Cancer and Chemotherapy

Question 1

What is the definition of cancer?

Answer 1

A group of diseases characterised by abnormal cell growth through which cells my acquire potential to metastasise from the site of origin to other sites in the body.

Question 2

What is tumour growth dependent on?

Answer 2

Delivery of nutrients and oxygen via increased vascular supply (angiogenesis).

Question 3

What are some of the modifiable risk factors for cancer?

Answer 3

Smoking, body weight, physical activity, diet, UV radiation.

Question 4

What are some non-modifiable risk factors for cancer?

Answer 4

Pollution, genetics, hormonal factors.

Question 5

What are some red flag symptoms for cancer?

Answer 5

Bleeding, bruising, lumps, swelling, appetite loss, swallowing difficulties.

Question 6

Why is chemo given in cycles?

Answer 6

Since chemo only targets dividing cells, some normal cells will be impacted and some non-dividing cancer cells won’t be impacted. The break means that by the next cycle, some of these cancer cells will now be dividing. Also, normal cells impacted by chemo repair damage more effectively than cancer cells, so while they may fully repair in this break, cancer cell damage builds up without causing permanent damage to normal cells.

Question 7

What are the common side effects of chemotherapy?

Answer 7

Weakness
Fatigue
Thrombocytopenia and anaemia Immunosuppression
Nausea and vomiting
Hair loss
Diarrhoea and constipation
Nerve damage.

Question 8

What can dexamethasone also be used for in palliative care?

Answer 8

Appetite loss.

Question 9

What can be given to alleviate chemotherapy-induced pain?

Answer 9

Opioids. Usually morphine. Can be taken prn or preventatively plus oral morphine for breakthrough pain. Can cause constipation.

Question 10

What can be given to alleviate opioid-induced constipation?

Answer 10

Osmotic laxative (lactulose, movicol, laxido) or stimulant (senna, docusate, bisacodyl). NOT bulk forming.

Question 11

What is neutropenic sepsis?

Answer 11

Sepsis caused by low neutrophil count, usually due to immunosuppressant treatment such as chemotherapy.

Question 12

Why is paracetamol not recommended in chemotherapy patients?

Answer 12

Paracetamol is an analgesic and an antipyretic, so can mask symptoms of infection such as pain and fever.

Question 13

Which opioid is least likely to cause nausea?

Answer 13

Fentanyl.

Question 14

What test should be done if sepsis is suspected?

Answer 14

NEWS2

Question 15

What does NEWS2 score measure?

Answer 15

CROPS T
C - Level of consciousness or new-onset confusion.
R- Respiratory rate
O - Oxygen saturation
P- Pulse rate.
S- Systolic blood pressure.
T - Temperature

Question 16

What is the criteria for neutropenic sepsis?

Answer 16

Neutrophil count of 0.5x10^9/L or lower
plus either
temperature of 38C or higher
other signs or symptoms consistent with sepsis.

Question 17

What should be given when sepsis confirmed?

Answer 17

BUFALO:
Blood tests - cultures, FBC, urea and electrolytes, CRP.
Urine - monitor urine output.
Fluids - IV fluids.
Antibiotics - broad-spectrum IV antibiotics.
Lactate - monitor lactate.
Oxygen - high flow oxygen.

Question 18

What is first line antibiotic treatment for sepsis:

Answer 18

Piperacillin with tazobactam IV 4.5g every 8 hours.

Question 19

When should a person be switched from IV to oral antibiotics:

Answer 19

After 48 hours if possible, based on COMS criteria:
C - clinical improvement observed.
O - oral route not compromised.
M- markers show trend towards normal. Apyrexial for 24 hours all but one of HR, RR, BP, and WCC normal.
S - specific indication/deep-seated infection? If so, speak to microbiology before switching.

Question 20

What are the benefits of switching from IV to oral antibiotics?

Answer 20

Cheaper
Patient can go home.
Lower risk of infection.
Lower risk of phlebitis.
Narrower spectrum based on blood cultures.

Question 21

What can be given to alleviate chemotherapy-induced nausea and vomiting?

Answer 21

Metoclopramide - dopamine and serotonin receptor antagonist.

Dexamethasone - steroid.