Principles of cancer management Flashcards
5 principles of cancer management
- surgery
- radiotherapy
- chemotherapy
- hormonal manipulation
- palliative care
6 signs of cancers
- palpable swelling
- symptoms of obstruction
- symptoms resulting from haemorrhage
- symptoms due to compression/invasion of local structures
- symptoms of metastasts
- asymptomatic incidental findings
3 categories of investigation of cancer
- endoscopic
- radiological
- pathology
6 endoscopic investigations
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)
8 radiology techniques used to detect cancer
- plain radiology
- contrast radiology
- ultrasound
- CT
- MRI
- PET (uses radioactive tracers)
- isotope/bone scans
- monoclonal antibodies
4 types of biopsy to investigate pathology of malignant disease
FNAC
needle biopsy
wedge biopsy
excision biopsy (remove whole tumour)
4 classes of surgery for cancer
- curative for primary cancers
- curative for secondary cancers
- reconstructive
- palliative
is surgery the first option for treatment of many cancers?why
no. many cancers respond better to chemo/radiotherapy
what influences curative surgery of primary cancers
mode of spread
direct is most effectively treated: invades continuous/lateral/ longitudinal along tubular structures
stages in diagnosing cancer
- clinical
- imaging (x ray, CT, MRI, US, PET within 2 weeks)
- histopathology (fine needle aspiration biopsy FNAB), incisional biopsy)
what is done about regional lymph node recurrence of melanoma if distant metastasis excluded by CT
block dissection
what to do if liver metastasis following colorectal resection is found
consider liver resection
3 categories of reconstructive surgery for malignant surgery
- primary closure
- skin grafts
- skin flaps (random pattern/axial/myocutaneous/free)
3 reasons for palliative surgery for malignant disease
- alleviation of obstructive symptoms
- diminution of transfusion requirements
- pain relief
3 categories of radiotherapy
- external beam irradiation
- local application of radiotherapy
- systemic radioisotope therapy
3 major applications of radiotherapy
- primary curative radiotherapy
- adjuvant radiotherapy
- palliative radiotherapy
3 systemic side effects of radiotherapy
-malaise fatigue nausea vomiting anorexia
side effects of radiotherapy on:
a. skin
b. abdomen/pelvis
c. head/neck
d. bone
e. chest
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)
2 oral side effects of radiotherapy
radiation caries (normally around root surface) radiation mucositis
3 reasons for palliative radiotherapy
- local control w minimal side effects
- preventing impending complications
- symptomatic relief
6 indications for palliative radiotherapy
- 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)
chemically, what are chemopathic agents
antimetabolite analogues of normal cellular nutrients
ways chemopathic agents affect cells ABCD
Antimetabolic Analgoues of normal cellular nutrients
Bind to DNA (alkylating agents)
Crosslink DNA
Disrupt mitotic spindle
define:
a. adjuvant chemotherapy
b. non-adjuvant chemotherapy
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
5 major applications of chemotherapy
- primary curative tx
- adjuvant chemotherapy
- general palliative tx
- palliation of distressing local symptoms
- direct administration of cytotoxic agents to the tumour
4 modes of application of chemo
- oral
- intramuscular
- intravenous
- intrathecal (in spinal theca)
what is a Hickman line
venous access device for chemotherapy
7 side effects of chemotherapy
- 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
oral side effect of chemotherapy
herpes
limitation of hormone tx for cancer
controls, does not cure
2 hormones that cause maintenance of growth of some breast and prostate cancers
oestrogen
androgen
2 hormones used on some primary breast tumours
oestrogen receptors
progesterone
