Chapter 11: Nutritional Effects Of Cancer Treatment

Question 1

What is medical oncology?

Answer 1

The diagnosis and treatment of cancer using antineoplastic therapies (chemotherapy, hormone therapy and biotherapy)

Question 2

What is radiation oncology?

Answer 2

The diagnosis and treatment of cancer utilizing a spectrum of ionizing teletherapy (external beam radiarion machines), brachytherapy (sealed sources of radiation), radiopharmaceutical therapy (unsealed sources of radiation)

Question 3

What is chemotherapy?

Answer 3

The use of chemical agents or drugs to systematically kill cancer cells. Usually done in cycles.

Question 4

Which body cells have rapid turnover and are susceptible to chemotherapy?

Answer 4

Bone marrow, hair follicles, gonads (testes and ovaries) GI mucosa.

Question 5

What are cell cycle non-specific chemotherapeutic agents?

Answer 5

They damage cells in all phases of the cell cycle (alkylating agents), antitumor antibiotics, hormone therapies, nitrosoureas

Question 6

What are cell cycle specific chemotherapeutic agents?

Answer 6

They exert their effect within a specific phase of the cell cycle. Include: antimetabolites, camptothecins (synthesis phase), plant alkaloydes and taxanes (mitosis phase)

Question 7

T/F: It can take weeks, months and even years for treatment related side effects to resolve.

Answer 7

True

Question 8

What is Biotherapy?

Answer 8

The 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. (AKA Immunotherapy or Biological Response Modifier)

Question 9

What are some types of biotherapy?

Answer 9

Monoclonal Antibodies, protein-targeted therapies, angiogenesis inhibitors, cytokines, and cancer vaccine.

Question 10

What is Hormone Therapy?

Answer 10

Use in the treatment of hormone-sensitive cancers (breast, ovarian, prostate)

Question 11

What are the types of Radiation Therapy?

Answer 11

External beam radiation, Brachytherapy or internal radiation or radiopharmaceutical therapy

Question 12

Diarrhea is an acute side effect of radiation to ___, ___, and ___.

Answer 12

pelvis, rectum, and stomach/abdomen

Question 13

Fatigue is an acute side effect of radiation to which sites>

Answer 13

All sites (brain, breast, chest, head/neck, pelvis, rectum, stomach/abdomen).

Question 14

Hair loss is an acute side effect of radiation to which sites?

Answer 14

All sites (brain, breast, chest, head/neck, pelvis, rectum, stomach/abdomen).

Question 15

Nausea/Vomiting are acute side effects of radiation to which sites?

Answer 15

Brain, chest, stomach/abdomen

Question 16

Throat changes are an acute side effect of radiation to which sites?

Answer 16

chest, head/neck

Question 17

T/F: Myelosuppression, nausea, vomiting, diarrhea, fatigue are common side effects of chemotherapeutic agents.

Answer 17

True

Question 18

Acute side effects of radiation to the brain?

Answer 18

Fatigue
hair loss
N/V
skin changes
headache
blurry vision

Question 19

Late side effects of radiation to the brain?

Answer 19

Headache
cognitive impairment 
Memory loss
Leukoencephalopathy
Dementia

Question 20

Acute side effects of radiation to the breast?

Answer 20

Fatigue
Hair loss
Skin changes
Breast swelling and tenderness

Question 21

Acute side effects of radiation to the chest?

Answer 21

Fatigue
Hair loss
N/V
Skin changes
Cough
Dyspnea (difficulty breathing)

Question 22

Acute side effects of radiation to the head and neck?

Answer 22

Fatigue
Hair loss
Skin changes
Throat changes (dysphasia, odynophagia, esophagitis)

Question 23

Acute side effects of radiation to the pelvis?

Answer 23

Diarrhea
Fatigue 
Hair loss
Fertility / sexual changes
Skin changes
Urinary/Bladder changes

Question 24

Acute side effects of radiation to the rectum?

Answer 24

Diarrhea
Fatigue 
Hair loss
Fertility / sexual changes
Skin changes
Urinary / Bladder changes (urinary frequency, cystitis, incontinence)

Question 25

Late side effects of radiation to the bone?

Answer 25

Damage to osteoblasts | Osteopenia

Question 26

Late side effects of radiation to the chest (cardiovascular area)?

Answer 26

Angina upon exertion Pericarditis Cardiac enlargement CHF

Question 27

Late side effects of radiation to the esophagus?

Answer 27

Esophageal stenosis, fibrosis or necrosis

Question 28

Late side effects of radiation to the GI tract?

Answer 28

Diarrhea Malabsorption Chronic enteritis/colitis Intestinal changes ( obstruction, stricture, ulceration, fistula, etc)

Question 29

Late side effects of radiation to the head and neck?

Answer 29

Trismus Permanent xerostomia Alterations in taste and smell Osteoradionecrosis (bone death)

Question 30

Late side effects of radiation to the lymphatics?

Answer 30

Secondary lymphedema in irradiated area

Question 31

Late side effects of radiation to the lungs?

Answer 31

Dyspnea Cough Pneumonitis

Question 32

Late side effects of radiation to the sexual organs?

Answer 32

Infertility

Question 33

Late side effects of radiation to the skin?

Answer 33

Telangiectasis (dialation of the capillaries causing red or purple color) Pigmentation changes Atrophy Fibrosis

Question 34

Late side effects of radiation to the bladder area?

Answer 34

Hematuria | Cystitis

Question 35

Possible side effects of monoclonal antibodies?

Answer 35

``` Infusion symptoms GI (n/v/d) usu mild Cardiotoxicity Myelosuppression Pulmonary toxicity Skin problems/rash ```

Question 36

Examples of protein targeted therapies?

Answer 36

Tyrosine kinase inhibitors mTOR Inhibitors Proteasome Inhibitors

Question 37

Examples of tyrosine kinase inhibitors?

Answer 37

``` Erlotinib (Tarceva) Gefitinib (Iressa) Imatinib (Gleevec) Sorafenib (Nexavar) Sunitib (Sutent) ```

Question 38

Examples of mTOR inhibitors?

Answer 38

Temsirolimus (Torisel) | Everolimus (Affinitor)

Question 39

Example of a proteasome inhibitor?

Answer 39

Bortezomib (Velcade)

Question 40

Possible side effects of protein targeted therapies?

Answer 40

Skin problems / rash Cardiotoxicity GI (n/v/d, decr appetite)

Question 41

Examples of angiogenesis inhibitors?

Answer 41

VEGF - Bevacizumab (Avastin) Immunomodulary Drugs - Lenalidomide (Revlimid) and Thalidomide

Question 42

Possible side effects of angiogenesis inhibitors?

Answer 42

``` HTN Cardiac (MI, stroke) Proteinuria Hemorrhage GI perforation Hypothyroidism ```

Question 43

Examples of cytokines?

Answer 43

Interleukein-2 (IL-2) (Aldesleukin) | Interferon-a (Roferin or Intron A)

Question 44

Possible side effects of cytokines?

Answer 44

``` Flu-like Symptoms Fatigue Anorexia Myelosuppression GI (n/v/d) Renal and cardiotoxicity ```

Question 45

Types of hormonal agents?

Answer 45

``` SERMS, Aromatase inhibitirs, Progesterones, Antiandrogens, LHRH Agonists ```

Question 46

Examples of SERMS | Selective Estrogen Receptor Modulators

Answer 46

Tamoxifen (Novaldex) Toremifene (Fareston) Raloxifene (Evista)

Question 47

Side effects of SERMS?

Answer 47

Menstrual symptoms (hot flashes, sweating, n/v) Fluid retention / peripheral edema Increased risk for endometrial changes and cancer Thrombembolic complications Skin changes / rash Joint pain Weight gain

Question 48

Examples of aromatase inhibitors?

Answer 48

Anastozole (Arimidex) Letrozole (Femara) Exemestane (Aromasin)

Question 49

Side effects of aromatase inhibitors?

Answer 49

``` Joint pain Hot flashes N/V -mild Thromboembolic events High cholesterol Fever / malaise ```