Chemotherapy Lecture Flashcards
What causes cancer?
Accumulated DNA mutations alter cellular function.
Mutations occur in proto-oncogenes (→ oncogenes) or tumor suppressor genes.
Leads to unchecked cell growth, tumor formation, and invasion
what are proto-oncogenes and oncogenes?
Sections of DNA that encode for genes used to make specific proteins vital to promoting cell growth
what are tumor suppressor genes?
Some genes encoded in DNA help regulate cell growth (ie, serve as a mechanism to prevent over-stimulating cell growth
How are the types of cancer named/classified?
typically named for site of origin/tissue type (breast, lung, colon)
solid tumors = affect organs and other solid tissues and is specified by origin of cell type
hematologic malignancies = affect blood cells
how is cancer treated?
Localized: Surgery, radiation.
Systemic: Chemotherapy (monoclonal antibodies), targeted therapy, CAR-T cell therapy, stem cell transplantation.
how is radiation used for cancer?
exposes the patient to ionizing radiation using high energy photon beams – destroys cancer cells or stops them from growing
*may cause damage to neighboring tissues
how is chemo used for cancer?
many chemo drugs targets normal mechanisms of cell function to block cancer cell growth and division
What is the purpose of combination chemotherapy?
Efficacy: Target cancer in multiple ways.
Toxicity: Minimize overlapping toxicities.
Mechanisms: Use drugs with differing MOAs to reduce resistance
What are neoadjuvant vs. adjuvant chemotherapy?
Neoadjuvant: Before surgery/radiation to shrink tumors.
Adjuvant: After surgery/radiation to eliminate residual cancer cells.
what is the dosing “risk” with chemo?
chemo kills in a dose dependent fashion. higher doses = kill more cells. HOWEVER, higher doses = more side effects.
what is apoptosis?
cell-mediated mechanism of cell death that can be induced by drugs blocking activities the cell needs to function
goals of cancer treatment?
Cure: a sustained cancer-free period
Control: reduce cancer burden, prevent extension of cancer and extend survival. *cure is unlikely
Polliation: reduce symptoms of disease, improve QoL, prolong survival. *cure is unlikely
what are the responses to cancer treatment?
Remission/Complete Response: unable to detect presence of cancer
Cure: prolonged period of remission (~5 years)
Partial Response: reduction in tumor burden but cancer still present
Stable Disease: tumor present but not grown or shrunk
Treatment Failure/Progressive Disease: cancer continues to grow despite treatment
how does a medical team determine the response to cancer treatment?
physical exam, radiographic tests (MRI, CT, PET), tumor markers (proteins in blood), biopsies/blood tests
what are other reasons there might be a lack of effect from chemo?
drug interactions between chemo and non-chemo drugs
food interactions
poor adherence to therapy
What is cancer-related fatigue, and how is it managed?
Fatigue that doesn’t resolve with rest; worsens with treatment.
Management: Regular exercise, hydration, balanced diet, managing comorbid conditions.
What is CAR-T therapy?
T-cells harvested, re-engineered to express chimeric antigen receptors (CARs), and reinfused.
Targets specific cancer antigens (e.g., CD19 in leukemia/lymphoma)
how are cancer cells able to evade detection by the immune system?
due to their development from normal cells and activation of methods to shut down immune-mediated destruction
how does immunotherapy help treat cancer?
enhances, manipulates, and/or mimics the body’s ability to identify and destroy cancer cells
why are monoclonal antibodies a good choice for immunotherapy for cancer?
laboratory created antibodies that target specific sites on cancer cells and has multiple mechanisms of action to kill cancer cells
what are the two types of hematopoietic stem cell transplant for cancer?
allogeneic and autologous
What is the difference between allogeneic vs. autologous hematopoietic stem cell transplant?
Allogeneic: Uses stem cells from a donor after chemo; includes risks of graft-versus-host disease (GVHD) but may provide graft-versus-tumor effect. *gives brand new immune system
Autologous: Uses patient’s own stem cells post-high-dose chemo; lower GVHD risk, primarily for rescue and recovery.
What are the side effects of chemotherapy?
Nausea/vomiting (CINV): Acute, delayed, anticipatory.
Myelosuppression: Neutropenia, anemia, thrombocytopenia.
GI: Diarrhea, mucositis, constipation.
Hair loss (alopecia)
are people undergoing chemo toxic?
NO lol
BUT urine, stool, blood, and vomit may contain active chemo so that should be considered a biohazard (usually is anyway)
What causes anorexia in cancer patients, and how is it managed?
Causes: Altered taste, reduced hunger mechanisms, chemo-induced nausea, GI ulcerations.
Management:
Small, frequent, high-calorie meals.
Light daily exercise to maintain muscle.
Medications
How is nausea and vomiting (CINV) managed?
Before chemo: 5HT3 antagonists (ondansetron) give meds to prevent acute and anticipatory
After chemo: cannabinoids after chemo to treat or prevent delayed CINV
What are the benefits of physical activity in cancer patients?
Improves strength, balance, and mental health.
Reduces fatigue, risk of DVT, osteoporosis, and secondary cancers.
Enhances overall quality of life
What are precautions for physical activity in cancer patients?
Avoid public gyms with neutropenia.
Modify activities for neuropathy, anemia, or IV catheters.
Avoid heavy weight exercises with osteoporosis or low platelets
What are colony-stimulating factors used for in cancer patients?
Stimulate WBC recovery post-chemotherapy
What is graft-versus-tumor effect?
Engrafted donor cells attack cancer cells, primarily seen in hematologic malignancies
What are secondary malignancies?
Cancers caused by mutagenic effects of prior chemo.
Commonly leukemia or lymphoma; typically harder to treat
What are the 3 phases of cancer patient care?
During treatment: Focus on tolerance and response.
Recovery: Rebuild strength, manage late effects.
Advanced cancer: Quality of life improvements.
What are the 3 phases of chemotherapy-induced nausea and vomiting (CINV)?
Acute: Within 24 hours of chemotherapy.
Delayed: Occurs 24–48 hours after chemotherapy.
Anticipatory: Triggered by prior negative experiences or anxiety about chemotherapy
Patient Factors that also affect the likelihood of CINV?
Age < 50 years
Anxiety
History of motion sickness
Female gender
Previous episodes of CINV
What are other GI tract toxicities of chemotherapy?
Diarrhea: Dehydration risk.
Constipation: From medication or reduced activity.
Mucositis: Painful ulcerations in the GI lining, affecting nutrition and quality of life
What is bone marrow suppression (myelosuppression)?
Most common dose-limiting toxicity of chemotherapy.
Affects production of red blood cells, white blood cells, and platelets.
Leads to anemia, neutropenia, and thrombocytopenia.
What are the effects and management of anemia in chemotherapy?
Effects: Fatigue, shortness of breath, dizziness, pallor.
Management: RBC transfusions or erythropoietin-stimulating agents
What is thrombocytopenia and how is it managed?
Definition: Low platelet count → increased bleeding risk (e.g., gums, nose, GI tract).
Management: Platelet transfusions; avoid NSAIDs and aspirin.
What is normal platelet count and what levels restrict patients from physical activity?
normal = 150K - 450K
<50K is super low and restricts physical activity
What is normal neutrophil count
3K - 7K
What is neutropenia, and why is it significant?
Definition: Low neutrophil count → ↑ risk of infections.
Management: Prophylactic antibiotics, G-CSF (e.g., filgrastim)
Precautions: Avoid public places; use masks and gloves.
What is the WHO Pain Ladder for managing cancer pain?
Non-opioids: NSAIDs, acetaminophen.
Weak opioids: Codeine, tramadol.
Strong opioids: Morphine, fentanyl, oxycodone.
What is alopecia in cancer treatment?
Hair loss caused by chemotherapy targeting rapidly dividing cells.
Usually starts 7–10 days after treatment begins; hair regrows post-treatment.
Management: wigs, hats, other head covering
What is extravasation, and why is it dangerous?
Definition: Leakage of chemotherapy drugs into surrounding tissues during IV administration.
Effects: Tissue damage, large open wounds
Occurs with only some chemotherapy - Vesicants: Vincristine
What are the signs/symptoms of Extravasation?
pain, redness, burning, pallor, no blood return, edema, decreased IV flow or flush
What is chemotherapy-induced neuropathy?
Symptoms: Sensory, motor, or autonomic nerve damage (e.g., pain, numbness, weakness).
Causes: Drugs like vincristine, cisplatin, paclitaxel.
Management: Physical therapy, duloxetine, gabapentin, TCAs
What are organ toxicities caused by chemotherapy?
Renal: Cisplatin.
Cardiac: Doxorubicin.
Pulmonary: Bleomycin.
Liver: Methotrexate.
Neurologic: Vincristine, paclitaxel.
What is the impact of cancer on patients?
Physical: Fatigue, nerve damage, deconditioning.
Mental: Cognitive impairment (“chemo brain”), anxiety, depression.
Social: Dependency, reduced quality of life
What are the ACS guidelines to reduce cancer risk in healthy individuals?
150–300 minutes of moderate or 75–150 minutes of vigorous activity per week.
Healthy diet: Limit alcohol, maintain healthy weight.
Avoid prolonged sitting; stay active daily.
What is targeted physical therapy for cancer patients?
Pain: Soft tissue mobilization, massage.
Deconditioning: Aerobic training to rebuild endurance.
Lymphedema: Range of motion, bandaging.
Genitourinary issues: Pelvic floor strengthening
When should you avoid exercise in cancer patients?
when it puts them at risk of injury or health issues
anemia
electrolyte imbalances
immunocompromised
unrelieved pain, N/V
Pts undergoing radiation avoid pools bc chemicals can irritate irradiated skin
when should you limit or change exercise in cancer patients?
severe fatigue
IV catheters or feeding tubes (avoid pool/lake/ocean to reduce infection risk)
^IV catheters avoid resistance training in area where IV is
AVOID heavy weights with osteoporosis or low platelets
What is the role of physical therapists in caring for cancer patients?
Assess functional limitations and provide tailored training.
Educate on activity benefits and fatigue management.
Design individualized plans for pain, deconditioning, and recovery
Why is surgery not typically used for hematologic malignancies?
Hematologic malignancies (e.g., leukemia, lymphoma) affect circulating cells, not solid tumors.
Surgery is limited to diagnostic biopsies or addressing specific complications
What are common prognostic factors for cancer?
Tumor-related: Size, grade, stage (TNM classification).
Patient-related: Age, comorbidities, functional status.
Biological: Genetic mutations, hormone receptor status, molecular markers
What is salvage chemotherapy, and when is it used?
High-dose chemo used for relapsed or refractory cancer.
Goal: Prolong survival, achieve remission in patients unresponsive to standard therapy
