WK 8- CLINICAL ONCOLOGY Flashcards
How does chemotherapy work
works by inhibiting cancer cell proliferation by inhibiting DNA synthesis and apoptosis
What are the side effects of chemotherapy
nausea, vomiting, infertility, alopecia, myelosuppression (GCSF), 2nd malignancy (anthracyclines, etoposide, alkylating agents)
What are the 4 ways in which chemotherapy can be used in cancer treatments
- Adjuvant= used after initial treatment to suppress developement of second tumour
- Curative= ie. leukemia
- Concurrent with radiation= head and neck cancers
- Palliative= metastatic, used to lessen pain
How do monoclonal antibodies (MAB) work to treat cancer
Block receptors and pathways (so that the cytokines cannot work and proliferation can’t occur), cause compliment mediated cell lysis (by antigen binding to antibody) and create Antibody dependant cell mediated cytotoxicity (ADCC→macrophage binds directly to the target cell via antibody=antigen connection)
What MAB are used in the treatment of HER-2 +ve breast cancer
Herceptin or Trastuzumab
What MAB are used in the treatment of EGFR +ve cancers
Iressa(lung), cetuximab (Colon)
What are the 3 mechanisms used in biological targeted therapy to treat breast cancer
- use of monoclonal antibodies
- use of antiangiogenic factors
- use of small molecules- like tyrosine kinase inhibitors
What antibodies block angiogenesis (are antiangiogenic)
Bevacizumab- colon cancer , breast cancer
How do hormonal agents work to treat certain cancers
If a tumour is hormone dependent/has receptors for certain types of hormones-> these receptors can be blocked to prevent tumour growth
What is an example of a hormone receptor blocker and what is it used to treat
Aromatase inhibitors (Tamoxifen, Letrozole, Anastrozole, Exemestane)- blocks Oestrogen production by overloading LSH - used to treat breast cancer
How does external beam/brachytherapy treat cancer
Works locally through DNA damage that prevents cell replication
What symptoms does palliative care treat and how
Pain= analgesics, nacrotics Nausea= anti-emetics (metaclopramide) Appetite= steroids Cough/SOB= codeine, narcotics Depression= counselling, antidepressants, Family support, aids, home visits, Physiotherapy, nutrition,
Why is it important to know the type and stage of cancer
You want to know if it is treatable= not curable (prolong life, and improve QOL), if curable (begin treatment)
-also want to know what method of treatment to utilise
What are the 5 different imaging modalities for staging
- X-rays
- CT scans
- MRI
- Bone scan
- PET scan
How does a bone scan work/ what are the issues with using this method
utilises osteoblastic activity (pick up bone repair)-> sometimes hard to know if it is cancer or a healing fracture-> will need to review X-RAY
How does a PET scan work
use radiolabelled glucose (detect metabolically active tissues- tumours are constantly growing and utilising glucose)
What are the indications for a PET scan
Usually when treating patients with curative intent or where aggressive treatment may offer prolonged survival, and to decrease the need for unnecessary intensive procedures if a cancer is deemed incurable (ie. do not want to remove the bowel in colon cancer if there are other mets present)
What are the different factors that can influence prognosis (for early cancers) (5)
- Age-> if someone is young, normally a poor prognosis as it is most likely genetic
- Size of the primary lesion
- Node involvement (metastasis)
- Receptor status (hormone receptor involvement has a good prognosis as can be treated)
- Molecular Markers
What factors are needed to make a diagnosis of cancer
patient history, physical examination, biopsy, scans (until you prove the lump is cancer, would only use scan to see if lump is close to blood vessels-biopsy is first)
What sorts of histological markers are looked for in a biopsy to determine whether the sample is cancerous
- if poorly differentiated/ demarcated,
- if cells are polymorphic
- abnormal mitosis
- increased nuclei to cytoplasmic ratio
- receptors involved (eg. growth receptors)
- molecular markers (predictive and prognostic markers)
What are some of the benefits of telehealth
don’t have to travel, efficient for patient/doctor/health system, provides equality of care to all patients, saves money
What is feasible on telehealth (what sort of things can be done)
everything you can do in a normal consultation (except procedures) can be done through telehealth (consultation, treatment, monitoring, case management with GP)
What medicolegal and ethical issues exist with telehealth
Confidentiality and consent
What 5 main types of cancer are incurable if they become metastatic
- Lung
- Breast
- Colon
- Cervical
- Head and Neck
