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2016 CSO Exam Study Group > Chapter 11: Nutritional Effects of Cancer Therapies > Flashcards

Chapter 11: Nutritional Effects of Cancer Therapies Flashcards

1
Q

What are the six different types Biotherapies used either alone or with chemotherapy?

A 
Monoclonal Antibodies
Protein-Targeted Therapies
Angiogensis Inhibitors
Cytokines
Cancer Vaccine Therapies
Radiopharmaceuticals
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2
Q

What are monoclonal Antibodies?

A

therapies that signal external cellular pathway targets

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3
Q

What are protein-targeted therapies?

A

Therapies that signal internal cellular pathway targets

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4
Q

What are angiogenesis inhibitors?

A

Therapies that target tumor vasculature and angiogenesis

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5
Q

What are cytokines?

A

therapies that stimulate a broad-based immune response as opposted to generating a targeted response to a specific tumor antigen

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6
Q

What are Cancer Vaccine Therapies?

A

Therapies that signal an individual’s own immune system against tumor antigens

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7
Q

What are Radiopharmaceuticals?

A

Monoclonal antibody therapies that deliver radioactive molecules to specific cancer cells

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8
Q

What are the two classifications of Chemotherapy?

A

Cell cycle non-specific agents - damage cells in all phases of cell cycle (alkylating agents, antitumor antibiotics, hormone therapies, and nitrosoureas)

Cell cycle-specific agents - exert their effect within a specific phase of the cell cycle (antimetabolites and campotothecins (sythesis phase), plant alkaloids and taxanes (mitosis phase) and others)

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9
Q

How are Antineoplastic Agents administered?

A 
Oral
IV
Intrathecal/Intraventicular (IT)
Intrapleural (IP)
Intra-arterial (IA)
Subcutaneous (SC)
Intramuscular (IM)
Topically

Given in Cycles

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10
Q

What are the three factors to note with Antineoplastic Agents?

A

Frequency of cycles (daily, weekly, every 14 days, every 21 days, monthly, continuously)

Length of cycles (Injection, bolus, or continuous)

Number of cycles (determined by research/trials)

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11
Q

Goal of Chemoprevention

A

use of meds, vit/min, or other agents to reduce the risk of, or delay the development of cancer

example: hormone therapy to reduce risk of breast CA in woman determined to be a high risk

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12
Q

Goal of Adjuvant Therapy

A

use of additional cancer treatment given after primary therapy to reduce risk of recurrence and decrease incidence of metastatic disease

example: chemo after lobectomy for lung CA; chemo, hormone therapy, and monoclonal antibody therapy after lumpectomy for breast CA

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13
Q

Goal of Definitive Therapy

A

use of radiation therapy prescribed as primary treatment modality, with or without chemo.

example: xrt as primary for prostate CA

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14
Q

Goal of Neoadjuvant Therapy

A

use of one or more treatment modalities given before the primary therapy to reduce size of primary tumor to improve the effectiveness of surgery/decrease incidence of mets

example: chemo and external beam XRT before an esophagectomy for esophageal CA

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15
Q

Goal of Palliation

A

use of cancer treatment modalities when cure/control of disease can’t be achieved to relief of side effects/symptoms cause by cancer and other serious illness to improve QOL

example: external beam XRT to palliate painful bony lesions related to met prostate CA

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16
Q

Goal of Prophylaxis Therapy

A

use of radiation therapy for relief of symptoms such as pain, bleeding, neurological compromise, or airway obstruction to improve QOL or treat life-threatening problems

example: whole brain irradiation given for asymptomatic individuals diagnosed with CA that have high risk of occurrence of mets (like sc lung CA)

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17
Q

Define Tumor Burden or Tumor Load

A

the size of the tumor or amount in the body. As increases in size, growth rate can slow, thus reducing the effectiveness of the treatment

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18
Q

Define Tumor Growth Rate

A

what proportion of cancer cells within the tumor are growing/dividing to form new ca cells. rapidly growing are usually more responsive to treatment

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19
Q

Principles of Chemotherapy

A

chemical agents or drugs to systemically kill cancer cells. Has a cytotoxic effect to all cells, side effects/toxicities are often the result of damage to rapidly dividing cells. Normal cells are able to better repair themselves, making most toxicities reversible.

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20
Q

What body cells are susceptible to the effects of chemotherapy?

A

Bone Marrow, hair follicles, gonads (testes/ovaries) and gastrointestinal mucosa

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21
Q

Five phases of cell cycle

A

G0 - Resting - cells are temporarily out of the cycle and have stopped dividing

G1 - Post-Mitotic - cells begin t the 1st phase of reproduction by synthesizing protein and RNA necessary for cell division

S - Synthesis - DNA is synthesized

G2 - Pre-Mitotic - cells prepare to divide

M - Mitosis - cell growth and protein production stops. Cellular energy is focused on the orderly division of two daughter cells

22
Q

What is Biotherapy?

A

treatment to boost or restore the ability of the immune system to fight cancer, infection, and other diseases by inducing, enhancing, or suppressing an individual’s own immune response

Also called immunotherapy or Biological Response modifier (BMR) therapy

23
Q

What are possible side effects/nutritional implications of Monoclonal antibodies?

A

Infusion-related symptoms - fever/chills/fatigue/headache

Gastrointestinal - N/V/D - usually mild*** Primary Nutrition Concern

Cardiotoxicity - dyspnea, peripheral edema

myelosuppression - increased risk if with chemo

pulmonary toxicity - cough, PIs, PEs

skin issues - rash, facial erythema, hand-food syndrome

24
Q

What are the five molecular targets for monoclonal antibodies? Name an example of each.

A

CD20: B-lymphocyte agtigen CD20 – Rituxan

EGFR: epidermal growth factor receptor – Erbitux

HER-2/neu: human epidermal growth factor receptor 2 – Herceptin

RANKL: receptor activator of nuclear factor kappa-B ligand – Xgeva

VEGF: vascular endothelial growth factor – Prolia

25
Q

What are the three different types/mechanism of action of Small Molecule Inhibitors (Protein targeted therapies)? Name an example for each.

A

Tyrosine Kinase Inhibitors (TKIs) – Gleevec

mTOR Inhibitor – Affinitor

Proteasome Inhibitor – Velcade

26
Q

What are possible side effects/nutritional implications of Protein-targeted therapies?

A

Skin issues - rash, facial erythema, hand-food syndrome

Cardiotoxicity - QT prolongation, HTN, Bleeding, MI

Gastrointestinal - N/V/D, decreased appetite

27
Q

What are two different targets for angiogenesis inhibitors? Name an example of each.

A

VEGF – Avastin

Immunomodulatory Drugs – Revlimid

28
Q

What are possible side effects/nutritional implications of angiogenesis inhibitors?

A

HTN

Arterial Thromboembolic events (MI, stroke)

Proteinuria

Hemorrhage - including GI bleed

GI perforation – can present at N/V/C/abd pain, fever and occur within first 60 days of treatment

Hypothyroidism

29
Q

What are two different targets for Cytokines? Name an example of each.

A

Interleukein-2 or IL-2 – Aldesleukin

Interferon-a – Roferon or Intron A

30
Q

What are possible side effects/nutritional implications of cytokines?

A

Flu-like Symptoms

Consitutional - fatigue/anorexia

myelosuppression

gastrointestinal - N/V/D

renal and cardiotoxicity - renal insufficiency, capillary leak syndrome

31
Q

What are the three therapies used for Radiation therapy?

A

External Beam Radiation Therapy - ionizing radiation delivered from outside the body to treat a specific field

Brachytherapy (internal) - temporary or permanent placement of radioactive material precisely placed inside a body cavity, tissue or surface

Radiopharmaceutical therapy - radioactive substances used to systemically treat cancer

32
Q

What are possible acute side effects from radiation therapy that is specific to brain treatment fields?

A 
Fatigue
Hair Loss
N/V
Skin Changes
Others: Headache, blurry vision
33
Q

What are possible acute side effects from radiation therapy that is specific to Breast treatment fields?

A

Fatigue
Hair Loss
Skin Changes
Others: Tenderness, swelling of breast

34
Q

What are possible acute side effects from radiation therapy that is specific to Chest treatment fields?

A 
Fatigue
Hair Loss
N/V
Skin Changes
Throat Changes (Dysphagia, Odynophagia, Esophagitis)
Others: Cough, Dyspnea
35
Q

What are possible acute side effects from radiation therapy that is specific to Head and Neck treatment fields?

A

Fatigue
Hair Loss
Skin Changes
Throat Changes (Dysphagia, Odynophagia, Esophagitis)
Others: Thick Salvia, Oral infections, stiffness of jaw

36
Q

What are possible acute side effects from radiation therapy that is specific to Pelvis treatment fields?

A 
Diarrhea
Fatigue
Hair Loss
Sexuality/Fertility Changes
Skin Changes
Urinary/Bladder Changes
37
Q

What are possible acute side effects from radiation therapy that is specific to Rectum treatment fields?

A 
Diarrhea
Fatigue
Hair Loss
Sexuality/Fertility Changes
Skin Changes
Urinary/Bladder Changes
38
Q

What are possible acute side effects from radiation therapy that is specific to Stomach and Abdomen treatment fields?

A 
Diarrhea
Fatigue
Hair Loss
N/V
Sexuality/Fertility Changes
Skin Changes
Urinary/Bladder Changes
39
Q

What are possible late side effects from radiation therapy that is specific to Brain treatment fields?

A

Headaches
Memory/Attention changes
Dementia

40
Q

What are possible late side effects from radiation therapy that is specific to Bone treatment fields?

A

Damage to Osteoblasts, Osteopenia

41
Q

What are possible late side effects from radiation therapy that is specific to Cardiovascular treatment fields?

A

Angina upon Exertion
Cardiac Enlargement
CHF

42
Q

What are possible late side effects from radiation therapy that is specific to Esophagus treatment fields?

A

Esophageal stenosis/fibrosis or necrosis

43
Q

What are possible late side effects from radiation therapy that is specific to GI treatment fields?

A

Diarrhea
Malabsorption
chronic enteritis/colitis
strictures/ulceration/obstruction/fistula

44
Q

What are possible late side effects from radiation therapy that is specific to Head and Neck treatment fields?

A

Trismus
alterations of taste/smell
permanent xerostomia (dry mouth)

45
Q

What are possible late side effects from radiation therapy that is specific to Lymphatics treatment fields?

A

secondary lymphedema

46
Q

What are possible late side effects from radiation therapy that is specific to Pulmonary treatment fields?

A

dyspnea
cough
pneumonitis

47
Q

What are possible late side effects from radiation therapy that is specific to Sexual Organs treatment fields?

A

infertility

48
Q

What are possible late side effects from radiation therapy that is specific to Skin treatment fields?

A

telangiectasias
pigmentation changes
atrophy
fibrosis

49
Q

What are possible late side effects from radiation therapy that is specific to Urinary treatment fields?

A

hematuria

cystitis

50
Q

Types of Brachytherapy

A

Interstitial - placed into the tumor (Breast, Gyn, HN, Lung, Prostate, Rectal)

Interacavitary or Contact - placed into a surgical/body cavity to be near a tumor (Gyn, HN)

51
Q

With what chemotherapy should cold foods be avoided?

A

Oxaliplatin (Eloxatin)

2016 CSO Exam Study Group (27 decks)

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