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YEAR 4 CANCER CARE > Management Principles Of Cancer > Flashcards

Management Principles Of Cancer Flashcards

1
Q

With regard to cancer treatment, what is meant by:
Palliative treatment?

A

Treatment designed to relieve symptoms and improve quality of life (chemo, radio, sometimes surgery)

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2
Q

With regard to cancer treatment, what is meant by:
Radical treatment?

A

Curative treatment, chemo acts as radiosensitiser alongside radiotherapy

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3
Q

With regard to cancer treatment, what is meant by:
Neoadjuvant treatment?

A

Administration of a therapeutic agent before definitive treatment (surgery or radiotherapy) to shrink tumour and optimise outcomes - make it easier to remove. This is often done for rectal cancer

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4
Q

With regard to cancer treatment, what is meant by:
Adjuvant treatment?

A

Treatment given after surgery to reduce the risk of disease recurrence (chemo or radiotherapy).
Goal = kill cancer calls that might have been left behind at surgery as they were too small to see.

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5
Q

With regard to cancer treatment, what is maintenance therapy?

A

Maintenance therapy is the ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment.

It is used to prevent the cancer’s return and delay the growth of advanced cancer after the initial treatment

Maintenance therapy can be given for long periods of time in either of these situations. A maintenance therapy treatment plan may include chemotherapy, hormonal therapy, immunotherapy, or targeted therapy.

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6
Q

What is chemotherapy?

A

Drugs used to directly or indirectly inhibit proliferation of rapidly growing cells
The effects on normal tissues with high cell turnover causes chemo side effects

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7
Q

How does chemotherapy differe from surgery or radiotherapy?

A

It is almost always used as a SYSTEMIC TREATMENT

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8
Q

What are two important properties of cytotoxic chemotherapy drugs?

1. have an ability to, 2. have an inability to..

A
  1. have an ability to inhibit cell division
  2. have an inability to distinguish between cancer and normal cells
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9
Q

What are basic principles of cytotoxic chemotherapy?

i.e. how would you describe it to pt.

A
  • kill cancer cells by treating them with chemicals that interfere with process of cell division
  • they do this by either damaging the proteins involved, or by damaging the DNA itself.
  • this leads to apoptosis
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10
Q

What are classes of chemotherapy?

A
  • alkylating agents
  • taxanes
  • vinka alkaloids
  • platinum compounds
  • antimetabolites
  • anthracyclines
  • antitumour antibodies
  • topoisomerase inhibitors
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11
Q

chemotherapy

What are examples of alkylating agents?

A

Cyclophosphamide
Ifosfamide
Temozolamide

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12
Q

What are side effects of:
1. Cyclophosphamide
2. Ifosfamide
3. Temozolamide

A
  1. Cyclophosphamide
    alopecia, skin toxicity, cardio-myopathy, arrythmias, pulmonary fibrosis, haemorrhagic cystitis, transitional cell carcinoma, meylosuppression
  2. Ifosfamide
    bruising and bleeding (due to low platelets), nausea, alopecia, haemorrhagic cystitis (inflam and bleeding in lining of bladder)
  3. Temozolamide
    headaches, reduced appetite, bowel changes (constipation and diarrhoea), seizures, weakness one side of body, alopecia, skin rashes.
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13
Q

chemotherapy

What are examples of taxanes?

A

Paclitaxel
Docetaxel
Cabazitaxel

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14
Q

What are side effects of taxanes?

A

Main one in induction lecture = peripheral neuropathy of both hands and feet.

Others:
Allergic reaction
Hypotension
Diarrhoea
UTIs
Mouth sores and ulcers

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15
Q

Phase 1 recap chemo

What is mechanism of action of alkylating agents?

A
  • Inhibit the transcription of DNA to RN by alkylation.
  • Alkylation is the process of adding an alkyl group ( CH3) to DNA.
  • This process prevents the DNA from being used in protein synthesis and the production of new cells, including cancer cells
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16
Q

chemo (+ phase 1 recap)

  1. What are examples of Vinka alkaloids?
  2. What is their mech of action?
  3. What are SE of vinka alkaloids?
A
  1. Vinolrelbine, Vincristine
  2. prevent spindle formation
  3. Hair thinning, mucositis, reduced reflexes. Vincristine = peripheral neuropathy of hands and feet
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17
Q

chemotherapy

  1. What are examples of platinum complexes?
  2. What is their mechanism of action?
  3. What are their side effects?
A
  1. Cisplatin, Carboplatin, Oxaliplatin
  2. forms DNA adducts - leading to inhibition of DNA synthesis.
  3. nausea, ototoxicity, nephrotoxicity
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18
Q

chemotherapy

  1. What are examples of antimetabolites?
  2. what is their mechanism of action?
  3. what are main side effects for these?
A
  1. Capecitabine, 5-Fluorouracil, Methotrexate, Gemcitabine, Pemetrexed
  2. 5-FU will inhibit thymidylate synthase - which is needed to convert deoxyuridine to thymidine (makes DNA helix). Without this, there is reduced DNA synthesis. Methotrexate targets dihydrofolate reductase, which is a critical enzyme in the formation of purines. By blocking purine synthesis, block DNA synthesis in cell cycle.
  3. palmo-plantar erythrodysesethesia, myelosuppression
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19
Q

This diagram hints to certain chemotherapies and their toxicicities/side effects. Describe what each letter is for, and side effect related to diagram.

A
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20
Q

chemotherapy

What are examples of anthracyclines?

A
  • doxorubicin
  • epirubicin
  • mitomicin
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21
Q
  1. What is an example of antitumour antibiotics?
  2. what are main side effects?
A
  1. bleomycin
  2. pulmonary fibrosis, hyperkaratosis, hyperpigementation, ulcerated pressure sores
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22
Q
  1. What are examples of topoisomerase inhibitors?
  2. What is mechanism of action of this?
A
  1. Irinotecan, Etoposide
  2. inhibit DNA replication - topoisomerase usually unwinds the DNA helix so it can undergo replication.
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23
Q

What is aim of combination chemotherapy?

A
  • to circumvent multiple resistance mechanisms
  • to maximise theraputic effect without undue (excessive) toxicity
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24
Q

What are prinicples of combination chemotherapy?

A
  • Use drugs with different modes of action and single agent activity
  • use each drug in its optimal dose and schedule
  • minimise toxicity overlap
  • use pulsed intermittent treatment to allow gut and marrow recovery
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25
Q

How are cytotoxic drug prescribed?

i.e what do you we need to think about/consider?

A
  • narrow theraputic indices
  • dose needs to be altered for the individual patient, based on: 1. their surface area/BMI, 2. drug handling ability (liver function, renal function), 3. general wellbeing (performance status
  • discuss combination of agents to give - for a synergistic effect
  • the route of administration
  • see slide pic below for thorough answer
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26
Q

What are possible routes of administration for cytotoxic drugs?

A
  • IV - most common
  • PO
  • SC (good as can be given at home)
  • Intralesional - directly into cancerous area
  • Intrathecal - via LP into CSF
  • Topical - onto the skin
  • IM
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27
Q

What are side effects of chemotherapy?

A
28
Q

What is immunotherapy?

A

Uses the immune system and its componenets to recognise, target and destroy cancer cells

29
Q

What is passive immunotherapy and active immunotherapy?

A

Passive immunotherapy:
* ex vivo-activated cells or molecules that once found inside the body, compensate for missing or deficient immune functions

Active immunotherapy:
* stimulates effector functions in vivo
* requires the patient’s immune system to be able to respond; upon challnge, gets competently stimulated and mediates effector functions

30
Q

What cells are involved in passive immunotherapy?
What is invoved in active immunotherapy?

A
31
Q

immunotherapy

What is function of monoclonal antibodies?
What are some examples of them, and what cancers are they related to treating?

A
32
Q

What are side effects of targeted therapies?

such as monoclonal antibodies

A
33
Q

monoclonal abod for targeted therapies

For each grade of skin rash, explain how they would be treated

A
34
Q

immunotherapy

How do checkpoint inhibitors target cancer?

A
  1. tumour cells release tumour antigens
  2. APCs gather thr tumour antigens and prepare to present them to the niave T cells
  3. T cells are then activated by the APC, which has presented the tumour antigen
  4. the activated t cells can now go around the body to find the tumour cells with the SAME tumour antigens and destroy them
  5. cancer cells will be destroyed
35
Q

Immunotherapy

What are examples of checkpoint inhibitors?

A
  • CTLA4 inhibitors = ipilimumab, which is used in melanoma
  • PD-1/PD-L1 inhibitors = Nivolumab, Pembrolizumab, which is used in renal, lung and melanoma cancers
36
Q

specific side effects of immunotherapy (think of pic of human body)

A

Dr Powell key ones:
Pneumonitis
Colitis
Dermatitis

37
Q

What are side effects of immunotherapy?

A
38
Q

What are specific hepatic and endocrine immunotherapy side effects ?

A
39
Q

What are specific neurological side effects of immunotherapy?
What are other side effects (all end in -itis)?

A
40
Q

What is radiotherapy?
How is it used? (i.e. on own or in combo with…)

A
41
Q

What is mechanism of action of radiotherapy?

A
42
Q

What are the types of radiotherapy?
What are their aims?

A

Aim = deliver highest dose to the tumor whilst minimising effects on surrounding tissues

43
Q

What are radiosensitisers?
What are examples?

A

chemicals or pharmaceutical agents that can enhance the killing effect on tumor cells by accelerating DNA damage and producing free radicals indirectly.

44
Q

What are side effects of radiotherapy?

A
45
Q

What are late side effects of radiotherapy?

A
46
Q

what are similarities and differences between palliative, best supportive and end of life care?

A

All of them = provide comfort for patients, with a focus on quality of life. Focus on pain, symptoms, and stress related to a progressive illness.

Palliative = active, total care. Patient has specialised care alongside curative treatment.

End of life = approaching end of life - within the next 12months

Supportive = Not treatment based. Care provided on symptoms of the illness and symptoms related to previous treaments.

47
Q

what are psycho-social side effects of chemotherapy?

A
48
Q

How do hormone therapies work for treatment of cancer?

A
  • Some cancers use hormones to grow or develop = that cancer is hormone sensitive / hormone dependent.
  • Hormone therapy for cancer uses medicine to block or lower the amount of horomones in the body - so stop or slow down the growth of cancer
49
Q

Name cancers that could use hormone therapy?

i.e. which cancers can be hormone sensitive ones?

A
  • breast cancer
  • prostate cancer
  • ovarian cancer
  • uterine or endometrial cancer (cancer of the womb)
50
Q

What are hormone therapies used in treating breast cancer?

A
  • Tamoxifen - blocks oestrogen receptors
  • Aromatase inhibitors - stop androgens becoming oestrogen
  • LH releasing hormone (LHRH) agonists or LH blockers = stop making LH so stop ovaries producing oestrogen
  • Fulvestrant = blocks oestrogen receptos and reduces number of oestrogen receptos on cancer cells.
51
Q

What hormone manipulation therapies can be used in prostate cancer?

A

LHRH agonists or LH blockers = e.g. goserelin
Anti-androgens = stop testosterone reaching cancer cells
GnRH blocker = stop production of testosterone
Newer hormone therapies = enzalutamide, abiraterone, darolutamide

52
Q

What hormone manipulation therapies can be used in womb (uterine, endometrial) cancer?

A

Oestrogen and progesterone treatments = to shrink larger cancers and treat cancer than has come relapsed.
- medroxyprogesterone acetate (Provera)

53
Q

What are side effects of hormone manipulation therapy?

women and men

A

side effects are worse at start of treatment then settle after a few weeks/months.

In women:
* tiredness
* nausea and vomiting, diarrhoea or constipation
* menopausal symptoms - vaginal dryness, hot flushes, seating , low sex drive, lighter periods (with tamoxifen), no periods (with LH blocker)
* hair thinning
* joint pains (aromotase inhib can cause bone thinning)
* weight gain
* heaadaches
* memory problmes
* mood swings, depression
* risk of VTE - tamoxifen

In men:
* tiredness
* impotence
* hot flushes and sweating (low testosterone can cause hot flush like menopause)
* gynaecomastia
* pain from tumour flare
* weight gain
* memory problems
* mood swings, depression
* bone changes - osteoporosis
* CVD worsens

54
Q

What are reasons for surgery in cancer care?

A
  • diagnose cancer - biopsy
  • to stage cancer
  • treat cancer (+/- other treatments) = curative.
  • reduce risk ofgetting cancer if high risk (e.g. Angelina Jolie)
  • to control symptoms or extend life - palliative treatment to improve quality of life (e.g. if tumour is causing bowel obstruction, or compressing spinal cord)
55
Q

What factors does choosing surgery for cancer treatment depend on?

A
  • type of cancer - e.g. leukaemia or lymphoma would be hard (as it often spread throughout body)
  • size of cancer and stage (spread)
  • where cancer is in body (could be close to major blood vessel)
  • general health - co-morbidites etc.
56
Q

What are side effects of surgery in cancer care?

A
  • side effects from anaesthesia
  • pain
  • fatigue
  • loss of appetite
  • organ dysfunction
  • lymphadema (if removed lymph nodes)
  • emotional side effects
  • if GU - could affect fertility
    At site of surgery:
  • infection
  • swelling
  • drainage
  • bruising
  • wound bleeding
  • numbness at area
57
Q

Outline the factors that may influence treatment options for cancer

A

Tumour:
- what is type of tumour
- stage of cancer
- how far has it spread?

Treatment factors:
- how available a treatment is
- treatment intent
- how likely is it to work / weigh up with side effects

Patient factors:
- patient choice
- patient co-morbiditis - heart failure, lung disease
- patient age
- use ECOG performacne status to decide on how to treat them.

58
Q

Name some long term toxicities of cancer treatments

A

screenshot from BB resources

59
Q

What is cancer survivorship?

A
  • In cancer, survivorship focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life.
  • This includes the physical, mental, emotional, social, and financial effects of cancer that begin at diagnosis and continue through treatment and beyond.
60
Q

What are challenges of cancer survivorship?

A
  1. adjusting to a new ‘normal’
  2. attending all hospital appointments
  3. late effects of cancer treatment
  4. family issues
  5. fear of cancer coming back (once remits)
  6. financial burden
  7. maintaining quality of life
  8. symptoms of treatment
  9. psychological impact - depression, anxiety
61
Q

Who is MDT for cancer care?

A
  • Surgeon
  • Medical oncologist
  • Clinical oncologist
  • Haematologist
  • Pathologist and Histopathologist
  • Clinical nurse specialist - speciailised in certain cancers
  • Radiologist

Others:
* OT
* PT
* Dietician
* Symptom contol nurse
* counsellor / psychologist

62
Q

Describe the role/importance of the MDT (multi-disciplinary team) in formulating management plans
for patients,

e.g. Medical oncologists, clinical oncologists, pathologists, radiologists, histopathologists, surgeons, and the palliative care team, specialist nurses

A

Main aim = coordinate high-quality diagnosis, treatment and care

  • they recommend best intitial treatment for cancer.
  • assess type and size of cancer
  • they will assess general health
  • they will consider national treatment guidelines

MDT come together to provide best care for patient - all of specialities provide their input /knowledge to make recommendations based on guidelines and weigh up options. = make balanced recommendations on evidence available.

Note: MDT can only recommend - a decision is made with the patient.

63
Q

What is role of clinical nurse specialist in cancer?

A
  • An experienced nurse who is able to give expert advice related to your specific condition or treatment.
  • They will take a key role in supporting your care - emotional and practical support.
  • Will be the main point of contact between yourself and your MDT.
  • introduce different services that help with care in hospital and community
  • guide you through complex systems - help with benefits, finances, grants, free prescriptions, family issues.
64
Q

Why may the following be needed in cancer care MDT?
1. dietician
2. physio
3. occupational therapist

A
  1. dietician = help eat and drink well through treatment, manage nutritional problems (nausea, weight loss, vomiting, taste changes), help become healthy as possible before a treatment or surgery, aid recovery and wound healing, aid lifestyle changes after treatment, educate on food choices
  2. physio = address symptoms of cancer or side effects of treatment - weakness, breathlessness, fatigue, pain, lymphodema, incontinence, moving or walking
  3. occupational therapist = assess functional deficits, help patients get back to optimal health after cancer, rehab for ADLs
65
Q

What key resources (for patient information) would you suggest to patient diagnosed with cancer?

A

Cancer research UK - info on all cancers and treatments available, side effects.
Macmillan cancer support - website, call, email, chat online

ADD ANY OTHER IDEAS - COULD NOT FIND MUCH!

66
Q

Describe the sources of information to aid decision-making for clinicians and patients (including NICE
guidance, online prognostic and predictive tools, genetic/ mutation screening)

answer is long

A

NICE guidelines:
* covers symptoms that could be caused by cancer
* outlines appropriate investiagtions in primary care
* and who to refer to for a specialist opinion
* recommendations are organsied by site of suspected cancer, symtpom (alphabetically), and findings for primary care investigations

Risk assessment tool: (RATs)
* added into IT system at GPs - can ID and quantify risk of cancer in symptomatic primary care patients.
* gives positive predictive values (maybe go over this after this deck!)

QCancer:
* calculates absolute risk of symptomatic or asymptomatic patient having a yet undiagnosed cancer
* considers patient symptoms, risk factors (age, sex, smoking, FHx, postcode, comorbidities)

7 point checklist for melanoma
* a single site clincial decision tool recommended by NICE for GPs in UK.
* Lesions scoring 3 or more = urgent referral

Macmillan’s cancer decision support tool:
* based on RATs and QCancer

NHS genetic test:
* if cancer runs in your family
* tests for genese that increase risk of cancer (predictive genetic testing)
* eligible if inherited faulty gene found in relatives, and strong FHx of cancer
* e.g. BRCA1 and BRCA2
* e.g. FAP, lynch syndrome, MAP

67
Q

What does this CXR show? which chemo is this likely to be from?

A

Bleomycin - shows pulmonary fibrosis. Also see lateral view of same patient:

YEAR 4 CANCER CARE (22 decks)

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