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Oncology > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

approximately what % of cancer patients will be chemotherapy

A

60-70%

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2
Q

how does chemotherapy exert an anti-cancer action

A

Most target DNA directly or indirectly

preferentially toxic towards actively proliferating cells

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3
Q

what are chemotherapeutic agents preferentially toxic towards

A

actively proliferating cells

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4
Q

which tumours normally act best to chemotherapy

A

those that divide rapidly with short doubling times

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5
Q

what is neoadjuvant chemotherapy

A

Pre-operative treatment of an operable tumour before definitive surgical intervention

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6
Q

what are the aims of neoadjuvant chemotherapy

A

to make the tumour smaller to allow less radical surgery and can also treat occult micro metastases

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7
Q

what is primary chemotherapy

A

initial chemotherapy for a tumour that is inoperable/unsure if operable, reduction of the tumour via chemo may make surgery with curative intent more feasible.
treatment which increases future cure rates

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8
Q

what is adjuvant chemotherapy

A

chemotherapy following a complete macroscopic clearance at surgery. Treats occult microscopic metastases which can cause relapse after surgery

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9
Q

what is palliative chemotherapy

A

treatment to alleviate symptoms and sometimes to prolong life in patients who cannot be cured.
carefully balanced decision so that the patients QoL doesnt get worse
can be given 2/3rd line chemo if disease remains chemo sensitive

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10
Q

what is curative chemotherapy

A

in some cancers there is a chance of cure even if there are distant metastases at presentation. justifies a more intensive treatment with greater toxicity

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11
Q

what cancers can be cured by chemo even with metastatic disease at presentation

A

Germ cell tumours
Hodgkins disease
Non-Hodgkins lymphoma
many childhood cancers

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12
Q

what is prophylactic chemotherapy

A

when hormonal treatments are given before obvious malignancy appears.
eg Tamoxifen may be used for in-situ breast cancer before invasive carcinoma is recognised

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13
Q

3 reasons why chemotherapy is usually given as a combination of drugs

A
  1. cancer drugs can act synergistically to kill more cancer cells together than they would do alone
  2. less chance of drug-resistant malignant cells emerging
  3. when drugs with different sites of toxicity are combined , dose can be maintained for each drug
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14
Q

when is single agent chemotherapy often used

A

in a palliative setting

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15
Q

why is chemo given cyclically

A

to allow normal cells to recover

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16
Q

which cells are usually affected at standard doses of chemotherapy

A

haematopoietic stem cells - low blood counts (mylesuppression)
lining of GI tract - mucositis

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17
Q

what is mucositis

A

Painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy

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18
Q

what is a conventional dose of chemo drug

A

doses of drugs known to be effect against the particular malignancy and where the side effects are tolerable in most patients

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19
Q

what support is required for patients having high dose treatments

A

bone marrow support

growth factors

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20
Q

under what circumstances/cancers are high dose treatments used

A

only when long term survival or cure are possible

cancers: Hodgkins disease and Ewings sarcoma

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21
Q

what is the advantage of oral chemotherapy

A

patient doesnt have to be in hospital attached to a drip

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22
Q

what is the disadvantage of oral chemotherapy

A

variable levels of drug in circulation based on whether and when the drug was taken

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23
Q

which chemo drugs are available orally

A

cyclophosphamide
Etoposide
Capecitabine
Tamoxifen

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24
Q

what is intravesical chemotherapy

A

chemo given straight in to the bladder - for bladder cancer

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25
Q

what are the advantages of intravesical cancer

A

produces high doses at the site of the tumour
little systemic absorption
minimal toxicity

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26
Q

what is intraperitoneal chemotherapy

A

chemo directly in to the peritoneal cavity

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27
Q

when would intraperitoneal chemo be given

A

for tumours that spread trans-coelomically (eg ovarian cancer)

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28
Q

what type of tumours are most suited to intra-arterial chemo

A

those with a well-defined blood supply

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29
Q

an example of intra-arterial chemo

A

hepatic artery infusion for liver metastases

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30
Q

what are the advantages of intra-arterial chemotherapy

A

higher doses to be delivered to the involved site

reduced systemic toxicity

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31
Q

how is the dose of routine chemo drugs calculated

A

on body surface area of the patient

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32
Q

How is the dose of the chemo drug carboplatin calculated

A

directly according to renal function

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33
Q

which cancer have a cure of advanced disease from chemo in >50% of cases

A 
Hodgkin's disease
Testicular cancer
Acute lymphoblastic leukaemia
Choriocarcinoma 
Paediatric cancers: leukaemias, lymphomas and sarcomas
34
Q

which cancers have <50% cure of advanced disease from chemo

A

Non hodgkins lymphoma
Ovarian cancer
Paediatric neuroblastoma Adult osteosarcoma, Ewing’s sarcoma, rhabdomyosarcomas

35
Q

which cancers have an increased cure rathe in high risk loco regional disease

A 
Breast
Colorectal
Non-small cell lung cancer
Oesophageal and gastric cancer
Bladder cancer
36
Q

what does remission mean in terms of cancer

A

areas of the cancer shrink,

with reduction in symptoms and frequently disease control for several months once treatment course is completed.

37
Q

what are 3 cancers considered curable

A

Breast cancer
Small cell lung cancer
Ovarian

38
Q

which cancers are considered to have a prolonged survival with chemo but there are few cures in advanced disease

A 
Non small cell lung cancer
Colorectal cancer
Gastric
Breast
Bladder
Prostate
39
Q

which cancers often have palliation of symptoms with chemo but limited responses

A 
Renal cancer
Melanoma
head and neck cancer
Pancreatic cancer
Biliary tract cancers
40
Q

what are the main aims for the use of combination chemotherapy regimens

A

max cell kill
min toxicity to non-tumour cells
min development of resistance

41
Q

How many tumour cells are usually killed per cycle of chemo

A

2 log reduciton (eg from 10^9 to 10^7)

42
Q

in chemo combination regimes how is toxicity minimized

A

avoid giving 2 or more drugs with the similar adverse effects as this may cause intolerable toxicity.
Agents with distinct organs of toxicity allow dose to be kept high

43
Q

how does giving multiple drugs in chemo minimise drug resistance

A

more tumour cells are killed when more drugs given

so increases probability of killing the initial population

44
Q

what procedure is necessary to deal with high dose regimes of chemotherapy

A

bone marrow transplant

peripheral Haematopoietic progenitor (stem cells) now more commonly used

45
Q

what class of drug is most commonly used to treat nausea and vomiting from chemo

A

5-HT antagonists (eg Ondansetron)

46
Q

How is myelosuppression caused in chemo

A

Chemo causes bone marrow suppression by killing haematopoietic progenitor cells

47
Q

at what after the chemo is the leuopenia and thrombocytopenia

A

10-14 days from the beginning of each cycle

48
Q

what is the lowest point of the drop in leukocytes and neurophils called

A

the nadir

49
Q

what count of neutrophils is generally not associated with infection

A

> 1x10^9/1

50
Q

what what level of neurophils is there significant risk of infection

A

0.5x10^9/1

51
Q

how long does haematopoietic recovery usually take

A

3-4 weeks (usually the length of cycles)

52
Q

what are the common GI side effects of chemo

A

oral mucositis
diarrhoea
constipation - dehydration, reduced oral intake, adverse effects of medications eg opiates and 5-HT antagonists

53
Q

what causes the side effect of alopecia associated with chemo

A

the effects of the cytotoxic drugs on the rapidly dividing cell population at the hair follicle.

54
Q

what can sometimes be used to try and minimise the alopecia

A

a cold cap - reduces the blood flow to the scalp

55
Q

what are the 4 types of neurological toxicity associated with chemo

A

Peripheral neuropathy
Autonomic neuropathy
Central neurological toxicity
Ototoxicity

56
Q

what chemo drugs causes peripheral neuropathies

A

Platinum drugs: cisplatin, taxanes and vinca alkaloids

57
Q

which chemo drug is associated with hearing loss

A

cisplatin - due to cochlear damage

58
Q

what is the effect of cisplatin on hearing

A

can cause permanent high tone hearing loss

59
Q

which s chemo drug is nephrotoxic

A

platinum agents - mostly cisplatin and ifosfamide (alkylating agent)

60
Q

which chemo drugs have bladder toxicity

A

Cyclophosphamide and ifosfamide

61
Q

what can the drugs causing bladder toxicity cause

A

haemorrhagic cystitis (in a dose dependent manner)

62
Q

which chemo drug can cause coronary artery spasm

A

5-FU

63
Q

what skin/soft tissue side effects can be caused by chemo drugs

A

Extravasation
Palmar and plantar erythema
Photosensitivity
Pigmentation

64
Q

what is extravasation

A

when a chemo drug leaks in to the surrounding tissue (of the cannula)

65
Q

what is hand-foot syndrome

A

palmar and plantar erythema

66
Q

what chemo drug causes pigmentation

A

bleomycin causes skin and nail pigmentation

67
Q

what chemo drug is associated with the side effects of myalgia and arthralgia?

A

paclitaxel

68
Q

which are the most carcinogenic anti-cancer drugs

A

alkylating agents and procarbazine

69
Q

which long term side effect is increasing with more people surviving cancer

A

Secondary malignancies (from anti-cancer drugs)

70
Q

which chemo drugs can cause pulmonary fibrosis in the long term

A

bleomycin

busulphan

71
Q

when does the nadir on myelosuppression normally occur?

A

about 10-12 days after chemo

72
Q

what can cause pancytopenia

A

bone marrow replacement by malignant infiltration

73
Q

what type of cancers is pancytopenia more common in

A

haematlogical malignancies
breast
lung
prostate cancer

74
Q

what type of anaemia can be caused by repeated chemo

A

macrocytic anaemia

75
Q

What Hb level do oncology pts require a blood transfusion

A

Hb <10 gldl

76
Q

what are 4 clinical signs of thrombocytopenia

A

petechial haemorrhage
spontaneous nosebleeds
corneal haemorrhage
haematuria

77
Q

If thrombocytopenia is prolonged, what sort of transfusion is required

A

platelet

78
Q

what level of platelets requires urgent platelet transfusion

A

<10 x10^9/L

79
Q

what is the most frequent cause of morbidity and mortality associated with myelosuppression

A

neutropenic infection

80
Q

what is the criteria for immediate in-patient broad spectrum antibiotics for neutropenic infection

A

FEVER

total white cell counts <1 x10^9/L

Oncology (3 decks)

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