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Heme/Onc Exam 1 > Treatment Modalities and Monitoring > Flashcards

Treatment Modalities and Monitoring Flashcards

1
Q

Treatment decisions for Cancer are based on:

A

● Extent of disease
● Prognosis and staging
● Patients wishes
● Determine curative or palliative care
● Treat comorbidities

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2
Q

Cancer Therapies are ____

A

Toxic

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3
Q

Cancer therapies have a _____

A

Narrow therapeutic index (TI)
May have to treat to the point of toxicity

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4
Q

Local Treatment

A

● Surgery
● Radiation
● Ablation

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5
Q

Systemic Treatment

A

● Chemotherapy
○ Hormone therapy
○ Molecular targeted therapy
● Biological Therapy
○ Immunotherapy

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6
Q

____ – chemo and/or radiation prior to surgical resection

A

Neoadjunctive Therapy

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7
Q

______ – chemo and/or radiation at the time or just after surgery

A

Adjunctive Therapy

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8
Q

Most effective means of treating cancer

A

Surgery

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9
Q

Why is surgery helpful with specific metastasis?

A

○ Limit lung metastasis from osteosarcoma
○ Colon cancer metastasis to the liver (fewer than 5 mets to 1 lobe)

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10
Q

Additional benefits to surgery

A

○ Decrease mass effect (debulking)
○ Preserve organ function
○ Make the cancer more treatable by other means

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11
Q

Why is it important to Avoid disturbance of tumor as much as possible in surgery?

A

Prevent vascular and lymphatic spread

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12
Q

_____ is the first draining node from the tumor

A

Sentinel node

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13
Q

Surgery Also used for _____

A

palliative or supportive measures

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14
Q

Radiation Therapy

A

● Ionizing radiation
○ Hydroxyl radicals from tissue/cell water
○ Breaks in DNA and generation of free radicals
● Free radicals aggressively search for and steal electrons from other molecules damaging the cell wall, proteins and organelles
● Uses X-rays and Gamma rays
○ Eject orbital electron and produce ions

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15
Q

Radiation dose is based on ____

A

the amount of energy absorbed by the
tumor

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16
Q

Goal of radiation dosing

A

Idea is to catch more cells in their mitotic phase, which makes them more susceptible to radiation damage

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17
Q

Radiation Therapy – Delivery types

A

● Teletherapy – focused beams of radiation generated at a distance and aimed at the tumor
○ External beam radiation, Gamma Knife
● Brachytherapy – encapsulated sources of radiation implanted directly into or adjacent to tumor tissues
○ Radioactive seed implant for prostate cancer
● Systemic Therapy – radionuclides administered
○ IV or PO but targeted to the tumor site

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18
Q

Urgent radiation

A

○ Malignant spinal cord compression
○ SVC Syndrome
○ Hemoptysis
■ Disruption of vessels and/or friable tumor
○ Airway obstruction

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19
Q

Goal of Urgent Radiation

A

● Urgent consult to Radiation Oncology
● Decrease the size of the tumor and/or reduce pain

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20
Q

Radiation damage can occur to healthy cells by

A

○ Acute toxicity
○ Chronic toxicity

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21
Q

Goal of Radiation Therapy

A

Maximize effect on tumor cells, while sparing healthy tissue

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22
Q

Injured tissues release ____ that cause systemic effects

A

cytokines

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23
Q

Tissues with ____ cell turnover are more susceptible to radiation damage

A

high

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24
Q

Chronic Radiation Toxicity

A

○ Thyroid failure
○ Cataracts and retinal damage → Blindness
○ Disrupts salivary glands → Dental caries
○ Anosmia
○ Myocardial infarction, pericarditis
○ Lung injury and/or fibrosis
○ Radiation enteritis or cystitis
○ Risk of second solid tumor ~1% each year after second decade of treatment

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25
Q

Ablative Therapy

A

Radio Frequency: Focused microwave (non-ionizing radiation) to induce thermal injury to the tissue
Cryosurgical: Using extreme cold to destroy the lesion
Thermal (not widely available): Usually done in conjunction with other Tx

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26
Q

3 Types of Chemotherapy

A

○ Conventional “Cytotoxic” Agents
○ Targeted Agents
■ Hormonal Therapies
○ Biologic Therapies

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27
Q

Conventional “Cytotoxic” Agents

A

● Main target is DNA
○ Not specific to cancer, can harm normal tissues
■ Narrow therapeutic indices
● Used in conjunction with surgery
○ Eliminate smaller disseminated tumors

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28
Q

Conventional “Cytotoxic” Agent groups

A

○ Alkylating Agents
○ Antitumor Antibiotics and Topoisomerase Poisons
○ Antimetabolites
○ Antimitotic Agents (Mitotic Spindle Inhibitors)

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29
Q

Alkylating Agents – Cyclophosphamide are used for

A

non-hodgkin’s lymphoma, breast cancer

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30
Q

Side effects of Alkylating Agents

A

Cystitis, pulmonary fibrosis, cardiac dysfunction
Contraindication: Liver disease impairs metabolism

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31
Q

Antitumor Antibiotics and Topoisomerase Poisons – Doxorubicin

A

○ Generate free radicals causing single stranded breaks DNA
○ Unwinds DNA (“S-phase”)
Used for many, many types of cancer

32
Q

Alkylating Agents – Cyclophosphamide

A

○ Cross-links DNA, giving the appearance of “breaks” in the DNA
○ Cannot complete normal cell division
○ Promotes apoptosis

33
Q

Side effects Doxorubicin

A

Myelosuppression, alopecia, nausea, and
mucositis, cardiotoxic

34
Q

Antimetabolites – Methotrexate

A

○ Interfere with purine or pyrimidine synthesis
○ Most toxic to cells in the “S phase”

35
Q

Antimetabolites – Methotrexate uses

A

Used for acute Lymphoblastic Leukemia (ALL), non Hodgkin lymphoma

36
Q

Side effects of Antimetabolites – Methotrexate

A

Myelosuppression, stromitis, diarrhea

37
Q

Antimitotic Agents – Vincristine

A

○ Disaggregation of microtubules
○ Block cell growth in the “M-Phase”
○ Strong promoter of apoptosis

38
Q

Antimitotic Agents – Vincristine uses

A

Used for hodgkin’s and non Hodgkin lymphoma, neuroblastoma

39
Q

Side effects of Antimitotic Agents (Mitotic Spindle Inhibitors) – Vincristine

A

Neurotoxicity – “glove and stocking” neuropathy, jaw pain,
paralytic ileus, urinary retention

40
Q

Systemic Treatment – Targeted Agents

A

Use of antibodies or cytokines directed at specific molecular targets (oncogenes products)expressed in the malignant tumor
● Ultimately leads to tumor cell death

41
Q

Targeted Agents example

A

Imatinib (non-receptor tyrosine kinase antagonist)

42
Q

Imatinib MOA

A

○ Targets ATP binding site of the p210 protein kinase
○ Which targets the Philadelphia chromosome of Chronic
Myelogenous Leukemia (CML)

43
Q

Targeted Agents - Hormonal Agents

A

● Alter gene transcription in hormone-responsive tissues

44
Q

Hormonal agent uses

A

○ Estrogen, androgen and glucocorticoid
○ Breast, prostate and lymph cancers

45
Q

Hormonal agents example

A

Tamoxifen

46
Q

Tamoxifen MOA

A

● Estrogen receptor antagonist, blocking biologic effect of the hormone
● Works best if the tumor manifests the estrogen receptor

47
Q

Systemic Treatment – Biologic (Immunologic)

A

● Help induce host immune response to the tumor cells
● Manipulate host tumor interaction

48
Q

Biologic (Immunologic) example

A

Rituximab

49
Q

Rituzimab MOA

A

● Targets CD20 molecule on B-cell lymphomas
● Effects both tumor signaling and activated immune response to B-cell
neoplasm

50
Q

Biologic treatment side effects

A

● Infusion hypersensitivity reactions – usually limited to the first infusion
● Hives, fever, fatigue, myelosuppression
● S/E can be managed with prophylactic glucocorticoids and antihistamines

51
Q

Stem Cell Transplant

A

● Used for leukemias
● Autologous or from a donor
● Higher dose of
chemotherapy can be used
● Stem cells used to “rescue”
the patient

52
Q

Precision Medicine

A

“Genomic medicine” – via DNA sequencing, target specific genetic
alterations associated with a tumor

53
Q

Precision medicine examples

A

○ BRAF – Vemurafenib (Inhibits BRAF enzyme, used in Melanoma)
○ RET – Sunitinib and sorafenib (Antineoplastic, tyrosine kinase inhibitors)

54
Q

Symptom Management in cancer is about

A

Maintaining and improving quality of life

55
Q

When we are talking about pain from cancer we need to determine whether ___

A

it is Pain from the tumor itself or from the treatment

56
Q

Determine the cause of the pain in Cancer includes deciphering whether it is ___

A

○ Nociceptive (somatic or visceral – structure involvement)
○ Neuropathic (CNS or nerve involvement)

57
Q

Pain treatment in cancer

A

○ Pain medications
○ Therapy aimed at the tumor
○ Neurostimulator
○ Regional analgesia

58
Q

Nausea management treatment

A

● Prochlorperazine (Compazine)
● Dexamethasone IV
● Ondansetron (Zofran)
● Metoclopramide (Reglan)

59
Q

Symptom management - Effusions

A

Fluid accumulation
○ “Malignant Pleural Effusion” (lung, breast, lymphoma)
○ Pericardial effusion → Cardiac Tamponade
○ Peritoneum

60
Q

drainage techniques for effusions

A

○ Thoracentesis or chest tube
○ U/S guided pericardiocentesis,
Surgery – “Pericardial window”
○ Paracentesis

61
Q

Symptom Management – Nutrition

A

Decreased appetite or changes in metabolism → Weight Loss
○ Cachexia

62
Q

What to Monitor for nutrition in Cancer symptoms

A

● Weight
● Albumin
● Transferrin

63
Q

Nutrition treatment in cancer

A

● Enteral nutrition supplementation (oral or feeding tube)
● Parenteral supplementation (IV)

64
Q

Symptom Management – Anemia

A

● Fatigue, exertional fatigue
● Tachycardia
● Dizziness
● Depression
● Anorexia

65
Q

Anemia treatment in cancer

A

Iron, EPO, transfusion with “packed RBC” (if criteria met)

66
Q

Myelosuppression

A

Radiation and/or Chemotherapy suppresses bone marrow production
of WBC

67
Q

Febrile Neutropenia

A

(Neutrophil < 1500; range 2,500-7000)
Single oral temperature > 101 F, or > 100.4 F for at least an hour, with
neutrophil count < 1500 cells/microliter

68
Q

Febrile Neutropenia Presentation

A

Fever, chills, rash, diarrhea, mouth ulcers, or any sign of infection

69
Q

Treatment of myelosuppression

A

● Neupogen – WBC growth factor
● Strict infection precaution
○ Lower threshold for antibiotics
○ Oncology consult (if not already established)

70
Q

Myelosuppression - Thrombocytopenia

A

○ Common in hematologic malignancy
○ Severe bleeding risk with platelets < 20,000/uL

71
Q

Myelosuppression - Thrombocytopenia treatment

A

Platelet Transfusion
○ Risk of transfusion reactions/sensitization
○ Rapid platelet clearance

72
Q

Stomatitis

A

● Common in chemo patients
● Ulcerations in the mouth and esophagus

73
Q

Stomatitis Treatment

A

● Good oral care
● Avoid irritative foods

74
Q

Response to treatment

A

○ Complete response – evidence that the cancer disappears
○ Partial response – decreased size of the cancer
○ Stable Disease – no change, remains stable
○ Progressive disease – new lesions or increase in size

75
Q

Monitoring criteria for Cancer

A

■ Labs
■ Imaging
■ Tumor markers
● Track progression or regression of tumor burden
● Not used for diagnosis (not specific enough)

Heme/Onc Exam 1 (7 decks)

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