Chapter 62 - Oncology 2 Flashcards
The five most common types of cancer are:
1- basal and squamous cell skin cancer (i.e., non-melanoma)
2 - breast
3 - lung
4 - prostate
5 - colorectal cancer
1- The patient’s physical functioning (Performance status) is assessed with rating systems such as:
2- Performance status can help determine:
3- Treatment goals:
1- Karnofsky
- Eastern Cooperative Oncology Group (ECOG)
2- Treatment goal.
3- Remission (with curative intent)
- Palliative (provide comfort, control sx (pain).
The response to treatment can be complete or partial:
-CR:
-PR:
■ A complete response, or complete remission, means that the treatment has destroyed all known tumors.
■ A partial response, or partial remission, means that at least 30% of the tumor was eliminated.
Fluorouracil, “5-FU”
- brand?
- route of administration?
- why do you give … with it?
- Efudexis also used for basal cell carcinoma
- Continuous intravenous infusion
- Leucovorin is given with fluorouracil to i the efficacy; helps fluorouracil bind more tightly to its target enzyme, thymidylate synthetase
Capecitabine
- brand?
- dose?
- BBW
- CI
- Xeloda
- 2 divided doses 12 hrs
apart, given with water within 30 min after a meal - Oral prodrug of fluorouracil
- BBW: Significant inc in INR during and up to 1 month after treatment, monitor INR frequently
- CI: Severe renal impairment (CrCI < 30 ml/min) (capecitabine)
5-FU & capecitabine and DPD deficiency
Antidote?
dihydropyrimidine dehydrogenase (DPD) deficiency inc risk of severe toxicity
ANTIDOTE: Uridine triacetate (Vistogard) can be given as an antidote for overdose or severe or early toxicity due to DPD deficiency
5-FU & capecitabine SE
- Hand-foot syndrome,
- diarrhea,
- mucositis,
- cardiotoxicity,
- photosensitivity,
- dermatitis
Cytarabine conventional
- Brand?
- Cytarabine Syndrome?
- Administration?
- BBW
- SE
- ara-C
- Cytarabine Syndrome: fever, flu-like symptoms, myalgia, bone pain, rash; responds to steroids
-Given via intrathecal (IT) administration for CNS leukemias/lymphomas
-BBW: Myelosuppression, hepatotoxicity and GI toxicities
SE:
- Pulmonary toxicity, encephalopathy,
- hand-foot syndrome,
- neuropathy,
- conjunctivitis (higher doses require use of steroid eye drops)
- IT administration can cause nausea, vomiting, fever and headache
Gemcitabine
- Gemzar
- Infusion rate affects efficacy and toxicity
SE:
- Myelosuppression,
- flu-like symptoms,
- hepatotoxicity,
- pulmonary toxicity
Stages of lung cancer
- Stage 1
- Stage 2
- Stage 3
- Stage 4
Stage 1: Tumor < 3 cm. There’s no metastasis.
Stage 2: Tumor < 6 cm. 1 metastasis has occurred
Stage 3: Tumor > 6 cm. Metastasis in lymph nodes.
Stage 4: The tumor passed to other organs.
Most common cancer in the US:
skin cancer
The three types of skin cancer are:
- basal cell (survivable)
- squamous cell (survivable)
- melanoma (rare but severe)
ABCDE - WARNING SIGNS OF MELANOMA SKIN CANCER
- ASYMMETRY: One half of the mole does not match the other.
- BORDER: Edges are irregular, notched.
- COLOR: Color is not the same all over.
- DIAMETER: Larger than 6 mm, or the size of the tip of a pencil eraser.
- EVOLVING: Mole is changing in size, color, shape or sx (itching, bleeding, tenderness)
After skin cancer, … is the most common cancer diagnosed in the United States.
breast cancer
Males have higher risk of breast cancer when they have a condition that increases … production, including … syndrome
estrogen
Klinefelter syndrome
screening for breast cancer:
The recommended imaging schedule varies by organization and is roughly every year or two, beginning at age 40 or 45.
diagnostic tools
- Mammograms use low-dose x-rays to identify abnormal breast tissue.
- A few images are taken in a screening mammogram, and if they look suspicious, a diagnostic mammogram is performed.
- An ultrasound is useful to differentiate between a benign fluid-filled cyst and a cancerous tumor, and can be used to guide the needle during a biopsy.
- High-risk women can receive an MRI,in addition to an annual mammogram.
–> abnormal test –> biopsy
does weight increase risk of breast cancer?
Overweight postmenopausal women have a higher breast cancer risk than lean women.
Fat cells contain androgens, which are converted to estrogens by the aromatase enzyme.
The decline in estrogen after menopause causes abdominal fat cells to store more fat.
Most women gain 5 - 10 pounds in the first ten years after menopause.
BRCA1 AND BRCA2 linked with increased risk for:
- breast
- ovarian
- prostate cancers
Estrogen receptors:
Hormone sensitive (e.g., ER+) cancer:
- Premenopausal - Tamoxifen
- Postmenopausal - Aromatase Inhibitor
Do all doses of Trexall require leucovorin rescue?
No, only high dose methotrexate >=500 mg/m2 requires leucovorin (folinic acid) rescue
Moderate-dose 100-499 mg/m2 may require leucovorin rescue.
Which toxicity is associated with all of the folate antimetabolites, but most frequently with high doses of methotrexate (2’1.gram/m 2). and what can we do about it?
Nephrotoxicity
- Hydration and IV sodium bicarbonate must be given to alkalinize the urine and J,risk of nephrotoxicity caused by high doses; ensure patient does not have 3rd spacing prior to the drug (ascites,pleural effusions, severe edema) because this will delay drug clearance
What is Voraxaze
Glucarpidase (Voraxaze)
is an antidote that will rapidly lower methotrexate levels that remain high despite adequate hydration and urinary alkalinization (with bicarb)
What are SE of Alimta and what can we do to decrease them?
Nephrotoxicity, hepatotoxicity, dermatologic toxicity (premedicate with dexamethasone)
give folic acid, vitamin B12
and dexamethasone
When do we stop Leucovorin rescue with methotraxte?
monitor methotrexate levels and renal function daily
and continue leucovorin until level is~ 0.05-0.1 micromolar.
