Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Palliative Care + Oncology > Chemo and Immunotherapy > Flashcards

Chemo and Immunotherapy Flashcards

1
Q

What systemic therapy can be offered for cancer

A

Chemotherapy
Biologics
Hormonal therapy
Immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are aims of Rx

A

Adjuvant
Neoadjuvant
Palliative
Curative or radical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is adjuvant

A

After definite and curative `rx to eradicate micromets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is neoadjuvant

A

Adjuvant Rx given before to improve change of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are SE of chemotherapy

A 
Relate to rapidly dividing tissue as that is what is attacked
Vomiting - prophylaxis usually given 
Alopecia
Mouth ulcer
Diarrhoea
Neuropathy 
Neutropenia most common 7-14d 
Thrombocytopenia
Infertility - impaired spermatogenesis or oocyte depletion leading to premature failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are major classes of systemic chemotherapy

A 
Alkyslating agent - disrupt DNA integrity
Anti-metabolites - disrupt DNA synthesis
Mitotic inhibitor 
Toposomerase inhibitor 
Other anti-tumour Ax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are antimetabolites and what do they do

A 
Disrupt DNA synthesis by interfering with metabolism 
Methotrexate
Fuorouracil (5-FU)
6-mercaptopurine
Cytrabine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are aklyating agent and what do they do

A

Disrupt DNA integrity
Cyclophosphamide
Cisplastin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is mitotic inhibitor

A

Vinca alkaloid

Taxanes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is topoisomerase inhibitor / Ax

A

Doxorubicin - inhibit DNA and RNA synthesis
Etoposide
Irontecan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anti-tumour Ax

A

Bleomycin - degrade DNA
Actinomycin
Doxorubicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are chemo used

A

Most chemo combined into regimens to achieve better kill

Must have different mechanism and no overlapping toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are SE of cyclophosphamide

A

Haemorrhagic cystitis
Myelosuppression
TCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SE of doxorubicin

A

Cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SE of bleomycin

A

Pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SE of methotrexate

A 
Myelosuppression
Mucositis
Liver fibrosis
Lung fibrosis
Teratogenic 
B12 defiecicny
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SE of 5-FU

A

Myelosuppression
Mucositis
Dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SE of other anti-metabolites

A

Myelosuppression

Ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does vinblastine / docetaxel do and what are SE

A 
Inhibit formation of microtubule
Peripheral neuropathy
Paralytic ileus
Myelosuppression 
Neutropenia = docetaxel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Other chemotherapy agents

A

Cisplastin

Hydroxyurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SE of cisplatin

A

Ototoxicty
Peripheral neuropathy
HypoMg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do biologic agents do and what are there categories

A

Inhibit orogenic stimulus that is driving cancer growth
Monoclonal Ab - imab
Tyrosine kinase inhibitors - inib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is ritixumab useful for

A

Anti-CD20 so useful in NHL - B cell lymphoma which express

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What has revolutionised CML Philadelphia chromosome +ve

A

Tyrosine kinase inhibitor - Imatinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes ligand inactivation

A

Bevacilumab

Stops VEGF which is over expressed in many cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What cause receptor inactivation

A

Tratuzumab against HER-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What hormone therapy in breast

A

Anti-oestrogen / SERM - tamoxifen
Aromatose inhibitor
GnRH agonist (goserelin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What hormone therapy in prostate cancer

A

Androgen suppression - goserelin or orchidectomy

Anti-androgen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What hormone therapy in endometrial

A

Progesterone

30
Q

What is systemic immunotherapy

A

Stimulates whole immune system
Interferon
Interluekin

31
Q

What are toxicity interferon

A 
Flu like
Nausea
Lethargy
Anorexia
LFT
32
Q

What are toxicity IL

A

Hypotension
Renal failure
Cardiac - may need ITU

33
Q

How do many cancers evade detection

A

Suppress T cell function through PD-1 on T cell or PDL-1 on tumour

34
Q

What Ab target this

A

PD-1 Ab - nivolumab / pemprolizumab = immune checkpoint inhibitors
PDL-1 Ab - atezolizumab
Used in solid organ tumour

35
Q

How do you administer

A

Injection

IV infusion

36
Q

What are SE related to overactive T cells which are key in killing cancer / SE immunotherapy

A 
Dry / itchy skin = most common
N+V
Decreased appettite
Diarrhoea 
Fatigue
SOB
Dry cough

Infusion reaction
Anaphylaxis

37
Q

How do you manage SE

A

Corticosteroid

Monitor LFT, U+E, TFT

38
Q

How does RT work

A

Produce free radicals which cause DNA damage
Leads to chromosomal aberration
No loss of genetic materally
Lose reproductive capability

39
Q

What is radiation dose

A

Energy deposited per unit mass = absorbed dose (Gray)

1 gray = 1 joule of energy in 1kg

40
Q

What is radiation tolerance

A

Amount of radiation tissue can receive and still remain functional

41
Q

What is tolerance dose

A

Dose that there is a high probability of serious Rx compliction

42
Q

What is AIM of Rx

A

High enough dose to achieve outcome whilst keeping critical nearby structure within radiation tolerance

43
Q

What does radical Rx tend to be

A

Curative intent
High dose
Low dose fraction as longer timeframe to minimise damage

44
Q

What is palliative Rx

A

Lower dose
High dose fraction as late effects less relevant
Short time

45
Q

What gives more damage

A

High dose per fraction

46
Q

How can RT be delivered

A 
External beam
Stereotactic - highly accurate form of EBRT for small lesions e.g. intracranial 
Brachytherapy sealed source
Brachytherapy unsealed
Radioisotope
47
Q

What is external beam

A

Most common

Linear accelerator delivers X-ray

48
Q

What can you do for deep tumour

A

Multiple field technique

As single radiation would over treat superficial tissue

49
Q

What is bradytherapy sealed source

A

Radioactive needle or wire implanted into or next to cancer for extremely high dose

50
Q

What is unsealed source

A

Radioactive isotope delivered by injection or ingestion which concentrates in region

51
Q

What do all patients with metastatic disease of unknown primary get

A 
FBC, U+E, LFT, 
Calcium
Urinanalysis
LDH
AFP + hCG 
CT CAP
52
Q

What do specific patient get

A 
Myeloma screen if lytic bone
Endoscopy
PSA
CA125 if peritoneal / ascites
Testicular USS
Mammography
53
Q

What does a PET scan do

A

Uses FDG radio tracer allowing 3D image of metabolic activity / uptake of glucose
Combines images with CT

54
Q

What is it useful for

A

Evaluating primary and metastatic disease

55
Q

What do you do if risk of infertility

A

Semen cyropersevation

Embro / oocyte preservation

56
Q

What are early reactions to RT

A 
Tiredness
Skin reaction - erythema, desquamation, ulceration
Mucositis 
N+V if stomach / liver or brain Rx
Diarrhoea after abdominal or pelbic
Dysphagia following thoracic
Cystitis after pelvic
57
Q

What can you do for N+V

A

Anti-emetic

58
Q

What do you do for mucositis

A

Avoid smoking

Anti-septic mouthwash

59
Q

What are late reaction to RT

A

Secondary cancer
Fibrosis of organs
Reduced fertility

Hypopituitarism / hypothyroid 
Erectile dysfunction / stenosis following pelvic RT 
Benign strictures of GI tract
Radiation proctitis
Pneumonitis Myelopathy
60
Q

What are chronic risks of chemo

A

Organ imapirment - may need ECHO / bone density scan
Reduced fertiltiy
Second cancer

61
Q

What are the RCHOP drugs

A 
Rutixumab
Cyclophosphamide
Doxorubicin hydrochlroide
Vincristin 
Prednisolone
62
Q

What is it used to treat

A

NHL

63
Q

SE of rutiximab

A 
Allergy - fever / rash / anaphylaxis 
Severe infections / reactivation 
Thrombocytopenia
Liver and lung toxicity 
Peripheral neuropathy
Night sweats
64
Q

What is metabolically demanding tissue

A

Brain
Heart
Liver

65
Q

What is mitotically

A

Bone marrow
Skin
Gut

66
Q

Aim of chemo to target mitotically active cells so SE

A

Cytopenia and neutropenic sepsis
Sore skin + mouth
N+V+D

67
Q

Why is it important to get rid of all cancerous cells with first round

A

If relapse will have a selected cell line that is resistant to chemo

68
Q

What are outcomes after Rx

A

Partial remission
Complete remission where cells undetectable (but still there)

Incurable but can control for long term

69
Q

What is important to remember

A

Will be cells that never undertake mitosis when getting chemo so never get killed and can come back when start division

70
Q

How do you treat pre-malignant conditions e.g. myelodysplasia

A

Low dose continuous therapy e.g. hydroxycarbamdie everyday

71
Q

Rx of ALL. /AML

A

Potentially curable
If relapse = very bad sign

If in remission for a few years chances its gone for good as cells would have come back

72
Q

Rx of CLL / CML

A

Less chemo sensitive as undergo mitosis less often
Usually monitor till cause problem / system
Rx = usually chemo based

Palliative Care + Oncology (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions