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Oncology, haematology and palliative care > Chemo and radiotherapy > Flashcards

Chemo and radiotherapy Flashcards

1
Q

What is chemotherapy

A

The use of any chemical substance to treat disease

The use of cytotoxic drugs in the treatment of cancer

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2
Q

What is the aim of chemotherapy?

A

Deliver enough cytotoxic drug to a cancer cell target which is expressed drug to a cancer cell target which is expressed differently to normal tissue

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3
Q

How frequently is chemo given?

A

In intervals

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4
Q

Why is chemo given in intervals?

A

To allow the normal tissue to recover

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5
Q

What method of cancer treatment is systemic

A

Chemo

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6
Q

Why are single chemotherapy agents rarely used

A

Genetically resistant cells are selected out

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7
Q

Why is it important for chemo to be systemic

A

Either due to metastases or the potential to metastasise in the future

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8
Q

Why is it advantageous for chemo to be a combination?

A

Different mechanisms of action and different side effect profiles reduces the likelihood of resistance and toxicity

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9
Q

What qualities should chemotherapy drugs have

A

Cytotoxic activity for that tumour, preferentially able to induce remission
Different mechanisms of action, ideally additive or synergistic effects
Non-overlapping toxicity to maximize benefit of full therapeutic doses
Different mechanisms of resistance

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10
Q

What is adjuvant chemo?

A

After other initial treatment to reduce the risk of relapse

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11
Q

What is neoadjuvant chemo?

A

Used to shrink tumours prior to surgical or radiological treatment - may allow later treatment to be more conservative

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12
Q

What is palliative chemo?

A

No curative aim, offers symptom relief may prolong survival

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13
Q

What are alkylating agents

A

Anti-proliferative drugs that bind via alkyl groups to DNA leading to apoptotic cell death

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14
Q

Give some examples of alkylating agents

A

Cyclophosphamide
Chlorambucil
Bulsulfan

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15
Q

Give examples of angiogenesis inhibitors?

A

Bevacizumab, aflibercept, sunitinib

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16
Q

What are antimetabolites

A

Interfere with cell metabolism including DNA and protein synthesis

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17
Q

Give examples of antimetabolites

A

Methotrexate

5-flurouracil

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18
Q

What are antioestrogens

A 
Aromatase inhibitors (letrozole, anastrozole) 
Oestrogen receptor antagonists (tamoxifen, raloxifene)
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19
Q

What are anti tumour antibiotics

A

Interrupt DNA function

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20
Q

Give examples of anti-tumour antibiotics

A

Dactinomycin
Doxorubicin
Mitomycin
Bleomycin

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21
Q

What are monoclonal antibodies

A

Antibodies to a specific tumour antigen can slow tumour growth by enhancing host immunity or be conjugated with chemo/radioactive isotopes to allow targeted treatment

22
Q

What are topimerase inhibitors

A

Interrupt regulation of DNA winding

23
Q

Give an example of a topimerase inhibitor

A

Etoposide

24
Q

What are vinca alkaloids

A

Spindle poison which target mechanisms of cell division

25
Q

Give an example of a vinca alkaloid

A

Vincristine
Vinblastine
Docetaxel

26
Q

List the main side effects of chemo

A

Vomiting
Alopecia
Neutropenia
Infertility

27
Q

Which cells experience more of the effect from chemo

A

Rapidly dividing cells - gut, hair, bone marrow, gametes

28
Q

What is extravasation of chemo

A

Inadvertent infiltration of a drug into the subcutaneous/subdermal tissue

29
Q

How does extravasation of chemo present

A

Tingling, burning, redness, swelling, no flashback/resistance from cannula

30
Q

Describe the management of extravasation of chemo

A

Stop and disconnect infusion
Aspirate any residual drug before cannula removed
Follow local policies and any drug specific recommendations
DNA binding drugs - use a dry cold compress to vasoconstrict and reduce drug spread
Non-DNA binding drugs - use a warm compress to vasodilate and increase drug distribution

31
Q

Describe how chemo and radiotherapy may lead to infertility

A

Damage spermatogonia causing impaired spermatogenesis or male infertility
Hasten oocyte depletion leading to premature ovarian failure

32
Q

What should be done prior to treatment if the treatment carries a risk of infertility

A

Men - semen cryopreservation
Women - cryopreservation of embryos, oocytes and ovarian tissue. Ovarian transposition (oophropexy) may be possible prior to pelvic radiation but protection is not guaranteed due to radiation scatter

33
Q

Describe the mechanism of action of radiotherapy

A

Uses ionizing radiation to cause damage to the DNA
Prevents cell division and causes cell death
The aim of radiotherapy treatment is to inactivate cancer cells without causing a severe reaction in normal tissue

34
Q

Describe radical radiotherapy treatment

A

Given with curative intent
Total doses range from 40-70 gray (Gy) in up to 40 fractions
Some regimens involve several smaller fractions a day with a gap of 6-8hrs.
Combination chemo is used in some sites such as oesophagus to increase response rates

35
Q

Describe palliative radiotherapy

A

Aims to relieve symptoms and may not impact on survival
Doses are smaller and given in fewer fractions to offer short term tumour control with minimal side effects. Palliation is used for brain metastases, spinal cord compression, visceral compression and bleeding
Bone pain from metastasis can be reduced or eliminated in 60% cases

36
Q

List some early reactions of radiotherapy

A 
Tiredness
Skin reactions
Mucositis 
Nausea and vomiting 
Diarrhoea 
Dysphagia
Cystitis
37
Q

List some late reactions of radiotherapy

A

CNS/PNS - somnolence, spinal cord myelopathy, brachial plexopathy
Lung - pneumonitis
GI - xerostomia, benign strictures, fistulae, radiation proctitis
GU - urinary frequency, vaginal stenosis, dyspareunia, erectile dysfunction
Endocrine - panhypopituitarism and hypothyroidism
Secondary cancers

38
Q

List the methods of giving radiotherapy

A

Conventional external beam radiotherapy (EBRT)
Stereotactic radiotherapy
Brachytherapy
Radioisotope therapy

39
Q

Describe conventional external beam radiotherapy

A

Delivers a beam of ionizing radiation to the patient from an external linear accelerator

40
Q

Describe stereotactic radiotherapy

A

Highly accurate form of EBRT
Used to target a small lesion with great precision
Often referred to by the manufactures name eg. Gamma knife

41
Q

Describe brachytherapy

A

Involves radiation source being placed within or close to a tumour, allowing high local radiation dose. Implants may be placed within a cavity or within tissue

42
Q

Describe radioisotope therapy

A

Uses tumour seeking radionuclides to target specific tissues

43
Q

What is interventional oncology

A

Interventional radiology procedures used in palliative care/cancer treatment.
Can be divided into disease modifying and symptomatic procedures

44
Q

Describe disease modifying interventional oncology

A 
Intended to modify cancer progression and/or to improve prognosis
Includes:
Image guided ablation 
Embolization 
Image guided brachytherapy 
Isolated perfusion chemotherapy
45
Q

Describe symptomatic interventional oncology

A

Provides relief from cancer related symptoms but does not modify the underlying disease process. The techniques can offer significantly improved quality of life, reduce admissions and increase time spent out of hospital

46
Q

Name the interventional treatment option of ascites or pleural effusions

A

Temporary/permanent image guided drain

47
Q

Name the interventional treatment option of oesophageal/large bowel obstruction

A

Stenting

48
Q

Name the interventional treatment option for tumour related haemorrhage

A

Trans arterial embolisation

49
Q

Name the interventional treatment option for jaundice

A

Biliary drainage and stenting

50
Q

Name the interventional treatment option for renal tract obstruction

A

Nephrostomy

Ureteric stenting

51
Q

Name the interventional treatment option for bone metastases

A

Image guided ablation

Oncology, haematology and palliative care (19 decks)

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