdominal radiotherapy?

A

Nausea and vomiting
Diarrhoea
Loss of appetite
Abdominal cramping

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14
Q

What is the mechanism of action of chemotherapy agents?

A

Disrupt various parts of the cell cycle

G1 growth
S DNA synthesis
G2 growth and prep for mitosis
M mitosis cell division

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15
Q

What are some of the side effects of chemo?

A

Bone marrow suppression - pancytopenia, risk of neutropenic sepsis
Due to rapid turnover of cells involved in haemopoiesis

Increased apoptosis in rapidly dividing epithelial cells in oral mucosa and intestine = mucosal damage
Mucositis, malabsorption, diarrhoea

Acts on CTZ causing nausea and vomiting

Chemo induced damaged to the rapidly dividing cells in the hair root - hair loss

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16
Q

What are the classes of chemo agents (by mechanism of action) and some examples?

A

—- Antimetabolites —-

Pyrimidine antagonists - inhibit thymidine synthase and halt DNA replication
e.g. Gemcitabine, 5-FU

Purine antagonists
6-mercaptopurine, azathioprine - measure TMPT levels before as deficiency of this could cause toxicity

Folate antagonists
Methotrexate

Ribonucleotide reductase inhibitors e.g. hydroxyurea in CML

—- Alkylating Agents —-
Act on DNA cause cross linking and cell death

Cyclophosphamide - breast, ovarian, SCLC

Platinum agents e.g. cisplatin, carboplatin, oxaliplatin

Nitrogen mustards - chlorambucil, melphalan

—- Topoisomerase inhibitors —-

—- Mitotic inhibitors —-
Act on microtubules
Cause myelosuppression and neurotoxicity

Vinca alkaloids - vincristine
Taxanes - paclitaxel

—- Antibiotics —–
Derived from antibiotic agents

Mitomycin C
Bleomycin - testicular cancer
Anthracyclines - doxorubicin
(Breast ca or NHL)

—- Protein kinase inhibitors —-
BCR-ABL - imatinib for CML
EGFRs - erlotinib, lung cas
Brunton - Ibrutinib - CLL

17
Q

What is palmar plantar erythrodysesthesia?

A

Painful erythematous rash
Occurs over palms, fingers and soles of feet

Lesions clearing demarcated, painful

Skin breakdown, blistering develops

Dose related side effect

Management is supportive, use of emollients and steroid creams to reduce inflammation

18
Q

What patient factors must be considered before initiating chemo?

A 
Performance status
Reaction to previous cycles
Bloods
Co-morbidities - esp. liver & kidney
Surface area/BMI of patient
19
Q

How can cancers develop resistance to chemotherapy agents?

A 
Increased efflux
Decreased influx
Alter drug target
Enhance DNA repair
Drug detoxification
20
Q

What are some long term side effects of chemotherapy?

A 
Chemo brain
Early menopause
Decreased lung capacity
Osteoporosis
Muscle weakness
Congestive HF
Hearing loss
Secondary Cancer
21
Q

What are the principles of immunotherapy?

A

Actively stimulate the immune system
Passively alter the immune system signalling
Treatment targeted at specific known antigenic targets or stimulating the immune system non-specifically

22
Q

What are the types of immunotherapy?

A 
Monoclonal antibodies
Checkpoint inhibitors
Cytokines
Vaccinations - clinical trials
CAR T-cell therapy
23
Q

How do monoclonal antibodies work?

A

MAB recognises and finds specific proteins on cells

Either triggers immune system to attack and kill cancer cells

Or attach to cancer cells, making it easier for cells of immune system to find and attack

24
Q

What are some examples of MABs?

A

Rituximab for CLL and some types of NHL
Cetuximab for advanced bowel, head and neck cancer
Trastuzumab - Herceptin for breast cancer, stomach cancer

25
Q

How do checkpoint inhibitors work?

A

Block the signals that switch off lymphocytes
Some cancer cells have the ability to deactivate T cells
Blocks protein meaning T cells can function again

26
Q

What are some side effects of checkpoint inhibitors and how are they managed?

A

Because the drugs boost the immune system, side effects are generally autoimmune and therefore managed with CORTICOSTEROIDS

  • diarrhoea
  • dermatitis
  • hypothyroid, adrenal
  • hepatitis
  • pneumonitis
27
Q

What are some examples of checkpoint inhibitors?

A

Nivolumab, pembrolizumab on PD-1 - melanoma, HL, NSCLC

Avelumab, atezolizumab
PDL-1
lung cancer, urinary tract

28
Q

What is cytokine immunotherapy?

A

Interferon
Kidney cancer, leukaemia, skin lymphoma

Interferes with the way cancer cells grow and multiply, stimulates immune system, encourages cancer cells to produce chemicals

Given as injection under the skin or infusion
3 times a week

Aldesleukin - interleukin 2
Kidney cancer

29
Q

What are the side effects of interferon and aldesleukin?

A 
Drop in blood cells causing increased risk of infection, bleeding problems, tiredness, breathlessness
Flu like symptoms
Diarrhoea
Tiredness and weakness
Feeling sick
Loss of appetite

Cancer Care (15 decks)

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