Oncology - Intro

Question 1

What is cancer?

Answer 1

Cancer is characterized by uncontrolled cell proliferation, loss of natural apoptotic mechanisms, decreased cellular differentiation, the ability to invade surrounding tissues, and the establishment of new growth at ectopic sites.

Question 2

What are some cancer prevention strategies?

Answer 2

Cancer prevention strategies include lifestyle modifications such as avoiding tobacco and alcohol, limiting exposure to carcinogens at work, engaging in regular exercise, and getting vaccinated against cancer-causing viruses like HPV.

Question 3

What are some examples of carcinogens to avoid at work?

Answer 3

Examples of carcinogens to avoid at work include arsenic, benzene, asbestos, wood dust, and low-strength radiation. These substances can lead to various cancers such as lung, skin, liver, and nasal cancer.

Question 4

What are some cancer-causing viruses?

Answer 4

Cancer-causing viruses include Epstein-Barr virus (associated with Burkitt’s lymphoma), human T cell lymphotropic virus (associated with adult T cell leukemia), hepatitis B virus (associated with liver cancer), and herpesvirus (associated with Kaposi’s sarcoma).

Question 5

What is the HPV vaccine used for?

Answer 5

The HPV vaccine aims to prevent cervical cancer by vaccinating girls aged 12-13, with a catch-up program available for girls up to 18 years old. The vaccine comes in quadrivalent and bivalent forms, with the current uptake at 80% for the complete program.

Question 6

What are some examples of histological classifications of malignant tumors?

Answer 6

Histological classifications of malignant tumors include carcinomas (epithelial origin), sarcomas (connective tissue origin), leukemia (bone marrow origin), and lymphomas (lymphoid tissue origin), among others.

Question 7

What are the stages and grades of cancer?

Answer 7

Cancer stages are determined by the size and spread of tumors (T), involvement of lymph nodes (N), and presence of metastasis (M). Grades reflect the degree of differentiation of cancer cells, ranging from well-differentiated (low grade) to poorly differentiated (high grade).

Question 8

What are some medications that could mask early signs of cancer?

Answer 8

Medications such as PPIs, cough lozenges, creams for itching/rash, and plasters for recurrent sores may mask early signs of cancer. Patients taking these medications for extended periods should be vigilant for signs of cancer.

Question 9

What are some immediate referral criteria for cancer?

Answer 9

Immediate referral criteria for cancer include the presence of a lump, sore that does not heal, change in a skin mole, persistent difficulty swallowing or indigestion, changes in urinary frequency, unexplained bleeding, coughing up blood, visual disturbances, and other concerning symptoms.

Question 10

What are some NHS screening programs for cancer?

Answer 10

NHS screening programs include mammograms for breast cancer, cervical screening for cervical cancer, and bowel cancer screening for individuals aged 60-89. There are currently no national screening programs for prostate cancer or testicular cancer.

Question 11

What are the different types of cells that can become cancerous?

Answer 11

Common cell types that can become cancerous include blood cells, muscle cells, nerve cells, bone cells, liver cells, and cartilage cells. Rapidly dividing cells, such as liver cells, are more prone to mutations, but any cell can become cancerous due to genetic predisposition or exposure to carcinogens.

Question 12

What are the two ways cancer can form?

Answer 12

Cancer can form through cellular changes or mutations, including spontaneous errors, external agents, and oncogenes, as well as through lifestyle risk factors such as smoking and poor nutrition.

Question 13

What are the risk factors for cancer?

Answer 13

Risk factors for cancer include biological factors (genetic predisposition, hormonal risk), chemicals in food (sodium nitrate, clostridium botulinum toxin), viral factors (herpes, human papillomavirus), medical factors (diethylstilbestrol, chemotherapy), and occupational/environmental factors (asbestos, radioactive substances). Social and psychological factors (stress, negative emotions) may also contribute.

Question 14

How do errors in DNA replication contribute to cancer?

Answer 14

Example of this is thymidine in tautomeric form where thymine binds to guanine, this occurs frequently but proof reading prevents this. Errors in DNA replication can occur due to chemical changes in DNA bases, leading to mutations. While the body has mechanisms to proofread and correct these errors, mutations can still occur, increasing the risk of cancer development. Think about what happens if proofreading goes wrong?

Question 15

How are tumors classified?

Answer 15

Tumors are classified as benign or malignant. Benign tumors are contained, while malignant tumors are not enclosed in a fibrous shell and can metastasize to other parts of the body.

Question 16

Why are symptoms of cancer often initially misdiagnosed?

Answer 16

Symptoms of cancer are often initially misdiagnosed because they can mimic signs of other diseases, leading to delays in diagnosis. For example, symptoms of pancreatic cancer may be mistaken for other conditions.

Question 17

What are the aims of cancer treatment?

Answer 17

Cancer treatment aims include curative treatment for complete disease eradication, adjuvant treatment to prevent cancer recurrence after local treatment, and palliative treatment to control cancer, prolong life, and reduce symptoms.

Question 18

What is neo-adjuvent?

Answer 18

Chemotherapy to shrink cancer cells before surgery

Question 19

What are the types of cancer treatment?

Answer 19

Cancer treatments include surgical intervention, radiotherapy, and chemotherapy. Chemotherapy involves various agents such as cytotoxic agents, hormonal therapies, immunomodulation, targeted treatments, and biological therapies.

Question 20

How does radiotherapy work?

Answer 20

Radiotherapy uses ionizing radiation to kill cancer cells, aiming to destroy tumors, reduce tumor size, or improve the patient’s quality of life. It can be delivered externally or internally, targeting cancer cells while minimizing damage to normal tissue.

Question 21

What is proton beam therapy, and when is it used?

Answer 21

Proton beam therapy is an advanced form of radiation therapy that precisely targets tumors without damaging surrounding healthy tissue. It is suitable for certain cancers such as complex brain, neck, and head cancers, as well as some sarcomas.

Question 22

What are some characteristics of chemotherapy agents?

Answer 22

Targets actively dividing cells
To know how different cytotoxic medicines work on dividing cells we need to think about cell cycle i.e., G1,S,G2 and M phases

Question 23

How does chemotherapy work on dividing cells?

Answer 23

G1 phase – longest phase and synthesis of protein occurs. S phase – DNA synthesis. G2 – growth phase where cell starts to divided. M phase – mitotic division. Can also switch from G1 to G0 which is a resting phase. Cytotoxic treatment = killing of actively dividing cells, cancers mainly consist of targeting cells (loose targeting), we also affect other fast growing cells like hair etc.

Question 24

How are chemotherapy regimens selected?

Answer 24

Advantage of combo is reduced resistance due to different MOAs. Chemotherapy regimens are selected based on clinical trial evidence, including drugs with known single-agent activity, different mechanisms of action, additive or synergistic effects, dose-limiting toxicities, and treatment-free intervals that allow normal tissue recovery.

Question 25

What are some treatments which minimize affect on healthy cells?

Answer 25

Targeted hormonal therapy things like tyrosine kinase inhibitors, MABs, check point inhibitors, manipulating endocrine system by inhibiting certain hormones e.g., steroid hormones are powerful drivers of gene expression in certain cancers so inhibiting will stop cancer growing

Question 26

Give an example of a common chemotherapy regimen

Answer 26

Breast (FEC-T), 5-flurouracil, epirubicin, cyclophosphamide, docetaxel
Lymphoma (RCHOP) - Rituximab, cyclophosphamide, doxorubicin, Vincristine, prednisolone
Lung (Cis-gem) - Cisplatin and gemcitabine

Question 27

What are some reasons for chemotherapy failure?

Answer 27

Chemotherapy may fail due to various reasons, including failure to achieve a sufficient kill rate of cancer cells in a cycle, existence of multiple resistant or non-responsive clones, altered drug targets, increased repair of drug-induced cell damage, and tumor sanctuary sites.

Question 28

Response to chemotherapy, what it may conceal?

Answer 28

Sensitive cells decrease by each cycle but at the start of treatment there were small number of resistant cells, but they grow as they are not affected by that chemotherapy treatment we get to a point where patient is doing well and is below detectable threshold, but in the background resistant cells increase. The lag could be months or years thus we have to be vigilant, hence survivorship and continual monitoring requires funding

Question 29

What are the routes of chemotherapy administration?

Answer 29

Chemotherapy can be administered via intravenous (IV), oral, intrathecal, subcutaneous (SC), intravesical (into the bladder), or intrapleural (into the pleural lining of the lungs) routes, depending on the type of cancer and the treatment intent.

Question 30

How is chemotherapy dosed and administered?

Answer 30

Chemotherapy dosing is based on concepts like body surface area (BSA), dose banding, and patient characteristics influencing drug toxicity. It is administered in cycles, with schedules depending on treatment goals, cancer type, chemotherapy type, and patient health status.

Question 31

What are some examples of venous access devices?

Answer 31

Examples of venous access devices include simple cannulas, peripherally inserted central catheters (PICCs), and implantable ports. These devices require specialized training for insertion and maintenance and are chosen based on patient characteristics and treatment requirements.

Question 32

What is the first-line delivery line for delivering medication?

Answer 32

cephalic vein is first choice it allows easy insertion and monitor the arm (this is on forearm on thumb side) Dorsal venous network is second (hand). Medial cubital vein – avoid limits movement and extraversion is more difficult to detect

Question 33

What are the anaphylaxis signs to look for when administrating chemotherapy?

Answer 33

Swelling of the conjunctiva, runny nose, swelling of lips, tongue, or throat, light-headedness, loss of consciousness, confusion, respiratory symptoms, heart and vasculature symptoms, skin reactions, pelvic pain, loss of bladder control, crampy abdominal pain, diarrhea, vomiting

Question 34

What to do when someone has an anaphylactic reaction?

Answer 34

Check airways, breathing, circulation, disability and exposure, call 2222 2222 for help, lie patient flat and raise their leg, give adrenaline. When skills and equipment available Establish airway, high flow oxygen, IV fluid challenge, chormpheniamine, hydrocortisone and monitor; pulse oximetry, ECG and BP

Question 35

What is extravasation?

Answer 35

Extravasation is the leakage of a drug from its intended compartment of delivery into adjacent compartments. Factors involved include patient factors, practical factors, personnel factors, and pharmacological factors. we get necrotic breakdown of tissue, we use DNA binding agents to localize and neutralize and non DNA binding agents to dilute and spread

Question 36

What are some recommended treatments for managing alopecia caused by chemotherapy?

Answer 36

Wigs, hair bands, scalp cooling, partial alopecia management tools such as wigs and scarves

Question 37

What are the risk factors and types of chemotherapy-induced nausea and vomiting (CINV)?

Answer 37

Risk factors include gender, age, previous chemotherapy-induced nausea and vomiting, lifestyle factors, and history of travel sickness. Types of CINV include acute vomiting, delayed N+V, anticipatory CINV, breakthrough N+V, and refractory vomiting.

Question 38

How do you treat CINAV by classification?

Answer 38

• Acute – 5HT3 receptor antagonist e.g., ondansetron, metoclopramide, dexamethasone
• Delayed – dexamethasone, NK1-blcoker e.g., aripiprant
• Breakthrough – metoclopramide, cyclizine
• Anticipatory –levomepromazine SC
• Refractory – levomepromazine, NK-1 blocker, nabilone

Question 39

MHRA advice on domperidone, metoclopramide and ondansetron

Answer 39

Domperidone
- Give lowest effective dose (30mg), for shortest possible time (48hr)
- Due to cardiac ADRs inc. QT prolongation
Metoclopramide – neurological effects, esp. in young adults avoid if can not first-line
- Max 30mg/24hrs or 0.5mg/kg
- Shorter term use up to 4 days, IV slow over >3mins
Ondansetron – QT prolongation, cardiac arrythmia
- Max IV dose restriction depending on age
- <75yrs 16mg
- >75yrs 8mg
- 15min infusion time
- Repeat doses at least 4hr intervals

Question 40

What are the effects of radiation and chemotherapy on oral mucositis, and what are the risk factors associated with it?

Answer 40

Effects include white patches along the cheeks and tongue due to cell damage. Risk factors include patient factors such as nutritional status, age, gender, and treatment factors such as dose, radiotherapy, and neutropenia.

Question 41

Treatment of oral mucositis

Answer 41

-Pain control, ice pops and chips, pain medication,
-Dietetic medication eat moist and soft foods to avoid irritation around gum, avoid food that require lots of chewing, avoid acidic, spicy, salty and hot foods
-Oral care, rinse mouth 5-6 times a day each day, brush teeth with a soft toothbrush regularly

Question 42

Why is chemotherapy typically administered every three weeks, and what are the predisposing factors for neutropenic sepsis?

Answer 42

Chemotherapy is administered every three weeks to allow for the replenishment of neutrophils, which dip around 11 days after treatment. Predisposing factors for neutropenic sepsis include the duration and severity of neutropenia, loss of immunity, and disruptions in skin or mucosal barriers.

Question 43

What are the risk factors and preventive measures for tumour lysis syndrome (TLS)?

Answer 43

Risk factors for TLS include high tumour burden, high proliferation rate, and chemotherapy-sensitive disease. Preventive measures include vigorous hydration, close monitoring of renal function and electrolyte levels, and initiation of hypouricemic agents.

Question 44

Treatment of Febrile Neutropenia

Answer 44

• Piperacillin with tazobactam (tazocin) IV monotherapy unless significant hypotension (diastolic BP <60mmHg) or septic shock – then add gentamycin
• Vancomycin only if obvious line infection and/or severe mucositis and reassess at 48hrs, if significant isolate amend therapy
  and give antibiotic and antifungal prophylaxis and only give antiviral proylaxis if history of herpes virus
  and granulocyte-colony stimulating factors 24hrs after chemotherapy

Question 45

What are the basis and steps of managing extravasation during chemotherapy?

Answer 45

The basis of extravasation management includes keeping a cannula in place, palliating immediate symptoms, and then either neutralizing or diluting and spreading the extravasated drug. Steps include treating as other ulcerated tissue, debriding and granulating, and using DNA or non-DNA binding agents as appropriate

Question 46

How should healthcare providers monitor toxicity during cancer treatment?

Answer 46

Monitoring may include assessing cardiac function, blood pressure, urine output, lung function, gastrointestinal symptoms, skin reactions, and hematological parameters.

Question 47

What are the risk factors and potential treatments for chemotherapy-induced peripheral neuropathy (CIPN)?

Answer 47

Risk factors include treatment schedule, prior neuropathy, age, and pre-existing conditions. Treatments may include neuroprotective agents, such as thiols, anticonvulsants, and antioxidants, as well as newer alternatives like green tea, B vitamins, and fish oils.