Chemotherapy

Question 1

What are the different biopsy techniques?

Answer 1

FNA
Tru-Cut: Tumour sampled under LA
Incisional: Tumour sampled at surgery
Excisional: Whole mass removed

Question 2

What is cytoreductive surgery?

Answer 2

Reduce the bulk of the tumour
Ovarian cancer
Likely to be of benefit if there is effective therapy for residual

Question 3

Give examples of palliative surgery for cancer

Answer 3

Bypass procedure for bowel obstruction due to intra-abdo tumour
Orthopaedic pinning of pathological fractures

Question 4

What is the mechanism of action for chemotherapy?

Answer 4

Most target DNA directly or indirectly

Chemotherapeutic agents are toxic towards actively proliferating cells

Question 5

What are the uses of chemotherapy?

Answer 5

Neoadjuvant
Primary
Adjuvant
Palliative
Curative
Prophylactic

Question 6

What is neoadjuvant treatment in chemotherapy?

Answer 6

Pre-op treatment of an operable tumour before surgery with the intent of shrinking the tumour & treating micro metastases
Osteosarcoma

Question 7

What is adjuvant treatment in chemotherapy?

Answer 7

Following complete macroscopic clearance at surgery. Used to treat occult microscopic mets which usually lead to relapse

Question 8

What types of cancer are chemo-sensitive?

Answer 8

Breast
Ovarian
Colorectal

Question 9

When can Tamoxifen be used?

Answer 9

In-situ breast cancer before invasive carcinoma is recognised

Question 10

Why is chemotherapy given as a combination of different drugs?

Answer 10

• Different classes have different actions, may kill more cancer cells together (synergism)
• Less chance of drug resistant malignant cells emerging
• Drugs with different sites of toxicity are combined dose can be maintained for each drug

Question 11

What normal cells are most effected by chemo?

Answer 11

Haematopoietic stem cells= myelosuppression

Lining of the GI tract= mucositis

Question 12

What is a conventional dose defined as?

Answer 12

Dose of drugs known to be effective against the particular malignancy which in the majority causes tolerable side effects.

Question 13

When are high dose chemo treatments acceptable?

Answer 13

Greater toxicity
Required specialised supportive care
Justified in long term survival or cure
Ewings Sarcoma
Hodgkin's disease

Question 14

In what type of cancer is maintenance chemo used?

Answer 14

Childhood leukaemia used for 18months following complete remission.
Long-term can lead to resistant clones & inc toxicity

Question 15

What are the regional types of chemotherapy?

Answer 15

Intravesical: Superficial bladder Ca, produces high doses at the tumour site with little systemic absorbance
Intraperitoneal: Administered directly into peritoneal cavity in context of tumours spread trans-coelomically (ovarian)
Intra-arterial: Any tumour with well defined blood supply, higher doses to involved site & reduced systemic toxicity

Question 16

Which diseases can chemo be used for palliation?

Answer 16

Limited response
Renal
Melanoma
Head & neck
Pancreatic
Biliary-tract

Question 17

Which diseases can chemo prolong survival & cure a few in advanced disease?

Answer 17

Non-small cell lung
Colorectal
Bladder
Prostate
Breast
Gastric

Question 18

Which diseases can chemo cause remission in most patients?

Answer 18

Curable chemo cancers
Breast
Ovarian
Small cell lung

Question 19

What are the aims of combined chemo regimens?

Answer 19

Maximise cell kill
Minimize toxicity to non-tumour cells
Minimise development of resistance

Question 20

What types of drugs can be given in ovarian cancer?

Answer 20

Platinum drugs

Paclitaxel

Question 21

What is platinum toxic to?

Answer 21

Kidneys (drug is excreted by the kidneys)
Rare: Paralytic ileus due to autonomic neuropathy
Ototoxic
Peripheral neuropathy

Question 22

What is primary and acquired resistance?

Answer 22

Primary: Initial characteristic of the initial malignant clone
Acquired: Develops through multiple genetic events in tumour progression

Question 23

What are immediate complications of chemo?

Answer 23

• N&V: Combination of direct stimulation of vomiting centre, peripheral stimulation & anticipatory causes.
• Myelosuppression: Kills haematopoietic progenitor cells. Leads to leucopenia & thrombocytopenia after 10-14days.
• GI upset: Oral mucositis, diarrhoea due to colitis or s.bowel mucosal inflammation. Constipation due to dehydration with reduced oral intake
• Alopecia
• Neurological: Peripheral neuropathies (sensory nerves), autonomic neuropathy, central neurological toxicity, ototoxicity (cochlear damage)
• Nephrotoxicity
• Bladder toxicity
• Extravasation
• Palmar plantar erythema
• Photosensitivity
• Pigmentation (Bleomycin)

Question 24

How is chemo related N&V treated?

Answer 24

Premed: Ondansetron & dexamethasone
Post-dose: Dexamethasone & Metoclopramide
Anticipatory nausea: Lorazepam
5-HT antagonists- Ondansetron

Question 25

What is the nadir?

Answer 25

The lowest point of the drop in haematopoietic cells

Question 26

What is hand-foot syndrome?

Answer 26

Erythema of the palms of the hands & soles of the feet usually with 5-FU, patients reviewed for other side effects

Question 27

What long term complications can occur with chemo?

Answer 27

• Second malignancies: Some drugs can cause sub-lethal DNA damage
• Infertility: Most on high dose treatments, males should consider sperm storage
• Pulmonary: Fibrosis induced by drugs (Bleomycin), pneumonitis
• Cardiac: Cardiac fibrosis, younger patients more susceptible

Question 28

What is chemoprevention?

Answer 28

NOT chemotherapy
Ways to prevent the progression of factors turning into cancer
e.g vaccines, dietary supplements, oral meds

Question 29

What is the max tolerated dose?

Answer 29

Give increasing doses of chemo until the side effects are too bad to tolerate

Question 30

What nail changes can be seen in chemo patients and why?

Answer 30

Bow’s lines

Nails stop growing during chemo cycles but start growing again during rest cycles

Question 31

Define dose density & dose intensity

Answer 31

Density: Max amount of drug in the system
Intensity: Time period drug is given