Oncology Flashcards
pathophysiology of cancer
- cells become more and more abnormal or old
- damaged cells survive when they shouldn’t
- new cells from when are not needed (unstoppable division)
drivers of cancer (genes)
- proto-oncogenes (involved in normal cell growth and division, if unregulated become oncogenes)
- tumour suppressor genes (involved in controlling cell growth and division, if down regulated, division uncontrolled)
- DNA repair genes (fix damaged DNA, cells with mutations in the genes tend to develop additional mutations)
what is carcinoma forms from
adenocarcinoma, basal cell carcinoma
epithelial cells
adenocarcinoma; epithelial cells that produce fluid or mucus
basal cell: basal layer of epidermis
what is sarcoma formed from
in bone and soft tissues of the body (including muscle, fat, blood vessels, lymph vessels and fibrous tissue)
def adjacent treatment
treatment given after definitive treatment with aim to increase chance of cure
def neoadjuvent treatment
given before main treatment to shrink/improve chance of cure
def palliative treatment
improve quality of life where cure is not possible
def radical treatment
treatment aim is to get rid of, or cure the disease
def symptomatic treatment
relieve symptoms of cancer but not its cause
def concurrent therapy
when 2+ therapies are given simultaneously
def cycle
chemotherapy administered over few hours once every 2-3 weeks
allows for WCC and organ recovery
def nadir
when WCC is low
in a sentence: FBC nadir
def regimen
multiple drugs given together
how is radiotherapy treatment broken down into
course of treatment, broken down into fractions (to allow for tissue recovery)
how long is fraction of treatment of radiotherapy
15-30 mins
SE of radiotherapy
(site dependent)
early:
fatigue, pain flare, esophagitis, pneumonitis (all the itis), skin reaction, diarrhoea, nausea, raised ICP, hair loss
late:
fibrosis, stricture, osteonecrosis, rib fracture, second malignancy
types of radiotherapy
conventional
stereotactic
brachytherapy
proton treatment
what are the different protocols to manage motion (in radiotherapy treatment)
- bladder protocol: empty bladder before treatment
- stomach: empty stomach/certain volume in stomach
- breath hold (for breast and lung)
- 4D CT scan
why part of the cell division cycle does chemotherapy target
S (DNA synthesis) or M (mitosis) phases
what are the different roles of chemotherapy
- curative (chemosensitive tumours)
- adjacent (reduce risk of relapse)
- radiosensitive (low dose to increase efficacy of radical radiotherapy)
- palliative
route of administration for chemotherapy
IV oral intrathecal intra-arterial intravsicular intraperitoneal
toxicity of chemotherapy (organ specific)
- bone marrow: neutropenia, thrombocytopenia
- GI: mucositis, D&V
- skin: alopecia, hand-foot syndrome
- heart: heart failure, angina/MI
- lungs: pulmonary fibrosis
- kidneys: renal impairment
- nerves: peripheral neuropathy, hearing loss
- reproduction: infertility
long term: cognitive impairment, increased chance of secondary cancers
what are the different chemotherapy emergencies
- febrile neutropaenia/neutropenic sepsis
- thrombocytopaenic haemorrhage
- tumour lysis syndrome
ECOG performance status
(highly correlated to survival)
0: fully active, able to carry out all pre-disease performance without restriction
1: restricted in physically strenuous activity but ambulatory and able to carry out light work
2: ambulatory and capable of all self care but unable to carry out any work activities (up and about for > 50 of waking hours)
3: capable of only limited self care. confined to bed/chair > 50% waking hours)
4. completely disabled and confined to bed/chair. no self care
5: deceased
presentation of lung cancer
- persistent cough
- haemoptysis
- dyspnoea
- chest pan
- hoarse voice
- stridor
- facial swelling
- finger clubbing
- lymphadenopathy
systemic:
- weight loss
- fatigue
- appetite loss
SIADH
when do you 2ww referral for lung cancer
- CXR suggestive of lung cancer
- > 40yo and unexplained haemoptysis
- offer CXR if > 40y and 2 of the following: smoker, cough, fatigue, SOB, chest pain, weight/appetite loss
- offer XCR if > 40y and 1 of following: persistent or recurrent chest infections, finger clubbing, supraclaviular lymphadenopathy, chest signs consistent wit lung cancer, thrombocytosis
investigations for lung cancer
- CXR
- blood tests (FBC, renal function, bone profile, liver function)
- pulmonary function tests (essential before treatment)
- CT scan (for staging)
- bronchoscopy and biopsy
- PETCT scan
- brain CT/MRI (for metastasis)
lung cancer complications
- metastasis: brain, liver, kidneys, pleura, bone, adrenal glands
- Horner syndrome (Pancoast Tumour)
- SVC obstruction
- Paraneoplatic syndrome
prognosis of lung cancer
1 year survival of 30%
types of lung cancer
small cell squamous adenocarcinoma large cell alveolar cell carcinoma
