Cancer treatments and symptom management Flashcards
Give 5 side effects of surgery to remove cancer
- wound infections/ complications
- VTE risk
- may reoccur if micro mets (not systemic)
- may miss some if poor margins
- some structures are vital so cant be removed
- anaethetic risks
- mostly specific to the surgery eg incontinence issues, impotence with prostatectomy
How does radiotherapy and brachytherapy work?
Ionising radiation is used to damage DNA, cells are most venerable to the damage when in mitosis. Since cancer cells divide more rapidly, more are in mitosis and so they’re more susceptible.
Doses range from 40-70 gray, given in up to 40 fractions for radical radiotherapy. Palliative chemo tends to be smaller doses and in fewer fractions, to relieve symptoms.
What types of radiotherapy are there and how do they work? (4)
- External beam radiotherapy: beams from linear accelerator
- Sterotactic radiotherapy: highly accurate form of EBRT, used to target small lesions with great precision- esp used for intracranial tumours (aka gamma knife)
- Brachytherapy: radioactive source placed within or close to tumour, can have seeds or one big hit- high dose rate (HDR)
- Radioisotope therapy: tumour seeking nucleotides to target specific tissues, eg radioiodine to target thyroid tissue after thyroidectomy for thyroid ca
Describe 7 side immediate effects of radiotherapy (peak 2-4 weeks after treatment)
- tiredness: most get, improves 4 weeks after complete
- skin reaction: erythema, dry or moist desquamation, use aqueous creams on unbroken skin
- mucositis: dental checks before radio if H&N ca, avoid smoking, antiseptic mouth wash, aspirin gargle
- N+V: when stomach, liver or brain treated
- Diarrhoea: after abdo or pelvic treatments, maintain good hydration and loperamide can be used
- dysphagia if H&N/ thoracic- SALT input and nutritional support
- cystitis after pelvic treatments- drink plenty of fluids, analgesia
how can oral thrush due to radiotherapy be treated
fluconazole, not nystatin as this may exacerbate nausea
How can N+V from radiotherapy be managed?
- ONDANSETRON most suitable (inhibits serotonin which is thought to be they cause)
- domperidone or metoclopramide can also be trialed
- levopromazine
State 5 possible delayed side effects of radiotherapy
- Somnolence (sleepiness) 4-6 weeks after brain radiotherapy- increase steroid dose
- Spinal cord myelopathy- weakness, needs MRI to exclude compression
- Brachial plexopathy- numb, weak or painful arm are axially radiotherapy
- Pneumonitis- dry cough + SOB 6-12 weeks later, bronchodilators and tapered steroids may help
- Xerostomia (reduce saliva), dental care and nutrition important treat with water, saliva substitutes and stimulants
- Strictures (oesophagus or bowel)- dilation
- Fistula
- Radiation proctitis
- Urinary frequency due to small fibrosed bladder
- Vaginal stenosis
- Erectile dysfunction
- Infertility
- Panhypopituitarism, hypothyroidism
- Secondary cancers- rare
Give 5 modes of actions of chemotherapy drugs
- alkylating agents: cyclophosphamide
- angiogenesis inhibitors: sunitinib
- antimetabolites: methotrexate, 5 FU
- anti oestrogens: aromatase inhibitors (letrozole) or ER antagonists (tamoxifen)
- anti tumour antibiotics: bleomycin, doxorubicin
- monoclonal antibodies
- topoisomerase inhibitors: interrupt regulation of DNA winding
- vina alkaloids and taxens: spindle poisions eg vincristine, vinblastine, docetaxel
give 10 possible side effects of chemotherapy
- vomiting
- alopecia
- neutropenia
- extravastation (when drug goes into subcut/ subdermal tissue
- anaemia
- mucositis
- pulmonary fibrosis
- cardiomyopathy
- arrrhythmias
- sterility
- myalgia
- tumour lysis syndrome
- GI perf at site of lymphoma (rare)
- DIC
How is vomiting due to chemo managed?
- ondansetron or APREPITANT (NK1 receptor antagonist) prophylaxis/ PRN
- Levopromazine 2nd line
How should extravastation of a chemo drug be managed?
- need to stop transfusion
- aspirate residual drug and then remove cannula,
- put on cold compress for DNA binding drugs to stop its spread (vasoconstrict) and warm compress for non DNA binding drugs (vasodilates)- this will increase its distribution
How is anaemia due to chemo managed
- transfusions
- iron supplements
What chemo drugs are particularly cardiotoxic and which cause pulmonary fibrosis
Doxorubicin is v cardiotoxic
Cyclophosphamide can cause arrhythmias.
Bleomycin and mitomycin most likley to cause pulmonary fibrosis
Which cancers are very chemo sensitive
- lymphoma
- germ cell tumours
- SCLC
- neuroblastoma
- wilms tumour
Which cancers are poorly sensitive to chemo?
- prostate
- renal cell
- brain tumours
- endometrial ca
