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Year 4 Cancer Care and Haem > Systemic Cancer Management > Flashcards

Systemic Cancer Management Flashcards

1
Q

Antimetabolites are a class of chemotherapy drug. How do they work?

A

Target S phase of cell cycle

Antagonises folic acid/purine synthesis or pyrimidine synthesis

Prevents either Thymidine or Nucleotide formation

Generally affects synthesis phase of other rapidly dividing cells

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2
Q

Give three examples of Antimetabolite agents and a common use

A

Methotrexate (inhibits dihydrogen folate reductase) - Leukaemia

Mercaptopurine - Acute Leukaemias

5FU - Wide Range

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3
Q

Give four examples of anti tumour antibiotics

A

Dactinomycin
Doxorubicin
Bleomycin
Mitomycin C

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4
Q

Give a use and a side effect of Doxorubicin

A

Breast Cancer

Permanent Cardiotoxicity

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5
Q

Give a use and a side effect of Bleomycin

A

Testicular Cancer

Pulmonary Toxicity

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6
Q

Give a use and a side effect of Mitomycin C

A

Intravesicle bladder cancer

Myelosupression

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7
Q

What is an Alkylating agent?

A

Alkyl groups interact with and cross link DNA

Can be monofunctional or bifunctional depending if one or two alkyl groups

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8
Q

Name two examples of Alkylating agents and their respective side effects

A

Mechlorethamine - Myelosupression

Cyclophosphamide - Haemorrhagic Cystitis

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9
Q

What are Anti-Microtubule agents? Describe the broad subtypes

A

Disrupt mitotic spindle disruption (targeting M phase)

Vinca Alkaloids - Blocks polymerisation of microtubules and stops mitotic metaphase

Taxanes - Promote and overstabilise microtubules which then becomes dysfunctional

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10
Q

Give an example of a Vinca Alkaloid and a side effect

A

Vincristine

Neurotoxicity

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11
Q

Give an example of a Taxane

A

Docetaxel

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12
Q

How do Platinum Agents work? Give an example

A

Similar to Alkylating agents as they cross link DNA

Cisplatin

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13
Q

How to Topisomerase work?

A

Inhibits nuclear enzymes which normally decline the supercoils in DNA to allow replication

Targets S Phase

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14
Q

Give two examples of Topisomerase inhibitors and respective uses

A

Irinotecan - Metastatic Colon Cancer

Etopiside - Lymphoma

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15
Q

Name four subtypes of Hormonal Therapies

A

SERM
Aromatase Inhibitors
GnRH Agonists
GnRH Antagonists

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16
Q

How are Glucocorticoids used as a Hormonal Therapy?

A

Can be used in combination for leukaemias and lymphomas

Reduces lymphoid mass and increases lymphocyte breakdown

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17
Q

How do SERMs work?

A

Can be an agonist, antagonist or partial agonist against oestrogen receptors

Tamoxifen is an antagonist in breast tissue
Tamoxifen is an agonist in endometrium
Raloxifene is a partial agonist in breast only

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18
Q

What is an Aromatase Inhibitor?

A

Post menopausal women produce a lot of oestrogen via aromatase pathway, which this inhibits

SE: Hot Flush, Reduced Bone Density

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19
Q

What are GnRH Agonists?

A

Eg Goserelin

Used for prostate cancer, constant stimulation of GnRH leads to desensitisation

Leads to an initial androgen flare

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20
Q

How are androgen flares treated during GnRH agonist therapies?

A

Anti Androgens such as Flutamide

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21
Q

Name a GnRH ANTagonist and give two side effects

A

Degarelix

Hot flushes
Impotence

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22
Q

How can biological/targeted therapies kill cancer cells?

A 
Block cell surface receptors
Receptor Ligand
Induce Immune Cells
Activating complement system
Delivering chemo straight to cancer cells
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23
Q

What is Herceptin? Give a side effect

A

Used in HER2 positive breast cancers

IgG Antibody that blocks receptor

Risk of Cardiotoxicity

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24
Q

What is Cetuximab? Give a Side Effect

A

A Mab that binds to VEGF used for metastatic colon cancer

Side effect is bleeding

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25
Q

What is Imatinib? Name a side effect

A

Tyrosine Kinase inhibitor active against BCRABL and used in CML

SE:Myelosupression

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26
Q

Biological/Targetted therapies can present with infusion reactions. How does it present?

A

Fever
Chills
Nausea

27
Q

Other than infusion reactions, name some side effects of biological therapies

A

Haemolytic Anaemia
Eosinophilia
Hepatitis/Dermatitis/Neuropathies

Often reversible with steroids

28
Q

What is Chemotherapy?

A

Systemic therapy used to kill cancer cells by causing apoptosis or cytotoxicity

Targets rapidly dividing cells

Can be cell cycle specific or cell cycle non specific

29
Q

Name five different uses of Chemotherapy

A

Induction therapy
Neoadjuvant to shrink before surgery/radio
Adjuvant (after surgery/radio)
Maintenance in lower doses (maintain remission)
Palliative (addressing symptoms)

30
Q

How is dosing of chemotherapy calculated?

A

Based on patients surface area

Cycles need to be the correct length to allow healthy cells to recover (but not cancer cells)

31
Q

Name seven common side effects of chemotherapy

A 
Alopecia 
Nausea and Vomiting
Neutropenia
Oral Mucositis
Weight Loss
Peripheral Neuropathy
Secondary Cancers
32
Q

Describe the side effect ‘Alopecia’ in Chemotherapy

A

Onset usually 7-10 days after chemotherapy

Managed with wigs and reassurance that it will return

33
Q

Describe the time frame of side effect ‘Nausea’ in Chemotherapy

A

Acute - within a few hours
Delayed - more than 24 hours
Anticipatory - conditioned response

34
Q

Describe the non pharmacological management of CINV

A

Small light meals several times a day
Dry Starchy food
Avoid vestibular stimulation
Sleep

35
Q

Describe the pharmacological options for management of CINV

A

Ondansetron
Aprepitant
Dexamethasone
Olanzepine

36
Q

Describe the side effect ‘Neutropenia’ in Chemotherapy

A

Neutrophils <1.5 (or <0.5 if severe)

Can consider G-CSF as prophylaxis
Antibiotics and sepsis 6 if any suspicion of neutropenic sepsis

37
Q

Describe the side effect ‘Oral Mucositis’ in Chemotherapy

A

Inflammation or ulceration of oropharyngeal mucosa which can interfere with eating/swallowing/speech
Onset peaks 7d after chemotherapy

38
Q

Describe the non pharmacological management of Oral Mucositis

A

8-12 cups of fluid
Avoid Spicy/Acidic Foods
Maintain good oral hygiene
Cryotherapy (such as ice chips)

39
Q

Describe the pharmacological management of Oral Mucositis

A

Mouth Rinses (not containing alcohol)

40
Q

Describe the management side effect ‘Weight Loss’ in Chemotherapy

A

Small frequent meals and nutrient supplementation

41
Q

Define Cachexia

A

Hypercatabolic state leading to weight loss despite nutritional supplementation

42
Q

Describe the side effect ‘Peripheral Neuropathy’ in Chemotherapy

A

Stocking and glove distribution

Managed by changing/adjusting dose, and trialing Gabapentin/Duloxetine

43
Q

What are the common secondary cancers

A

Myelodysplastic Syndromes

Acute Myeloid Leukaemia

44
Q

What is Radiotherapy?

A

Electromagnetic spectrum used to treat cancer (normally in XRay/Gamma Ray range)

It works by causing direct damage to DNA and or Indirect damage (by radical formation)

Targets rapidly dividing cells in M phase

45
Q

What are the four Rs that affect the efficacy of Radiotherapy ?

A

Repair of DNA by the cell (using fractionation wisely)

Repopulation of tumour cells in between fractions

Reassortment (solved by giving over many fractions to ensure all cells have been hit in M Phase)

Reoxygenation (cells further away from O2 supply are less radiosensitive)

46
Q

What are the three types of Radiotherapy?

A

External Beam Radiotherapy
Brachytherapy
Stereotactic Radiosurgery

47
Q

What is Brachytherapy?

A

Radioactive pellets inserted into tumour either temporarily (HDR) or permanently (LDR)

48
Q

What is Stereotactic Radiotherapy?

A

Uses either linear accelerators or specialises gamma knife

49
Q

What investigations are used to mark out tumour size and volume?

A

CT

PET

50
Q

How is chemotherapy often useful as a Radiotherapy adjunct?

A

It can be used as a radiosensitiser

51
Q

How can Radiotherapy be used palliatively?

A 
Bone Mets
Lung Mets
Brain Mets
Spinal Cord Compression
SVCO
52
Q

Lymphoedema is one of the long term complications of systemic therapy. What is it?

A

Swelling due to the obstruction of lymph fluid outflows causing build up in tissues

Progresses over two to four years causing pitting/thickening/achiness

53
Q

How is the severity of Lymphoedema determined?

A

Difference in circumference between affected and unaffected limb

Stage 1: 2-3cm difference
Stage 2: 3-5cm difference
Stage 3: >5cm difference

54
Q

Give one protective factor and one risk factor for Lymphoedema

A

Protective - Good skin care

Risk - LN dissection

55
Q

How is Lymphoedema managed?

A

Avoid tight clothes
Compression
Physio

56
Q

Radiation dermatitis and fibrosis is one of the long term complications of systemic therapy. What is it?

A

Fibrotic transformation due to repeated inflammation and healing

Can result in skin thickening, ulcers, dysphagia and urethral strictures

57
Q

How can radiation dermatitis/fibrosis be avoided?

A

Loose fitting clothes

Unscented water based moisturisers avoided pre therapy

Topical steroids after each session

58
Q

Describe the effect of chemotherapy on fertility

A

Can affect central or peripheral pathways

Can reduce sperm count

Chemotherapy is less toxic to oocytes than to follicular development (meaning temporary Amenorrhoea rather than early menopause)

59
Q

How does Radiotherapy affect fertility?

A

More damaging than chemotherapy

Can affect implantation as well as eggs/sperm

60
Q

How can fertility in systemic therapy be managed?

A

Pre-emptive preservation

Administering preserving medications during therapy

61
Q

How is Neuropathy secondary to chemotherapy managed?

A

Physiotherapy
Electrostimulation
Neuropathic Pain drugs

62
Q

How does Chemotherapy affect cognition and memory?

A

Chemotherapy- generally mild but can persist for months/years after

63
Q

How does Radiotherapy affect cognition and memory?

A

Biphasic

Temporary decline followed by permanent decline

Year 4 Cancer Care and Haem (16 decks)

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