Chemo & Radiotherapy Flashcards by Luse Mwenechanya

Maintenance chemotherapy is the routine treatment for which cancer and for how long?

Childhood leukaemia

18 months

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Which hormone therapy is available orally?

Tamoxifen

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Intravesical chemotherapy is used to treat which type of cancer?

Bladder

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Intra-arterial chemotherapy is used to treat which type of tumours? What is the benefit of this form of chemo?

Any tumour with a well defined blood supply
E.g. Liver metastases have a good blood supply via the hepatic artery
Higher doses can be delivered directly to the tumour with reduced systemic effects

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Which formula is used to calculate chemotherapy doses?

DuBois and DuBois

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What are the 3 main aims of chemotherapy regimes?

Maximise cell kill
Minimise toxicity
Minimise development of resistance

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Is single agent or multiple agent chemotherapy preferred and why?

Multiple agent - can combine drugs with non-overlapping mechanisms which overcome the potential resistance that some tumour cells may have

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What are the important factors to note when choosing which chemotherapy drugs to combine?

Non-overlapping toxicity - allows anti-tumour effect to be maximised
Different modes of action - increase extent of tumour killing & overcomes resistance

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Why is chemotherapy given in cycles?

To allow normal tissues to recover. Too long of an interval between cycles may also allow tumour cells to recover

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Tumour resistance to chemotherapy can be categorised in to which two types?

Primary - initial resistance of the tumour to the drugs

Acquired - tumour develops resistance over time

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High dose chemotherapy requires which other type of support?

Bone marrow support - stem cells

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High dose chemotherapy is required in the treatment of which cancers?

Most solid tumours:
High grade NHL
HL
Acute/chronic leukaemia 
Multiple myeloma
Germ cell tumours of testes
Ewing's sarcoma

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High dose chemotherapy is associated with what percentage mortality?

1-2%

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Chemotherapy induced nausea is treated with which antiemetic

Ondansetron 5-HT antagonist

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What is used to treat anticipatory nausea?

Benzodiazepine

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Cisplatin can cause which GI side effects?

Autonomic neuropathy causing paralytic ileus

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What is nadir and when does it occur?

The lowest blood cell count whilst someone is on chemotherapy - occurs 10-14 days after each cycle

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What is the general neutrophil count & platelet count required to commence chemotherapy?

ANC - ≥1x10[9]

platelets - ≥ 100x10[9]

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How long after a cycle of chemotherapy to haematopoietic cells take to recover?

3-4 weeks

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Platinum drugs most commonly cause which type of side effects?

Peripheral neuropathies

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Cisplatin is most associated with which neurological side effect? Therefore who should not receive it?

Permanent hearing loss due to cochlear damage

Contraindicated in those with pre-existing high tone hearing damage

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Bladder toxicity due to chemotherapy can present in which way? What is the antidote?

Haemorrhagic cystitis

Mesna

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What is hand-foot syndrome?

Erythema of the palms & soles, usually due to 5-FU

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What are the side effects of bleomycin?

Skin & nail pigmentation

Pulmonary fibrosis

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Who should you not give oxygen therapy to?

Patients on bleomycin - pulmonary fibrosis

What is the pneumonic for counselling patients on the side effects of chemotherapy

``` Never Fall on My HIP Nausea Fatigue Mucositis & diarrhoea Hair loss Infection Peripheral neuropathy ```

Sub-lethal DNA damage due to chemotherapy can lead to what?

Secondary malignancy

Which are the most carcinogenic chemotherapies?

Alkylating agents & procarbazine

What type of anaemia may chemotherapy cause?

Macrocytic non-megaloblastic

What are the clinical signs of thrombocytopenia

Petechial haemorrhage Nosebleeds Corneal haemorrhage Haematuria

Who should receive prophylactic antibiotics during chemotherapy?

COPD | Patients with lymphoma - at risk of PCP therefore give co-trimoxazole

The names of monoclonal antibodies end in what? | What route are they usually administered?

-mad | IV

Trastuzemab is also known as what?

Herceptin

The names of tyrosine kinase inhibitors end in what? What route are they usually administered?

-ib | Oral

TKIs are metabolised via what?

Liver - CYP pathways

How do TKIs work?

Block cell growth factors & angiogenesis

What cancers are TKIs commonly used in?

Palliative treatment of - renal cell, pancreatic neuroendocrine & gusto-intestinal stromal

Which cancers are hormone dependant?

``` Prostate Breast Endometrial Ovarian Lymphocytic (corticosteroid hormones) ```

What is the mode of action of goserelin & leuprorelin?

LHRH analogues - reversible medical castration via inhibition of FSH & LH

Aromatase inhibitors are useful in which group of people?

Post-Menopausal women as hormone therapy (inhibit conversion of androgen to oestrogen)

Non-steroidal anti-androgens are used in which cancer?

Prostate - inhibit testosterone

High dose glucocorticoids have what effect on cells?

``` Induce apoptosis in some malignant lymphoid cells Good for: Lymphoid leukaemia Lymphomas Myelomas Hodgkin's ```

What percentage of cancers are avoidable?

42%

How does radiotherapy work?

X-rays penetrate & release free radicals which cause DNA damage to both cancer cells & normal cells Normal cells can repair damage and therefore survive

The dose of radiotherapy is expressed in which units?

Gray (Gy)

What are the acute side effects of radiotherapy?

skin reaction oral mucositis diarrhoea

Obesity accounts for what percentage of cancers?

What are some long term side effects of radiotherapy?

Infertility Lung fibrosis Skin atrophy Second malignancy

Brachytherapy is useful in which types of cancers?

Prostate Head & neck gynaecological Oesophageal

What are the two main types of brachytherapy?

Intracavity - placed inside the cavity e.g. uterus | Interstitial - put in to the target - e.g. prostate

What is the most commonly used radioisotope?

Iodine - used in thyroid cancers

What is partial response to treatment defined as?

All lesions have shrunk by at least 30%. But disease still present

If lesions have increased in size by >20% what is this called?

Progressive disease

What is defined as stable disease?

<20% increase in size or lesions have shrunk by <30%

What is defined as stable disease?

<20% increase in size or lesions have shrunk by <30%

MRI is gold standard for staging which type of cancers?

Neurospinal Rectal Prostate MSK

What can be used to assess tumour blood flow?

Duplex & Doppler ultrasound scan

What scan can be used to differentiate malignant from benign pathologies?

PET scan

When is the foecal occult blood test offered and how often?

60-74 | Every 2 years

What is a Kaplan-Meier graph?

Used to estimate the survival rates of those with disease | Plots survival against time

Who is radiotherapy administered by?

Clinical oncologists

What is the most common side effect of radiotherapy?

Fatigue

What is a side effect of Gossorelin? Who should it be avoided in?

Can cause tumour flare | Avoid in those with MSCC - use degrilex instead

A 59 year old women is invited for he cervical smear how often?

Every 5 years

What is the aim of a phase 1 clinical trial?

Determine toxicity & establish maximum tolerated dose

Who are phase 1 clinical trials available to?

Any tumour that is not suitable for other treatment

What is the aim of a phase 2 clinical trial?

assess the anti-tumour activity of the treatment (measures radiological shrinkage)

What is the aim of a phase 3 clinical trial?

Compare new treatments to established ones

Pain is assessed using which questionnaire?

McGill pain questionnaire

What is tumour lysis syndrome?

When a large tumour is lysed by chemotherapy, the contents may spill in to the bloodstream and cause hyperkalaemia, hyperphosphateamia & hypocalcaemia Causes tetany, myopathy, parkinsonism, decreased cognition