Lecture 4 - Cancer treatment Flashcards
What are the aims of surgery?
1) Remove the tumour in one area of the body
2) Remove lymph nodes if they are affected by cancer
3) Reduce tumour bulk
What are the types of surgery?
1) Diagnostic
2) Staging
3) Tumour removal
4) Debulking
5) Pallitation
6) Reconstruction
7) Prevention
What are the minimally invasive types of surgery?
1) Laparoscopic surgery
2) Laser surgery
3) Cryosurgery
4) Endoscopy
What are the types of breast cancer surgery?
1) Lupectomy: Small excised area
2) Wide excision: More significant removal of tumour a slight bit of surrounding area
3) Quadrantectomy: Even larger removal
4) Mastectomy: Breast removal
5) Implant - Breast reconstruction
How might a breast be reconstructed?
Lat flap: Skin, fat and muscle moved from latissimus dorsi to the breast
Abdominal: Muscle moved from abdominal area
Superior gluteal artery perforator: Uses blood vessel and section of skin from upper buttocks to reconstruct hip - doesn’t use muscle
What are the side effects of surgery?
1) Limited range of movement - (abdomen for colorectal)
2) Swelling around wound
3) Numbness and tingling
4) Scarring (skin tightness)
5) Pain/Soreness
6) Lymphoedema
What is cording?
Pain which feels like a tight cord running from armpit to back of the hand - this is due to hardened lymph vessels
What are things that need to be looked out for with lymphoedema?
1) Swelling of affected arm or leg
2) Heavy/hot limb
3) Redness or irritation
4) Restricted range of movement, discomfort/pain in affected limb
What are the guidelines for lymphoedema when working with clients?
No sleeve = no exercise
1) Ensure sleeve fits correctly
2) No static contractions
3) Include resistance training and build up very gradually
4) Include stretching and mobility exercises to improve ROM
5) CV to facilitate weight loss
6) Temperature
7) Water based exercise but not hot tubs
8) Frequent breaks/no prolonged activity on affected limb
9) Slow gradual progression of all elements as tolerated
10) Monitor for changes in affected limb at each visit
What are the aims of radiotherapy?
1) Curative
2) Enhance other treatment
3) Reduce risk of cancer coming back after surgery
4) Relieve symptoms
How does radiotherapy work?
1) Uses high energy rays
2) Target cells which are rapidly synthesising DNA
3) Radiation tends to damage cancer cells more than normal cells - cancer cells rapidly synthesising so have more areas to target
4) Damages normal cells
5) Normal cells recover between treatment fractions
Outline the types of radiotherapy?
External beam:-Beams at cancer cells from multiple angles - given in fractions - Gray (gy)
- Tattoo dot on skin used as marker
- Patients receive radiotherapy on out-patient basis (5 days for several weeks)
Brachytherapy:
- Radioactive seeds are implanted near the tumour
- Radioactivity level of implants diminishes to nothing
What are the side effects of radiotherapy?
1) Fatigue build up
2) Skin reaction
3) Nausea (head, neck, digestive area)
4) Hair loss (reversible or irreversible)
5) Lymphoedema
6) Limited ROM (scar tissue)
7) Cardiotoxicity or damage to other nearby organs
What are the aims of chemotherapy?
1) Cure
2) Control
3) Pallitation
What is common chemotherapy regime?
- Commonly administered in combinations
- Typical course is 6 cycles
- Further drug combinations may be required in the future
What is chemotherapy induced peripheral neuropathy?
- Damage to nerves between CNS and rest of body
What is the use of exercise for CIPN
1) Blood circulation moves neurotoxic chemicals away from dorsal root ganglia - reduces oxidative stress, inflammation, nerve hyperexcitabiltiy
2) Nerve regeneration and repair
3) Maintaining muscle length and reducing cramping
4) Rehab can allow patients to maintain healthy level of activity
What is hormone therapy for breast cancer and what does it do? (pre-menopause)
1) Pre menopause - Ovaries surgically removed
2) Ovaries ablated by radiation
3) Ovaries made inactive by drug called Zoladex
(tamoxifen can be given instead)
What are side effects of hormonal treatment for breast cancer?
1) Hot flushes
2) Night sweats
3) Weight gain
4) Joint pain
5) Risk of low bone density
6) Cholesterol
7) Fatigue
8) Vaginal irritation
9) Cognitive dysfunction
What is androgen deprivation therapy (ADT) and what are the side effects?
- Hormonal treatment lowers levels of testosterone Sides: 1) Fatigue 2) Increased body fat 3) Low muscle mass 4) Emotionally labile (more sensitive) 5) Feminisation (hair thicker/breasts) 6) Lower bone density 7) Sexual dysfunction 8) Incontinenece
What are the different types of biological therapy?
1) Monoclonal antibodies
2) Cancer growth blockers
3) Anti-angiogenics
4) PARP inhibitors
5) Immunotherapy: Checkpoint inhibitors, Cytokines, CAR T-cell therapy, Vaccines
What are side effects of biological therapies?
1) Flu
2) Skin rash
3) Cardiac complications
4) Nausea
5) Vomiting
6) Loss of appetite
7) Extreme tiredness
What is herceptin?
- Monoclonal antibody
- Blocks chemical signal from HER2 receptor (HER2 Growth factor in 15-25% breast cancers)
- Side effect of cardiotoxicity
