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CVNT 2 > Oncology > Flashcards

Oncology Flashcards

1
Q

indications for chemotherapy

A
  • chemo-sensitive tumours
  • primary therapy for haemopoietic malignancies (lymphoma)
  • adjunctive therapy for solid tumours
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2
Q

why we don’t use chemo for treatment of solid tumours

A
  • acts on rapidly dividing cells
  • cells in resting phase of cell cycle (G0) are most resistant to chemo
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3
Q

treatment options for lymphoma

A
  • single agent prednisolone (MST 2-3 months)
  • single agent doxorubicin (MST 6-9 months)
  • COP (6-9 months, 70-80% remission)
  • CHOP (MST 12 months, 75-90% remission)
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4
Q

CHOP multi agent protocol

A

Cyclophosphamide
Hydroxydaunorubicin
Oncovin
Prednisolone

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5
Q

dangers of chemotherapy

A
  • chemo drugs can be found in urine, saliva and faeces
  • drugs are mutagenic, abortifacient, teratogenic and carcinogenic
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6
Q

safe handling of chemo

A
  • PPE
  • closed system of administration (luer-lock syringe)
  • use of plastic pad (inco sheet)
  • use of chemo room
  • allocated bins
  • no pregnant women handling drugs
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7
Q

effects on GI tract from chemo

A
  • death of rapidly dividing cells can increase risk of sepsis due to loss of mucosal integrity
  • vom, diarrhoea, nausea
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8
Q

effects on bone marrow from chemo

A
  • low WBC count leads to susceptibility to infections
  • low RBC leads to anaemia (low platelets)
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9
Q

how to make perivascular injection of chemo drugs less likely?

A
  • flush catheter
  • appropriate restraint
  • highly visible injection sight (unwrap bandage)
  • use catheter (don’t go off needle)
  • clean stick catheters only (no repeated attempts on one vein)
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10
Q

side effects of chemo on organ systems

A
  • renal
  • cardiac
  • hepatic
  • urinary (cystitis symptoms)
  • dermatological (perivascular admin)
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11
Q

cancer definition

A

persistent, purposeless proliferation of host cells, detrimental to the host

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12
Q

6 necessary features of neoplasia

A
  • evading apoptosis
  • self-sufficiency in growth signals
  • insensitivity to anti-growth signals
  • tissue invasion and metastasis
  • limitless replicative potential
  • sustained angiogenesis
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13
Q

local behaviour of malignant tumour

A
  • diffuse, indistinct boundaries
  • fixation of tumour in one or more planes
  • thickening of adjacent tissue
  • spontaneous bleeding or ulceration
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14
Q

metastatic potential

A
  • ability to spread to distant tissues is a feature of malignancy
    spread may be:
  • via blood
  • via lymphatics
  • transcoelomic (across pleura)
  • iatrogenic
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15
Q

what are paraneoplastic syndromes (PNS)

A
  • arise from production and release of biologically active substances
  • can affect distant organs
  • can develop before or after diagnosis of cancer
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16
Q

what is haematological PNS

A
  • changes in RBC, WBC and platelet counts occurring with neoplasia
  • anaemia, thrombocytopenia
17
Q

mechanisms for paraneoplastic anaemia

A
  • myelopthisis- invasion of bone marrow by neoplastic cells
  • haemorrhage- some neoplasia bleeds, some are severe enough to cause hypovolaemia
  • immune-mediated haemolytic anaemia- reactivity between cancer and RBC causes destruction of RBC
  • anaemia of chronic disease- due to disordered iron handling
18
Q

hyperviscosity syndrome

A
  • due to anything that makes the blood more sludgy
  • increased blood cell numbers (erythrocytosis, polycythaemia)
  • excessive production of gamma-globulins
19
Q

hyperhistaminaemia

A
  • some tumours release histamine and vasoactive amines
  • this can be responsible for signs local to the tumour: swelling, erythema, pruritus
  • or signs away from the tumour: GI ulcers
  • anaphylactic shock is possible if huge, sudden release of histamine
20
Q

immune mediated PNS

A
  • due to reactivity between cancer cells and healthy cells
  • immune-mediated thrombocytopenia
  • immune-mediated haemolytic anaemia
  • myaesthenia gravis
21
Q

endocrine related PNS

A
  • endocrine tumours and non endocrine tumours can produce hormones
  • clinical signs are dependant on the hormone that is excessively produced
22
Q

pyrexia as PNS

A
  • thought to be due to production of cytokines by neoplasm
  • other causes of pyrexia should be ruled out first
23
Q

cachexia

A
  • loss of fat and muscle in patients with cancer
  • despite adequate nutritional intake
  • thought to be due to production of cytokines by neoplastic cells
24
Q

aims of investigating cancer

A
  • histological/cytological diagnosis
  • determine extent of local and distant spread
  • investigate and treat tumour-related complications
  • patients ability to tolerate therapy
  • determine prognosis
25
Q

diagnosing cancer

A
  • history
  • physical exam
  • lab testing
  • imaging
  • biomarkers (unreliable)
  • biopsy (cytology, histopathology)
26
Q

biopsy: cytology samples

A
  • collects individual cells or small clusters
  • can be collected through:
    • touch/impression preps (moist lesions)
    • FNAs- fine needle aspirates
    • cytospins of body fluids/effusions
27
Q

biopsy: histology samples

A
  • collects whole pieces of tissue
  • more invasive than cytology
  • allows tumour grading
  • incisional or excision
28
Q

tumour grading

A

microscopic quantification of parameters that correlate with the clinical aggressiveness of a neoplasm based on the tumours architecture
- invasion of adjacent tissues?
- evidence of metastasis? (presence of neoplastic cells in blood vessels)

29
Q

5 rules of incisional biopsy

A
  1. avoid superficial ulceration, inflammation or necrosis
  2. ensure adequate depth
  3. try to include a boundary between tumour-normal tissue
  4. do not predispose to local tumour recurrence or dissemination (spread of neoplastic cells into the body)
  5. do not compromise subsequent therapy
30
Q

when is excisional biopsy indicated?

A
  • when incisional biopsy is too dangerous (tumour in lungs can cause pneumothorax)
  • if knowledge of tumour type and grade doesn’t change treatment approach (bleeding splenic tumour)
31
Q

clinical staging

A
  • determines extent of neoplastic disease for therapy and prognosis
    considers:
  • histological grade
  • local invasion
  • metastatic spread
    All 4 views of inflated thorax should be radiographed prior to any treatment
32
Q

TNM staging system

A

T- tumour- size and invasiveness
N- nodes- assessing drainage for evidence of spread
M- metastasis- assessing spread to other organs

33
Q

aims of cancer treatment

A
  • cure- all cells with capacity for tumour regeneration are eradicated
  • remission- cancer had disappeared but cells remain and will relapse over time
  • palliation- reduce pain, improve quality of life, correct physiological malfunction
34
Q

surgical excision of tumour

A
  • primary objective is to remove all tumour cells
  • more aggressive a malignancy is, the wider the excision margins will need to be
  • insufficient margins will leave satellite cells leading to tumour regrowth
35
Q

intracapsular resection (debulking)

A
  • mass excised within their capsule leaving behind neoplastic tissue
  • recurrence will occur unless followed with adjunctive therapy
  • incurable malignant neoplasia of vital structures (mouth, CNS)
36
Q

post-op complications

A

failure of surgery occurs when:
- regrowth at primary site due to incomplete resection
- already metastasised
- tumour is systemic (lymphoma)

37
Q

radiotherapy

A
  • external beam radiation therapy, brachytherapy
  • causes ionisation, damaging DNA within cells causing cell death
  • radiation needs to given to neoplastic tissue only to prevent damage to healthy cells
38
Q

when is radiotherapy an option

A
  • primary tumours with no metastasis but cannot be controlled with purely surgery due to size or site
  • oral or nasal cavity, CNS tumours

CVNT 2 (33 decks)

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