WK 8- CLINICAL ONCOLOGY

Question 1

How does chemotherapy work

Answer 1

works by inhibiting cancer cell proliferation by inhibiting DNA synthesis and apoptosis

Question 2

What are the side effects of chemotherapy

Answer 2

nausea, vomiting, infertility, alopecia, myelosuppression (GCSF), 2nd malignancy (anthracyclines, etoposide, alkylating agents)

Question 3

What are the 4 ways in which chemotherapy can be used in cancer treatments

Answer 3

1. Adjuvant= used after initial treatment to suppress developement of second tumour
2. Curative= ie. leukemia
3. Concurrent with radiation= head and neck cancers
4. Palliative= metastatic, used to lessen pain

Question 4

How do monoclonal antibodies (MAB) work to treat cancer

Answer 4

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)

Question 5

What MAB are used in the treatment of HER-2 +ve breast cancer

Answer 5

Herceptin or Trastuzumab

Question 6

What MAB are used in the treatment of EGFR +ve cancers

Answer 6

Iressa(lung), cetuximab (Colon)

Question 7

What are the 3 mechanisms used in biological targeted therapy to treat breast cancer

Answer 7

1. use of monoclonal antibodies
2. use of antiangiogenic factors
3. use of small molecules- like tyrosine kinase inhibitors

Question 8

What antibodies block angiogenesis (are antiangiogenic)

Answer 8

Bevacizumab- colon cancer , breast cancer

Question 9

How do hormonal agents work to treat certain cancers

Answer 9

If a tumour is hormone dependent/has receptors for certain types of hormones-> these receptors can be blocked to prevent tumour growth

Question 10

What is an example of a hormone receptor blocker and what is it used to treat

Answer 10

Aromatase inhibitors (Tamoxifen, Letrozole, Anastrozole, Exemestane)- blocks Oestrogen production by overloading LSH - used to treat breast cancer

Question 11

How does external beam/brachytherapy treat cancer

Answer 11

Works locally through DNA damage that prevents cell replication

Question 12

What symptoms does palliative care treat and how

Answer 12

Pain= analgesics, nacrotics
Nausea= anti-emetics (metaclopramide)
Appetite= steroids
Cough/SOB= codeine, narcotics
Depression= counselling, antidepressants, Family support, aids, home visits, Physiotherapy, nutrition,

Question 13

Why is it important to know the type and stage of cancer

Answer 13

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

Question 14

What are the 5 different imaging modalities for staging

Answer 14

1. X-rays
2. CT scans
3. MRI
4. Bone scan
5. PET scan

Question 15

How does a bone scan work/ what are the issues with using this method

Answer 15

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

Question 16

How does a PET scan work

Answer 16

use radiolabelled glucose (detect metabolically active tissues- tumours are constantly growing and utilising glucose)

Question 17

What are the indications for a PET scan

Answer 17

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)

Question 18

What are the different factors that can influence prognosis (for early cancers) (5)

Answer 18

1. Age-> if someone is young, normally a poor prognosis as it is most likely genetic
2. Size of the primary lesion
3. Node involvement (metastasis)
4. Receptor status (hormone receptor involvement has a good prognosis as can be treated)
5. Molecular Markers

Question 19

What factors are needed to make a diagnosis of cancer

Answer 19

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)

Question 20

What sorts of histological markers are looked for in a biopsy to determine whether the sample is cancerous

Answer 20

1. if poorly differentiated/ demarcated,
2. if cells are polymorphic
3. abnormal mitosis
4. increased nuclei to cytoplasmic ratio
5. receptors involved (eg. growth receptors)
6. molecular markers (predictive and prognostic markers)

Question 21

What are some of the benefits of telehealth

Answer 21

don’t have to travel, efficient for patient/doctor/health system, provides equality of care to all patients, saves money

Question 22

What is feasible on telehealth (what sort of things can be done)

Answer 22

everything you can do in a normal consultation (except procedures) can be done through telehealth (consultation, treatment, monitoring, case management with GP)

Question 23

What medicolegal and ethical issues exist with telehealth

Answer 23

Confidentiality and consent

Question 24

What 5 main types of cancer are incurable if they become metastatic

Answer 24

1. Lung
2. Breast
3. Colon
4. Cervical
5. Head and Neck