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CVNT2 > Oncology > Flashcards

Oncology Flashcards

1
Q

what is the spectrum of behaviour shown by tumours?

A

truly benign to highly malignant

some may have local characteristics of malignancy but do not metastasise

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2
Q

what are the 6 features necessary for the development of cancer?

A

self-sufficiency in growth signals

insensitivity to anti-growth signals

tissue invasion and metastasis

limitless replicative potential

sustained angiogenesis

evasion of apoptosis

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3
Q

what is the hallmark of cancer?

A

alterations in genes

different from hereditary disease

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4
Q

what are overactive oncogens?

A

tumour-promoting genes (secondary to mutation)

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5
Q

what is the other genetic component of cancer?

A

loss of tumour suppressor genes

e.g. alteration to P53 checkpoint gene

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6
Q

what is neoplasia defined as?

A

“new growth” - but inferring abnormal growth

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7
Q

what is a tumour?

A

a swelling (but inferred to be a neoplasm)

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8
Q

what does benign mean?

A

a neoplasm that forms a solid cohesive tumour and does not metastasise

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9
Q

what does malignant mean?

A

a neoplasm with the capacity for local invasion and metastasis

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10
Q

what is a cancer?

A

a malignant tumour

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11
Q

what does metastasis mean?

A

development of a secondary tumour remotely from the primary tumour

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12
Q

tumours are described according to…

A

the tissue of origin (epithelial/mesenchymal/round cell)

status (benign/malignant)

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13
Q

what suffix do benign tumours end in?

A

-oma

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14
Q

what is a benign squamous epithelial tumour called?

A

papilloma

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15
Q

what is a benign glandular tissue tumour called?

A

adenoma

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16
Q

what is a benign bone tissue tumour called?

A

osteoma

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17
Q

what is a benign blood vessel tumour called?

A

haemangioma

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18
Q

what is a malignant squamous epithelial tissue called?

A

squamous cell carcinoma

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19
Q

what is a malignant glandular tissue tumour called?

A

adenocarcinoma

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20
Q

what is a malignant bone tissue tumour called?

A

osteosarcoma

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21
Q

what is a malignant blood vessel tissue tumour called?

A

haemangiosarcoma

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22
Q

what is malignant caner of the lymphocytes called?

A

lymphoma

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23
Q

what is malignant cancer of the mast cells called?

A

mast cell tumour

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24
Q

what are the epithelial tissues most prone to tumour formation?

A

squamous

glandular

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25
Q

what are the mesenchymal tissues most prone to tumour formation?

A

bone

blood vessels

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26
Q

what are the round cells most prone to tumour formation?

A

lymphocytes

mast cells

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27
Q

what are the 2 important clinical features of a cancer?

A

effect on the host

response to treatment

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28
Q

what factors will affect the effect on the host and the response to treatment of a cancer?

A

tumour growth (how actively the cancer is developing)

tumour grade (how severe the neoplasm is on histopathological analysis)

tumour behaviour (local behaviour, metastatic potential, paraneoplastic effects)

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29
Q

when does a tumour do most of its growing?

A

before detection

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30
Q

what size/weight does a tumour have to be to be detectable by palpation or radiography?

A

1cm diameter

0.5-1 gram in weight

10^9 cells

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31
Q

what is the growth fraction?

A

the proportion of actively dividing cells in a tumour

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32
Q

what does the “tumour doubling time” refer to?

A

the time taken for a tumour to double in size

a reflection of the growth fraction

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33
Q

what happens to the tumour doubling time as the tumour grows?

A

tendency to lengthen

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34
Q

how receptive are tumours to treatment in the early stages of growth?

A

dividing and growing rapidly - sensitive to chemotherapy and radiation therapy

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35
Q

how receptive are tumours to treatment by the time they are detectable?

A

growth fraction is reaching plateau - less susceptible than healthy tissues to therapy

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36
Q

why are treatments that attack rapidly dividing cells likely to be toxic to the body?

A

proportion of dividing cells is often less than that in normal, rapidly dividing body tissues such as the intestinal epithelium and bone marrow (by the time the tumour can be detected by palpation)

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37
Q

which types of tumours are still susceptible to treatment even when palpable?

A

tumours which maintain a high growth fraction despite a large tumour burden (e.g. lymphoma)

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38
Q

are tumours homogenous?

A

no - a tumour cell population is quite heterogenous

Cancer cells modify their properties as they grow, mainly by small sequential mutations

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39
Q

what does the grade of a tumour depend on?

A

mitotic rate

cellular and nuclear characteristics

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40
Q 
with respect to benign and malignant tumours, describe:
rate of growth 
manner of growth 
effects on adjacent tissues 
effects of surgery 
metastasis 
effect on host 
paraneoplastic effects
A
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41
Q

what factors have an impact on tumour behaviour?

A

rate and manner of growth

effects on adjacent tissues

surgery

metastasis

effect on host

paraneoplastic effects

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42
Q

how do malignant tumours grow?

A

local invasion

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43
Q

what are the physical clues of local invasion?

A

diffuse, indistinct boundaries

fixation of the tumour in one or more planes

thickening of adjacent tissue

spontaneous bleeding

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44
Q

how do malignant cancers spread?

A

via the blood, producing secondary tumours in any body organ

via lymphatics, to local and regional lymph nodes

transcoelomic across the pleural or peritoneal space

iatrogenic e.g. seeding by FNA or tru-cut biopsy

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45
Q

where is the most common site for the development of haematogenous secondary tumours?

A

lungs - primary lung tumours are rarer, but will metastasise to peripheral sites

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46
Q

which other sites are prone to development of haematogenous secondary tumours?

A

those with high blood flow e.g. liver, spleen, kidneys, bone and CNS

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47
Q

which tumour is usually the largest?

A

the primary tumour

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48
Q

what are paraneoplastic syndromes (PNS)?

A

signs arising from the indirect effect of tumours’ production and release of biologically active substances

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49
Q

what do PNS affect?

A

distant organs - may be the first evidence of neoplastic disease

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50
Q

what are the haematologic PNS?

A

anaemia (weakness, lethargy, tachypnoea)
thrombocytopaenia (bleeding)
leukopenia (susceptibility to infection)

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51
Q

what is hyperviscosity syndrome (HS)?

A

increased blood cell numbers with sludging blood and poor circulation

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52
Q

what are the physiological effects of hyperviscosity syndrome?

A

leukaemia

primary polycythaemia

secretion of excess erythropoietin causing secondary polycythaemia

excess gammaglobulins (especially IgM) secreted by multiple myeloma (plasma cell tumour)

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53
Q

what are the clinical signs of HS syndrome?

A 
lethargy  
episodic weakness 
thromboembolism 
disorientation 
bleeding 
tremors, ataxia, seizures 
retinal haemorrhage and detachment
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54
Q

what causes hyperhistaminaemia?

A

mast cell tumours - often release histamine and vasoactive amines (especially when handled for FNA/surgery)

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55
Q

what are the local effects of hyperhistaminaemia?

A

oedematous swelling with erythema and pruritus

tendency for localised bleeding

delayed wound healing or dehiscence after surgery (released proteases)

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56
Q

what are the systemic effects of hyperhistaminaemia?

A

anaphylactic shock due to massive sudden release of histamine (vasodilation and hypotension)

gastroduodenal ulcer (can perforate)

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57
Q

how do you avoid anaphylactic shock due to hyperhistaminaemia?

A

premedication with H1 antagonist (diphenhydramine) prior to surgical manipulation of tumour

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58
Q

how do you avoid gastroduodenal ulcer due to hyperhistaminaemia?

A

Treat with H2 antagonist (cimetidine or ranitidine)

or proton pump inhibitor (omeprazole)

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59
Q

what are the common immune-mediated reactions associated with neoplasia?

A

immune-mediated haemolytic anaemia and/or thrombocytopaenia

neuropathies - insulinoma

myasthenia gravis

feline paraneoplastic alopecia (shiny skin disease)

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60
Q

why do immune-mediated reactions occur alongside neoplasia?

A

cross-reactivity between cancer cells and healthy cells leading to dysregulation of the immune system

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61
Q

what are the main 2 resulting issues of endocrine-related PNS?

A

hypercalcaemia

hypoglycaemia

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62
Q

what is the most common neoplastic syndrome in dogs?

A

hypercalcaemia

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63
Q

how does hypercalcaemia occur in oncology?

A

tumours release parathyroid hormone-related peptide

increases total and ionised calcium concentrations

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64
Q

which type of cancer most commonly causes neoplasia?

A

lymphoma

but also anal sac adenocarcinoma, multiple myeloma and carcinoma/sarcoma with skeletal metastasis

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65
Q

what are the clinical signs of hypercalcaemia?

A

renal effects are of greatest importance: dehydration and renal failure

PUPD 
anorexia and vomiting 
lethargy, depression (neuro depression) 
muscular weakness (NM depression) 
bradycardia (CVS depression)
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66
Q

what causes hypogylcaemia in oncology?

A

pancreatic insulinoma

excessive consumption of glucose by the body (hepatoma, hepatocellular carcinoma, large intra-abdominal masses, chronic lymphocytic leukaemia)

release of an insulin-like factor

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67
Q

what causes cancer cachexia?

A

muscle and fat loss
enhanced catabolism
reduced food intake

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68
Q

what commonly causes fever during cancer?

A

pyrogens cytokins (IL-1, IL-6)

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69
Q

what are the aims of investigation into a cancer?

A

make a histological diagnosis of the type and grade

determine the extent of the disease (stage)

investigate and treat any tumour-related or concurrent complications

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70
Q

what is required to make an accurate diagnosis of cancer?

A

microscopic examination of representative tissues or cells - cannot diagnose via palpation

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71
Q

all excised masses should be…

A

submitted for histology

fixed and stored, just in case the owners change their mind or the patient deteriorates

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72
Q

what types of cytology samples can be made?

A

touch/impression preparations

FNAs

analysis of body fluids/effusions

73
Q

how do you prep for an FNA?

A

no need to prep of clip skin
no need for sedation or GA
use 21G or 23G needle

74
Q

what can cytology tell us?

A

nature of the tumour i.e.

type of cell (epithelial/mesenchymal/round cell)

cytological features

75
Q

what can cytology not tell us?

A

the definitive diagnosis

false negatives may occur (sarcoma)

can be difficult to differentiate inflammation from neoplasia, especially if tumour outgrows blood supply or is necrotic

76
Q

what types of histological sampling can be performed?

A

surgical biopsy
needle (tru-cut)
punch biopsy

77
Q

why is surgical biopsy the best histological sampling method?

A 
can tell us:
cellular features of malignancy 
tumour architecture 
invasion of adjacent tissues 
evidence of metastatic behaviour (presence in blood vessels/lymphatics)
78
Q

what types of surgical biopsy are there?

A

incisional - part of tumour along with a part of healthy tissue

excisional - removal of the entire tumour and a margin of healthy-looking tissue

79
Q

what are the rules for taking a biopsy?

A

avoid superficial ulceration/inflammation/necrosis

ensure adequate depth

try to include a boundary between tumour and normal tissue

80
Q

in which cases might we not obtain a biopsy?

A

where the risk of obtaining a biopsy may be too great (e.g. brain tumour)

where performing a biopsy does not alter what is done to the patient (e.g. splenectomy)

81
Q

what does clinical staging of a tumour aim to identify?

A

cytological or histological grade
local invasion
metastatic spread

82
Q

what is the TNM staging system?

A

Tumour - assessing size and invasiveness

Nodes - assessing local draining lymph nodes for evidence of spread

Metastasis - assessing spread to other organs

83
Q

what are the grades of T in the TNM staging system?

A

T0 - no evidence of primary tumour

T1-4 - size and/or extent of primary tumour

84
Q

what are the grades of N in the TNM staging system?

A

N0 - no regional lymph node involvement

N1-4 - degree of involvement of regional lymph nodes

85
Q

what are the grades of M in the TNM staging system?

A

M0 - no distant metastasis

M1, M2 - distant metastasis is present (single/multiple)

86
Q

which tests can be performed to assess the distant spread of a tumour?

A

history and physical exam

thoracic radiographs (3 views) or CT

abdominal radiographs and US

FNA of lymph nodes/liver/spleen

bone marrow aspiration (if haematological abnormalities)

87
Q

how can you evaluate the local/regional lymph nodes?

A

palpation of size and texture

imaging of deeper nodes

FNAs to distinguish tumour spread from reactive hyperplasia due to tumour necrosis

88
Q

why is clinical staging never exact?

A

differences between clinical stage and true pathological state may occur because of microscopic tumour extensions or deposits that are impossible to detect in vivo

89
Q

which factors play a role in deciding the best treatment for cancer?

A

nature of the disease

options and side effects

prognosis with/without treatment

cost

tumour biology/histology/grade/stage

90
Q

what is considered ‘cured’ cancer?

A

all cells that have the capacity for tumour regeneration eradicated

91
Q

what is considered remission?

A

all clinical evidence of cancer has disappeared, but occult cancer cells remain and relapse will occur at some point

92
Q

what is palliation?

A

reduction of pain/improved sense of well-being and/or correcting physiological malfunction
cancer still clinically identifiable

93
Q

what are the three main methods of cancer treatments in animals?

A

surgical excision
radiation
anti-cancer/cytotoxic drugs (chemotherapy)

94
Q

what is the most effective treatment?

A

surgery is the most effective treatment for the majority of solid tumours, and offers the best chance of a cure, as the primary objective is to remove all tumour cells

95
Q

what is a surgical excision suitable for?

A

truly benign tumours - fibroma, lipoma, benign mammary tumours

96
Q

what is a wide local excision?

A

wide margins (1-2cm) and two tissue planes of apparently normal tissue excised to ensure that all tumour is removed so that growth doesn’t occur

97
Q

what type of tumours is wide local excision suitable for?

A

locally invasive tumours e.g. basal cell carcinoma, squamous cell carcinoma, mast cell tumours

98
Q

when might wide local excision be challenging?

A

if there is insufficient normal tissue to be able to close the wound
e.g. chest wall, distal limbs, head, oral cavity

often requires local excision of underlying bone

99
Q

what is compartmental resection?

A

resection involves removing every tissue compartment which the tumour involves
‘en bloc’

reconstructive procedures often needed to close the wound

100
Q

which tumours often require compartmental resection?

A

soft tissue sarcomas - fibrosarcoma, haemangiopericytoma

101
Q

when does failure of surgery occur?

A

when the tumour grows at the primary site due to incomplete resection

when the tumour has already metastasised

when the cancer is systemic, e.g. multicentric lymphoma

102
Q

what is surgical debulking?

A

partial removal of the tumour without curative intent

followed by subsequent therapy with drugs, radiation or other adjunctive measure

103
Q

what type of tumour is surgical debulking used for?

A

surgically incurable malignant neoplasms

104
Q

what are the general rules for surgical excision of a tumour?

A

mark out margins (include a margin of normal tissue)
cut large and deep
use two sets of instruments?

105
Q

why should you use two set of instruments for surgery?

A

one for excision and one for closure

to avoid iatrogenic seeding of cancerous cells

106
Q

what are the considerations when filling out the form for a laboratory sample?

A

provide a clinical history

if concerned about a particular margin, mark it and inform pathologist

identify and orientate samples (labels)

submit all the samples and the entire tumour

107
Q

what are the general considerations post-op?

A

nutrition
analgesia
wound care/management
functionality

108
Q

what can excessive tension at wound closure result in?

A 
compromise to circulation 
ischaemia 
oedema 
slow wound healing 
wound breakdown 
necrosis 
distortion of anatomic areas e.g. anus, eyelid
109
Q

what are the patient factors involved in wound breakdown (intrinsic and extrinsic)?

A

intrinsic = concurrent disease, poor nutrition

extrinsic = chemotherapy, steroids, radiotherapy

110
Q

what are the wound factors which contribute to wound breakdown?

A 
neoplasia 
tissue handling/haemostasis  
excessive tension 
motion 
poor suturing 
infection 
patient interference
111
Q

how should a wound be managed after it has broken down/re-opened?

A

do not re-suture - considered dirty/contaminated

allow to heal via second intention

112
Q

what is a seroma?

A

accumulation of fluid at the level of a wound

113
Q

how can seroma formation be prevented?

A

limit formation of dead space - drain placement

rest - limit motion

leave alone

pressure bandage

114
Q

how should a wound be managed if it becomes infected?

A

provide drainage
allow to heal via second intention
antibiotics based on culture and sensitivity
exploration of wound if necessary

115
Q

what is radiation therapy?

A

the medical use of ionizing radiation as an integral part of cancer treatment by killing or controlling malignant cells

116
Q

when might radiation be used?

A

it is the most effective and least toxic local treatment if surgery is incomplete

117
Q

what is the main principle of radiation therapy?

A

radiation interacts with biological material by removing an orbiting electron, a process termed ionisation

118
Q

what are the 2 methods of application of radiotherapy?

A

brachytherapy

external beam radiation therapy/teletherapy (most common)

119
Q

what are the 2 types of radiation used in radiation therapy?

A

electrons (beta particles) - absorbed by tissue or easily shielded

high - energy x-rays - penetrating and harmful

120
Q

how is brachytherapy administered (3 ways)?

A

applied to the surface of a tumour

implanted within the tumour (gold seeds)

administered systemically but concentrated in the tumour

121
Q

what is external beam radiation therapy?

A

radiation therapy given by an external radiation source at a distance from the body

122
Q

why is use of teletherapy limited?

A

because of restricted availability of a fixed radiation source or a linear accelerator (LINAC)

123
Q

what are the acute reactions to radiotherapy?

A 
skin reddening 
vesiculation 
desquamation 
severe exfoliative dermatitis 
localised heat loss
124
Q

what are the signs of late toxicity after radiation therapy?

A

depigmentation
dermal fibrosis
osteonecrosis
neural necrosis (blindness, neurological signs)

125
Q

what is the response to chemotherapy dependent on?

A

the growth fraction

drug resistance

126
Q

are tumours in their early stages sensitive to chemotherapy?

A

yes - sensitive to chemotherapy and radiation

127
Q

are tumours receptive chemotherapy by the time they are detectable?

A

less susceptible to chemotherapy than healthy tissues

growth fraction is reaching plateau

128
Q

which healthy tissues are most susceptible to chemotherapy?

A

bone marrow

gut epithelium

129
Q

how do chemotherapy drugs work?

A

act upon processes in cell growth and division - DNA replication, mitotic spindle, metabolic activities

130
Q

what is the main principle of chemotherapy treatment?

A

efficacy vs toxicity

using the highest possible dose to effect maximum fractional kill with minimum side effects

131
Q

when is chemotherapy most effective?

A

when tumour burden is at its lowest and growth fraction highest, i.e. early or after surgical ‘debulking’

132
Q

how can you maximise efficacy and minimise toxicity?

A

use repeated cycles of a range of drugs, allowing recovery time (typically 3 week cycles)

133
Q

how is dosing calculated?

A

as a function of surface area (m^2)

134
Q

which types of cancer are highly sensitive to chemotherapy?

A

lymphoma
myeloma
some forms of leukaemia

135
Q

which types of cancer are moderately sensitive to chemotherapy?

A

high grade sarcomas

mast cell tumours

136
Q

which types of cancer are poorly sensitive to chemotherapy?

A

most slow-growing sarcomas
most carcinomas
melanomas

137
Q

what is combination therapy?

A

the combination of different classes of chemotherapy agents with different mechanisms of action

138
Q

what is the favoured approach in chemotherapy?

A

combination therapy - more effective than a single agent

139
Q

why is combination therapy more effective than a single agent?

A

greater tumour cell kill achieved
less resistance
fewer side effects

140
Q

what are the common chemotherapy protocols for cats and dogs with lymphoma?

A

COP for cats

CHOP for dogs

141
Q

is chemotherapy used as a first-line treatment for solid tumours?

A

rarely of value as sole therapy - best treated with surgical resection and/or radiotherapy

142
Q

why might chemotherapy be used as an adjunct to surgical and/or radiotherapy?

A

to reduce tumour mass to enable surgical resection

to try to prevent/delay metastasis

143
Q

what is metronomic chemotherapy?

A

palliative low doses of chemotherapy drugs, given daily

144
Q

why is metronomic chemotherapy given?

A

anti-angiogenic - targets the endothelium or tumour stroma

designed to minimize toxicity and palliative only

145
Q

what is chemoembolisation?

A

local, directed delivery of chemotherapy drug and embolisation to treat inoperable solid tumours

146
Q

how is chemoembolisation performed?

A

chemotherapy drug injected in blood vessel supplying the tumour

synthetic material (embolic) placed inside the blood vessel trapping the chemotherapy in the tumour

147
Q

what is involved in safe use of chemotherapy?

A

use of protective equipment (gloves, mark, glasses, apron)

use of a sealed closed system for admin of injectable chemo

cleaning procedures

use of a chemo room

clear protocol for disposal with allocated bins

pregnant women should not handle any chemo drugs

148
Q

what is involved in safe handling of cytotoxic drugs?

A

chemo room locked

use of a cabinet with vertical flow containment hood

use of a plastic pad, the drug is never in direct contact with a surface

use of luer-lock syringes for administration

149
Q

how should chemotherapy material be disposed of?

A

all material used is gathered in a sealed plastic bag and disposed in bin for chemo wastes

150
Q

what is involved in nursing care of chemotherapy patients?

A

designated kennel with clear ID of agents used

PPE for those caring for patient (gloves, gown, eye protection)

all materials that have been in contact with the animal should be regarded as potentially contaminated - use a dedicated cytotoxic waste bin

151
Q

what is the average period of risk to humans after chemo drug administration?

A

3-7 days

152
Q

how should cleaning of materials be handled when the dog is at home?

A

wash any food bowls/toys/bedding separately from other household items

use latex gloves when cleaning up urine/faeces/bodily fluids, disinfect area with household bleach, wash hands

dispose of gloves in trash, double bagged

153
Q

what is the inherent toxicity of chemotherapy agents due to?

A

effect on dividing cells, including normal tissues with a high cell turnover (bone marrow, intestinal)

154
Q

why does chemotherapy cause GI toxicity?

A

direct toxic effects on the GI tract through death and loss of intestinal epithelial cells

155
Q

how long after chemotherapy admin do GI side effects start to occur?

A

5-10 days

156
Q

what are the GI side effects of chemotherapy?

A

stomatitis
vomiting
mucoid/haemorrhagic diarrhoea

some drugs (e.g. doxorubicin) also induce early nausea and vomiting by stimulation of the CRTZ

157
Q

how are signs of GI toxicity due to chemotherapy treated?

A

treatment is symptomatic

IV fluid therapy
ant-emetics
gastroprotectants for GI ulceration
parenteral antibiotics (if immunosuppressed or haemorrhagic diarrhoea)

158
Q

what coat changes can occur in an animal undergoing chemotherapy?

A

cats usually only lose their whiskers

not a major problem in most dogs but some breeds are susceptible to significant patchy hair loss

159
Q

what is myelosuppression?

A

a decrease in bone marrow activity that results in reduced production of blood cells

160
Q

why is routine haematology performed before cytotoxic agents are given?

A

most cytotoxic drugs are myelosuppressive - treatment is delayed and/or reduced if there is myelosuppression

161
Q

what does myelosuppression cause?

A

neutropenia (can be life-threatening)

thrombocytopaenia

anaemia (rarely clinically significant)

162
Q

at what neutrophil count is the patient at risk of sepsis and/or pyrexia?

A

<2 x 10⁹/L

163
Q

why are patients with myelosuppression at risk of sepsis?

A

due to translocation of enteric bacteria across the mucosa into the bloodstream

164
Q

what does management of neutropenia depend on?

A

absolute cell count

clinical signs

165
Q

at what myelosuppression grade should chemotherapy be stopped?

A

moderate (<2 x 10⁹/L)

166
Q

why might neutropenia grade be associated with a better prognosis?

A

neutropenia is an indicator of maximum tolerated dose being reached/approached

167
Q

which cytotoxic drug may cause hypersensitivity/anaphylaxis?

A

rare but reported in dogs with doxorubicin

168
Q

what should be done if a hypersensitivity/anaphylaxis reaction occurs?

A

stop the drug admin

give IV fluids, soluble corticosteroids, adrenaline and antihistamines

169
Q

what can happen if a cytotoxic drugs extravasates?

A

can cause phlebitis or tissue necrosis

170
Q

what can occur if a vesicant drug (e.g. doxorubicin) moves peri-vascularly?

A

severe and/or irreversible tissue injury and necrosis

171
Q

how can risks of extravasation be reduced?

A

using drugs in a sealed system

adequate restraint of the patient

“clean stick” - don’t re-arrange catheter after it is placed

catheter flushed with saline before and after

172
Q

how is perivascular leakage of doxorubicin treated?

A

stop infusion but do not remove the catheter

aspirate extravasated drug through catheter and give intralesional saline to dilute drug

draw back blood and remove catheter

IV hydrocortisone and cold compress

?antidote - dexrazosane

173
Q

what are the signs of sterile haemorrhagic cystitis?

A

profuse haematuria - sometimes irreversible

174
Q

how is sterile haemorrhagic cystitis treated?

A

no specific treatment - an irritant effect of the drug

MESNA may be protective

175
Q

how can you minimise the risk of sterile haemorrhagic cystitis?

A

administer drug early in morning so not retained in bladder overnight

ensure good fluid intake

encourage frequent urination

concurrent steroids of furosemide will assist diuresis

monitor urine for blood/protein (urine dipstick before each administration)

176
Q

what is a sign of acute doxorubicin toxicity?

A

tachyarrhythmias

177
Q

what is a sign of chronic doxorubicin toxicity?

A

dose-dependent cardiomyopathy

irreversible

178
Q

what other specific toxicities are associated with chemotherapy drugs?

A

hepatotoxicity (increase in liver enzymes)

nephrotoxicity (monitor urea/creatinine)

CVNT2 (47 decks)

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