Oncology Overview and Side Effect Management Flashcards
Cancer risk factors
Sunlight exposure, tobacco use, excessive alcohol intake, obesity, older age, poor diet, and low physical activity
External factors of cancer
chemicals, radiation
Internal factors of cancer
hormones, genetic disorders
These 2 types of skin cancer are common and unlikely to metastizie
basal cell and squamous cell carcinoma
_____ is the least prevalent type of skin cancer but is the most deadly.
melanoma
Treatment given after the primary therapy (usually surgery) or concurrent with other therapy (usually radiation) to eradicate residual disease and decrease recurrence
adjuvant
Treatment given before the primary therapy (which is usually surgery) to shrink the size of the tumor and make surgery more effective
neoadjuvant
The disappearance of the signs and symptoms of cancer, but not necessarily the presence of the disease (cancer could be undetectable but still present)
remission
TNM staging: T refers to…
tumor size and extent
TNM staging: N refers to…
spread of cancer to lymph nodes
TNM staging: M refers to…
whether the cancer has metastasized
Type of tumor marker common in colon cancer
carcinoembryonic antigen (CEA)
CAUTION warning signs of cancer that warrant referral to a physician
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening of lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
What medication is recommended for prevention of colorectal cancer?
low-dose aspirin
Using a broad-spectrum sunscreen, at least SPF _______, and reapplying every _______ reduces the risk of developing skin cancer.
15-30; 2 hours
Lifetime cumulative dose: 400 units
Toxicity: ?
bleomycin; pulmonary toxicity
Lifetime cumulative dose: 450-550 mg/m2
Toxicity: ?
doxorubicin; cardiotoxicity
Dose per cycle shouldn’t exceed 100 mg/m2
Toxicity: ?
cisplatin; nephrotoxicity
Single dose capped at 2 mg
Toxicity: ?
vincristine; neuropathy
Medication that prevents cardiac damage from doxorubicin
dexrazoxane
Almost all chemo drugs cause myelosuppression, except:
asparaginase, bleomycin, vincristine
Match the management to their related toxicity:
- Neutropenia: __
- Anemia: __
- Thrombocytopenia: __
a. Platelet transfusions
b. Colony-stimulating factors (CSFs)
c. RBC transfusions, and (in palliation only) erythropoiesis-stimulating agents (ESAs)
- b
- c
- a
Cisplatin, cyclosphosphamide, and ifosfamide commonly cause which chemo-related toxicity?
nausea and vomiting
What medications are used to manage chemo-induced nausea and vomiting (CINV)?
neurokinin-1 receptor antagonist (NK1-RA), serotonin-3 receptor antagonist (5HT3-RA), dexamethasone, olanzapine, metoclopramide, prochlorperazine
IV/PO fluid hydration
Which chemo drugs most commonly cause mucositis?
fluorouracil and methotrexate
Chemo drugs that commonly cause diarrhea
irinotecan, capecitabine, fluorouracil, methotrexate
Therapeutic treatment of chemo-induced diarrhea
IV/PO fluid hydration, antimotility meds (loperamide)
Irinotecan: Atropine for early-onset diarrhea
Chemo drugs that commonly cause constipation and its management
vincristine
Management: Stimulant laxatives, PEG 3350 (Miralax)
Management of xerostomia (dry mouth)
artificial saliva substitutes, pilocarpine, amifostine
Chemo drugs that commonly cause:
Pulmonary fibrosis
Pneumonitis
Pulmonary fibrosis: Bleomycin, busulfan, carmustine, lomustine
Pneumonitis: Methotrexate (with chronic use) and MAbs targeting CTLA-4 or PD-1
Management of pulmonary toxicity caused by chemo
- Symptomatic management
- Stop therapy
- Steroids (if an autoimmune mechanism is suspected) for immunotherapy agents
- Do not exceed recommended lifetime cumulative dose of 400 units for bleomycin
Drugs that commonly cause hepatotoxicity
- Antiandrogens (bicalutamide, flutamide, nilutamide)
- Folate antimetabolites (methotrexate)
- Pyrimidine analog antimetabolites (cytarabine)
- Some MAbs
Drugs that commonly cause nephrotoxicity and its management
Cisplatin and methotrexate (high doses)
Management:
- Amifostine (Ethyol) can be given prophylactically with cisplatin to reduce the risk of nephrotoxicity
- Adequate hydration
- Max dose of cisplatin
Which chemo drugs causes hemorrhagic cystitis?
ifosfamide (all doses)
cyclophosphamide (higher doses > 1 g/m2)
Which drug is always given prophylacticallt with ifosfamide (and sometimes with cyclophosphamide) to reduce the risk of hemorrhagic cystitis?
Mesna (Mesnex)
Chemo drugs that cause peripheral neuropathy and autonomic neuropathy
Peripheral: Vinca alkaloids (vincristine, vinblastine, vinorelbine), platinums (cisplatin, oxaliplatin), and taxanes (paclitaxel, docetaxel, cabazitaxel)
Autonomic: Vinca alkaloids
Oxaliplatin causes an acute ______________; instruct patients to avoid _________ and avoid drinking _________.
Cold-mediated sensory neuropathy; cold temperatures; cold beverages
Aromatase inhibitors (e.g., anastrozole, letrozole), SERMs (e.g., tamoxifen, raloxifene), and immunomodulators commonly cause what chemo-induced toxicity?
thromboembolism
Adjunctive treatment used as prophylaxis to prevent ________ from cisplatin.
Amifostine (Ethyol) and hydration; nephrotoxicity
Given with fluorouracil to enhance efficacy (as a cofactor)
leucovorin or levoleucovorin
Fluorouracil or capecitabine antidote: Use within __ hours for an overdose or to treat severe, life-threatening or early-onset toxicity.
Uridine triacetate; 96
Adjunctive treatment used as prophylaxis to prevent ________________ from ifosfamide.
Mesna (Mesnex) and hydration
Used to prevent or treat acute diarrhea from irinotecan
atropine
Used to treat delayed diarrhea from irinotecan
loperamide
Given prophylactically after high-dose methotrexate to decrease ___________ and ____________.
Leucovorin or levoleucovorin; myelosuppression; mucositis
Antidote to decrease excessive methotrexate levels d/t acute _______________.
glucarpidase; renal failure
The lowest point that WBCs and platelets reach is called the _______, which occurs (with most drugs) about ________ days after chemo.
nadir; 7-14
The RBC nadir generally occurs after several months of treatment, d/t the long life-span of RBCs, which around _______ days.
120
How long does it take WBCs and platelets to recover post-treatment?
3-4 weeks
Neutropenia is defined as an ANC of less than ________ cells/mm3.
1,000
Severe neutropenia is defined as an ANC of less than _____ cells/mm3.
500
How do growth colony stimulating factors (G-CSFs or CSFs) work? How and why are they given?
- Stimulate the production of WBCs in the bone marrow
- Given prophylactically after chemo
- Shorten the time that a pt is at risk for infection d/t neutropenia
- Reduce mortality from infections
T/F: G-CSFs are used for acute treatment of neutropenia.
False; only used to prevent (or reduce) neutropenia
Example of a G-CSF
filgastrim
Example of a pegylated G-CSF
pegfilgastrim
Filgastrim is given ______, and pegfilgastrim is given __________.
daily; once per chemo cycle
What is the advantage of pegfilgastrim over filgastrim?
Pegfilgastrim is pegylated, which extends its half-life.
CSF that’s used only for stem cell transplants.
sargramostim