Principles of cancer management

Question 1

5 principles of cancer management

Answer 1

• surgery
• radiotherapy
• chemotherapy
• hormonal manipulation
• palliative care

Question 2

6 signs of cancers

Answer 2

• palpable swelling
• symptoms of obstruction
• symptoms resulting from haemorrhage
• symptoms due to compression/invasion of local structures
• symptoms of metastasts
• asymptomatic incidental findings

Question 3

3 categories of investigation of cancer

Answer 3

• endoscopic
• radiological
• pathology

Question 4

6 endoscopic investigations

Answer 4

endoscopy: camera inside body
- oesophagogastroscopy
- ERCP endoscopic retrograde cholangiopancreatography (pancreatic ducts)
- sigmoidoscopy (rectal part of colon)
- colonoscopy (whole bowel)
- bronchoscopy (airways)
- staging laparoscopy (keyhole surgery)

Question 5

8 radiology techniques used to detect cancer

Answer 5

• plain radiology
• contrast radiology
• ultrasound
• CT
• MRI
• PET (uses radioactive tracers)
• isotope/bone scans
• monoclonal antibodies

Question 6

4 types of biopsy to investigate pathology of malignant disease

Answer 6

FNAC
needle biopsy
wedge biopsy
excision biopsy (remove whole tumour)

Question 7

4 classes of surgery for cancer

Answer 7

• curative for primary cancers
• curative for secondary cancers
• reconstructive
• palliative

Question 8

is surgery the first option for treatment of many cancers?why

Answer 8

no. many cancers respond better to chemo/radiotherapy

Question 9

what influences curative surgery of primary cancers

Answer 9

mode of spread

direct is most effectively treated: invades continuous/lateral/ longitudinal along tubular structures

Question 10

stages in diagnosing cancer

Answer 10

• clinical
• imaging (x ray, CT, MRI, US, PET within 2 weeks)
• histopathology (fine needle aspiration biopsy FNAB), incisional biopsy)

Question 11

what is done about regional lymph node recurrence of melanoma if distant metastasis excluded by CT

Answer 11

block dissection

Question 12

what to do if liver metastasis following colorectal resection is found

Answer 12

consider liver resection

Question 13

3 categories of reconstructive surgery for malignant surgery

Answer 13

• primary closure
• skin grafts
• skin flaps (random pattern/axial/myocutaneous/free)

Question 14

3 reasons for palliative surgery for malignant disease

Answer 14

• alleviation of obstructive symptoms
• diminution of transfusion requirements
• pain relief

Question 15

3 categories of radiotherapy

Answer 15

• external beam irradiation
• local application of radiotherapy
• systemic radioisotope therapy

Question 16

3 major applications of radiotherapy

Answer 16

• primary curative radiotherapy
• adjuvant radiotherapy
• palliative radiotherapy

Question 17

3 systemic side effects of radiotherapy

Answer 17

-malaise
fatigue
nausea
vomiting
anorexia

Question 18

side effects of radiotherapy on:

a. skin
b. abdomen/pelvis
c. head/neck
d. bone
e. chest

Answer 18

a. skin: skin breakdown, itchy, red
b. abdomen/pelvis: nausea, vomiting, diarrhoea, dysuria, haematuria
c. head/neck: dry painful mouth, dysphagia (pain swallowing), altered taste, mucositis, hair loss
d. bone: osteoradionecrosis
e. chest: dysphagia (pain swallowing)

Question 19

2 oral side effects of radiotherapy

Answer 19

radiation caries (normally around root surface)
radiation mucositis

Question 20

3 reasons for palliative radiotherapy

Answer 20

• local control w minimal side effects
• preventing impending complications
• symptomatic relief

Question 21

6 indications for palliative radiotherapy

Answer 21

• pain control (bone pain from breast/prostate/lung metastases or nerve and soft tissue infiltration)
• dyspnoea (shrinking obstructing tumour)
• ulcerating lesions (breast, skin, head/neck cancers)
• haemorrhage(haemoptysis, haematuria, rectal/cervical bleeding)
• emergency complications (spinal cord compression, SVC obstruction, raised intracranial pressure, oesophagus/upper GIT/ureter obstrution)
• symptomatic space-occupying tumours (eg brain metastasis)

Question 22

chemically, what are chemopathic agents

Answer 22

antimetabolite analogues of normal cellular nutrients

Question 23

ways chemopathic agents affect cells ABCD

Answer 23

Antimetabolic Analgoues of normal cellular nutrients
Bind to DNA (alkylating agents)
Crosslink DNA
Disrupt mitotic spindle

Question 24

define:

a. adjuvant chemotherapy

b. non-adjuvant chemotherapy

Answer 24

a. adjuvant chemotherapy: given after surgery/radiotherapy has been used to control primary disease
b. non-adjuvant chemotherapy: chemo given as inital tx to improve local control by combing 2 modalities

Question 25

5 major applications of chemotherapy

Answer 25

• primary curative tx
• adjuvant chemotherapy
• general palliative tx
• palliation of distressing local symptoms
• direct administration of cytotoxic agents to the tumour

Question 26

4 modes of application of chemo

Answer 26

• oral
• intramuscular
• intravenous
• intrathecal (in spinal theca)

Question 27

what is a Hickman line

Answer 27

venous access device for chemotherapy

Question 28

7 side effects of chemotherapy

Answer 28

• bone marrow suppression
• immunosuppression
• nausea/vomiting
• disruption of GI epithelial turnover
• toxicity to hair follicles (hair loss)
• gondal injury
• long term risk of other malignancies

Question 29

oral side effect of chemotherapy

Answer 29

herpes

Question 30

limitation of hormone tx for cancer

Answer 30

controls, does not cure

Question 31

2 hormones that cause maintenance of growth of some breast and prostate cancers

Answer 31

oestrogen

androgen

Question 32

2 hormones used on some primary breast tumours

Answer 32

oestrogen receptors

progesterone