Chemotherapy

Question 1

approximately what % of cancer patients will be chemotherapy

Answer 1

60-70%

Question 2

how does chemotherapy exert an anti-cancer action

Answer 2

Most target DNA directly or indirectly

preferentially toxic towards actively proliferating cells

Question 3

what are chemotherapeutic agents preferentially toxic towards

Answer 3

actively proliferating cells

Question 4

which tumours normally act best to chemotherapy

Answer 4

those that divide rapidly with short doubling times

Question 5

what is neoadjuvant chemotherapy

Answer 5

Pre-operative treatment of an operable tumour before definitive surgical intervention

Question 6

what are the aims of neoadjuvant chemotherapy

Answer 6

to make the tumour smaller to allow less radical surgery and can also treat occult micro metastases

Question 7

what is primary chemotherapy

Answer 7

initial chemotherapy for a tumour that is inoperable/unsure if operable, reduction of the tumour via chemo may make surgery with curative intent more feasible.
treatment which increases future cure rates

Question 8

what is adjuvant chemotherapy

Answer 8

chemotherapy following a complete macroscopic clearance at surgery. Treats occult microscopic metastases which can cause relapse after surgery

Question 9

what is palliative chemotherapy

Answer 9

treatment to alleviate symptoms and sometimes to prolong life in patients who cannot be cured.
carefully balanced decision so that the patients QoL doesnt get worse
can be given 2/3rd line chemo if disease remains chemo sensitive

Question 10

what is curative chemotherapy

Answer 10

in some cancers there is a chance of cure even if there are distant metastases at presentation. justifies a more intensive treatment with greater toxicity

Question 11

what cancers can be cured by chemo even with metastatic disease at presentation

Answer 11

Germ cell tumours
Hodgkins disease
Non-Hodgkins lymphoma
many childhood cancers

Question 12

what is prophylactic chemotherapy

Answer 12

when hormonal treatments are given before obvious malignancy appears.
eg Tamoxifen may be used for in-situ breast cancer before invasive carcinoma is recognised

Question 13

3 reasons why chemotherapy is usually given as a combination of drugs

Answer 13

1. cancer drugs can act synergistically to kill more cancer cells together than they would do alone
2. less chance of drug-resistant malignant cells emerging
3. when drugs with different sites of toxicity are combined , dose can be maintained for each drug

Question 14

when is single agent chemotherapy often used

Answer 14

in a palliative setting

Question 15

why is chemo given cyclically

Answer 15

to allow normal cells to recover

Question 16

which cells are usually affected at standard doses of chemotherapy

Answer 16

haematopoietic stem cells - low blood counts (mylesuppression)
lining of GI tract - mucositis

Question 17

what is mucositis

Answer 17

Painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy

Question 18

what is a conventional dose of chemo drug

Answer 18

doses of drugs known to be effect against the particular malignancy and where the side effects are tolerable in most patients

Question 19

what support is required for patients having high dose treatments

Answer 19

bone marrow support

growth factors

Question 20

under what circumstances/cancers are high dose treatments used

Answer 20

only when long term survival or cure are possible

cancers: Hodgkins disease and Ewings sarcoma

Question 21

what is the advantage of oral chemotherapy

Answer 21

patient doesnt have to be in hospital attached to a drip

Question 22

what is the disadvantage of oral chemotherapy

Answer 22

variable levels of drug in circulation based on whether and when the drug was taken

Question 23

which chemo drugs are available orally

Answer 23

cyclophosphamide
Etoposide
Capecitabine
Tamoxifen

Question 24

what is intravesical chemotherapy

Answer 24

chemo given straight in to the bladder - for bladder cancer

Question 25

what are the advantages of intravesical cancer

Answer 25

produces high doses at the site of the tumour little systemic absorption minimal toxicity

Question 26

what is intraperitoneal chemotherapy

Answer 26

chemo directly in to the peritoneal cavity

Question 27

when would intraperitoneal chemo be given

Answer 27

for tumours that spread trans-coelomically (eg ovarian cancer)

Question 28

what type of tumours are most suited to intra-arterial chemo

Answer 28

those with a well-defined blood supply

Question 29

an example of intra-arterial chemo

Answer 29

hepatic artery infusion for liver metastases

Question 30

what are the advantages of intra-arterial chemotherapy

Answer 30

higher doses to be delivered to the involved site | reduced systemic toxicity

Question 31

how is the dose of routine chemo drugs calculated

Answer 31

on body surface area of the patient

Question 32

How is the dose of the chemo drug carboplatin calculated

Answer 32

directly according to renal function

Question 33

which cancer have a cure of advanced disease from chemo in >50% of cases

Answer 33

``` Hodgkin's disease Testicular cancer Acute lymphoblastic leukaemia Choriocarcinoma Paediatric cancers: leukaemias, lymphomas and sarcomas ```

Question 34

which cancers have <50% cure of advanced disease from chemo

Answer 34

Non hodgkins lymphoma Ovarian cancer Paediatric neuroblastoma Adult osteosarcoma, Ewing's sarcoma, rhabdomyosarcomas

Question 35

which cancers have an increased cure rathe in high risk loco regional disease

Answer 35

``` Breast Colorectal Non-small cell lung cancer Oesophageal and gastric cancer Bladder cancer ```

Question 36

what does remission mean in terms of cancer

Answer 36

areas of the cancer shrink, | with reduction in symptoms and frequently disease control for several months once treatment course is completed.

Question 37

what are 3 cancers considered curable

Answer 37

Breast cancer Small cell lung cancer Ovarian

Question 38

which cancers are considered to have a prolonged survival with chemo but there are few cures in advanced disease

Answer 38

``` Non small cell lung cancer Colorectal cancer Gastric Breast Bladder Prostate ```

Question 39

which cancers often have palliation of symptoms with chemo but limited responses

Answer 39

``` Renal cancer Melanoma head and neck cancer Pancreatic cancer Biliary tract cancers ```

Question 40

what are the main aims for the use of combination chemotherapy regimens

Answer 40

max cell kill min toxicity to non-tumour cells min development of resistance

Question 41

How many tumour cells are usually killed per cycle of chemo

Answer 41

2 log reduciton (eg from 10^9 to 10^7)

Question 42

in chemo combination regimes how is toxicity minimized

Answer 42

avoid giving 2 or more drugs with the similar adverse effects as this may cause intolerable toxicity. Agents with distinct organs of toxicity allow dose to be kept high

Question 43

how does giving multiple drugs in chemo minimise drug resistance

Answer 43

more tumour cells are killed when more drugs given | so increases probability of killing the initial population

Question 44

what procedure is necessary to deal with high dose regimes of chemotherapy

Answer 44

bone marrow transplant | peripheral Haematopoietic progenitor (stem cells) now more commonly used

Question 45

what class of drug is most commonly used to treat nausea and vomiting from chemo

Answer 45

5-HT antagonists (eg Ondansetron)

Question 46

How is myelosuppression caused in chemo

Answer 46

Chemo causes bone marrow suppression by killing haematopoietic progenitor cells

Question 47

at what after the chemo is the leuopenia and thrombocytopenia

Answer 47

10-14 days from the beginning of each cycle

Question 48

what is the lowest point of the drop in leukocytes and neurophils called

Answer 48

the nadir

Question 49

what count of neutrophils is generally not associated with infection

Answer 49

>1x10^9/1

Question 50

what what level of neurophils is there significant risk of infection

Answer 50

0.5x10^9/1

Question 51

how long does haematopoietic recovery usually take

Answer 51

3-4 weeks (usually the length of cycles)

Question 52

what are the common GI side effects of chemo

Answer 52

oral mucositis diarrhoea constipation - dehydration, reduced oral intake, adverse effects of medications eg opiates and 5-HT antagonists

Question 53

what causes the side effect of alopecia associated with chemo

Answer 53

the effects of the cytotoxic drugs on the rapidly dividing cell population at the hair follicle.

Question 54

what can sometimes be used to try and minimise the alopecia

Answer 54

a cold cap - reduces the blood flow to the scalp

Question 55

what are the 4 types of neurological toxicity associated with chemo

Answer 55

Peripheral neuropathy Autonomic neuropathy Central neurological toxicity Ototoxicity

Question 56

what chemo drugs causes peripheral neuropathies

Answer 56

Platinum drugs: cisplatin, taxanes and vinca alkaloids

Question 57

which chemo drug is associated with hearing loss

Answer 57

cisplatin - due to cochlear damage

Question 58

what is the effect of cisplatin on hearing

Answer 58

can cause permanent high tone hearing loss

Question 59

which s chemo drug is nephrotoxic

Answer 59

platinum agents - mostly cisplatin and ifosfamide (alkylating agent)

Question 60

which chemo drugs have bladder toxicity

Answer 60

Cyclophosphamide and ifosfamide

Question 61

what can the drugs causing bladder toxicity cause

Answer 61

haemorrhagic cystitis (in a dose dependent manner)

Question 62

which chemo drug can cause coronary artery spasm

Answer 62

5-FU

Question 63

what skin/soft tissue side effects can be caused by chemo drugs

Answer 63

Extravasation Palmar and plantar erythema Photosensitivity Pigmentation

Question 64

what is extravasation

Answer 64

when a chemo drug leaks in to the surrounding tissue (of the cannula)

Question 65

what is hand-foot syndrome

Answer 65

palmar and plantar erythema

Question 66

what chemo drug causes pigmentation

Answer 66

bleomycin causes skin and nail pigmentation

Question 67

what chemo drug is associated with the side effects of myalgia and arthralgia?

Answer 67

paclitaxel

Question 68

which are the most carcinogenic anti-cancer drugs

Answer 68

alkylating agents and procarbazine

Question 69

which long term side effect is increasing with more people surviving cancer

Answer 69

Secondary malignancies (from anti-cancer drugs)

Question 70

which chemo drugs can cause pulmonary fibrosis in the long term

Answer 70

bleomycin | busulphan

Question 71

when does the nadir on myelosuppression normally occur?

Answer 71

about 10-12 days after chemo

Question 72

what can cause pancytopenia

Answer 72

bone marrow replacement by malignant infiltration

Question 73

what type of cancers is pancytopenia more common in

Answer 73

haematlogical malignancies breast lung prostate cancer

Question 74

what type of anaemia can be caused by repeated chemo

Answer 74

macrocytic anaemia

Question 75

What Hb level do oncology pts require a blood transfusion

Answer 75

Hb <10 gldl

Question 76

what are 4 clinical signs of thrombocytopenia

Answer 76

petechial haemorrhage spontaneous nosebleeds corneal haemorrhage haematuria

Question 77

If thrombocytopenia is prolonged, what sort of transfusion is required

Answer 77

platelet

Question 78

what level of platelets requires urgent platelet transfusion

Answer 78

<10 x10^9/L

Question 79

what is the most frequent cause of morbidity and mortality associated with myelosuppression

Answer 79

neutropenic infection

Question 80

what is the criteria for immediate in-patient broad spectrum antibiotics for neutropenic infection

Answer 80

FEVER | total white cell counts <1 x10^9/L