Principles of Cancer Management

Question 1

how is cancer diagnosed ?

Answer 1

clinical
imaging - Xray, CT, MRI, PET
histopathology - fine needle aspiration, incisional biopsy

Question 2

what are the principles of cancer management ?

Answer 2

surgery,
radiotherapy,
chemotherapy,
hormonal manipulation,
palliative care

Question 3

what are the signs and symptoms of malignant disease ?

Answer 3

palpable swelling
symptoms of obstruction
heamorrhage
compression/invasion of local structures 
metastatic disease
asymptomatic incidental findings

Question 4

what are the methods of investigation for cancer ?

Answer 4

endoscopic
radiological
pathology in the investigation of malignant disease

Question 5

what are the different types of endoscopic investigation ?

Answer 5

oesophagogatroscopy,
endoscopic retrograde cholangiopancreatography,
sigmoidoscopy,
colonoscopy,
bronchoscopy,
staging laparoscopy

Question 6

what are the different types of radiological investigation ?

Answer 6

plain radiology,
contrast radiology,
ultrasound,
CT,
MRI,
isotope,
bone scans,
thyroid scan,
monoclonal antibodies

Question 7

what types of biopsy are used to investigate malignant disease ?

Answer 7

FNAC, needle biopsy, wedge biopsy, excision biopsy

Question 8

what does curative surgery for primary disease involve ?

Answer 8

'en bloc' resection
influenced by the mode of spread of disease
direct spread-
invasion of continuous structures,
into laterally placed tissue,
longitudinally along tubular structures 
spread via lymphatics

Question 9

what does curative surgery for secondary malignant disease involve ?

Answer 9

local recurrence,
regional lymph node recurrence treated with block dissection if distant metastasis excluded by CT,
second look surgery in colorectal disease,
detection of liver metastases following colorectal resection consider live resection

Question 10

what does reconstructive surgery for malignant disease involve ?

Answer 10

primary closure,
skin grafts,
skin flaps - 
random pattern flaps,
axial flaps,
myocutaneous flaps,
free flaps

Question 11

what is the purpose of palliative surgery for malignant disease ?

Answer 11

alleviation of obstructive symptoms,
diminution of transfusion requirements,
relieve pain

Question 12

how can radiotherapy be delivered ?

Answer 12

external beam radiation,
local application,
systemic radioisotope therapy

Question 13

what are the major applications of radiotherapy ?

Answer 13

primary curative, adjuvant, palliative

Question 14

what are the complication of radiotherapy ?

Answer 14

systemic side effects -
malaise and fatigue,
nausea, 
vomiting,
anorexia
side effects in irradiated tissue - 
skin - redness, itching, pain, breakdown
abdomen/pelvis - nausea, vomiting, diarrhoea, dysuria, haematuria 
head and neck - dry, painful mouth, dysphagia, mucositis, hair loss, radiation caries  
bone - osteoradionecrosis
chest - pain

Question 15

what is the purpose of palliative radiotherapy ?

Answer 15

local control with minimal side effects,
prevent impending complications,
provide symptomatic relief

Question 16

what are the indications for palliative radiotherapy ?

Answer 16

pain control - bone pain, nerve root and soft tissue infiltration
dyspnoea - shrinkage of obstructing tumour
ulcerating lesions - breast, skin, head, neck
haemorrhage - rectal and cervical bleeding
emergency complications - spinal cord compression, superior vena cava obstruction, raised intracranial pressure, tubular visceral obstruction (oesophagus, GI, ureter)

Question 17

how does chemotherapy work ?

Answer 17

drugs destroy tumour cells based on their increased mitotic and metabolic rates
alkylating agents bind to DNA,
some drugs cross link DNA,
some drugs disrupt the mitotic spindle

Question 18

what is adjuvant chemotherapy ?

Answer 18

chemotherapy given after surgery or radiotherapy has been used to control the primary disease

Question 19

what is neo-adjuvant chemotherapy ?

Answer 19

chemotherapy given as an initial treatment to improve local control by combining two local modalities

Question 20

what are the major applications of chemotherapy ?

Answer 20

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

Question 21

what are the modes of application of chemotherapy ?

Answer 21

orally, intramuscularly, intravenously, intrathecally, implanted lumps

Question 22

what are the side effects of chemotherapy ?

Answer 22

bone marrow suppression,
immunosuppression,
nausea and vomiting,
disruption of gastrointestinal epithelial turnover,
toxicity to hair follicles,
gondal injury,
long term risk of other malignancies,
rapid tumour destruction on a massive scale

Question 23

what are the principles of palliative care ?

Answer 23

assess prognosis and sequence of terminal events,
discuss prognosis and life expectancy with patient and relatives,
arrange consultations with GP,
ensure immediate access in the event of sudden deterioration,
identify future nursing requirement,
anticipate the development of symptoms,
prevention and early treatment of pain, nausea, vomiting, diarrhoea and constipation
continually review drug therapy, minimise side effects