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Oncology, haematology and palliative care > Chemo and radiotherapy > Flashcards

Chemo and radiotherapy Flashcards

1
Q

What is chemotherapy

A

The use of any chemical substance to treat disease

The use of cytotoxic drugs in the treatment of cancer

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2
Q

What is the aim of chemotherapy?

A

Deliver enough cytotoxic drug to a cancer cell target which is expressed drug to a cancer cell target which is expressed differently to normal tissue

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3
Q

How frequently is chemo given?

A

In intervals

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4
Q

Why is chemo given in intervals?

A

To allow the normal tissue to recover

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5
Q

What method of cancer treatment is systemic

A

Chemo

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6
Q

Why are single chemotherapy agents rarely used

A

Genetically resistant cells are selected out

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7
Q

Why is it important for chemo to be systemic

A

Either due to metastases or the potential to metastasise in the future

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8
Q

Why is it advantageous for chemo to be a combination?

A

Different mechanisms of action and different side effect profiles reduces the likelihood of resistance and toxicity

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9
Q

What qualities should chemotherapy drugs have

A

Cytotoxic activity for that tumour, preferentially able to induce remission
Different mechanisms of action, ideally additive or synergistic effects
Non-overlapping toxicity to maximize benefit of full therapeutic doses
Different mechanisms of resistance

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10
Q

What is adjuvant chemo?

A

After other initial treatment to reduce the risk of relapse

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11
Q

What is neoadjuvant chemo?

A

Used to shrink tumours prior to surgical or radiological treatment - may allow later treatment to be more conservative

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12
Q

What is palliative chemo?

A

No curative aim, offers symptom relief may prolong survival

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13
Q

What are alkylating agents

A

Anti-proliferative drugs that bind via alkyl groups to DNA leading to apoptotic cell death

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14
Q

Give some examples of alkylating agents

A

Cyclophosphamide
Chlorambucil
Bulsulfan

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15
Q

Give examples of angiogenesis inhibitors?

A

Bevacizumab, aflibercept, sunitinib

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16
Q

What are antimetabolites

A

Interfere with cell metabolism including DNA and protein synthesis

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17
Q

Give examples of antimetabolites

A

Methotrexate

5-flurouracil

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18
Q

What are antioestrogens

A 
Aromatase inhibitors (letrozole, anastrozole) 
Oestrogen receptor antagonists (tamoxifen, raloxifene)
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19
Q

What are anti tumour antibiotics

A

Interrupt DNA function

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20
Q

Give examples of anti-tumour antibiotics

A

Dactinomycin
Doxorubicin
Mitomycin
Bleomycin

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21
Q

What are monoclonal antibodies

A

Antibodies to a specific tumour antigen can slow tumour growth by enhancing host immunity or be conjugated with chemo/radioactive isotopes to allow targeted treatment

22
Q

What are topimerase inhibitors

A

Interrupt regulation of DNA winding

23
Q

Give an example of a topimerase inhibitor

24
Q

What are vinca alkaloids

A

Spindle poison which target mechanisms of cell division

25
Give an example of a vinca alkaloid
Vincristine Vinblastine Docetaxel
26
List the main side effects of chemo
Vomiting Alopecia Neutropenia Infertility
27
Which cells experience more of the effect from chemo
Rapidly dividing cells - gut, hair, bone marrow, gametes
28
What is extravasation of chemo
Inadvertent infiltration of a drug into the subcutaneous/subdermal tissue
29
How does extravasation of chemo present
Tingling, burning, redness, swelling, no flashback/resistance from cannula
30
Describe the management of extravasation of chemo
Stop and disconnect infusion Aspirate any residual drug before cannula removed Follow local policies and any drug specific recommendations DNA binding drugs - use a dry cold compress to vasoconstrict and reduce drug spread Non-DNA binding drugs - use a warm compress to vasodilate and increase drug distribution
31
Describe how chemo and radiotherapy may lead to infertility
Damage spermatogonia causing impaired spermatogenesis or male infertility Hasten oocyte depletion leading to premature ovarian failure
32
What should be done prior to treatment if the treatment carries a risk of infertility
Men - semen cryopreservation Women - cryopreservation of embryos, oocytes and ovarian tissue. Ovarian transposition (oophropexy) may be possible prior to pelvic radiation but protection is not guaranteed due to radiation scatter
33
Describe the mechanism of action of radiotherapy
Uses ionizing radiation to cause damage to the DNA Prevents cell division and causes cell death The aim of radiotherapy treatment is to inactivate cancer cells without causing a severe reaction in normal tissue
34
Describe radical radiotherapy treatment
Given with curative intent Total doses range from 40-70 gray (Gy) in up to 40 fractions Some regimens involve several smaller fractions a day with a gap of 6-8hrs. Combination chemo is used in some sites such as oesophagus to increase response rates
35
Describe palliative radiotherapy
Aims to relieve symptoms and may not impact on survival Doses are smaller and given in fewer fractions to offer short term tumour control with minimal side effects. Palliation is used for brain metastases, spinal cord compression, visceral compression and bleeding Bone pain from metastasis can be reduced or eliminated in 60% cases
36
List some early reactions of radiotherapy
``` Tiredness Skin reactions Mucositis Nausea and vomiting Diarrhoea Dysphagia Cystitis ```
37
List some late reactions of radiotherapy
CNS/PNS - somnolence, spinal cord myelopathy, brachial plexopathy Lung - pneumonitis GI - xerostomia, benign strictures, fistulae, radiation proctitis GU - urinary frequency, vaginal stenosis, dyspareunia, erectile dysfunction Endocrine - panhypopituitarism and hypothyroidism Secondary cancers
38
List the methods of giving radiotherapy
Conventional external beam radiotherapy (EBRT) Stereotactic radiotherapy Brachytherapy Radioisotope therapy
39
Describe conventional external beam radiotherapy
Delivers a beam of ionizing radiation to the patient from an external linear accelerator
40
Describe stereotactic radiotherapy
Highly accurate form of EBRT Used to target a small lesion with great precision Often referred to by the manufactures name eg. Gamma knife
41
Describe brachytherapy
Involves radiation source being placed within or close to a tumour, allowing high local radiation dose. Implants may be placed within a cavity or within tissue
42
Describe radioisotope therapy
Uses tumour seeking radionuclides to target specific tissues
43
What is interventional oncology
Interventional radiology procedures used in palliative care/cancer treatment. Can be divided into disease modifying and symptomatic procedures
44
Describe disease modifying interventional oncology
``` Intended to modify cancer progression and/or to improve prognosis Includes: Image guided ablation Embolization Image guided brachytherapy Isolated perfusion chemotherapy ```
45
Describe symptomatic interventional oncology
Provides relief from cancer related symptoms but does not modify the underlying disease process. The techniques can offer significantly improved quality of life, reduce admissions and increase time spent out of hospital
46
Name the interventional treatment option of ascites or pleural effusions
Temporary/permanent image guided drain
47
Name the interventional treatment option of oesophageal/large bowel obstruction
Stenting
48
Name the interventional treatment option for tumour related haemorrhage
Trans arterial embolisation
49
Name the interventional treatment option for jaundice
Biliary drainage and stenting
50
Name the interventional treatment option for renal tract obstruction
Nephrostomy | Ureteric stenting
51
Name the interventional treatment option for bone metastases
Image guided ablation

Oncology, haematology and palliative care (19 decks)

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