Clinical approaches to a cancer patient Flashcards

Question

special concerns for Cure goal

Answer 1

Delayed and late side effect | - eg leukaemia cure rate of 80% --> cardiomyopathy --> die from Heart failure in 30-40yo.

Answer 2

value of added time pt live longer okay?

Answer 3

symptoms control

Answer 4

finding correct dose

Answer 5

Avoid treating those who are already cured

Answer 6

Treat when added time outweighs side effects

Answer 7

Treat when not treating leads to lower quality of life

Answer 8

respond ethically to patient’s perception of intent

Answer 9

``` §  Type of cancer and extent of involvement §  Treatment goals §  Age §  Performance status §  Concomitant diseases §  Social and economic factors §  Patient’s and/or family member’s wishes §  and many more.. ```

Answer 10

``` performance status scales ECOG 0-5 0 = normal activity 1 = symptoms but ambulatory both outpatient ``` 2 = <50% in bed 3 =>50% in bed 4= 100% in bed 5 = death KARNOFSKY - 100% normal 70-100 = outpatient 0 = dead

Answer 11

10^12 = 1 kg = Severe metastatic disease, death 10^11 = 100 gm = Advanced metastases 10^10 = 10 gm = Regional spread of cancer 10^9 = 1 gm = Clinically detectable disease (symptoms) ``` 10^8 = 100 mg= Subclinical disease 10^4 = 1 mg = Subclinical disease ``` ``` 10^3 = 1 mcg = Carcinoma in situ 10^0 = 1 ng = Neoplastic Transformation ```

Answer 12

Chemo / cytotoxic only for rapid growing cancer.

Answer 13

prostate and kidney cancer

Answer 14

3 log kill, 1 log regrowth

Answer 15

target = below 10^9 and continue till 0 cells interval for chemotherpy = 3 weeks so as to allow body to recover. chemo can kill bonemarrow cells, therefore WBC etc drops. recovery phase allow cancer cells to regrowth and also allow WBC to increase in number shorten interval for chemotherapy by giving WBV growth factor. interval shorten to 2 months. thus less time for cancer to growth but increase toxicity

Answer 16

1.   Surgery 2.   Radiation 3.   Hematopoietic Stem Cell Transplant 4.   Hormonal Therapy 5.   Targeted Therapies 6.   Immunotherapy 7.   Chemotherapy

Answer 17

``` Surgical oncology (solid tumor; normally combi) § The most ancient mode of treatment for cancer; It was the only treatment that could cure cancer prior to the advent of chemotherapy and radiotherapy ``` ``` Multiple roles §  Preventive (prophylactic) surgery §  Diagnostic and staging surgery §  Debulking surgery §  Palliative surgery ```

Answer 18

Destruction of cancer cells by ionizing radiation; treats localized disease § Rarely used by itself with curative intent; parts of multi-modality treatment approach Many techniques available § Internal Interstitial Radiation (Brachytherapy) § External Beam Radiation therapy

Answer 19

Radiation Therapy (XRT) Acute: Interruption of rapidly dividing tissues; patients can become fatigue, develop skin reactions, nausea, vomiting, diarrhea, dysphagia, mucositis, xerostomia, myelosuppression Chronic: Pulmonary fibrosis, tissue edema, may induce secondary malignancies XRT is mutageneic, carcinogenic and teratogenic

Answer 20

Stem Cell Transplantation §  Administration of higher than usual myelosuppressive chemotherapy and/or radiation therapy to treat a malignancy or to replace a diseased bone marrow ``` Types of Transplants: §  Allogeneic (other ppl) §  Autologous (own stem cell) §  Syngeneic §  Cord Blood Transplant ```

Answer 21

Hormonal Agents §  aka Hormonal Antagonists §  Manipulation of the endocrine therapy through exogenous administration of specific hormones as number of cancers are driven by the hormones §  Castration of hormones can be performed by pharmacological or surgical means - stop production of certain hormones OR - hormones will not bind to receptors and stimulate growth

Answer 22

§ Molecularly targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth Two main categories §  Monoclonal antibodies §  Tyrosine kinase inhibitors

Answer 23

Immunotherapy §  Using the immune system to detect and destroy cancer ``` Some examples include: §  Immune system modulators - Interleukins and interferons §  Monoclonal antibodies (targeted) §  Immune Checkpoint Modulators §  Cancer Treatment vaccines §  Immune Cell Therapies ```

Answer 24

7. Chemotherapy § Induction ---- 1st tx that bring pt to remission (10^9) § Consolidation --- more chemo to maintain remission § Maintenance -- v. low dose chemo to maintain remission/cure ---- after finishing consolidation tx (haematological cancer) § Adjuvant --- tx given after surgery to maintain remission § Neoadjuvant -- chemo given before surgery to shrink tumor down before cutting it---- after that can start adjuvant

Answer 25

increased efficacy balance between activity and safety (compatible side effect) activity = different mechanism of action and resistance only give drug that has response rate of >=30% response rate = tumor size reduction

Answer 26

Sq rt [ ( Height(cm) X weight (Kg) ) / 3600 ]

Answer 27

Dose rounding is recommended not to exceed 5-10%

Answer 28

 Heterogeneity: Tumor cells are generally unstable and tend to form different cell clones (mutation --> various response --> resistant) § Site ---> BBB, Bone hard to penetrate § Size - the larger the tumor: - The greater the heterogeneity - The poorer vascularization - The smaller the growth fraction (Gompertzian Growth) - Drug resistance – many mechanisms

Answer 29

Systemic Administration §  Intravenous §  Intramuscular §  Subcutaneous ``` Local/regional administration §  Intraperitoneal §  Intrathecal and intraventricular §  Intravesical §  Intra-arterial (Hepatic Arterial and regional limb perfusion ) ```

Answer 30

Pros § Treat micrometastasis (clinically undetectable tumor) § Prevents systemic recurrence § Effective for treatment of widespread tumor sites Cons § Increases toxicity to a wide range of tissues and organ systems throughout the body § ↑ risk of life-threatening toxicity § ↑ risk of systemic symptoms

Answer 31

``` PROS § Provide high dose to specific site § Low risk of systemic toxicities § Low rates of systemic symptoms § May allow treatment in patient unable to tolerate systemic system ``` ``` CONS § Do not treat micrometastasis § ↑ risk of systemic failure § Tumors needs to be localized § Technically difficult? § May require drugs with specific characteristics that allow for regional administration ```

Answer 32

§ Responses – Complete Response, Partial Response, Stable Disease § Survival – Overall Survival, Progression Free Survival § Tumor markers – e.g. CA-125, CEA § Quality of life

Answer 33

Diarrhea Renal failure ``` cystitis local reaction alopecia myalgia pulmonary fibrosis sterility ``` neuropathy myelosuppression phlebitis cardiotoxicity mucositis Vomiting / nausea cognitive impairment

Answer 34

1: dry mucous membranes and/or diminished skin turgor 2: requiring IV fluid replacement (brief) 3) requiring IV replacement (sustained) 4) physiologic consequences requiring intensive care, hemodynamic collapse. 3/4 = can cause death need interrupt tx and give supportive tx.

Answer 35

§  Dose limiting toxicity – can limit the amount of drug exposure to a patient §  Hematological toxicities - Objective toxicities e.g. neutropenia - Clear guidelines to withhold or delay §Non-hematological toxicities - Often subjective toxicities e.g. fatigue - Individual threshold varies §  Economics of managing AE-related admissions - Direct Medical Costs = SGD$ 4747 - Length of stay ~ 6.1 days

Answer 36

Supportive care is a discipline within oncology which is devoted to the prevention and treatment of toxicities associated with cancer and anticancer treatment, with an ultimate aim to alleviate cancer patients’ symptoms and complications. This includes the management of physical and psychological symptoms and side effects that patients experience across the continuum of the cancer.