Treatment modalities

Question 1

Chemotherapy

Answer 1

Drugs that affect the DNA/RNA of all cells, not just cancer cells

Question 2

Chemo classes:
Alkylating agents
Antibotics
Antimetabolites
Plant alkaloids
Monoclonal Antibodies
*Which class causes cancer?

Answer 2

• Alkylating agents: (-MIDE, -MINE) Mechlorthamin, Cyclophosamide, Chloramabucil, Melphalan, Ifosamide, bedamustine, thiotepa, hexamelamine, busulfan, carmustine, platinums
• Antibiotics: (-MYCIN, - ICIN) also include the anthracylines-doxorubicin, daunarubicin, idarubicin, mitoxantrone, bleomycin
• Antimetabolites: 5-FU, 6-Mercaptopurine (6-MP), Cytarabine, Floxuridine, fludarabine, gemcitibine, hydroxycarbamide

-Plant alkaloids:
Vinca alkaloids (VIN-) vincristine, vinblastine, vinorelbine
Taxanes (-TAXEL): Paclitaxel, docetaxel
Podophyllotoxins: etoposide, tenisopide
Camptothecan analogs: (-CAN) topotecan, irinotecan

-Monoclonal Antibodies (-MAB)

alkylating agents (ex: cyclophosamide) causes cancer

Question 3

Side effects of chemo by class:
Alkylating agents
Antibotics
Antimetabolites
Plant alkaloids
Monoclonal Antibodies

Answer 3

• Alkylating agents: carcinogenic, pulmonary system
• Antibiotics: anthracyclines are colorful and cardiotoxic, all are vesicants, bleomycin is not cardio or vesicant but is pulmonary toxic
• Antimetabolites: need supplementation B12 and folate
• Plant alkaloids: peripheral neuropathy
• Monoclonal Antibodies: allergic rxn, VEGF affects vasculature (increased BP)

Question 4

Treatment terms:
Neoadjuvant
Adjuvant
Concurrent
Sequential
Dose dense

Answer 4

• Neoadjuvant: chemo before surgery
• Adjuvant: chemo after surgery
• Concurrent: at the same time as surgery
• Sequential: following the radiation or surgery
• Dose dense: too much dosing at once, spread out over longer time - cyclophosamide/doxorubicin

Question 5

LEEP

Loop electro surgical excision

Answer 5

LEEP

• wire loop heated by electric current to remove cells and tissue in women’s lower vaginal tract

Nurse intervention
-avoid inserting anything into vaginal for 4 weeks

Question 6

Targeted therapies
EGFR
VEGF

Answer 6

• Targeted therapies have a cummulative effect, side effects can get better/worse as you continue to hit the target
• EGFR: nolotinib, AE: skin rash, avoid sun, cool showers, topical steroids or antinflammatory
• VEGF-ranibizumab, bevacizumab, affects vasculature, increased BP

Question 7

Radiation
External beam
IGRT
Brachytherapy
Others: gammaknife, cyberknife, fractionation
Define - fraction, trismus, tx vaginal stenosis, oophoplexi

Answer 7

-External beam: IMRT
beam doesnt know where to go, it must be calculated, measured, and input into the machine, dosing can be adjusted during treatment
-IGRT: beam doesnt know where to go, using coordinates the beam will find the tumor
-Brachytherapy: afterload machine is placed at predetermined positions marked by loaded applicator
-Fraction: dose of radiation
-Trismus: lock jaw, exercise b4
-vaginal stenosis: tx dialator
-oophoplexi: move ovaries out of the radiation field

Question 8

Immunity:
Cytotoxic immunity
Humoral immunity
Adaptive/Specific immunity

Answer 8

• Cytotoxic: T-cell mediated, dir cell ability to kill cancer cells - parts of the immune system can fight cancer, w/CTLA-4(ipi) and PD-1(pembro,nivo) and GVHD
• Humoral: B-cells mediated cant kill on its own, use the immune system to kill by flagging them- used in MAB
• Adaptive/specific: cell-mediated response attack the cancer cells

Question 9

Checkpoint inhibitors:
CTLA-4
PD-1

Answer 9

• T-cell mediated
• side effect is that it can start attacking normal cells
• CTLA-4: ipilimumab
• PD: programmed death, puts up blinders sot hat they dont kill all the cells, PD-1 inhibitors (pembro, nivo) will put down the blinders and kill all cells, PDL-1 inhibitor: Atezoluzimab