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Oncology > Pre-placement > Flashcards

Pre-placement Flashcards

1
Q

What are the most common cancers for men in England?

A
  • Prostate
  • Lung
  • Colorectal
  • Bladder
  • Non-Hodgkin Lymphoma
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2
Q

What are the most common cancers for women in England?

A
  • Breast
  • Lung
  • Colorectal
  • Uterus
  • Ovary
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3
Q

What is palliative treatment in oncology?

A

Therapy where the aim is to improve QoL but where the cure is not possible. This could include most cancer treatments (chemotherapy, radiotherapy, surgery) and symptomatic treatment.

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4
Q

What is the course of radiotherapy?

A
  • Given as a course to give healthy tissue a chance to recover in between
  • Given in fractions: 1-10 usually palliative, 20-33 usually radical/curative
  • Can give alone or concurrently with chemo
  • Takes 15-30 mins, usually once per day
  • Patient is seen in clinic and written info is given then consent > planning scan taken and then treatment within a few days for palliative, 10-14 days if radical
  • Planning methods - CT stimulator or clinical mark-up (if cancer is on the skin)
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5
Q

What can be used for positioning in radiotherapy?

A
  • Immobilisation shells
  • Breast/lung boards
  • Radiotherapy tattoos
  • Lasers
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6
Q

What are the early side effects of radiotherapy?

A
  • Normal tissue gets inflamed
  • Fatigue
  • Pain flare
  • Oesophagitis
  • Pneumonitis
  • Skin reaction
  • Diarrhoea
  • Nausea
  • Cystitis
  • Increased ICP
  • Hair loss
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7
Q

What are the late side effects of radiotherapy?

A
  • Fibrosis
  • Stricture
  • Osteonecrosis
  • Rib fracture
  • Second malignancy
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8
Q

What is radical radiotherapy?

A
  • Given with curative intent e.g. prostate, larynx, cervix, lung
  • Treat whole tumour: extra margins for microscopic spread, extra margin for set up error, organ motion
  • Keep normal soft tissues to safe limit
  • Planning is complex
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9
Q

How do you manage motion in radiotherapy?

A
  • Bladder protocol e.g. empty bladder before treatment
  • Stomach protocol - don’t eat for 2 hours before
  • Breath hold
  • 4D CT scan
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10
Q

What is brachytherapy?

A

Typically done on prostate/cervix&raquo_space; radioactive seeds placed within the target tissue, so treats cancer from the inside out.

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11
Q

What is proton treatment?

A

Protons minimise exit dose to normal tissues especially useful if target near sensitive structures/in paediatric patients.

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12
Q

What is palliative radiotherapy?

A
  • Not curative, given to relieve symptoms e.g. pain, SOB, bleeding, obstruction
  • Don’t need to treat whole tumour, only the part that’s causing symptoms
  • Late effects less of an issue - not as concerned about normal tissue
  • Planning more simple - priority to plan and treat quickly
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13
Q

What are the classes of chemotherapy?

A
  • Platinum and other classical alkylating agents
  • Anthracycline abx
  • Non-anthracycline abx e.g. bleomycin, actinomycin D
  • Antimetabolites e.g. methotrexate, purine analogues, pyrimidine analogues
  • Topoisomerase inhibitors e.g. irinotecan, toptecan, etoposide
  • Toxanes e.g. paclitaxel and docetaxel
  • Vinca alkaloids e.g. vincristine, vinblastine, vinorelbine
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14
Q

What are the roles of chemotherapy?

A
  • Curative - to cure chemo-sensitive tumours: lymphoma, germ cell tumours, leukaemia
  • Adjuvant: to reduce risk of relapse, neo-adjuvant in stomach/oseophagus, adjuvant in breast/colon/lung
  • Radio-sensitise: low doses to increase efficacy of radical radiotherapy
  • Palliation: relieve symptoms from wide-spread incurable tumours
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15
Q

What is the nomenclature of chemotherapy?

A
  • Chemotherapy is normally administered over a few hours once every 2-3 weeks in cycles (to allow patient/organ/blood count recovery)
  • Hence cycle 2 day 15 would be a time of FBC nadir
  • Multiple drugs given together are known as a regimen
  • Treatment for relapse is 2nd or in haematoncology, salvage
  • Most lines of therapy would consist of no more than 6 cycles over 5 months of treatment
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16
Q

What are the side effects of chemotherapy?

A
  • Bone marrow: neuropenia, thrombocytopenia
  • GI tract: mucositis, n+v, diarrhoea
  • Skin: alopecia, hand-foot syndrome
  • Heart: heart failure, angina/MI
  • Lungs: pulmonary fibrosis
  • Kidney: renal impairment
  • Nerves: peripheral neuropathy, hearing loss
  • Endometrium and reproductive organs: infertility
17
Q

What are chemotherapy emergencies?

A
  • Febrile neutropenia/neutropaenic sepsis (biggest killers
  • Thrombocytopaenic haemorrhage (rare outside of haematological cancer)
  • Tumour lysis syndrome - complication of success, rapid cell breakdown leads to severe biochemical abnormalities
18
Q

What can be done to help with preservation of fertility?

A
  • Should be discussed with patients as follows - males from adolescance onwards, females of reproductive age, pre-pubertal females are a special case dealt by paediatricians
  • Semen crypopreservation is typically successful, oocyte less so
  • Embryo preservation is optimal for female patients in stable relationships
19
Q

What are side effects of immunotherapy?

A
  • Infusion Related Reaction (IRR) - anaphylactoid in nature and are treated similarly, through adrenaline is reserved later in treatment pathway
  • CPIs (immune checkpoint inhibitors) may cause immune activation against normal tissues - essentially autoimmunity (-itis) (treat with steroids ~1 month)
20
Q

What are the side effects of tyrosine kinase inhibitors?

A
  • Diarrhoea
  • Rash
  • LFT abnormalities - drug-drug interactions)
  • Cytopenias possible in haematological cancers
  • Typically managed by holding the drug and reintroducing at a lower dose
21
Q

What is the ECOG Performance Status Scale?

A

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 >50% of waking hours.
3 Capable of only limited self care, confined to bed/chair >50% of waking hours
4 Completely disabled and confined to bed/chair. No self-care
5 Deceased

22
Q

What are the options for breast cancer treatment?

A
  • Hormone treatment
  • Surgery - wide local excision (lumpectomy) or mastectomy (prognosis very similar)
  • Chemotherapy - neo-adjuvant (prior to definitive treatment)
  • Radiotherapy - adjuvant after wide local excision
23
Q

What are the indications for a mastectomy?

A
  • Multifocal tumour
  • Central tumour
  • Large lesion in small breast
  • DCIS >4cm
  • If multiple lumpectomies haven’t been successful
  • If can’t have radiotherapy after e.g. pregnant
  • Genetic predisposition (BRCA 1 + 2) - bilateral
24
Q

What are the indications for a wide local excision?

A
  • Solitary lesion
  • Peripheral tumour
  • Smal lesion in large breast
  • DCIS <4cm
25
Q

What does the grade of cancer mean?

A
  • Grade 1: cancers are generally slow growing and similar to healthy cells
  • Grade 2: intermediate
  • Grade 3: fast growing cancer cells
26
Q

What would be in a pathology report for a tumour?

A
  • Grade
  • Ki-67: mitotic index, proportion of cells under active division (>10% is significant) - high % then may need adjuvant therapy
  • Clear margins: no cancer cells at the edge of the specimen, don’t need to operate again
  • No. of lymph nodes the cancer was found in - usually take them all out but may require additional radiotherapy to the area to ensure there are no cancer cells left behind.
27
Q

What lymph nodes drain from the breast?

A
  • Axillary
  • Supraclavicular
  • Internal mammary chain
28
Q

What are the side effects of axillary node clearance?

A
  • Lymphodema - heavy arm, enlarged, painful, cellulitis, lose feeling in hand
  • Tx: compression sleeves, physiotherapy
29
Q

What can be given in HER2+ cancers?

A

Traztuzumab or pertuzumab - monoclonal antibodies which target the HER2 receptor to prevent its activation and arrest growth

30
Q

What treatment would be used in pre-menopausal women for breast cancer?

A

Tamoxifen (SERM) which blocks oestrogen receptors in the breast, preventing growth. Used in pre-menopausal women as they continuously produce oestrogen (from ovaries).

31
Q

What treatment would be used in post-menopausal women for breast cancer?

A

Anastrozole is an aromatase inhibitor. This drug blocks the conversion of peripheral fat into oestrogen. Post-menopausal women do not produce oestrogen from their ovaries, this is their main source of oestrogen.

32
Q

When would radiotherapy be offered after a mastectomy?

A
  • T3-4 tumours
  • > /= 4 positive axillary nodes - also include the supraclavicular fossa and potentially the axilla if >10 nodes but no distant mets
33
Q

Why are bisphosphonates used in breast cancer?

A

Reduce risk of bone related events e.g. metastatic disease

34
Q

What investigations would you do for oesophageal cancer?

A
  • CT thorax, abdomen and pelvis
  • PET - metastatic disease
  • Endoscopy - visualise and biopsy
  • Upper 1/3 oesophagus - bronchoscopy, lower 1/3 - laparoscopy
35
Q

What are the side effects of capecitabine and cisplatin?

A
  • Capecitabine - vasospasm and increases risk of angina, heart attack and stroke. This risk is higher with prior hx of IHD.
  • Cisplatin - requires a large volume of fluid due to renal excretion and risk of toxicity, so good cardiac function is important. Poor cardiac function may lead to acute HF/pulmonary oedema
36
Q

What are the early side effects of radiotherapy?

A
  • Tiredness
  • Skin soreness, redness and itching in treatment area
  • Increased saliva or mucous production
  • Loss of appetite > weight loss
  • Oesophagitis - odynophagia/dysphagia
  • Indigestion or heartburn
  • N+v
  • Abdo discomfort or bloating
  • Hair loss in treatment area
  • Pneumonitis - cough, SOB
  • May require feeding via tube into stomach/small intestine
37
Q

What are the late side effects of radiotherapy?

A
  • Oesophageal stricture
  • Fibrosis (scarring) of underlying lung - SOB, cough or changes on XR
  • Risk of damage to heart - risk depends on position of tumour in oesophagus
  • Skin changes in treatment area including: altered colour (lighter or darker), scarring, telangiectasia (small visible blood vessels, look like spidery marks)
  • Oesophageal or gastric ulceration or perforation (tear) > surgery
  • Oesophageal fistulation: abnormal connection between oesophagus and airways
  • Myelitis: inflammation of nerves which may cause a change in muscle power or sensation
  • Risk of rib fracture after an injury
  • A different cancer in the treatment area - not related to the current cancer, may occur yrs later
38
Q

Why is the rule around radiotherapy and food?

A

Do not eat for 2 hours before radiotherapy, digestion of food can move tumour so it’s not as targeted therapy and will increase exposure of the stomach to radiation.

39
Q

What are the differentials for further dysphagia after treatment of oesophageal cancer?

A
  • Recurrence of cancer
  • Benign oesophageal stricture (radiotherapy SE)
  • Achalasia
  • Oesophageal dysmotility

Oncology (7 decks)

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