Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cancer care > Principles of cancer therapy > Flashcards

Principles of cancer therapy Flashcards

1
Q

What is the role of the cancer MDT?

A 
Standardise
Continuity 
Reduce delays
Communication
Recruitment to clinical trials
Education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neoadjuvant meaning

A

Chemo/radio given before definitive surgery/radio to optimise outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Adjuvant meaning

A

Treatment after definitive surgery/radio to reduce recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Maintenance treatment

A

Maintain remission or slow growth after initial treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Curative treatment

A

Aims for no detectable cancer after treatment

Usually means a systemic treatment because of micro-mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Palliative treatment

A

To relieve sx + improve QoL, can affect prognosis but not lead to cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Performance status

A

0-asymptomatic
1-fully mobile but restricted in strenuous activity
2-mobile, self-care, but can’t do work activities, in bed <50% of the day
3-limited ability t self-care, in bed/chair >50% of the day
4-completely disabled, not able to self-care
5-dead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can cancer cells acquire resistance to chemo?

A
  • Efflux pumps
  • Reduced drug uptake
  • Increased drug metabolism
  • Alteration of cell cycle checkpoints
  • Impaired apoptosis
  • Altered drug target morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do they try to prevent chemo resistance?

A
  • Combination of drugs based on action + not overlapping toxicities
  • Some toxicity permissible as need maintained doses when cure realistic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are bone marrow cells very sensitive to cytotoxics?

A

BM cells (+ other rapidly dividing cells) omit the G0 (resting) phase, which is the phase where cytotoxics cannot act

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antimetabolite chemo?

A

E.g. methotrexate, gemcitabine, fluorouracil, capecitabine

Act at G1 by inhibiting/mimicking DNA bases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anthracycline chemo

A

E.g. doxorubicin

Acts at G1 by affecting mitochondrial DNA thus energy generation, and at S phase by inhibiting DNA topoisomerase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Alkylating agents

A

E.g. cyclophosphamide

Act at S phase by binding DNA helix preventing transcription

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anti-tumour antibiotics

A

E.g. bleomycin

Act at S phase - break DNA strands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Platinum compounds

A

E.g. cisplastin

Act at S phase - bind to nucleotide bases = deform double helix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vinca alkaloids

A

E.g. vincristine

Act at G2 by inhibiting microtubules and also affect the M phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Topoisomerase inhbitros

A

E.g. topotecan

Act at G2 by inhibiting microtubules and also affect the M phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Taxanes

A

E.g. docetaxel

Act at G2 by inhibiting microtubules and also affect the M phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Outline the cell cycle

A

G0 - resting

G1 - cell growth + preparation for DNA synthesis

G1 checkpoint

S - DNA replication

G2-more growth, prep for mitosis

G2 checkpoint

M - mitosis

20
Q

What must be taken into account when prescribing cytotoxics?

A
  • Narrow therapeutic indices
  • Dose for the individual based on PS, BMI, drug handling ability
  • Combination to allow synergism
  • Route: IV, PO, SC, intralesional, intrathecal, topical, IM
21
Q

List the common side effects of chemotherapy

A
  • Head: fatigue, alopecia, ‘chemo brain’
  • Skin: plantar palmar erythema, nail ridging as growth stops each cycle, peripheral neuropathy, extravasation
  • Lungs: pneumonitis, PE, fibrosis
  • Heart: cardiomyopathy (e.g. doxorubicin)
  • Blood: myelosuppression, NS, thromboembolism
  • Liver: deranged LFTs
  • GIT: N+V, mucositis, diarrhoea, constipation
  • Renal: AKI, electrolyte imbalance, toxicity
  • Bladder: haemorrhagic cystitis
  • Repro: impaired fertility, reduced libido, premature menopause, teratogenic
22
Q

Oral mucositis

A

Causes difficulty eating + talking, complicated by candida

M: prevention is best like mouth wash after meals/ice cube sucking/carbonated drinks/soft bristle toothbrush, chlorhexidine or saline mouth wash, anaesthetic mouthwash/spray, barrier gels, topical/systemic antifungals if candida

23
Q

BM suppression

A

Risk in all cytotoxics except vincristine and bleomycin

Usually peak effect 7-10d after dose

24
Q

Which agents are most linked to N+V during chemo?

A

Cisplatin, carboplatin, doxorubicin, daunorubicin, oxalipplatin

25
Q

When do chemo drugs cause N+V?

A

In the first 24h acutely, or delayed up to 5d after chemo

Due to stimulation of the CTZ in the area postrema - activates emesis centre in reticular formation

26
Q

How might N+V be prevented?

A

Prescribe known antiemetic regiments in preparation - IV pre-treatment, or oral pre-treatment, or daily
Aim at agent with the highest emetogenic potential

27
Q

Which antiemetics are used for chemo-induced N+V

A 
Ondansetron
Dexamethasone
Aprepitant
Domperidone
Metoclopramide
28
Q

What meds are used for constipation?

A
  • Co-danthramer: stimulant + softener but only in EOLC as poss cardiotoxic
  • Glycerine: often as a suppository, local colon irritation to stimulate passage
  • Docusate: softener + mild stimulant, draws water into stool
  • Lactulose: disaccharide not absorbed from GIT so softens stool by osmosis
  • Senna: increases motility + mucous, and reduces fluid absorption
  • Movicol: iso-osmotic, adds bulk + increases water absorption + stimulates propulsion + lubrciates
29
Q

Management of diarrhoea due to chemo

A

Fluids if dehydrated
Anti-diarrhoeal e.g. loperamide - can prescribe for PRNs but dont use as prophylaxis
May temporarily stop causative agent

30
Q

Causes + CF of extravasation

A

Leakage of agent into the tissue around the vein, as cannula doesn’t remain in the vein’s lumen

CF: may have ‘flashback’ but actually a haematoma; pain stinging burning erythema at site of injury (check under clothes as may be away from site of cannula), blistering, change in skin colour

Can lead to severe damage of tendons/nerves/joints/tissues

Not itchy or urticarial - suspect allergy

31
Q

Management of extravasation

A
  • Stop infusion immediately + disconnect, mark borders of erythema
  • DO NOT remove cannula/line
  • Aspirate drug from the cannula + some blood if poss
  • Cold pack + seek expert advice + implement recommended plan
  • Follow up as may evolve over some days
32
Q

Infusion reactions

A

Common esp with carboplatin + monoclonal antibodies, so usually give a pre-med to reduce the risk
M-SC atropine
May not necessarily need to avoid in future if reaction was only mild

33
Q

Non-systemic venous irritation

A

Due to the drug, other things in preparation, concentration, degradation, too cold (vasospasm if below room temp) and vascular tone

M: stop infusion, warm to encourage vasodilation, flush with a compatible fluid to dilute it, IV steroid, hydrocortisone cream to skin

34
Q

Late effects of chemotherapy?

A

Peripheral neuropathy, secondary cancers esp leukaemia, infertility, early menopause, osteoporosis, heart/lung/renal problems, fatigue, mild cognitive impairment

35
Q

Outline the principles of immunotherapy

A

Interfere with immune response, most usually immune checkpoint inhibitors which interfere with the relationship between T cells and antigen presenting cells

Interleukins e.g. IL-2 to activate T cell responses

36
Q

Side effects of immunotherapy

A
  • Any ‘itis’ (excessive immune activity, but usually resolve after stopping or steroids)
  • GI like pain, blood in stool, diarrhoea, perforation
  • Skin: immune dermatitis, pruritus, dry skin, SJS/TEN
  • Hepatic toxicity
  • Neuro: GBS, MG (cos immune neuropathies)
  • Endocrine effects like hypothyroidism and adrenal insufficiency
37
Q

Principles of molecular targeted therapies

A

Patient expresses the targeted molecule AND the drug can interrupt a growth-critical pattern in that cancer

  • Monoclonal antibodies (MAB): they bind to a certain antigen blocking downstream signalling thus stopping proliferation. E.g. HER2 inhibitor trastuzumab in breast + some gastric Ca, EGFR inhibitors in bowel cancer (Cetuximab)
  • Receptor kinase/small molecule inhibitors (IB): e.g. imatinib (inhibits BCR-ABL fusion in CML)
38
Q

Side effects of targeted therapies

A
  • Skin: aceniform rash, dryness, hair growth disorder, pruritis, nail changes
  • Fatigue
  • Myelosuppression
  • Diarrhoea, nausea, GI perf
  • Arterial thromboembolic events, cardiac ischaemia
  • Flu like sx
  • Abnormal LFTs
39
Q

Principles of hormone therapy

A

Blocking oestrogen in breast + endometrial cancer, e.g. tamoxifen

Blocking androgens in prostate cancer

Minimal toxicity but need to have the detectable cellular receptors

40
Q

How does radiotherapy work?

A

High energy ionising radiation damages DNA + causes free radicals which damage proteins/membranes

Is v specific calculation involving lots of planning

41
Q

Aims of radiotherapy

A
  • radical: usually 4-7w daily treatment in small fields with high total dose. esp for CNS + lymphoma, or as part of adjuvant
  • palliative: to alleviate sx like bone mets or RICP or obstructions. Usually 1-10 daily treatments with a larger field of irradiation + low total dose
42
Q

Early side effects of radiotherapy (d-w)

A

Erythema, desquamation, fatigue, N+V, alopecia, dysphagia, oral mucositis (esp H+N-often need a PEG), sterility, diarrhoea, low blood counts from going through bone, lymphedema, dysuria, radiation cystitis

43
Q

Late side effects of radiotherapy (m-y)

A

Unrelated to acute s/e - due to loss of slowly-proliferating cells causing fibrosis + ischaemia

  • Skin: necrosis, pigmentation, telangiectasia, ulceration
  • Bone: necrosis, #, impaired growth
  • Mouth: ulcers, dryness
  • Eyes: cataract, vision loss
  • CR: pulmonary/pericardial fibrosis, cardiomyopathy
  • Gonads: infertility, menopause
  • Bowel: strictures, adhesions, fistulae
  • Secondary malignancies: any really, haematological appear earlier
44
Q

Typical side effects of specific chemotherapy drugs

A
  • Pyrimidine analogues e.g. 5-FU: mucositis, dermatitis
  • Platinum analogues e.g. cysplatin: ototoxicity, peripheral neuropathy
  • Alkylating agents e.g. haemorrhagic cystitis
  • Folic acid antagonists e..g methotrexate: mucositis, liver/lung fibrosis
  • Vinca alkaloids e.g. vincristine: neurotoxicity so never give intrathecally; peripheral neuropathy, paralytic ileus
  • Bleomycin - lung fibrosis
  • Doxorubicin - cardiomyopathy
45
Q

Types of radiotherapy

A
  • External beam: commonest, like a CT scanner
  • Brachytherapy: usually a boost treatment in prostate + cervix, radioactive seeds stay inside and release radiation
  • Systemic injected/swallowed (rare)

Radiosensitisers often used when having chemo + radio i.e. chemo that work well with radio, so can have a lower dose of chemo

Cancer care (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions