Clinical management of malignant disease Flashcards
What are the signs and symptoms of cancer?
Painless lump. Dark pigmented skin lesions. Obvious changes in previous stable warts and moles. Ulceration of skin and mucous membranes. Persistent unexplained pain. Anorexia & weight loss. Fatigue. Dysphagia, dyspepsia. Persistent unusual constipation, diarrhoea, rectal bleeding.
What is the difference between curative and palliative
treatment?
Curative treatment:
Treatment can be aggressive.
Used when there is a possibility of long term control or
‘cure’.
Patient is said to be cured when they have a normal life
expectancy and are disease free.
Palliative treatment:
Used to improve quality of life.
Brings disease under control.
Achieves a worthwhile increase in survival time.
Weigh up toxicity of treatment vs benefit.
What are the different methods of cancer treatment?
Surgery. Radiotherapy. Cytotoxic drugs. Immunotherapies. Tyrosine kinase inhibitors. Gene therapy. Hormone therapy. CAR-T cell therapy.
When should surgery be done?
Most effective when cancer is a solid localised tumour.
Ranges from simple excision to removal of entire organ and regional tissues at risk of tumour involvement.
Most cancers must be removed for long term tumour control.
Usually surgery is followed by adjuvant therapy e.g. –
radiotherapy or chemotherapy.
Neo-adjuvant- preoperative treatment(chemotherapy/
immunotherapy).
What are the side effects of radiotherapy?
Acute effects:
Brain - nausea and vomiting, alopecia. Upper GI tract - mucositis, dysphagia. Skin - radiotherapy burns, sore skin. Lower abdomen - diarrhoea, bowel damage. Upper abdomen - nausea and vomiting.
Late effects:
Lung, bladder or skin fibrosis.
Bowel structure.
How can side effects be managed?
Skin:
Avoid soaps deodorants in treated areas.
Dab skin gently to dry.
Avoid tight fitting clothes.
Use baby powder to keep areas dry after washing.
Can treat mild symptomatic erythema with 1%
hydrocortisone or aqueous cream.
Treat moist desquamation with silver sulphadiazine
(flamazine®).
Dysphagia:
Liquid medications.
Thickened fluids.
Oxetacaine/antacid.
Why has combination chemotherapy become standard clinical practice?
They achieve better clinical outcomes e.g.
survival, cure rate.
Drugs are chosen from different classes:
To prevent resistance.
Broader coverage of activity.
To minimise side effects.
What are the side effects of chemotherapy?
Bone marrow suppression.
Chemotherapy- induced nausea and vomiting
(CINV).
Mucositis.
Diarrhoea.
Extravasation.
What is mucositis?
A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth.
Management:
Mouthcare. Pain relief. Mouthwashes. Chlorhexidine, Benzydamine, caphosol. Ascorbic acid. Artificial saliva.
How do you treat diarrhoea in cancer patients?
Discontinue / dose reduce subsequent
chemotherapy.
Codeine phosphate.
Loperamide.
Octreotide (used in carcinoid tumours).
Atropine (Irinotecan).
What is extravasation?
Leakage of drug from vasculature into
surrounding tissue.
Symptoms:
Pain, erythema, skin blistering and
exfoliation, discolouration, tissue necrosis.
What are the side effects of immunotherapy?
Pneumonitis. Rash. Adrenal insufficiency. Nephritis or renal dysfunction. Diarrhoea or colitis. Diabetes. Hepatitis. Hypothyroidism. Hypothyroidism. Hypophysitis. Uveitis.
