Key topic lectures Flashcards
How much does 1 bag of red cells raise the Hb
10 g/L (in 70 kg male)
What are some long term lines that can be inserted for cancer treatment
Tunnelled central lines (between chest wall and superior vena cava)
PICC line (between anterior cubital fossa and heart)
Implantable ports
What is tumour lysis syndrome
Tumour lysis releases cellular components into circulation
Imbalance: high uric acid, high potassium, high phosphorus, low calcium
Can cause: arrhythmias, sudden death, seizures
Management: allopurinol (blocks uric acid production), rasburicase (urate oxidase)
What is the guidance around pregnancy and chemotherapy
Avoid pregnancy whilst on chemotherapy
Can use norethisterone (stops periods)
Avoid COCP (high thrombotic risk)
Advise barrier protection (to protect partners)
What is criteria for neutropenic sepsis
Fever > 38
Fever > 37.5 for > 1 hour
Neutropenia < 0.5
Neutropenia < 1 and falling
What is the management for neutropenic sepsis
Follow hospital neutropenic sepsis protocol (similar to sepsis 6)
G-CSF (granulocyte colony stimulating factor): SC injection, can reduce severity and duration of neutropenia, side effects (bone pain, headaches, nausea, fever)
Which cells come from the myeloid line
Megakaryocytes (thrombocytes)
Erythrocytes
Mast cells
Myeloblasts (basophils, neutrophils, eosinophils, monocytes (macrophages))
Which cells come from the lymphoid line
Small cells (B cells (plasma cells), T cells)
Natural killer cells
What are the symptoms of hypercalcaemia
Fatigue
Abdominal pain
Nausea and vomiting
Constipation
Confusion
Headaches
Polydipsia
Polyuria
What are the symptoms of hyperviscosity
Headaches
Somnolence
Visual disturbance
Ischaemic events
Which drugs are now potentially curable for CML
Tyrosine kinase inhibitors (imatinib)
What are the properties of cancer cells that promote growth
Evade apoptosis
Self-sufficiency in growth signal
Insensitive to anti-growth signal
Tissue invasion and metastasis
Limitless replicative potential
Sustained angiogenesis
What is neoadjuvant therapy
Given before definitive management
Shrink tumour
Optimise outcome
What is adjuvant therapy
Given after treatment
Reduce risk of recurrence
What is palliative care
Symptom relief
Improve quality of life
What is 5-fluorouracil
Inhibits thymidylate synthesis
How do cancer cells develop drug resistance
Decreased uptake of drug
Increased drug metabolism
Altered drug targets
Impaired apoptotic pathways
Altered cell cycle checkpoints
Efflux pumps
What things are important to remember when prescribing chemotherapy drugs
Narrow therapeutic index
Alter doses based on: BMI, renal/hepatic function, performance status
Often give drugs in combination (synergistic effecr)
What are the side effects of chemotherapy
Brain (chemo-brain, peripheral neuropathy, fatigue)
Hair (alopecia)
Circulation (neutropenic sepsis, cardiomyopathy, myelosuppression)
GI tract (vomiting, mucositis)
Bladder (haemorrhagic cystitis)
Large intestine (diarrhoea, constipation)
Skin (rash, nail ridging/loss)
Reproductive organs (impaired fertility, decreased libido, premature menopause)
Kidneys (AKI, electrolyte disturbance)
Liver (deranged LFTs)
Lungs (pneumonitis, PE)
What are some examples of antiemetics used in cancer treatment
5HT3 antagonists (ondansetron)
Dopamine receptor antagonists (metoclopramide)
Steroids (dexamethasone)
Antihistamines (cyclizine)
NK1 receptor antagonists (aprepitant)
How do monoclonal antibodies work
Bind to cancer cell antigen
Block downstream signalling pathways
Arrest cell cycle proliferation
What are the side effects of immunotherapy
Skin toxicity
Hair growth disorders
Pruritus
Nail changes
Fatigue
Myelosuppression
Diarrhoea
Nausea and vomiting
Hypertension
Proteinuria
GI perforation
Delayed wound healing
Arterial thromboembolic events
Cardiac ischaemia
Abnormal LFTs
Allergic reaction
What are immunotherapy checkpoint inhibitors
Aid binding of PD-1 (on T cell) and PD-L1 (on tumour cell)
Block proteins that stop immune system from killing cancer cells
What are the aims of radiotherapy
Deliver maximum dose to tumour
Minimise dose to surrounding normal tissue