Principles of Cancer Management Flashcards
how is cancer diagnosed ?
clinical
imaging - Xray, CT, MRI, PET
histopathology - fine needle aspiration, incisional biopsy
what are the principles of cancer management ?
surgery, radiotherapy, chemotherapy, hormonal manipulation, palliative care
what are the signs and symptoms of malignant disease ?
palpable swelling symptoms of obstruction heamorrhage compression/invasion of local structures metastatic disease asymptomatic incidental findings
what are the methods of investigation for cancer ?
endoscopic
radiological
pathology in the investigation of malignant disease
what are the different types of endoscopic investigation ?
oesophagogatroscopy, endoscopic retrograde cholangiopancreatography, sigmoidoscopy, colonoscopy, bronchoscopy, staging laparoscopy
what are the different types of radiological investigation ?
plain radiology, contrast radiology, ultrasound, CT, MRI, isotope, bone scans, thyroid scan, monoclonal antibodies
what types of biopsy are used to investigate malignant disease ?
FNAC, needle biopsy, wedge biopsy, excision biopsy
what does curative surgery for primary disease involve ?
'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
what does curative surgery for secondary malignant disease involve ?
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
what does reconstructive surgery for malignant disease involve ?
primary closure, skin grafts, skin flaps - random pattern flaps, axial flaps, myocutaneous flaps, free flaps
what is the purpose of palliative surgery for malignant disease ?
alleviation of obstructive symptoms,
diminution of transfusion requirements,
relieve pain
how can radiotherapy be delivered ?
external beam radiation,
local application,
systemic radioisotope therapy
what are the major applications of radiotherapy ?
primary curative, adjuvant, palliative
what are the complication of radiotherapy ?
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
what is the purpose of palliative radiotherapy ?
local control with minimal side effects,
prevent impending complications,
provide symptomatic relief
what are the indications for palliative radiotherapy ?
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)
how does chemotherapy work ?
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
what is adjuvant chemotherapy ?
chemotherapy given after surgery or radiotherapy has been used to control the primary disease
what is neo-adjuvant chemotherapy ?
chemotherapy given as an initial treatment to improve local control by combining two local modalities
what are the major applications of chemotherapy ?
primary curative treatment,
adjuvant chemotherapy,
general palliative treatment,
palliation of distressing local symptoms,
direct administration of the cytotoxic agents to the tumour
what are the modes of application of chemotherapy ?
orally, intramuscularly, intravenously, intrathecally, implanted lumps
what are the side effects of chemotherapy ?
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
what are the principles of palliative care ?
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
