Basics Of Systemic Treatment

Question 1

How does traditional chemotherapy work ?

Answer 1

Systemic drug used to kill cancer cells by causing lethal cytotoxicity or apoptosis.

Question 2

Where can chemotherapy be used ?

Answer 2

Primary chemotherapy - induction of remission
Neo-adjuvant - treat/shrink cancer before surgery
Adjuvant - after surgery to kill any remaining cells
Maintenance lower doses to prolong remission
Palliative - improve cancer symptoms

Question 3

What are some benefits of targeted therapy over chemotherapy ?

Answer 3

More specific
Better tolerated
Can be given for longer periods

Question 4

What is an example of a small molecule agent ( targeted therapy ) ?

Answer 4

Tyrosine kinase inhibitor - imatinib

Question 5

How are biologic therapies used in cancer management ?

Answer 5

Usually monoclonal antibodies against cell surface or circulating antigens

Question 6

In what cancers are hormonal agents useful ?

Answer 6

Breast
Prostate

Question 7

When can hormonal agents be used in breast cancer and what is given ?

Answer 7

When the cancer is oestrogen positive
Selective oestrogen receptor modulators or aromatase inhibitors

Question 8

What hormonal therapy can be given for prostate cancer ?

Answer 8

Androgen deprivation therapy - GnRH agonists or antagonists

Question 9

When does Alopecia occur in cancer management ?

Answer 9

Usually 7-10 days after chemotherapy

Question 10

What causes nausea and vomiting in cancer management ?

Answer 10

Traditional chemotherapy

Question 11

What are some management options for nausea and vomiting due to chemotherapy ?

Answer 11

Ondansetron
Olanzapine
Dexamethasone

Question 12

When does neutropenia occur in cancer management ?

Answer 12

Traditional systemic agents

Question 13

When is neutropenia an emergency after chemotherapy ?

Answer 13

Associated with a fever - neutropenic sepsis

Question 14

What can cause oral mucositis ?

Answer 14

Traditional chemo
Radiotherapy

Question 15

What is oral mucositis ?

Answer 15

Acute inflammation or ulceration of the oral or oropharyngeal mucosal membranes which can interfere with eating, swallowing or speech due to pain or discomfort.

Question 16

Which medications are associated with peripheral neuropathy ?

Answer 16

Traditional chemo - platinum therapies and microtubule inhibitors

Question 17

How can chemo induced peripheral neuropathy be managed ?

Answer 17

Consider dose adjustment
Gabapentin or duloxetine

Question 18

What are some cancer treatments associated with secondary cancers ?

Answer 18

Chemotherapy - alkylating agents, platinum agents, topoisomerase inhibitors
Targeted therapies - SSC of the skin

Question 19

How do alkylating agents work ?

Answer 19

Cell cycle non specific drugs which contain alkyl groups that form reactive molecular species that interact with and cross link with DNA. This halts DNA replication.

Question 20

What is an example of an alkylating agent ?
( and its indications )

Answer 20

Cyclophosphamide
ALL, CLL, Hodgkin’s and non-Hodgkin’s, myeloma, breast, ovary, Wilma tumour

Question 21

What are some side effects of cyclophosphamide ?

Answer 21

Alopecia
Nausea and vomiting
Diarrhoea
Myelosuppression
Haemorrhagic cystitis

Question 22

What are some examples of microtubule inhibitors ?

Answer 22

Vincristine
Docetaxel and paclitaxel

Question 23

What are some indications for vincristine ?

Answer 23

Hodgkin and other lymphomas
Wilson tumour
Rhabdomyosarcoma
Neuroblastoma

Question 24

What are some side effects of vincristine ?

Answer 24

Neurotoxicity
Peripheral neuropathy
Myelosuppression

Question 25

What are the indications of docetaxel ?

Answer 25

Breast Non small cell lung cancer Ovarian cancer Bladder Head and neck cancer

Question 26

what are some side effects of docetaxel ?

Answer 26

Hypersensitivity Neutropenia Peripheral neuropathy

Question 27

What are some examples of platinum agents ? ( +Indications )

Answer 27

Cisplatin, Carboplatin and oxaliplatin Testicular Ovarian Bladder

Question 28

What are some side effects of platinum agents ?

Answer 28

Peripheral neuropathy Ototoxicity Nephrotoxicity Nausea and vomiting Myelosuppression

Question 29

What is an example of selective oestrogen receptor modulators ( + indications ) ?

Answer 29

Tamoxifen Oestrogen responsive breast cancer

Question 30

What are some side effects of tamoxifen ?

Answer 30

Hot flushes Vaginal bleeding DVT Endometrial hyperplasia and malignancy

Question 31

What are some aromatase inhibitors ?

Answer 31

Anastrozole and letrozole

Question 32

What are the indications for aromatase inhibitors ?

Answer 32

Oestrogen positive breast cancer in postmenopausal women

Question 33

What are some side effects of aromatase inhibitors ?

Answer 33

Hot flashes Reduced bone mineral density Arthralgia

Question 34

What is an example of a monoclonal antibody in cancer management ?

Answer 34

Herceptin

Question 35

When can herceptin be used in breast cancer management ?

Answer 35

HER-2 positive

Question 36

What are some side effects of herceptin ?

Answer 36

Cardiotoxicity Reduction in left ventricular ejection fraction

Question 37

What is an indication of imatinib ?

Answer 37

Chronic myeloid leukaemia

Question 38

What are some side effects of imatinib ?

Answer 38

Myelosuppression Hepatotoxicity Fluid retention

Question 39

Which cancers can be treated with hydroxyurea ?

Answer 39

Head and neck CML Melanoma Ovarian Myeloproliferative

Question 40

What cancers can bleomycin be used for ?

Answer 40

Testicular Lymphomas

Question 41

What are some side effects of bleomycin ?

Answer 41

Pulmonary toxicity - Pneumonitis and fibrosis

Question 42

What can Rituximab be used for ?

Answer 42

Non-Hodgkin’s B cell lymphoma

Question 43

What is radiation ?

Answer 43

Released when an unstable higher energy atom configuration changes into a more stable lower energy configuration. Uses X ray waves

Question 44

What happens at the level of tissue in the process of killing a cancer using radiation ?

Answer 44

Repair - cancer cells can’t repair between the fractions of radiation Repopulation - radiation damages the tumour cells ability to repopulate Re-assortment - the radiation will catch cells in different phases of the cell cycle ( different fractions will catch cells in more vulnerable phases of the cycle ) Re-oxygenation - indirect damage

Question 45

In palliative setting when is radiation used ?

Answer 45

Bone mets Lung mets Brain mets Spinal cord compression SVC obstruction

Question 46

What are some side effects of radiation therapy ?

Answer 46

Fatigue Sun - burnt appearance Dry skin Hair loss Mucositis Cough Pneumonitis Dysphagia Nausea and vomiting diarrhoea Headache Marrow suppression

Question 47

What are some WHO principles of screening ?

Answer 47

Important health problem There should be a treatment Facilities should be available Latent stage of disease Test or exam for the disease Test should be acceptable to public Agreed policy for who to treat

Question 48

What is the purpose of staging ?

Answer 48

Assessment of local disease Assessment of distant disease This determines operability and choice of treatment