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Cancer Care > General Principles > Flashcards

General Principles Flashcards

1
Q

How does 5 FU work?

A

Inhibits thymidylate synthesis to prevent production of thymidine therefore cannot synthesise DNA

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2
Q

How do platinum agents work?

A

Form intra and inter strand DNA links to prevent DNA unwinding and therefore prevent replication

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3
Q

What is the principle of topoisomerase inhibition?

A

This enzyme relieves tension on the ends of DNA when they coil during replication. Inhibition of this causes supercoiling of DNA ends and causes damage.

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4
Q

Name the 6 mechanisms of cancer cell resistance

A 
Decreased uptake 
Increased metabolism 
Altered targets 
Impaired apoptotic pathway 
Efflux pump 
Altered cell cycle checkpoints
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5
Q

Describe the WHO performance status

A 
0 = normal, very good energy
1 = can do everything used to but more tired
2 = 50% of expected 
3 = >50% of day resting
4 = bed bound
5 = dead
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6
Q

Give some side effects of chemotherapy

A 
Alopecia 
Nephrotoxicity 
Neutropenic 
Decreased fertility 
Thrombocytopenia 
Fatigue
Nausea and vomiting 
Skin rashes 
Mucositis 
Myelosuppression
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7
Q

What is the mechanism of action of ondansetron?

A

5HT3 (serotonin) antagonist

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8
Q

What is the MoA of metoclopramide?

A

Dopamine antagonist

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9
Q

What is the MoA of cyclizine?

A

Antihistamine

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10
Q

What is passive immunotherapy?

A

Identify something that is lacking in the patient’s immune system and substitute that

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11
Q

What is active immunotherapy?

A

Trigger something that is already present in the system to increase in function

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12
Q

Give examples of monoclonal antibodies

A

HER 2 inhibitors
VEGF Inhibitors
EGFR inhibitors

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13
Q

Herceptin is used to treat…

A

Breast and gastric Ca

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14
Q

VEGF inhibitors are used to treat …

A

Ovarian and bowel Ca

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15
Q

EGFR inhibitors are used for …

A

Bowel Ca

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16
Q

What are PD-1 inhibitors?

A

Stop the binding of PD-L1 protein of a tumour cell to the PD-1 receptor on the T cell. The binding would stop the T cell attacking so this prevents this.

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17
Q

What are the main SEs of PD-1 inhibitors?

A

Autoimmune flares - all the ‘itis’ conditions

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18
Q

What is the difference between the direct and indirect pathways of radiotherapy?

A

Indirect - produce free radicals which damage DNA

Direct - damages DNA directly

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19
Q

When are you most likely to get neutropenic sepsis?

A

7-10 days post chemotherapy

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20
Q

What is the definition of neutropenic sepsis?

A

Any patient on chemo with a temp >38 and neutrophils <0.5

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21
Q

Lines are most likely to grow which type of organisms?

A

Gram positive cocci

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22
Q

Spinal cord compression is most common in which part of the spine?

A

Thoracic

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23
Q

What examination findings suggest cauda equina?

A

Saddle anaesthesia
Decreased anal tone
Motor/sensory deficits

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24
Q

What is the normal calcium range?

A

2.2 - 2.6 mmol/L

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25
Q

Name some symptoms of hypercalcaemia

A 
Nausea
Confusion 
Polydipsia
Polyuria 
Constipation
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26
Q

What is the management of hypercalcaemia?

A 
Fluids - at least 3L saline over 24 hours
IV bisphosphonates (make sure  properly hydrated before starting)
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27
Q

Describe the biochemical changes that occur in tumour lysis Syndrome

A

Hyperuricaemia
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

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28
Q

How might tumour lysis Syndrome present?

A

Nausea, vomiting, diarrhoea
Haematuria
Anorexia
Heart failure

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29
Q

How do we prevent TLS?

A

Hydration
Allopurinol
Rasburicase

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30
Q

What are the symptoms of SVC obstruction?

A 
SoB
Swelling of face, neck, arm
Headache
Lethargy 
Choking sensation
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31
Q

What is the management of SVC obstruction?

A

Steroids
Stenting
Chemo/radiotherapy

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32
Q

Pain from bone mets tends to respond to …

A

NSAIDs

Radiotherapy

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33
Q

Pain from the liver tends to respond to…

A

Steroids

NSAIDs

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34
Q

What are the symptoms of opioid toxicity?

A 
Pinpoint pupils
Hallucinations
Drowsiness
Vomiting
Respiratory depression 
Myoclonus jerks
Confusion
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35
Q

What is the maximum dose of codeine?

A

60mg QDS

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36
Q

How do you titrate up morphine?

A

Add up the total daily dose of opioid
Half this for their slow release dose
Divide by 6 for their PRN dose

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37
Q

How does SC morphine dose compare to oral?

A

SC 10 mg = PO 20 mg

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38
Q

Describe how to write a controlled drug prescription

A

Name and ID of patient
Write prescription as normal
Write supply and give the pharmacist exact instructions: name and formulation of drug. Total number of tablets written in words and figures.

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39
Q

List common causes of nausea and vomiting in cancer patients

A 
Infection 
Hypercalcaemia
GI disturbance 
Gastric stasis 
Drug related
Chemotherapy 
Anxiety 
Raised ICP
40
Q

Which hormones act at the CTZ?

A

5HT3 - serotonin
Dopamine D2
NK1

41
Q

Which hormones act at the vomiting centre?

A

Histamine
ACh
NK1

42
Q

Which hormones act at the VIII nucleus?

A

Histamine

ACh

43
Q

What is the use of haloperidol in cancer patients?

A

Potent dopamine blocker
Good antiemetic for hypercalcaemia
And if low renal function

44
Q

What does metoclopramide do?

A

Antagonist of dopamine at CTZ

Prokinetic so causes emptying of stomach

45
Q

When is ondansetron most useful?

A

Chemo
Post radiotherapy
Post op GI surgery

46
Q

Which antiemetics might you give for a chemical cause of nausea?

A

Haloperidol

Metoclopramide

47
Q

What anti-emetic would you give in gastric stasis?

A

Metoclopramide

Domperidone

48
Q

What anti-emetic might you prescribe for bowel obstruction?

A

Cyclizine

Dexamethasone

49
Q

What antiemetic would you prescribe for raised ICP?

A

Dexamethasone

Cyclizine

50
Q

What anti-emetic would you prescribe post surgery or radiotherapy?

A

Ondansetron

51
Q

Which laxative would you prescribe for cancer patients?

A

Laxido
Gentle osmotic effect
Doesn’t trigger peristalsis

52
Q

What is sodium picosulfate?

A

Bowel stimulant and softener

53
Q

What are the treatment options for malignant bowel obstruction?

A

Drip and suck (IV fluids, NG tube)
Venting gastromy rather than NG
Steroids to decreased bowel oedema
All medicines SC

54
Q

What medication can you give for breathlessness at the end of life?

A

Low dose morphine

1-2mg oramorph

55
Q

What are the 5 main symptoms of dying?

A 
Pain
Nausea/vomiting
SoB
Respiratory secretion 
Restlessness/agitation
56
Q

What are the 10 hallmarks of cancer?

A 
Genome instability and mutation
Resisting cell death
Sustaining proliferative signalling
Evading growth suppressors 
Enabling replication immortality 
Inducing angiogenesis 
Activating invasion and metastasis 
Reprogramming energy metabolism
Tumour promoting inflammation
Evading immune destruction
57
Q

Define palliative care

A

Treatment designed to relieve symptoms and improve the quality of life

58
Q

What is the mechanism of action of 5FU?

A

Inhibits thymidylate synthesis to prevent DNA synthesis

59
Q

Which cancers might we treat 5FU with?

A 
Breast
Bowel
Skin
Oesophagus
Pancreas
60
Q

What is the mechanism of action of methotrexate?

A

Inhibits dihydrofolate reductase to inhibit DNA synthesis

Acts in the S phase

61
Q

What cancers can we use methotrexate to treat?

A 
Leukaemia
Lymphoma 
Breast
Lung
Head and neck cancers
62
Q

Platinum analogues are used to treat…

A

Testicular, ovarian and lung cancers
Lymphomas
Eg. cisplatin

63
Q

Give examples of alkylating agents

A

Cyclophosphamide
Chlorambucil
Dacarbazine

64
Q

How do alkylating agents work?

A

DNA cross links are used to interfere with cell replication

65
Q

What cancers are alkylating agents used to treat?

A 
Lung
Breast
Ovary
Leukaemia/lymphoma
Hodgkin’s
Myeloma
Sarcoma
66
Q

What types of cancer are highly sensitive to chemo?

A 
Lymphomas
Germ cell tumours
Small cell lung
Neuroblastoma
Wilms
67
Q

What tumours have low sensitivity to chemo?

A

Prostate
Brain
Renal cell
Endometrial

68
Q

Which chemotherapy agents cause cardiomyopathy?

A

Doxorubicin

High dose cyclophosphamide

69
Q

Which chemotherapy agents cause arrhythmias?

A

Cyclophosphamide

Etoposide

70
Q

Neutropenic sepsis has neutrophils of …

A

Less than 0.5

71
Q

What are the symptoms of cord compression?

A 
Back pain
Motor/sensory loss
Decreased anal tone
Bowel or bladder dysfunction 
Saddle anaesthesia 
Sexual dysfunction
72
Q

What is the best investigation for cord compression?

A

MRI spine

73
Q

What is the management of cord compression?

A

Dexamethasone

Radiotherapy or decompressive surgery

74
Q

What is the most common cancer causing SVC obstruction?

A

Lung

75
Q

What are the symptoms of SVC obstruction?

A 
SoB
Cough
Chest pain
Cyanosis
Engorged veins on anterior chest wall
Swollen face and arm
76
Q

What investigations are needed for SVC obstruction?

A

CXR

CT with contrast

77
Q

What is the management of SVC obstruction?

A

Oxygen
Corticosteroids
Radio or chemotherapy
Stenting

78
Q

Which cancers are most likely to cause tumour lysis Syndrome?

A

Leukaemia
Lymphoma
Germ cell tumours

79
Q

What abnormalities occur in the blood in TLS?

A

Hyperkalaemia
Hyperuricaemia
Hyperphosphataemia
Hypocalcaemia

80
Q

What can be given to prevent TLS?

A

Allopurinol

Fluids

81
Q

What are the symptoms of hypercalcaemia?

A 
N+V
Constipation
Polyuria and Polydipsia
Confusion
Bone and abdominal pain
Weakness
82
Q

Define malignant neoplasia

A

Abnormal growth of cells which persists after the initiating stimulus is removed and invades and spreads to distant sites

83
Q

Define dysplasia

A

Abnormal maturation of cells within a tissue

84
Q

Carcinomas most commonly spread via …

A

Lymphatics

85
Q

Sarcomas most commonly spread via …

A

Blood

86
Q

How is cell to cell interaction affected?

A

Decreased expression of cadherins

87
Q

How is cell to stroma interaction affected?

A

Decreased expression of integrins

88
Q

How do cancer cells metastasise?

A

Cells synthesise and release metric metalloproteinases which digest collagen allowing the cell to digest ECM and break through the BM

89
Q

Ras mutations are most common in which cancers?

A

Colon

Lung

90
Q

How do monoclonal antibodies work?

A

Recognise and attack to specific proteins on the cancer cell surface
Mimic natural antibodies and make it easier for immune system to find and attack the cancer cells

91
Q

Give some examples of monoclonal antibodies

A

Rituximab
Cetuximab
Trastuzumab

92
Q

Name some tyrosine kinase inhibitors and what they treat

A

Imatinib - CML, ALL, gastrostomal tumours

Axitinib - RCC

93
Q

Describe DNA replication

A

Helicase unwinds the DNA helix
Leading strand synthesised in 5-3 direction by DNA polymerase
Lagging strand synthesised discontinuously - RNA primer is extended by DNA polymerase to form Okazaki fragments
DNA ligase joins the fragments

94
Q

What is Lambert Eaten Myasthenia Syndrome?

A

Development of antibodies to presynaptic calcium channels
Usually due to an underlying cancer
Presents as proximal muscle weakness

95
Q

MEN1 predisposes to which cancer?

A

Pancreatic islet cell

Pituitary adenoma

96
Q

MEN2 predisposes to which cancers?

A

Medullary thyroid

Phaeochromocytoma

97
Q

Neurofibromatosis 1 predisposes to which cancers?

A

Neurofibrosarcoma
Phaeochromocytoma
Optic glioma

Cancer Care (7 decks)

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