Principles of Oncology

Question 1

Tumor Node Metastasis (TNM) Staging

Answer 1

T: Tumor size and relation to surrounding structures
N: Features of regional lymph Nodes (number involved, location, size, extracapsular involvement)
M: Presence of distance Metastasis

Question 2

Treatment Terminology: Regional

Answer 2

Drug therapy localized to a specific area (e.g Intrathecal, intraperitoneal)

Question 3

Treatment Terms: Maintenance

Answer 3

-Drug therapy used to maintain remission

Question 4

Treatment Terms: High dose

Answer 4

-Doses above the standard range used primarily in combo with marrow rescue. Assumption that dose intensity is effective

Question 5

Treatment Terms: Palliation

Answer 5

Drug therapy given to reduce symptoms without an intent to cure disease

Question 6

Drug Classifications

Answer 6

-Alkylating agents
-Anthracyclines
-Anti-metabolites
-Taxanes
-Abx: dactinomycin, mitomycin, bleomycin
-Platinum analogues
-Topoisomerase I Inhibitors
-Topoisomerase II Inhibitors
-Tubulin Interactive agents
-Hormonal agents
-Biologic agents

Question 7

What is the oldest treatment that started in 1940s?

Answer 7

-Systemic Antineoplastic Treatment
-Cytotoxic therapy: interfere with DNA biosynthesis and the cell replication machinery

Question 8

What drug treatment inhibits signaling and metabolic pathways? It will destroy specific cells with antigenic markers

Answer 8

-Molecular targeted therapy
-Ex: Rituximab, Trastuxumab, Cetuximab, Bevacizumab

Question 9

What do hormonal agents do for cancer treatment methods?

Answer 9

-Block or prevent hormonal effects on tumor cells
-Examples: Tamoxifen, Anastrazole (breast), Leuprolide, bicalutamide (prostate)
-Can have a major toxicity with hormonal dysfunction

Question 10

What cancer treatment uses the hosts own immune system to fight cancer?

Answer 10

-Systemic antineoplastic treatment: Immunotherapy
-AKA immune checkpoint inhibitors (ICI)
-Immunoactivited NOT immunocompromised
-Caution with prescribing steroids as they can be counterproductive to the immunotherapy

Question 11

ICI Toxicities commonly affect which organs? (immunotherapy)

Answer 11

-Can with every organ system
-Most common: GI, derm, hepatic, lung, and endocrine
-Can have toxicity even up to 6 months after exposure
-Dose doesn’t matter

Question 12

ICI Toxicity Treatmetn

Answer 12

-High dose steroids (usually 1mg/kg) for several weeks or months
-Slow taper (guided by onc)
-Prophylaxis with PCP abx (Bactrim), daily PPI, Ca & vit D, prednisone

Question 13

Chemo Toxicity: Affects on fast growing cells

Answer 13

-Bone marrow
-Oral mucosa
-GI mucosa
-Skin

Question 14

Chemo toxicity: Agent specific effects

Answer 14

-Nephrotoxicity
-Neurotoxicity
-Hepatotoxicity
-Encephalopathy
-Pulmonary toxicity
-Secondary malignancies

Question 15

Most common chemo toxicity

Answer 15

-Skin: alopecia, nail changes
-Oral mucosa: mucositis
-GI Mucosa: diarrhea
-Bone Marrow: Cytopenia
-Others nausea/vomiting
-Fatigue

Question 16

Cutaneous Eruptions: Toxic erythema of chemotherapy (TEC)

Answer 16

-Hand-foot syndrome
-SJS
-Acneiform eruption
-Taxane rash (unofficially most common)

Question 17

SJS/TEN

Answer 17

-vesicles and bullae develop
-Within days skin begins to slough
-Resembles thermal injury
-Usually starts on face/thorax before spreading to other areas
-Symmetrical presentation
-Usually spares scalps, palms, and soles
-PAINFUL
-Treatment similar to burn victims

Question 18

Complications and Treatment of SJS/TEN

Answer 18

-Massive fluid loss, hypovolemic shock
-Infection/sepsis
-MODS
-Pulm complications
-GI: Diarrhea, bleed, colonic perforation, small bowel intussusception
-DIC

Question 19

Oral Toxicities

Answer 19

-Mucositis
-Candida (oral and esophageal)
-Other common AEs (taste changes, dry mouth)

Question 20

Mucositis

Answer 20

-starts with burning/pain/sensitivity
-Followed by solitary, elevated, white desquamative patches
-Involves tongue, palette, gums, and buccal areas
-Severe eruption can lead to infection or sepsis
-Risks with severe dehydration, poor PO intake, severe malnutrition

Question 21

Mucositis: Treatments

Answer 21

-Good oral hygiene
-Early: baking soda + saltwater rinses
-Severe: Augmentin
-Liquid steroid rinses
-Compounded mouthwashes
-Focal ulcerations: with lidocaine viscous

Question 22

White plaques on the buccal mucosa, palate, tongue and/or oropharynx

Answer 22

-Candidiasis: oropharyngeal

Question 23

Candidiasis treatment

Answer 23

-Nystatin
-Clotrimazole troches (can be expensive)
-Moderate-severe disease: Fluconazole (monitor LFTs)

Question 24

Hallmark sign of odynophagia and may or may not have oral candidiasis

Answer 24

Esophageal candidiasis

Question 25

Treatment of esophageal candidiasis

Answer 25

-Systemic antifungal (not topical) duration 14-21d

Question 26

Who is at highest risk of oral toxicities

Answer 26

Neutropenic patients

Question 27

Components of Cardiotoxicity

Answer 27

-Arrhythmias (afib most common)
-HF
-Myocardial necrosis causing dilated cardiomyopathy
-Myocarditis
-Cardiac dysfunction
-Prolong QTC
-Vasospasm
-Pericardial disease
-Arterial occlusive events

Question 28

What are common chemo agents that can cause cardiotoxicity?

Answer 28

-HER2 agents
-Anthracyclines
-Fluoropyrimidines

Question 29

True or False: Most cardiotoxicities have >90% risk of event reoccurrence with re-exposure to the offending agent

Answer 29

TRUE

Question 30

Drug induced pulmonary toxicity effects unilateral or bilateral lungs?

Answer 30

-Bilateral usually vs. radiation is usually unilateral

Question 31

Xray vs. CT for pulmonary toxicity dx

Answer 31

-CT imaging (xray usually will not be diagnostic)