Treatment

Question 1

What are Weinberg’s hallmarks of cancer

Answer 1

Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
enabling replicative immortality
Inducing angiogenesis
Resisting cell death

Question 2

What is brachytherapy

Answer 2

Delivery of a local radiotherapy using small physical objects inserted in the target organ instead of an external beam

Question 3

What is radical treatment

Answer 3

Curative intent - aims to eradicate the tumour often at the expense of treatment related side effects

Question 4

What is palliative treatment

Answer 4

Non-curative, aims to improve symptoms/QoL and prolong life but not at the expense of significant side effects

Question 5

What is adjuvant therapy

Answer 5

After surgery aimed at reducing the risk of reccurence

Question 6

What is neo-adjuvant therapy

Answer 6

Before surgery, usually to shrink a tumour before surgical removal

Question 7

What is overall survival

Answer 7

Time alove

Question 8

What is disease free survival

Answer 8

Time without any symptoms/signs of cancer

Question 9

What is progression free survival

Answer 9

Time living with cancer that is not getting worse

Question 10

What is local control

Answer 10

Time without recurrence or progression at a specific tumour site

Question 11

What are some chemotherapy options

Answer 11

Alkylating agents
Platinum salts
Anti-metabolites
Taxanes
Anthracyclines
Topoisomerase inhibitor

Question 12

What do alkylating agents do

Answer 12

Attach an alkyl group to DNA

Question 13

What do platinum salts do

Answer 13

DNA cross-linking

Question 14

What do anti-metabolites do

Answer 14

Interfere with DNA/RNA growth

Question 15

What do taxanes do

Answer 15

They are mitotic inhibitors

Question 16

What do anthracyclines do

Answer 16

Interfere with enzymes for DNA coying

Question 17

What does a topoisomerase inhibitor do

Answer 17

Prevents DNA strands from unwinding

Question 18

What are some (well known) side-effects of chemotherapy

Answer 18

General malaise and fatigue
Alopecia
GI- diarrhoea, nausea, mucositis (mouth ulcers) and altered taste
Haem - neutropenia (low neutrophils), thrombocytopenia (low platelets) and anaemia

Question 19

What are the other side-effects of chemotherapy

Answer 19

Peripheral neuropathy
renal/liver impairment
Nail changes
Fertility changes / menopause

Question 20

How does radiation kill cnacer

Answer 20

The wavelength causes a double strand break in the DNA - preventing division and causing cell death

Question 21

What are the acute symptoms of radiotherapy (weeks)

Answer 21

Fatigue
Erythema/desquamation
Head and Neck -Mucositis, pain odynophagia (painful swallowing)
Pelvis - diarrhoea, cystitis
Thorax/Abdomen - oesophagitis, nausea/vomiting

Question 22

What are some late symptoms of radiotherapy (months-years)

Answer 22

Skin fibrosis/ulceration
Dysphagia
Bowel dysfunction
Incontinence
Bladder instability
Pneumonitis (Cough, dyspnoea)
Menopause
Infertility
Secondary cancer

Question 23

How is radiotherapy prescribed

Answer 23

In Grays (Gy) as a unit of absorbed dose divided into fractions delivered Mon-Fri.

Question 24

How does radical and palliative radiotherapy compare in delivery

Answer 24

Radical is usually done over 25-30 fractions (4-6w) and often combined with chemotherapy
Palliative radiotherapy is at much lower doses

Question 25

Whatdoes Herceptin/traztumab do

Answer 25

Binds to HER2 receptors in the epithelial growth factor (EFGR) family