Cancer Therapies Flashcards
What are the roles of surgery in the management of cancer?
- biopsy for histological diagnosis
- laparoscopic staging
- curative intent
- palliative debulking, stabilization of fractures
- prophylactically in BRCA/FAP
What is the purpose of radiotherapy in the management of cancer?
Use of ionizing radiation to produce free radicles which damage DNA to kill tumour cells
Normal cells are better at repairing this damage than cancer cells so recover before the next dose
Define neoadjuvant chemo
Agent before definitive Tx, shrink, optimise outcomes
Define primary therapy chemo
Sole treatment
Define adjuvant chemo
After Tx
Reduce the chance of relapse after surgery
Define palliative chemo
Provide relief from symptomatic metastatic disease and possible prolong survival
What is an alkylating agent?
Cancer therapy drug class
Antiproliferative drugs that bind via alkyl groups to DNA
e.g. cyclophosphamide, chlorambucil, busulfan
What is an antimetabolite?
Cancer therapy drug class
Interfere with normal cellular metabolism of nucleic acids
e.g. methotrexate, 5-fluorouracil (Inhibits thymidylate synthesis (enzyme required for thymidine)
What is a vinca alkaloid?
Cancer therapy drug class
Inhibits function of microtubules
e.g. vincristine, vinblastine
What is an anti-tumour antibiotic?
Cancer therapy drug class
e.g. dactinomycin, mitomycin (form adducts with DNA)
What is a monoclonal Ab?
Cancer therapy drug class - immunotherapy
Bind to cell surface Ag = block downstream signaling = arresting cell prolif
- HER2 inhib (herceptin/trastuzumab) = breast/gastric Ca
- VEGR (vascular ep growth receptor) inhib (bevacizumab) = ovarian/bowel Ca
- EGFR (ep GF receptor) inhib (panitumumab) = bowel Ca
SE = skin toxicity, hair gwroth disorders, pruritus, fatigue, D&N, HTN, proteinuria, GI perf
What are the possible side effects from cancer therapies?
- Brain = chemo brain, peripheral neuropathy, fatigue
- Hair = alopecia
- Lungs = pneumonitis, PE
- Liver = deranged LFTs
- Kidneys = AKI, electrolyte disturbances
- Repro = impaired fertility, decreased libido, prem menopause
- Heart/blood = cardiomyopathy, myelosuppression
- Bladder = haemorrhagic cystitis
- LI = dirrahoea, constipation
- Skin = PPE, rash, nail ridging/loss
- Injection site = hardens, thebitis, tracking, extravasasion
Neutropenia = most commonly 10-14d after chemo
- neutropenic sepsis
Tumour cell lysis = gout, hyperK, hypoCa, urate nephropathy, ca-phos nephropathy
What are the principles of combination chemo?
Increases tumour cell killing
Offers broader range of drug activity
Prevents/slows development of new drug resistant cells
What early reaction are seen when giving radiotherapy?
- tiredness
- mucositis (head, neck)
- N+V (stomach, liver, brain)
- diarrhoea (abo, pelvic)
- dysphagia (thoracic)
- cystitis (pelvic)
- BM suppression
What late reactions are seen when giving radiotherapy?
CNS
- somnolence
- spinal cord myopathy
- brachial plexopathy
- reduced IQ (<6yrs olds)
Lung
- pneumonitis
GI
- xerostomia
- benign strictures
- radiation proctitis
GU
- urinary frequency
- decreased fertility
- vaginal stenosis + dyspareunia
