Principles of Oncology Flashcards
Tumor Node Metastasis (TNM) Staging
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
Treatment Terminology: Regional
Drug therapy localized to a specific area (e.g Intrathecal, intraperitoneal)
Treatment Terms: Maintenance
-Drug therapy used to maintain remission
Treatment Terms: High dose
-Doses above the standard range used primarily in combo with marrow rescue. Assumption that dose intensity is effective
Treatment Terms: Palliation
Drug therapy given to reduce symptoms without an intent to cure disease
Drug Classifications
-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
What is the oldest treatment that started in 1940s?
-Systemic Antineoplastic Treatment
-Cytotoxic therapy: interfere with DNA biosynthesis and the cell replication machinery
What drug treatment inhibits signaling and metabolic pathways? It will destroy specific cells with antigenic markers
-Molecular targeted therapy
-Ex: Rituximab, Trastuxumab, Cetuximab, Bevacizumab
What do hormonal agents do for cancer treatment methods?
-Block or prevent hormonal effects on tumor cells
-Examples: Tamoxifen, Anastrazole (breast), Leuprolide, bicalutamide (prostate)
-Can have a major toxicity with hormonal dysfunction
What cancer treatment uses the hosts own immune system to fight cancer?
-Systemic antineoplastic treatment: Immunotherapy
-AKA immune checkpoint inhibitors (ICI)
-Immunoactivited NOT immunocompromised
-Caution with prescribing steroids as they can be counterproductive to the immunotherapy
ICI Toxicities commonly affect which organs? (immunotherapy)
-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
ICI Toxicity Treatmetn
-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
Chemo Toxicity: Affects on fast growing cells
-Bone marrow
-Oral mucosa
-GI mucosa
-Skin
Chemo toxicity: Agent specific effects
-Nephrotoxicity
-Neurotoxicity
-Hepatotoxicity
-Encephalopathy
-Pulmonary toxicity
-Secondary malignancies
Most common chemo toxicity
-Skin: alopecia, nail changes
-Oral mucosa: mucositis
-GI Mucosa: diarrhea
-Bone Marrow: Cytopenia
-Others nausea/vomiting
-Fatigue
Cutaneous Eruptions: Toxic erythema of chemotherapy (TEC)
-Hand-foot syndrome
-SJS
-Acneiform eruption
-Taxane rash (unofficially most common)
SJS/TEN
-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
Complications and Treatment of SJS/TEN
-Massive fluid loss, hypovolemic shock
-Infection/sepsis
-MODS
-Pulm complications
-GI: Diarrhea, bleed, colonic perforation, small bowel intussusception
-DIC
Oral Toxicities
-Mucositis
-Candida (oral and esophageal)
-Other common AEs (taste changes, dry mouth)
Mucositis
-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
Mucositis: Treatments
-Good oral hygiene
-Early: baking soda + saltwater rinses
-Severe: Augmentin
-Liquid steroid rinses
-Compounded mouthwashes
-Focal ulcerations: with lidocaine viscous
White plaques on the buccal mucosa, palate, tongue and/or oropharynx
-Candidiasis: oropharyngeal
Candidiasis treatment
-Nystatin
-Clotrimazole troches (can be expensive)
-Moderate-severe disease: Fluconazole (monitor LFTs)
Hallmark sign of odynophagia and may or may not have oral candidiasis
Esophageal candidiasis
Treatment of esophageal candidiasis
-Systemic antifungal (not topical) duration 14-21d
Who is at highest risk of oral toxicities
Neutropenic patients
Components of Cardiotoxicity
-Arrhythmias (afib most common)
-HF
-Myocardial necrosis causing dilated cardiomyopathy
-Myocarditis
-Cardiac dysfunction
-Prolong QTC
-Vasospasm
-Pericardial disease
-Arterial occlusive events
What are common chemo agents that can cause cardiotoxicity?
-HER2 agents
-Anthracyclines
-Fluoropyrimidines
True or False: Most cardiotoxicities have >90% risk of event reoccurrence with re-exposure to the offending agent
TRUE
Drug induced pulmonary toxicity effects unilateral or bilateral lungs?
-Bilateral usually vs. radiation is usually unilateral
Xray vs. CT for pulmonary toxicity dx
-CT imaging (xray usually will not be diagnostic)
