Neoplasms and cancer Flashcards
How does chemotherapy work?
Chemotherapy works by targeting cells that divide quickly, it affects numerous areas of the body which rely on fast cellular reproduction such as the red blood cells (erythrocytes).
Different chemotherapy drugs act on different stages of the cell cycle, but they all work to prevent mitosis
What are the side effects of chemotherapy?
Nausea
Vomiting
Diarrhea
Hair loss
Bleeding
Fatigue
Fever
Constipation
Pain
What is the link between bone marrow and chemotherapy?
Red bone marrow contain stem cells. Stem cells multipy rapidly which makes them vulnerable to chemotherapy and leads to many of the complications of chemo.
How does chemotherapy affect platelets?
Chemo can rapidly destroy the platelets causing thrombocytopenia (low platelet count). This can:
Increases risk of haemorrhage
Complicate surgical procedures
Delay or stop further chemotherapy
How does chemotherapy affect neutophils?
It can cause neutroenia, making patients immunosuppresed
How is chemotherapy induced neutropenia treated?
Patients sometimes given prophylactic ABX to prevent infections.
Injections of growth factors can stimulate the white blood cell production helping to prevent neutropenia- granulocyte colony stimulating factor (G-CSF).
How long after chemotherapy will pateints have their lowest WBC count?
7-14 days
What is neutropenic sepsis?
Neutropenic sepsis (NS) is sepsis infection along with a neutropneic state - a common and predictable life threatening complication of bone marrow disorders and cytotoxic chemotherapy
What are the main complications of chemotherapy?
Stem cell death
Anaemia
Thrombocytopenia
Neutropenia (and neutropenic sepsis)
Tumor lysis syndrome
Severe nausea and vomiting
Fatigue
What may be unusual about a neutropenic sepsis presentation?
Typical sepsis signs and symptoms may not be present
The source of infection may not be apparent
It may just present as generalised deterioration or with non-specific symptoms e.g. confusion
What is the incidence and mortality rate of neutropenic sepsis?
70-100% of patients during the neutropenic phase after intensive chemo will develop neutropenic sepsis.
Mortality rate is 2-21%
What is tumor lysis syndrome and how does it develop?
When chemotherapy causes large numbers of cancer cells to die rapidly and deposit their contents into the blood.
When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise faster than the kidneys can remove them. This causes TLS.
This can affect the functioning of several organs, especially the kidneys, and also the heart, brain, muscles, and gastrointestinal tract.
It is a medical emergency requiring immediate attention.
What are the signs and symptoms of tumor lysis syndrome?
Symptoms are generally nonspecific and can include:
-Nausea with or without vomiting
-Lack of appetite and fatigue
-Dark urine, reduced urine output, or flank pain
-Numbness, seizures, or hallucinations
-Muscle cramps and spasms
-Heart palpitations
Kidney failure and death can occur, especially if TLS is left untreated.
It can also present with frank kidney and organ failure.
How is tumor lysis syndrome diagnosed and what are the cardinal findings?
TLS is diagnosed based on blood tests, along with signs and symptoms. Its onset may be subtle, with only a few abnormal laboratory values.
The cardinal signs of TLS are:
-Hyperkalemia
-Hyperphosphatemia
-Hypocalcemia
-Hyperuricemia.
When does tumor lysis syndrome typically present and who is at greater risk?
Often occurs within the first week of chemotherapy
Patients with many tumours, rapidly growing tumours or existing kidney problems are at greatest risk.
