General / systemic anti-cancer treatments / radiotherapy misc Flashcards
List the most common types of solid organ cancers
- Lung
- Breast
- Bowel
- Prostate
- Skin
- Head and Neck
Outline the cancer target for the UK
The time between when cancer is first suspected and started treatment = < 62 days
(includes confirmed diagnosis)
What % of cancer patients are meeting the 62 day target
60% in June 2023
State some modifiable and non-modifiable risks factors for developing cancer (general)
Modifiable:
- Tobacco use / smoking
- Alcohol
- Diet
- Obesity / sedentary lifestyle
- Acquired infections e.g. Hepatitis B, HPV
- Immunodeficiency
Non-modifiable:
- Increasing age
- Family history / genetic component e.g. BRCA
Briefly outline the 5 stages of WHO performance status
0 = Normal
- Fully active without restriction
1 = Some restriction in physical activity
- Restricted in physically strenuous activity
- However ambulatory
- Able to carry out light work e.g., light house work, office work
2 = More significant restriction
- Ambulatory
- Capable of all self-care
- Unable to carry out any work activities
- Up and about more than 50% of waking hours
3 = Significant restriction
- Capable of only limited self-care
- Confined to bed or chair more than 50% of waking hours
4 = Completely disabled
- Cannot self care
- Totally confined to bed or chair
5 = Dead
State some common side effects of chemotherapy (think by system, head to toe)
Head / brain:
- Hearing loss / tinnitus
- Alopecia
- Fatigue (late)
- Insomnia (late)
- Dizziness (late)
GI tract:
- Mucositis
- Diarrhoea
- N&V
- Dry mouth
- Change to smell / taste
Lungs / heart:
- Pleuritis (late)
- Pericarditis (late)
- Pneumonitis
- Dyspnoea
- Cardiovascular complications (late)
- Risk of VTE
Liver:
- Liver dysfunction
Urinary system:
- Cystitis
- Renal insufficiency
- Tumour lysis syndrome = AKI
Skin / nerves:
- Peripheral neuropathy (late)
- Skin sensitivity
- Rash
Bones:
- Myelosuppression / anaemia / thrombocytopenia / leukopenia = risk of neutropenic sepsis
- Arthralgia (late)
- Myalgia (late)
State some psychosocial effects of chemotherapy
- PTSD
- Depression
- Social isolation
- Strained relationships with partner / family / friends
- Employment / schooling difficulties
- Financial burden (e.g. missing work)
State some specific long term impacts of chemotherapy (think by system, head to toe)
Head:
Loss of higher brain function / memory loss
Cataracts
Peripheral neuropathy / Raynaud’s
Tinnitus / deafness
Lungs:
Pulmonary fibrosis
Heart:
Coronary artery disease
HTN
Ventricular failure
Renal:
CKD
Haemorrhagic cystitis
Renal tract malignancy
Reproductive organs:
Infertility
Primary hypogonadism
Bones:
Femoral head necrosis
Osteoporosis
Other:
Secondary malignancy
Fatigue
Psychosocial impact
State how the following long-term chemotherapy complications are monitored
Head:
Loss of higher brain function / memory loss
Cataracts
Peripheral neuropathy / Raynaud’s
Tinnitus / deafness
Lungs:
Pulmonary fibrosis
Heart:
Coronary artery disease
HTN
Ventricular failure
Renal:
CKD
Haemorrhagic cystitis
Renal tract malignancy
Bones:
Femoral head necrosis
Osteoporosis
Head:
Loss of higher brain function / memory loss = baseline MMSE
Cataracts = yearly fundoscopy
Peripheral neuropathy / Raynaud’s = neurological assessment yearly for first 3 years
Tinnitus / deafness = baseline audiometry
Lungs:
Pulmonary fibrosis = baseline tests and yearly respiratory examination
Heart:
Coronary artery disease
HTN
Ventricular failure = echocardiogram
Renal:
CKD = baseline U&Es and yearly BP and urinalysis
Haemorrhagic cystitis
Renal tract malignancy
Bones:
Femoral head necrosis = yearly clinical examination
Osteoporosis = bone density scan
State some general common side effects of radiotherapy (immediate and long term) which are not organ specific
Side effects of radiotherapy are usually local - depending on anatomical site
Immediate side effects:
Tend to resolve within a few weeks
- Local skin reaction (erythema, desquamation)
- Hair loss in affected area
- Nausea
- Diarrhoea
- Mucositis
- Fatigue
- Lymphoedema
- Dysuria / radiation cystitis
- Sterility
Long term side effects:
Occurs months to years after a course of radiation (from excessive extracellular matrix, deposition of collagen and fibrinogenesis)
- Radiation-induced fibrosis
- Atrophy
- Neural or vascular damage
- A range of endocrine effects (e.g. diabetes, hypothyroidism)
*Small risk of a secondary malignancy, due to radiation-associated DNA damage
State some common side effects of targeted therapy
- Diarrhoea
- Fatigue
- Coagulation issues
- Wound healing issues
- Hypertension
- Mouth sores
- Mail changes
- Skin problems, rash or dry skin
Outline in very basic terms how radiotherapy works
Radiotherapy uses high energy, ionising radiation to eliminate cancer cells (ionising means charged particles, which then deposit energy into the cells of the tissues they pass through)
Local technique - aim is to maximise the dose of radiation delivered to cancer cells whilst minimising exposure to healthy cells
Causes cell death in one of two ways:
1) Triggering apoptosis by causing significant DNA damage
2) Preventing proliferation, by causing single and double-stranded breaks in DNA (known as mitotic cell death)
State the unit of radiotherapy dosage
‘Grays’ (commonly abbreviated as Gy)
- Quantifies amount of energy absorbed
State the 2 most common methods of delivering radiotherapy
2 primary methods of delivering radiation to tumours:
1) External beam radiation:
- Delivered from outside the body by aiming high-energy rays
2) Internal radiation (brachytherapy):
- Uses radioactive material in catheters or seeds
- Delivers high doses of radiation from inside the body directly into the tumour site
+ systemic treatment, with radioactive substance (injected/swallowed)
State 2 solid cancers for which internal radiotherapy (brachytherapy) are commonly used
- Cervical cancer
- Prostate cancer
State some common side effects of radiotherapy given in the head & neck region
Head:
- Hair loss
Mouth:
- Dry mouth
- Mouth and gum sores
- Tooth decay
Neck:
- Dysphagia
- Jaw stiffness
- Lymphoedema
State some common side effects of radiotherapy given in the region of the chest
- Dysphagia
- Dyspnoea
- Radiation pneumonitis
- Radiation fibrosis (permanent lung scarring as a result of untreated radiation pneumonitis)
State some common side effects of radiotherapy given in the abdominal region
- Abdominal pain / cramping
- Nausea and vomiting
- Diarrhoea
- Anorexia
State the 3 main classes of analgesics
Opioids
Non-opioids
Adjuvants (drugs whose primary indication is not for pain)
State some examples of adjuvant drug categories and some examples
Antidepressants e.g. Amitriptyline, Duloxetine
Anticonvulsants e.g. Gabapentin, Pregabalin
Benzodiazepines e.g. Diazepam, Clonazepam
Bisphosphonates e.g. Zoledronic acid, Pamidronate
Steroids e.g. Dexamethasone
Give some examples of weak opioids
- Co-codamol
- Codeine
- Dihydrocodeine
- Tramadol
Give some examples of strong opioids
- Morphine/ Diamorphine
- Oxycodone
- Fentanyl
- Buprenorphine
State some common initial side effects of opioids, as well as common ongoing side effects
Initial side effects:
- Nausea and vomiting
- Drowsiness
- Dizziness / lightheadedness
- Cognitive impairment
Ongoing side effects:
- Dry mouth
- Constipation
State medications that bone metastasis pain responds well to
- NSAIDs
- Bisphosphonates
State the conversion ratio of codeine to morphine
Codeine to Morphine ratio is 10:1
e.g. 1g of Morphine is equivalent to 10g of Codeine
State a form of immediate release morphine and 2 forms of slow release morphine (as well as their methods of administration)
Immediate release:
- Oramorph liquid 10mg/5ml
Slow release:
- Zomorph capsule BD (12 hourly)
- MST tablets BD
Also parental (subcut) Morphine sulphate for injection
State the equation for working out regular background dose of morphine as well as working out breakthrough (PRN) dose of morphine
1) Calculate total daily dose (total amount of morphine taken in a 24 hour period)
Regular background dose = total daily dose / 2
Breakthrough (PRN) dose = total daily dose / 6
How long does a Fentanyl patch take to become effective and how regularly does a patch need to be changed?
Takes 12-24 hours to reach a steady state release (although will get some benefit initially)
Patch needs to be replaced every 72 hours (3 days)
NOT renally excreted = good for poor renal failure
State 2 medications that should always be written up with opioids
1) Anti-emetic
2) Laxative
What is the maximum limit for PRN doses given in 24 hours in palliative care
Limit PRN doses to 1 hourly
Maximum of 6 doses in 24 hours, at which point they need medical review
State some signs/symptoms of opioid overdose
- Pintpoint pupils
- Reduced RR (espiratory depression)
- Vomiting
- Drowsiness
- Confusion
- Myoclonic jerks
- Hallucinations
State some possible causes of opioid overdose
- Recreational drug use e.g. Heroin users
- Error of prescribing
- AKI
- Rapid escalation of opioid dosage
- Additional interventions to reduce pain e.g. nerve block
State 7 essential things to be done for a controlled drug prescription
- Name, DOB (age if >12) and address of the patient
- Form of the preparation (e.g. tablets)
- Include the strength of the preparation (if appropriate)
- Include the total quantity in both words and figures (e.g. 20 (TWENTY) tablets, 100 (ONE HUNDRED) millilitres)
- Include the dose to be taken
- Diagonal line underneath prescription OR “no more items” under the last prescription
- Dated, signed, GMC number and include the prescriber’s address
State how opioid toxicity should be managed
1) Stop opioids
2) Check renal function (U&Es)
3) Speak to senior
State the 3 most common sites of cancer metastasis and how it may present
- Brain
- Bone
- Lung
Brain = headaches, seizures, or neurological deficits
Bones = pain and fractures
Lungs = cough, shortness of breath, or chest pain
State the 6 hallmark features of cancer
- Resist cell death
- Angiogenesis
- Sustain proliferative signalling
- Evade growth suppressors
- Activate invasion and metastasis
- Enable replicative immortality
State the 3 most common cancers
State the 3 most deadly cancers (in terms of highest number of deaths)
Most common:
1. Breast / prostate
2. Lung
3. Bowel
Highest number of deaths:
1. Lung
2. Breast / prostate
3. Bowel
State 3 other treatments that radiotherapy can be combined with
Radiotherapy alone
- Surgery
- SACT
- Hormonal treatment
State rough categories of chemotherapy drugs
Alkylating agents (Platinum complexes) - target DNA itself
Antimetabolites
Spindle poisons (Taxanes / Vinka alkaloids)
Anthracyclines
Anti-tumour antibiotics
Topoisomerase inhibitors
State some routes of administration of chemotherapy
- PO
- IM
- IV
- Topical
- Intralesional (directly into a cancerous area)
- Intrathecal (into the CSF via lumbar puncture)
State which WHO performance status you can give chemotherapy to
0-2 (0, 1 or 2)
3 - unlikely
4 - definitely not
What is extravasation
Unintentional leakage of vesicant fluids or medications from the vein into the surrounding tissue
*Emergency - need to call plastics
State the 4 stages of a cell cycle and what happens in each stage
G1 - cell growth, synthesises mRNA
S - DNA synthesis
G2 - rapid cell growth, DNA checking
M - mitosis (cell division = prophase, metaphase, anaphase, telephase)
State the different categories of chemotherapy drugs with 2 example drugs for each
Alkylating drugs:
- Platinum compounds e.g. Cisplatin, Carboplatin, Oxaliplatin
- Cyclophosphamide
- Ifosfamide
Antimetabolites:
- Methotrexate
- 5-Fluorouracil
Spindle poisons:
- Taxanes e.g. Paclitaxel, Docetaxel
- Vinca alkaloids e.g. Vincristine, Vinorelbine
Topoisomerase inhibitors:
- Topoisomerase I inhibitors e.g. Irinotecan, Topotecan
- Topoisomerase II inhibitors e.g. Doxorubicin, Epirubicin
Alkylating drugs excluding platinums (traditional chemotherapy) - state the following:
- Subtypes
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
Specific drug examples:
- Cyclophosphamide
- Ifosfamide
- Subcategory of platinum compounds also e.g. Cisplatin or Oxalipatin
Mechanism of action:
- Targets DNA itself
- Covalent bond to DNA via alkylating groups
- Prevents DNA unwinding and replicating (cell arrest)
Cancers they are most useful for:
- Breast cancer
- Sarcoma
Spindle poison drugs (traditional chemotherapy) - state the following:
- Subtypes
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
- Side effects / toxicity
Subtypes:
- Taxanes
- Vinca alkaloids
Specific drug examples
- Taxanes e.g. Paclitaxel, Docetaxel, Cabazitaxel
- Vinca alkaloids e.g. Vincristine, Vinorelbine
Mechanism of action:
- Taxanes = prevent formation of microtubules
- Vinca alkaloids = polymerisation (promote assembly) and prevent disassembly of microtubules
Cancers they are most useful for:
- Taxanes = Breast, Lung, Prostate
- Vinca alkaloids = Lung, Mesothelioma, Sarcoma
Side effects / toxicity:
- Peripheral neuropathy
- Alopecia
Platinum Alkylating drug (traditional chemotherapy) - state the following:
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
- Side effects / toxicity
Specific drug examples:
- Cisplatin
- Oxaliplatin
Mechanism of action:
- Targets DNA itself
- Covalent bond to DNA via alkylating groups
- Prevents DNA unwinding and replicating (cell arrest)
Cancers they are most useful for:
- Breast
- Lung
- Colon
- HPB
- H&N
- Radiosenitiser
Side effects / toxicity:
- HIGHLY emetogenic
- Ototoxic
- Nephrotoxic
- Peripheral neuropathy
Antimetabolite drugs (traditional chemotherapy) - state the following:
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
- Side effects / toxicity
Specific drug examples:
- Methotrexate
- 5-Fluorouracil
Mechanism of action:
- Interfere with DNA synthesis (through various mechanisms)
- Methotrexate competitively inhibits
Cancers they are most useful for:
- Breast
- Colon
- HPB
- Lung
- Sarcoma
Side effects / toxicity:
- Palmar plantar erythema
- Mucositis
- Diarrhoea
Topoisomerase I inhibitors drugs (traditional chemotherapy) - state the following:
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
- Side effects / toxicity
Specific drug examples:
- Irinotecan
- Topotecan
Mechanism of action:
- Inhibits Topo I (involved in DNA replication)
Cancers they are most useful for
- Colon
- HPB
- Lung
Side effects / toxicity
- Alopecia
- Diarrhoea
Topoisomerase II inhibitors drugs (traditional chemotherapy) - state the following:
- Specific drug examples
- Mechanism of action
- Cancers they are most useful for
- Side effects / toxicity
Antibiotic derived!
Specific drug examples:
- Doxorubicin
- Epirubicin
Mechanism of action:
- Inhibits Topo I (involved in DNA replication)
Cancers they are most useful for:
- Breast
- Sarcoma
Side effects / toxicity:
- Cardiomyopathy (cumulative dose)
- Alopecia
- Vesicant (burning)
State the main side effect of Bleomycin
Pulmonary fibrosis
State the main side effect of Vincristine (Vinka alkaloid)
Peripheral neuropathy
State the main side effects of Cisplatin and Carboplatin (platinum compound alkylating agents)
- Ototoxicity
- Nephrotoxicity
State the main side effect of Doxorubicin (Topoisomerase II enzyme) and Trastuzumab (monoclonal antibody)
Cardiotoxicity
State the main side effect of Cyclophosphamide
Haemorrhagic cystitis
State the main side effect of Methotrexate and 5-Fluorouracil
Myelosuppression
State what is meant by a central line and which veins they are generally inserted into
Central line is any catheter that is inserted into a large vein close to the heart
Generally ends up in either the superior vena cava or inferior vena cava
Commonly inserted into:
- Internal jugular vein (most common)
- Subclavian vein
State some benefits and risks of central lines
Benefits:
- Long term / less invasive for regular treatments / can be done at home
Reduced risk of extravasation (vesicants)
- Can give continuous infusion (>24 hours), with more than one drugs at one time (multilumen)
- Can give nutrition via central catheters
Risks (mainly relate to insertion):
- Infection
- Bleeding
- Pneumothorax / haemothorax
- Misplacement / insertion in artery
- Embolism (air or thrombus)
Name the 4 main types of IV Access that can be used for chemotherapy
- Peripheral cannula
- PICC (peripherally inserted central line)
- Hickman / tunneled central line
- Implantable port
Roughly describe a PICC central line (peripherally inserted central line)
Insertion point:
Basilic vein -> towards SVC
+ Less prone to infection
Roughly describe a tunnelled central line (Hickman line)
Insertion point:
- Inserted under general anaesthetic via ultrasound or x-ray guidance
- Enters through chest wall, however tunnels under skin until it reaches the jugular vein
+ Long term solution e.g. patients returning home
+ Less prone to infection
Roughly describe a implantable port central line
Insertion point:
- Inserted under general anaesthetic via ultrasound or x-ray guidance
- Enters through chest wall, however tunnels under skin until it reaches the jugular vein
- Unique as it has a ‘hub’ under the surface of the skin
+ Long term solution e.g. patients returning home
+ Less prone to infection
State some fertility options for chemotherapy patients prior to treatment
Females: egg collection
Men: sperm bank
State some (general) preventable risk factors for cancers
Tobacco use
Alcohol consumption
Unhealthy diet
Excess body weight
Physical inactivity
Infectious agents e.g. HPV and cervical cancer
State some more recent advances in radiotherapy techniques (which help to reduce damage)
MRI guided radiotherapy - helps to track tumours that are difficult to track e.g. lung cancer
IRMT radiotherapy - shapes the radiation beam to match the tumour
SABR - uses more intense radiation beams which gives a greater chance of killing the tumour cells (fewer hospital trips)
Proton beam therapy - stops beam when passed through the tumour, good for radiotherapy
Internal radiotherapy (radioactive iodine / brachytherapy) - can more precisely kill tumour cells
Describe how lymph nodes generally feel in the following situations:
- Benign lymph nodes
- Reactive lymph nodes
- Lymphadenopathy associated with haematological malignancy
- Lymphadenopathy associated with metastatic cancer
Benign lymph nodes:
- Typically small (less than 1cm)
- Smooth
- Round
- Mobile
- Non-tender
Reactive lymph nodes:
- Smooth
- Round
- Mobile
- Tender
- Associated with infective symptoms e.g. fever
Lymphadenopathy associated with haematological malignancy:
- Widespread enlarged
- Rubbery
Lymphadenopathy associated with metastatic cancer:
- Hard
- Firm
- Irregular
- Non-mobile / tethered
Lymphadenopathy in groups draining affected organ
What % of lung cancers are caused by smoking
Around 70%
List some cancers most associated with obesity
- Endometrial
- Oesophageal (gullet)
- Bowel
- Kidney
- Breast (if post-menopausal)
Outline the meaning of radical / curative in terms of cancer treatment
Radical therapy aims to reduce the size of the tumour shrink and control the growth of the tumour, with the intent of curing the cancer and prolonging life (intended to induce remission and prevent recurrence)
Vs palliative, which aims to control the cancer and sometimes cancer, but without curative intent
Outline the meaning of life-extending treatment in terms of cancer treatment
Treatment offered with the aim of extending life for a meaningful period of time (sometimes with intent to be present at a life event e.g. birth of a grandchild), but without being curative
Different to palliative as it’s not aimed at improving palliative symptoms or QOL specifically
Outline the meaning of palliative in terms of cancer treatment
Intent of treatment is not to cure, expectation is that treatment will improve patient’s symptoms and QOL (sometimes at the expense of other outcomes e.g. survival) or prevent development of cancer-related symptoms
It’s an approach that takes into account the person as a whole
Outline the meaning of neo-adjuvant in terms of cancer treatment and some examples
Treatment given to shrink the size/burden of a tumour prior to surgery (or other main treatment), to improve the success rate of the main treatment
Examples:
- Chemotherapy
- Radiotherapy
- Hormone therapy
Outline the meaning of adjuvant in terms of cancer treatment
Treatment given after the main treatment, to kill any residual cancer cells and reduce the risk of the cancer recurring
Outline the meaning of maintenance in terms of cancer treatment
Ongoing treatment after cancer has responded to initial treatment, with the intention of reducing the cancer coming back after initial therapy
Longer term therapy that can last for years, to help remission last as long as possible
List some examples of palliative cancer treatments
Radiotherapy
Chemotherapy
Hormone therapy / targeted cancer drugs
Surgery
Radiofrequency ablation
Cryotherapy
List some examples of proto-onocogenes
EGFR
VEGF
HER-2
KRAS
HRAS
List some examples of tumour-suppressor genes
BRCA1
p53
TGF
APC
State 4 cancers associated with the BRCA1/2 mutations
- Breast
- Prostate
- Ovarian
- Pancreas
Worldwide, what % of cancer cases are linked to exposure to tobacco smoke?
33%
Worldwide, how many new cases of cancer are there each year?
18 million new cases worldwide
Worldwide, how many death are caused by cancer each year?
10 million deaths from cancer worldwide each year
State the purpose of clinical trials in cancer care management
Trials test if a new treatment is more effective than the current treatment
Also provides information on safety profile + side effects of new treatment
Briefly explain the phases of Cancer clinical trials
Pre-clinical: tested microscopically and then on animals
Phase 0 + 1 (small numbers + lots of cancer types):
- What dose of a drug is safe?
- Whether positive effect on cancer?
- Side effects?
Phase 2 (larger numbers + 1 cancer type):
- Which cancers can it be used for?
- More detail about side effects + how to manage side effects
Phase 3 (larger numbers + 1 cancer type):
- It new treatment as good as the standard treatment?
- Fewer side effects?
If a phase 3 trial shows a cancer drug is safe and effective = company can apply for a drug license
Phase 4 (test drugs already licensed):
- Success when used on more people
- Long-term effects
- More about rare side effects + safety
State 4 different types of Cancer clinical trials
-Placebo and blind
- Controlled
- Randomised controlled
- Multi-arm
List some complications of chemotherapy
Failure
Secondary malignancy
Tumour lysis syndrome
Infections (immunodeficiency)
Neurotoxicity
Cardiotoxicity
Infertility
Stunted growth
List medications that should be used for chemo-induced nausea and vomiting
5HT antagonists (should work in 60% of cases):
- Ondansetron
- Granisetron
+ Dexamethasone if needed
Second line:
- Metoclopramide
- Prochlorperazine
- Cyclizine
- Benzodiazepines e.g. Lorazepam
- Domperidone
State the 3 main types of sarcoma
- Osteosarcoma – the most common form of bone cancer
- Chondrosarcoma – cancer originating from the cartilage
- Ewing sarcoma – a form of bone and soft tissue cancer most often affecting children and young adults
List some ways in which sarcomas may present, ways in which they are investigated and how they can be managed
Presentation:
- Soft tissue lump (esp. if growing, painful or large)
- Bone swelling
- Persistent bone pain
Investigations:
- X-ray (if bone suspected)
- Ultrasound(if bone soft tissue suspected)
- CT /MRI scans (more detail / metastatic spread)
- Biopsy
Management:
Managed by sarcoma MDTs at specialist sarcoma centres
- Surgery (surgical resection is the preferred treatment)
- Radiotherapy
- Chemotherapy
- Palliative
State some risk factors for sarcoma
- Inherited syndromes e.g. familial retinoblastoma, neurofibromatosis type 1
- Radiotherapy
- Exposure to chemicals e.g. industrial chemicals
- Exposure to viruses (human herpesvirus 8 for Kaposi’s sarcoma)
State the 4 main mechanisms of cancer spread
- Direct
- Lymphatic
- Haematogenous
- Transcoelomic
Outline some treatment options for brain metastases
Palliative approach = symptom control/comfort e.g. Dexamethasone
Treatment:
- Neurosurgery
- Stereotactic radiosurgery (gamma knife)
- Immunotherapy
- Whole brain radiotherapy (WBRT): extensive disease
For the following treatment options for brain metastases, outline when they can be used
- Neurosurgery
- Stereotactic radiosurgery (gamma knife)
- Immunotherapy
- Whole brain radiotherapy (WBRT): extensive disease
Neurosurgery:
- Single met or <3 accessible lesions
- Disease otherwise well controlled
Stereotactic radiosurgery (gamma knife):
- Small number of mets
- Overall good performance status
- Disease otherwise well controlled
Immunotherapy:
- Multiple small volume metastases
- Overall good performance status
Whole brain radiotherapy (WBRT):
- Extensive disease
List some side effects of steroids
- Difficulty sleeping
- Increased appetite (weight gain)
- Hypertension
- Hyperglycaemia or diabetes
- Osteoporosis
- Immunosuppression risk e.g. chickenpox, shingles and measles
- Cushing’s syndrome
- Glaucoma / cataracts
- Changes in mood e.g. anxiety / irritability
Outline the difference between targeted therapy and immunotherapy
Targeted therapy:
- Work by targeting the differences in cancer cells that help them to grow and survive
Immunotherapy:
- Help the immune system to attack cancer
State some side effects of immunotherapy in cancer
General inflammation in the body
- Allergic reaction / anaphylaxis
- Diarrhoea / abdominal pain
- Fatigue
- Flu-like symptoms e.g. fever, muscle aches, headaches
- Reaction at site of injection e.g. pain, erythema / skin rash
- Palpitations
- Sweating
- Weight changes / appetite changes
- Polyuria
- Organ inflammation (more rare)
State some side effects of targeted therapy in cancer
Side effects can be more varied than chemotherapy
- Diarrhoea
- Liver problems
- Fatigue
- Hypertension
- Mouth ulcers
- Nail changes
- Loss of hair color
- Skin problems, which might include rash or dry skin
- Clotting disturbances
- Poor wound healing
State 3 cancers that can be treated with hormone manipulation
- Breast cancer
- Endometrial cancer
- Prostate cancer
