Chemotherapy and Radiotherapy Flashcards
What is chemotherapy?
Use of any chemical substances that treat disease. Usually this refers to use of cytotoxic drugs. They are usually given in cycles to allow normal cells to recover. Chemotherapy can be single agent or combination therapy. Single agent is rarely curative as cancer cells can evolve resistance.
What are the common side effects of chemotherapy?
Most commonly related to cell lines that divide quickly so: hair loss, gut problems, bone marrow and fertility. Chemo brain and pins and needles common.
Vomiting – prophylaxis usually given
Alopecia – wig services are available
Neutropenia – all patients should be warned of the sign of sepsis
What is extravasation?
Infiltration of chemotherapy drug in submucosal/subdermal tissue during transfusion. Presents with tingling, burning, pain, redness, swelling and no flashback in cannula. Stop and disconnect the transfusion and attempt to aspirate any residual drug.
How does chemotherapy affect fertility?
Both chemo and radio therapy will affect the fertility of men and women causing infertility in men and premature ovarian failure in women. Men should be encouraged to store sperm samples – intracytoplasmic insertion of sperm means only a small sample is needed. Women should be encouraged to freeze eggs.
How does radiotherapy work?
Uses ionising radiation to damage DNA preventing cell division and alerting the immune system to the location of cancer.
Radical radiotherapy is given with curative intent and is given in fractionated doses.
Palliative radiotherapy is given to help control symptoms or extend life given in much smaller doses and fractions.
What are the common early reactions to radiotherapy?
Early reactions to Radiotherapy
Occur 2 weeks after administration and peak at 4 weeks.
• Tiredness – stay as active as possible can be chronic
• Skin reactions – erythema, desquamation and ulceration
• Mucositis – dental check before starting, avoid smoking and use analgesic and antiseptic mouthwashes. Treat oral thrush with fluconazole.
• Nausea and vomiting – when stomach, liver or brain treated. Metoclopramide, domperidone and ondansetron are best in this.
• Diarrhoea – after abdominal or pelvic use, stay well hydrated and avoid high fibre diets.
• Dysphagia – thoracic treatment – speech and language input and check nutrition
• Cystitis – after pelvic treatment, drink plenty of fluids.
What are the common late reactions to radiotherapy?
Late reactions to Radiotherapy
Months – years after treatment
• Lethargy – consider steroids use
• Pneumonitis – dry cough, dyspnoea. Bronchodilators and tapered steroids help
• GI – Xerostomia (reduced saliva) treat with water, saliva substitutes and stimulants. Benign strictures treat with dilatation. Fistulae – seek surgical advice.
• GU – LUTS, vaginal stenosis, dyspareunia, erectile dysfunction and reduced fertility.
• Panhypopituitarism, GH replacement may be required. Be aware of hypothyroidism.
• Secondary cancers – more important for younger patients. Especially wary of leukaemias. Women treated for Hodgkin’s lymphoma should be offered breast screening from 8yrs after treatment.
How does cisplatin work and what are its common side effects?
Cross linking of DNA
Ototoxicity, peripheral neuropathy and hypomagnesia
How does Hydroxyurea (hydroxycarbamide) work and what are its common side effects?
Inhibits ribonucleotide reductase deccreasing DNA synthesis
Myelosupression
How does Docetaxel work and what are its common side effects?
Prevents microtubule depolymerisation and disassembly
Neutropenia
How does vincristine/vinblastine work and what are its common side effects?
Inhibits formation of microtubules
Vincrisitine – peripheral neuropath and paralytic Ileus
Vinblastine – myelosupression
How does 5-flurouracil work and what are its common side effects?
Pyrimidine analogue inducing cell cycle arrest and apoptosis
Myelosupression, mucositis and dermatitis
How does methotrexate work and what are its common side effects?
Inhibits dihydrofolate reductase and thymidylate synthesis
Myelosupression, mucositis, liver firosis and lung fibrosis
How does doxorubicin work and what are its common side effects?
Inhibits DNA and RNA synthesis
Cardiomyopathy
How does Bleomycin work and what are its common side effects?
Degrades DNA
Lung fibrosis
