Oncological management

Question 1

Non-surgical management types

Answer 1

• Cytotoxic chemotherapy (kills all cells, doesn’t differentiate well between cancerous/non-cancerous cells)
• RT (done by clinical oncologists, not medical oncologists)
• Targeted therapies
• Immunotherapy (risk of inducing autoimmune reactions)
• Endocrine
• Bisphosphonates (breast cancer - reduce recurrence; also treats hyperCa2+ and bone mets)
• Supportive care

Question 2

Prognosis of different cancers.

a) Good
b) Bad

Answer 2

a) Testicular, prostate, breast, melanoma (note: even if metastatic, may have good treatments that mean they live for years)
b) Pancreas, UGI, lung, brain, thyroid?

Question 3

Selecting candidates for treatment

a) Cancer features
b) Performance status

Answer 3

a) TNM, biology,

b) WHO grades 0-5 (>2 risks probably outweigh benefit)

Question 4

Haematological (non-solid) cancers - managed by…?

Answer 4

Haematologists, not oncologists

Question 5

Chemotherapy types

Answer 5

• Radical (e.g. metastatic germ cell)
• Adjuvant (after surgery) and neoadjuvant (before surgery) - reduce risk of local/distant relapse
• Chemoradiotherapy (potentiates effect of RT; used in head and neck, anorectal, bladder, cervix; e.g. cisplatin)
• Palliative - may improve QoL by reducing symptoms

Question 6

Investigations

Answer 6

History and examination
Imaging of mass
Staging CT (generally CAP)
Biopsy and grading

Question 7

Breast cancer drug management

Answer 7

- ER positive:
Pre-menopausal: tamoxifen 
Post-menopausal: aromatase inbibtor (anastrazole)
- HER positive: 
herceptin
- Other?

Question 8

Radiotherapy

Answer 8

• Stereotactic (gamma knife) - brain primaries and secondaries
• Proton therapy

Question 9

Endocrine treatment

Answer 9

• Tamoxifen - selective oestrogen receptor modulator - breast Ca (pre-menopausal)
• Aromatase inhibitors - breast Ca (post-menopausal only)
• GnRH analogues - prostate Ca

Question 10

Targeted therapies

Answer 10

• Tyrosine kinase inhibitors - given in …?

- CDK4/6 inhibitors - given in breast Ca with aromatase inhibitors

Question 11

Radiotherapy: side effects

a) Common skin problems (and management)
b) Other common issues
c) Site-specific: i) Head and neck, ii) Chest, iii) Abdo/ Pelvis

Answer 11

a) Acute radiation dermatitis: range from erythema and itching to blistering and ulceration. Manage with topical therapies
b) Fatigue

c) i) N/V, dry mouth, mouth sores, metallic taste, jaw stiff
ii) Breast tenderness, SOB, radiation pneumonitis/ fibrosis
iii) N/V, diarrhoea, bladder dysfunction, rectal bleeding, sexual dysfunction and infertility

Question 12

Chemotherapy: side effects

think ‘loss’

Answer 12

• Loss of hair
• Loss of appetite and weight loss
• Loss of muscle strength/ fatigue
• Loss of cognitive function
• Loss from back passage (diarrhoea)
• Beau’s lines in nails

Question 13

RT/chemo: late effects

Answer 13

• Second cancer (esp. RT - cause skin cancer/thyroid)
• Chest: HTN, CCF, arrhythmias, lung fibrosis
• Endocrine: infertility, hypopituitarism, sexual dysfunction
• Psychological: depression, anxiety, etc.

Question 14

Most common treatment-related reasons for admission in oncology patients

Answer 14

• Suspected neutropenic sepsis
• Infection, not neutropenic
• Nausea and vomiting
• Diarrhoea
• Electrolyte imbalance (including tumour lysis)
• Head and neck radiotherapy symptom management

Question 15

Most common non-treatment related reasons for admission in oncology patients

Answer 15

• Pain and symptom management
• Oncology emergency (collapse)
• Disease related symptoms (e.g. jaundice, hypercalcaemia)
• Pulmonary embolus, DVT