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CCC - LM > Chemo & Radiotherapy > Flashcards

Chemo & Radiotherapy Flashcards

1
Q

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

A

Childhood leukaemia

18 months

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2
Q

Which hormone therapy is available orally?

A

Tamoxifen

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3
Q

Intravesical chemotherapy is used to treat which type of cancer?

A

Bladder

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4
Q

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

A

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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5
Q

Which formula is used to calculate chemotherapy doses?

A

DuBois and DuBois

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6
Q

What are the 3 main aims of chemotherapy regimes?

A

Maximise cell kill
Minimise toxicity
Minimise development of resistance

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7
Q

Is single agent or multiple agent chemotherapy preferred and why?

A

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

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8
Q

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

A

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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9
Q

Why is chemotherapy given in cycles?

A

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

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10
Q

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

A

Primary - initial resistance of the tumour to the drugs

Acquired - tumour develops resistance over time

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11
Q

High dose chemotherapy requires which other type of support?

A

Bone marrow support - stem cells

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12
Q

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

A 
Most solid tumours:
High grade NHL
HL
Acute/chronic leukaemia 
Multiple myeloma
Germ cell tumours of testes
Ewing's sarcoma
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13
Q

High dose chemotherapy is associated with what percentage mortality?

A

1-2%

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14
Q

Chemotherapy induced nausea is treated with which antiemetic

A

Ondansetron 5-HT antagonist

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15
Q

What is used to treat anticipatory nausea?

A

Benzodiazepine

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16
Q

Cisplatin can cause which GI side effects?

A

Autonomic neuropathy causing paralytic ileus

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17
Q

What is nadir and when does it occur?

A

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

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18
Q

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

A

ANC - ≥1x10[9]

platelets - ≥ 100x10[9]

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19
Q

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

A

3-4 weeks

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20
Q

Platinum drugs most commonly cause which type of side effects?

A

Peripheral neuropathies

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21
Q

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

A

Permanent hearing loss due to cochlear damage

Contraindicated in those with pre-existing high tone hearing damage

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22
Q

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

A

Haemorrhagic cystitis

Mesna

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23
Q

What is hand-foot syndrome?

A

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

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24
Q

What are the side effects of bleomycin?

A

Skin & nail pigmentation

Pulmonary fibrosis

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25
Q

Who should you not give oxygen therapy to?

A

Patients on bleomycin - pulmonary fibrosis

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26
Q

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

A 
Never Fall on My HIP
Nausea 
Fatigue 
Mucositis & diarrhoea 
Hair loss
Infection 
Peripheral neuropathy
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27
Q

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

A

Secondary malignancy

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28
Q

Which are the most carcinogenic chemotherapies?

A

Alkylating agents & procarbazine

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29
Q

What type of anaemia may chemotherapy cause?

A

Macrocytic non-megaloblastic

30
Q

What are the clinical signs of thrombocytopenia

A

Petechial haemorrhage
Nosebleeds
Corneal haemorrhage
Haematuria

31
Q

Who should receive prophylactic antibiotics during chemotherapy?

A

COPD

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

32
Q

The names of monoclonal antibodies end in what?

What route are they usually administered?

A

-mad

IV

33
Q

Trastuzemab is also known as what?

A

Herceptin

34
Q

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

A

-ib

Oral

35
Q

TKIs are metabolised via what?

A

Liver - CYP pathways

36
Q

How do TKIs work?

A

Block cell growth factors & angiogenesis

37
Q

What cancers are TKIs commonly used in?

A

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

38
Q

Which cancers are hormone dependant?

A 
Prostate
Breast
Endometrial
Ovarian 
Lymphocytic (corticosteroid hormones)
39
Q

What is the mode of action of goserelin & leuprorelin?

A

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

40
Q

Aromatase inhibitors are useful in which group of people?

A

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

41
Q

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

A

Prostate - inhibit testosterone

42
Q

High dose glucocorticoids have what effect on cells?

A 
Induce apoptosis in some malignant lymphoid cells
Good for:
Lymphoid leukaemia
Lymphomas 
Myelomas 
Hodgkin's
43
Q

What percentage of cancers are avoidable?

A

42%

44
Q

How does radiotherapy work?

A

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

45
Q

The dose of radiotherapy is expressed in which units?

A

Gray (Gy)

46
Q

What are the acute side effects of radiotherapy?

A

skin reaction
oral mucositis
diarrhoea

47
Q

Obesity accounts for what percentage of cancers?

A

5%

48
Q

What are some long term side effects of radiotherapy?

A

Infertility
Lung fibrosis
Skin atrophy
Second malignancy

49
Q

Brachytherapy is useful in which types of cancers?

A

Prostate
Head & neck
gynaecological
Oesophageal

50
Q

What are the two main types of brachytherapy?

A

Intracavity - placed inside the cavity e.g. uterus

Interstitial - put in to the target - e.g. prostate

51
Q

What is the most commonly used radioisotope?

A

Iodine - used in thyroid cancers

52
Q

What is partial response to treatment defined as?

A

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

53
Q

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

A

Progressive disease

54
Q

What is defined as stable disease?

A

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

55
Q

What is defined as stable disease?

A

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

56
Q

MRI is gold standard for staging which type of cancers?

A

Neurospinal
Rectal
Prostate
MSK

57
Q

What can be used to assess tumour blood flow?

A

Duplex & Doppler ultrasound scan

58
Q

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

A

PET scan

59
Q

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

A

60-74

Every 2 years

60
Q

What is a Kaplan-Meier graph?

A

Used to estimate the survival rates of those with disease

Plots survival against time

61
Q

Who is radiotherapy administered by?

A

Clinical oncologists

62
Q

What is the most common side effect of radiotherapy?

A

Fatigue

63
Q

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

A

Can cause tumour flare

Avoid in those with MSCC - use degrilex instead

64
Q

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

A

Every 5 years

65
Q

What is the aim of a phase 1 clinical trial?

A

Determine toxicity & establish maximum tolerated dose

66
Q

Who are phase 1 clinical trials available to?

A

Any tumour that is not suitable for other treatment

67
Q

What is the aim of a phase 2 clinical trial?

A

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

68
Q

What is the aim of a phase 3 clinical trial?

A

Compare new treatments to established ones

69
Q

Pain is assessed using which questionnaire?

A

McGill pain questionnaire

70
Q

What is tumour lysis syndrome?

A

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

CCC - LM (14 decks)

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