Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oncology > Treatments > Flashcards

Treatments Flashcards

1
Q

List some common adverse effects of chemotherapy

A 
Dyspnoea 
Diarrhoea/constipation 
Dysuria 
Infection 
Nausea and vomiting 
Oral mucositis 
Dysphagia 
Anorexia 
Pain 
Weight loss/gain 
Fatigue 
Peripheral neuropathy
Alopecia - temporary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Traditional chemotherapy typically targets which cell types

A

Rapidly dividing cells

This means the cancer cells are targeted but also healthy cells which happen to divide rapidly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In which tissues do chemo side effects typically occur in

A

GI tract, bone marrow and hair matrix

This is because the cells here are rapidly dividing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does chemotherapy attack cells

A

Disrupting cell division
Attacking DNA
Disrupting essential metabolism for DNA replication
Can also affect cytoplasmic signalling, cell membrane receptor synthesis, expression and function and the cellular environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chemotherapy doses are typically calculated in relation to which factor

A

The patient’s body surface area

Also consider renal excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why are breaks given between chemotherapy cycles

A

To maximise tumour cell death whilst minimising normal cell death
This is because normal cells have greater propensity for recovery than
malignant cells, therefore rest between cycles allows normal cell
recovery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between neo-adjuvant and adjuvant chemotherapy

A

Neo-adjuvant - to shrink tumour prior to surgery/
radiotherapy and treat micro-metastases

Adjuvant - given after surgery/radiotherapy to destroy
any remnant cancer cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chemotherapy induced nausea &

vomiting affects which proportion of patients

A

70-80%

One of the most common side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common treatment for chemotherapy induced nausea and vomiting

A

Give ondasentron prior to chemo dose

Given in combination with dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List non-pharmacological treatments for chemo induced nausea and vomiting

A

Stay hydrated - sip on cool drinks
Small meals staggered throughout the day
Easy to swallow food
Food/drink with minimal smells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the major adverse effect of ondansetron to consider when prescribing

A

QT prolongation

More common ones include constipation and headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should always be considered in a cancer patient with back pain

A

Metastatic spinal cord compression

Usually the result of bony mets which are most commonly seen in lung, breast and prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When prescribing an opiate, you should always co-prescribe

A

A laxative and an antiemetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which chemotherapy drugs can cause peripheral neuropathy

A

carboplatin and paclitaxel

Many other can as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the typical distribution of peripheral neuropathy caused by chemo

A

Symmetrical ‘glove and stocking’ distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What effect of chemo leads to the life threatening side effects such as neutropenic sepsis

A

Myelosuppression - bone marrow suppression
Can lead to infection
(neutropenic sepsis), bleeding (thrombocytopenia) and
anaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you reduce the amount of hair loss during chemo

A

Cold caps
These lower the temperature of the scalp, which reduces
the amount of chemotherapy drug reaching the hair
follicles
Don’t work for everyone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A fever in a chemo patient should make you suspect what

A

Neutropenic sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the diagnostic features of neutropenic sepsis

A

A temperature >38C + neutrophils 0.5×10^9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you manage neutropenic sepsis

A
  1. Initiate Sepsis 6 protocol
  2. Start empirical antibiotic therapy - NICE recommends
    Piperacillin with Tazobactam. Gentamicin, vancomycin and
    ciprofloxacin can be used if penicillin allergic.
  3. Confirm diagnosis with blood results
  4. Senior review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does targeted cancer therapy work

A

These drugs have specific molecular targets they work on - can be an individual gene from patient or tumour or specific proteins expressed by the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List some examples of targeted cancer therapy

A

Hormonal therapies
Angiogenesis
inhibitors
Apoptosis inhibitors

Common targets include
BRAF in melanoma
HER2 in breast - Herceptin
BRCA1/2 in ovarian/breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the major issue with targeted cancer drugs

A

Cancer cells will eventually develop
resistance.
This may either be due to finding an alternative
pathway that doesn’t require the targeted molecule, or mutation
of the target itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Targeted cancer drugs are often used on their own - true or false

A

False
They are often
used in combination and alongside traditional chemotherapy
Due to resistance risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a patient is taking 30mg of slow release morphine bd for pain control, what should their breakthrough dose of oramorph be

A

10mg

The breakthrough dose should be 1/6 of the daily dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Radiotherapy is prescribed in what units?

A

Gray (Gy)
one joule deposited per kilogram
Delivered in fractions over several treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which breast cancer patients can be treated with Tamoxifen

A

Pre or post menopausal
Those who have had children
Those with metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do radiologists make sure they target the same area with radiotherapy each time

A

Patients have dots tattooed on them which line up with the machine
Also line up bony landmarks on CT images
In head and neck cancers a fitted mask is made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patients are required to stay in hospital following radiotherapy - true or false

A

False

Most can go straight home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patients are required to stay in hospital following radiotherapy - true or false

A

False

Most can go straight home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cisplatin chemo can be toxic to which organ

A

Kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Vincristine chemo can be toxic to which organ

A

Nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most common side-effect of radiotherapy

A

Tiredness

Also the only major non-local effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Radiotherapy side effects tend to only affect the area being irradiated - true or false

A

True

This means side effects will differ based on the tumour site being treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

List some common side effects of radiotherapy

A

Skin reactions- erythema to moist desquamation
Telangectasia/ vasculitis
Tiredness (especially after radical treatments)
Nausea, vomiting (stomach/liver/brain radiation)
Diarrhoea/cystitis (abdominal/pelvic radiation)
Mucositis (head and neck radiation)
Dysphagia (thoracic radiation)
Pneumonitis (acute/chronic)
Cardiac damage
Bone marrow suppression (more likely with chemotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which guideline is used to prescribe pain management

A

WHO analgesic ladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Paracetamol and/or NSAIDs at all steps of the pain ladder unless contraindicated - true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the 1st line subcutaneous treatment for severe pain in cancer patients

A

Diamorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the strong opiate of choice in the pain ladder

A

Morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

List signs of opiate toxicity

A 
Drowsiness
Nausea and vomiting
Confusion
Myoclonic jerks
Hallucinations
Pupils
Respiratory depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How often do you take modified release morphine

A

12- hourly

It is long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the drug of choice for breakthrough pain

A

Oramorph - quick acting liquid
1/6th of total 24 hour dose
Given PRN up to hourly if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Subcut morphine is weaker than oral so you double the dose - true or false

A

False

Subcut morphine is twice as strong as oral morphine, so half the oral dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which drugs can be used as adjuvant treatment for metastatic bone pain

A

Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which drugs can be used as adjuvant treatment for neuropathic pain

A 
Tricyclic antidepressant (e.g. amitriptyline) 
Anticonvulsant (e.g. gabapentin, pregabalin)

Must monitor for side-effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which drug is used as adjuvant treatment for raised ICP in cancer

A

Dexamethasone 16mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the drug of choice for treating chemo induced nausea and vomiting

A

Ondasentron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the drug of choice for treating anticipatory/anxiety related nausea and vomiting

A

Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the drug of choice for treating nausea and vomiting caused by impaired gastric emptying/ bowel issues

A

metoclopramide/ domperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the drug of choice for treating nausea and vomiting caused by obstruction of the oesophagus

A

Dexa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the drug of choice for treating nausea and vomiting caused by cerebral disease/ raised ICP

A

Cyclizine and dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which anti-emetic causes anticholinergic side effects

A

Cyclizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which anti emetic causes extrapyramidal side effects

A

Metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which anti-emetic causes constipation

A

5HT3 antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What can cause constipation in cancer patients

A

immobility, drugs, altered gut function, pain, altered habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which types of laxatives can be used in cancer care

A

Stimulant laxatives (senna, bisacodyl), osmotic laxatives Macrogol (Movicol®), stool softeners

Rectal treatment may be needed if faecal impaction/bed-bound (e.g. phosphate enema/ glycerol suppository/arachis oil enema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Oral laxatives should be co-prescribed with analgesia - true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How does radiation damage cancer cells

A

Direct DNA/RNA damage
- Protons work via this method
- They cause a double strand break in the DNA
Accumulations of these breaks should make it hard for the cancer to repair

Indirect DNA damage (more commonly)
The radiation contacts water molecules and creates free radicals which damage the DNA
Can also bind with O2 to make superoxidisers which also damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which types of radiation are used in radiotherapy

A

It is ionising radiation - particles or rays
Most commonly photons are released in a beam to the target
Electrons and protons can also be used but are less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What stage of the cell cycle is radiotherapy most effective in

A

M phase

As this is when the chromosome is dividing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Why is radiotherapy given in fractions

A

It distributes the damage among all tumour cells
A single dose will not catch all cells in the tumour at their most vulnerable (in m phase of the cell cycle) so by spreading the dose over time you kill more of the cells

Also leads to irreversible damage as one dose may only cause incomplete damage where the cell can still repopulate

Indirect damage requires O2 but the cells in the tumour centre are often hypoxic. Using fractions kills off the O2 rich cells first and then allows the centre cells to re-oxygenate, making them more sensitive to the next treatment fraction

Also allows normal cells to recover in between sessions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the main mechanism of DNA damage caused by radiotherapy?

A

Free radical formation causing double strand breaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the most common delivery mechanism for radiotherapy

A

External beam radiotherapy - radiation delivered from outside the body
Generated by linear accelerators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How can the radiotherapy beam be targeted to the tumour rather than surrounding tissues

A

The beam can be shaped to the tumour shape by multi-leaf
collimators (movable metal leaves).
This allows a higher dose to be given to the target
tissue, whilst minimising radiation to surrounding tissue.

Intensity Modulated Radiotherapy (IMRT) is an even more precise version of this
This reduces dose to organs at risk and long term toxicities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is brachytherapy

A

A type of radiotherapy where radioactive pellets are inserted into the tumour
Gives high dose to the tumour whilst sparing normal tissue (rapid dose fall off)

66
Q

Brachytherapy is most commonly used in which type of cancer

A

Prostate
Cervical
Endometrial

67
Q

Which factors are taken into account when planning the radiotherapy target

A

Gross tumour volume - area where it is
Clinical target volumes - adds a margin for microscopic cells not seen on CT
Can also plan which nodes you want to irradiate
Organs at risk (OAR) are identified- allows planning to minimise radiation to important structures

All done based on the patient’s CT

68
Q

Radiotherapy comes with a risk of secondary malignancy - true or false

A

True
Can occur many years later at the irradiated sight
More common if someone had radiotherapy as a child
Less common these days due to better targeting of treatment

69
Q

How is the skin typically affected by radiotherapy

A

It may be erythematous and pruritic
(sun-burn type lesion)
Dry, peeling or weeping.
Rarely patients may develop ulcers and bleeding

70
Q

What causes radiation pneumonitis

A

Irradiation of the lungs

71
Q

How does radiation pneumonitis present

A

Cough
Fever
Hypoxia
Dyspnoea

72
Q

List common side effects of radiotherapy for head and neck cancer

A 
mucositis
xerostomia
dysphagia 
taste alteration 
pain 
thrush infections
weight loss from
poor nutritional intake
73
Q

List common side effects of radiotherapy to the bowel

A

Nausea and vomiting
Diarrhoea - also seen in pelvic raditaion
Bowel erosions, ulceration and inflammation

74
Q

List common side effects of radiotherapy to the bones

A

Marrow suppression

75
Q

List common side effects of radiotherapy to the brain

A

Raised ICP
Headaches
Seizures

76
Q

What is the most common type of immunotherapy used in the treatment of cancer

A

Immune Checkpoint Inhibitors

77
Q

How doe Immune Checkpoint Inhibitors work

A

They block the cancer cell signalling pathways which switch off T cells
This effectively
switches back on the body’s natural immune surveillance, allowing T cells to kill cancer cells

78
Q

List types of cancer that can be treated with immunotherapy

A 
Melanoma
NSCLC
Renal Cell Carcinoma (RCC)
Bladder
Head and neck
MSI Colorectal – e.g. Lynch syndrome
79
Q

What are the main side effects of immunotherapy

A

Can cause inflammation at many sites throughout the body
Pneumonitis, thyroiditis and colitis are particular risks

An erythematous, vesicular rash is another common one

80
Q

Physical activity can reduce your risk of which cancers

A

Convincing - Colon
Probable - Breast (post-meno), endometrial
Limited but suggestive - lung, pancreas, breast (pre-meno)

81
Q

How might physical activity directly protect against cancer

A

Through several biologic mechanisms, including promoting healthier levels of circulating hormones, decreasing inflammation and maintaining a healthy body weight.

82
Q

How can physical activity benefit cancer patients

A

Fitter individuals tolerate treatment better
Slowed decline in quality of life
Preserved functional outcomes
Decrease in fatigue - excessive rest = deconditioning
Less severe symptoms
Reduces risk of secondary health issues following treatment

83
Q

What causes visceral pain in cancer

A

Pain caused by infiltration,
compression, extension or stretching of the
thoracic, abdominal or pelvic viscera
eg. liver capsule pain

84
Q

What causes somatic pain in cancer

A

Activation of pain receptors in either
cutaneous or deep tissues (muscoloskeletal)
Cutaneous – sharp, burning, pricking
Deep – dull, aching (eg. bone mets)

85
Q

What causes neuropathic pain in cancer

A

Damage to the nervous system:
Compression of nerves/spinal cord
Infiltration of nerves/spinal cord
Chemical damage – chemotherapy/XRT

86
Q

Which factors can affect the perception of pain

A

Mood – depression, anxiety

Context – expectation, pain beliefs, placebo

87
Q

How long must pain last to be defined as chronic

A

At least 3 month duration

88
Q

List the steps of the WHO pain ladder

A

MILD: Paracetamol
MILD to MODERATE: Co-codamol 30/500, dihydrocodeine, tramadol
MODERATE to SEVERE: Morphine, diamorphine, oxycodone, hydromorphone,
Methadone

ADJUVANT: NSAID’s, TCA’s, anticonvulsants, corticosteroids, anxiolytics, muscle
relaxants, antimuscarinics

89
Q

List some of the side effects of opioids

A

Initially - N&V, drowsiness, unsteadiness, confusion

On-going - constipation

Occasional - dry mouth, sweating, pruritus, hallucinations, myoclonus

Rare - respiratory depression, psychological dependence

90
Q

How potent is codiene in relation to morphine

A

Codeine is 1/10th as potent as morphine

91
Q

How potent is oxycodone in relation to morphine

A

Oxy is 2x as potent as morphine

92
Q

How potent is methadone in relation to morphine

A

Methadone is 10x as potent as morphine

93
Q

How do you convert oral morphine to subcut

A

Divide oral dose by 2

94
Q

If morphine is not suitable which other opiods can be used

A 
Oxycodone/Hydromorphone – less CNS 
side-effects
Fentanyl – less constipation
Fentanyl/Alfentanil – good in renal 
Impairment (shorter half-life)
95
Q

Which other drugs should be started at the same time as opioids

A

Antiemetic for first few days

Regular laxative

96
Q

How should you manage drowsiness caused by opioids

A

Reduce dose or switch

97
Q

How should you manage hallucinations caused by opioids

A

Haloperidol or switch

98
Q

How should you manage myoclonus caused by opioids

A

reduce dose, switch or benzodiazepine

99
Q

How should you manage pruritus caused by opioids

A

antihistamine or switch if does not settle

100
Q

How should you manage respiratory depression caused by opioids

A

Give naloxone

101
Q

NSAIDs are good as an adjuvant for which type of cancer pain

102
Q

NSAIDs are good as an adjuvant for which type of cancer pain

103
Q

How can corticosteroids help in the management of cancer pain

A

Reduce inflammation (cerebral mets, spinal cord
compression, liver capsule pain)
Stimulate appetite
Antitumour effect (lymphoma etc)

104
Q

Which drugs are good for neuropathic cancer pain

A

TCA - amitriptyline

Anti-convulsants - carbamazepine, gabapentin etc

105
Q

How can benzos be used in the treatment of cancer

A

Can help reduce agitation, dyspnoea

Diazepam also works as a muscle relaxant - reduces muscle spasm pain

106
Q

How do antimuscarinics help with cancer pain

A

Can reduce colicky bowel pain

107
Q

How is ketamine used as adjuvant therapy for cancer pain

A

Reduces opioid requirement
Good for neuropathic pain
Given oral or subcut

108
Q

What are some of the complications of chemo induced N&V

A

Dehydration
Electrolyte imbalance
Risk of aspiration pneumonia

109
Q

List risk factors for developing chemo-induced N&V

A

Age <50 years
Female
Alcohol intake
Prone to N +V

110
Q

What are the 2 categories of chemo-induced N&V

A

Acute - within 24 hours of chemotherapy

Delayed - 24 hours to 7 days post chemo

111
Q

What is the most effective was to control chemo-induced N&V

A

To prevent symptoms of acute and delayed CINV by using a combination of an NK1 antagonist, 5HT3 antagonist and dexamethasone

112
Q

Why does chemotherapy cause N&V

A

Causes cell damage which may Increased afferent input to the chemoreceptor trigger zone and vomiting center
May also directly activates the CTZ which activates the vomiting centre

113
Q

5­HT3 receptor pathway antagonists are most effective for which type of chemo-induced N&V

A

Effective in acute vomiting
Very limited efficacy for delayed events

They block the release of serotonin from enterochromaffin cells in GI tract

114
Q

Which treatment is effective for delayed chemo-induced nausea and vomiting

A

NK1 receptor blockade

This receptor responds to substance P whichrelays noxious sensory information to the brain

115
Q

Which treatment is effective for nausea specifically in chemo-induced nausea and vomiting

A

Dexamethasone
Its also good for both acute and delayed vomiting

M.O.A not fully understood

116
Q

List side effects of 5HT3 anatagonists

A

constipation, abdominal spasms, headaches

117
Q

Give an example of a 5HT3 anatagonist used in chemo-induced N&V

A

Ondasentron

Granisentron

118
Q

How are 5HT3 anatagonists administered for chemo-induced N&V

A

Best given as a stat dose pre-chemo

Oral and IV equally effective

119
Q

List side effects of dexamethasone

A

heartburn/indigestion, agitation, hiccups, abnormal BM’s (all manageable in most instances)

120
Q

How is dexa administered for chemo-induced N&V

A

Acute: pre-dose before chemo
Delayed: 2-4 days after

121
Q

How do you treat anticipatory nausea and vomiting

A

Lorazepam is an effective treatment

122
Q

What is anticipatory nausea and vomiting

A

A conditional response - often to sights and smells
Involves higher cortical centres of brain

Occurs in 30% of chemo patients

123
Q

What is meant by breakthrough symptoms in relation to chemo-induced N&V

A

N + V in spite of optimal preventative treatment

Add in another anti-emetic - choice guided by the cause

124
Q

What is meant by concomitant treatment

A

Combined modality treatment (Chemo/radiotherapy)

125
Q

What is the aim of palliative treatment

A

To reduce cancer load thereby improving symptoms and prognosis

126
Q

How can chemotherapy be delivered

A 
Oral
Intravenous
- Bolus / Infusional
- Central / Peripheral
Locally 
- Intratheccal
- Intraperitoneal / Intravesical
- Topical 
- Intra-arterial (limb perfusion)
Subcutaneous or Intramuscular
127
Q

List the 4 traditional chemotherapy classes

A

Antimetabolites - Interfere with DNA/RNA growth

Antimicrotubule agents -prevent microtubule function therefore preventing the separation of chromatids

Alkylating agents - add an alkyl group to DNA and cause cross-linking, includes platinum

Antitumour antibiotics - interferes with both transcription and replication of DNA by upsetting proper DNA supercoiling.

128
Q

Which hormone based treatments can be used as chemo

A

Prednisolone / Dexamethasone

Tamoxifen - breast 
Aromatase Inhibitors (Letrozole, Anastrozole) - breast

Gonadotropin releasing hormone agonists (Zoladex)

129
Q

Which cytokine based treatments can be used as chemo

A

Interferon alpha

130
Q

How are monoclonal antibodies used in the treatment of cancer

A

Designed to target highly expressed tumour specific antigens thereby increasing the immune response to the tumour cell

131
Q

What effect does chemo toxicity have on the skin/hair

A 
Palmar plantar erythodysthesia
Sun sensitivity
Extravasation
Rashes
Alopecia

Often worse if tumour is superficial or on skin itself as skin gets a higher dose

132
Q

Radiotherapy side effects tend to be in the target ares for treatment - true or false

A

True

Localsied to the area being irradiated and the surrounding tissues

133
Q

List common side effects of radiotherapy to the pelvis

A 
Diarrhoea 
Reduced lubrication 
Narrowing of passages 
Less flexibility of tissues 
Impotence or difficulties with erection
134
Q

The side effects of radiotherapy can continue after the treatment is finished - true or false

A

True
Cell destruction can continue for up to 10-14 days post treatment end
94% patients were still experiencing at least one symptom 14-21 days after completion of therapy .

135
Q

What is the difference between hypo and hyperfraction in relation to radiotherapy

A

Hypofractionation – greater than 2Gy per fraction

Hyperfractionation – less than 1.8Gy per fraction

136
Q

Radiotherapy can be used as curative treatment for which types of cancer

A 
Head and neck
Lung
Bladder
Prostate
Anal
Cervical
137
Q

How is radiotherapy used palliatively

A

Local control
Symptom control
Lower doses than radical treatment

138
Q

What determines the toxicity of radiotherapy

A

Dependent on tissue irradiated, dose, dose per fractionation, duration of treatment

139
Q

Radiotherapy can cause long term/permanent effects in which tissues

A 
Occur in slowly proliferating tissues
Kidney
Heart
Central nervous system
Lens

Will depend if these were in the area getting treatment
Can occur months – years after treatment

140
Q

Radiotherapy can cause short term/temporary effects in which tissues

A 
Occur in rapidly proliferating tissues
GI tract
Skin
Bladder
Haematopoetic system

Will depend if these were in the area getting treatment
Often peak at end of treatment but resolve over weeks

141
Q

What is Stereotactic ablative body radiotherapy (SABR)

A

More accurate delivery of external beam radiotherapy
Uses higher doses per fraction
Generally better tolerated (good for elderly populations where surgery would not be appropriate)

142
Q

Which cancers is Stereotactic ablative body radiotherapy (SABR) typically used for

A

Used mainly in lung cancer (particularly small cancers) but also has uses in CNS and liver

143
Q

Which treatments are available for head and neck cancer

A

Surgery
Radiotherapy +/- SACT
Systemic Anti-Cancer Therapy (SACT) - conventional chemo and immunotherapy
Supportive Care

144
Q

What are the advantages of radiotherapy

A

Preserves tissue function
Treats microscopic disease
Fewer systemic side effects

145
Q

What are the disadvantages of radiotherapy

A

4-6 weeks treatment - have to come in every day
acute side effects
late sequelae

146
Q

What are the advantages of Systemic Anti-Cancer Therapy (SACT)

A

Improved local control
Decreasing incidence distant metastases
Relief of symptoms - reduces tumour size

147
Q

What are the disadvantages of Systemic Anti-Cancer Therapy (SACT)

A

Increased toxicity

May increase rate of treatment related deaths

148
Q

Which head and neck cancers are treated with Systemic Anti-Cancer Therapy (SACT)

A

Squamous cancers
Locally Advanced Disease
Those who need palliation of symptoms

149
Q

List common platinum based chemo agents

A

Cisplatin, Carboplatin

150
Q

List common monoclonal antibodies used in the treatment of cancer

A

Cetuximab - target EGFR
Nivolumab - targets a checkpoint inhibitor
Pembrolizumab

151
Q

Platinum based chemos commonly cause which side effects

A

Vomiting, tinnitus, deafness, paraesthesia, renal impairment

152
Q

Taxane chemos commonly cause which side effects

A

alopoecia, nail dystrophy, hypersensitivity

153
Q

5FU chemos typically cause which side effects

A

mouth ulcers, diarrhoea

154
Q

What is performance status used to predict

A

Prognosis and toxicity

More important than age
Can change over time/during treatment

155
Q

What is the typical length of a chemotherapy regime

A

Most chemotherapy regimes are 4-8 cycles
Cycles can vary in length – typically 2-4 week
Will have small gaps between cycles to allow normal tissue to recover

156
Q

How long does a schedule of radical radiotherapy typically last

A

Usually 25-30 fractions (4-6 weeks) - will come in 5/7 days a week

Palliative is shorter and a lower dose

157
Q

List some radiotherapy toxicities that can last months/years after treatment

A 
Skin fibrosis/ulceration
Dysphagia
Bowel dysfunction
Incontinence
Bladder instability
Pneumonitis (cough, dyspnoea)
Menopause
Infertility
Secondary cancer
158
Q

Describe the 4 different phases of a clinical trial

A
  • Phase 1 – Is the drug safe?
  • Phase 2 – Does the drug work?
  • Phase 3 – Is the drug better than current standard of care?
  • Phase 4 – Is the trial representative of real world?
159
Q

Which treatments come under systemic anti-cancer therapy

A

Chemo
Immunotherapy (Immune checkpoint inhibitors)
Targeted agents
Hormones

160
Q

How do you manage the side effects of immunotherapy in cancer treatment

A
  • Supportive care
  • STEROIDS
  • Hormone replacement
  • Specialist input

Oncology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions