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Oncology > Clinical approaches to a cancer patient > Flashcards

Clinical approaches to a cancer patient Flashcards

1
Q

Cancer is a term for diseases in which abnormal cells divide without control, characterized by local tissue invasion and distant metastases

A

Cancer is a term for diseases in which abnormal cells divide without control, characterized by local tissue invasion and distant metastases

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2
Q

Oncology is the medical subspecialty dealing with the study and treatment of cancer

A

Oncology is the medical subspecialty dealing with the study and treatment of cancer

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3
Q

1 in ____ sg dies of cancer

A

1 in 4 sg dies of cancer

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4
Q

________ppl dies from cancer everyday

A

14 ppl dies from cancer everyday

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5
Q

_____ ppl diagnosed w cancer everyday

A

28 ppl diagnosed w cancer everyday

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6
Q

top 3 men cancer incident

A
  1. Colorectal Cancer (17.1%)
  2. Lung Cancer (15.1%)
  3. Prostate Cancer (12.4%)
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7
Q

men Colorectal Cancer rank and %

incident

A
  1. Colorectal Cancer (17.1%)
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8
Q

men Lung Cancer rank and %

incident

A
  1. Lung Cancer (15.1%)
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9
Q

men Prostate Cancer and %

incident

A
  1. Prostate Cancer (12.4%)
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10
Q

men top 3 cancer death

A
  1. Lung Cancer (27.1%)
  2. Colorectal Cancer (13.8%)
  3. Liver Cancer (12.6%)
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11
Q

men Lung Cancer rank and %

death

A
  1. Lung Cancer (27.1%)
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12
Q

men Colorectal Cancer rank and %

death

A
  1. Colorectal Cancer (13.8%)
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13
Q

men liver Cancer rank and %

death

A
  1. Liver Cancer (12.6%)
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14
Q

women cancer incident

A
  1. Breast Cancer (29.2%)
  2. Colorectal Cancer (13.3%)
  3. Lung Cancer (7.6%)
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15
Q

women Breast Cancer rank and %

incident

A
  1. Breast Cancer (29.2%)
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16
Q

women colorectal Cancer rank and %

incident

A
  1. Colorectal Cancer (13.3%)
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17
Q

women lung Cancer rank and %

incident

A
  1. Lung Cancer (7.6%)
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18
Q

women cancer death

A
  1. Breast Cancer (17.6%)
  2. Lung Cancer (16.5%)
  3. Colorectal Cancer (15.2%)
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19
Q

women death breast cancer rank and %

A
  1. Breast Cancer (17.6%)
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20
Q

women death lung cancer rank and %

A
  1. Lung Cancer (16.5%)
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21
Q

women death colorectal cancer rank and %

A
  1. Colorectal Cancer (15.2%)
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22
Q

treatment goals

A
  1.   To cure
  2.   To prolong life
  3.   To palliate
  4.   To experiment
  5. To Cure
    Overall 70% of germ cell tumors can be cured with chemotherapy alone
    Overall 50% of lymphomas can be cured with chemotherapy alone
    More than 90% of standard risk testicular cancers are curable
2. To Prolong life
The traditionally highly treatable cancers are usually the “hormonal” types 
§ Breast 
§ Ovarian 
§ Thyroid 
§ Prostate

§ With the advent of molecular therapies and immunotherapies, traditionally treatment-resistant cancers are becoming highly amenable to treatment

Cure and prolong –> fine line grey area. coz tx is v good.

  1. To Palliate (due to recur/resistance)
    “ Living well may not add years to your life, but it will add meaning to your years
    §  Treat when not treating leads to lower quality of life
    §  Illness-related concerns
     - Symptom distress
    §  Social-related concerns
    -  Maintaining normalcy
  • to give comfort
  • low dose chemo/radio to increase QOL and ddecrease symptoms / stress

To Experiment
§ Reasonable option to offer a patient with relapsed or refractory disease
§ Not an option if gold standard therapies are still available…or rather, is it ethical to offer experimental treatment over gold standard treatment?
§ Phase I studies (no guarantee cure)
must have exhausted all standarised tx and gold std

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23
Q

BAD prognosis (in survival rate)

A

<80-90% 5 year survival rate = bad prognosis

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24
Q

Tolerance of side effects in tx goal

A

Cure = high
Extend life = moderate
Pallitive = low
Experimental = expected

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25
Q

special concerns for Cure goal

A

Delayed and late side effect

- eg leukaemia cure rate of 80% –> cardiomyopathy –> die from Heart failure in 30-40yo.

26
Q

special concerns for extend life goal

A

value of added time

pt live longer okay?

27
Q

special concerns for pallitive goal

A

symptoms control

28
Q

special concerns for experimental goal

A

finding correct dose

29
Q

Challenges in patient selection and management

Cure goal

A

Avoid treating those who are already cured

30
Q

Challenges in patient selection and management

extend life goal

A

Treat when added time outweighs side effects

31
Q

Challenges in patient selection and management

palliative goal

A

Treat when not treating leads to lower quality of life

32
Q

Challenges in patient selection and management

experiment goal

A

respond ethically to patient’s perception of intent

33
Q

Factors to consider in determining treatment goals

A 
§  Type of cancer and extent of involvement 
§  Treatment goals  
§  Age 
§  Performance status  
§  Concomitant diseases 
§  Social and economic factors 
§  Patient’s and/or family member’s wishes 
§  and many more..
34
Q

ECOG and KARNOFSKY

A 
performance status scales 
ECOG  0-5 
0 = normal activity 
1 = symptoms but ambulatory 
both outpatient

2 = <50% in bed
3 =>50% in bed
4= 100% in bed
5 = death

KARNOFSKY
- 100% normal
70-100 = outpatient
0 = dead

35
Q

cellular kinetics

A

10^12 = 1 kg = Severe metastatic disease, death

10^11 = 100 gm = Advanced metastases

10^10 = 10 gm = Regional spread of cancer

10^9 = 1 gm = Clinically detectable disease (symptoms)

10^8 = 100 mg=  Subclinical disease 
10^4 = 1 mg = Subclinical disease 
10^3 = 1 mcg = Carcinoma in situ 
10^0 = 1 ng = Neoplastic Transformation
36
Q

slow growing vs rapid growing cancer tx

A

Chemo / cytotoxic only for rapid growing cancer.

37
Q

eg of slow growing cancer

A

prostate and kidney cancer

38
Q

____ log kill, ___ log regrowth

A

3 log kill, 1 log regrowth

39
Q

chemotherapy concepts

A

target = below 10^9 and continue till 0 cells

interval for chemotherpy = 3 weeks
so as to allow body to recover.
chemo can kill bonemarrow cells, therefore WBC etc drops.
recovery phase allow cancer cells to regrowth and also allow WBC to increase in number

shorten interval for chemotherapy by giving WBV growth factor. interval shorten to 2 months.
thus less time for cancer to growth but increase toxicity

40
Q

Different Modalities of cancer treatment

A
  1.   Surgery
  2.   Radiation
  3.   Hematopoietic Stem Cell Transplant
  4.   Hormonal Therapy
  5.   Targeted Therapies
  6.   Immunotherapy
  7.   Chemotherapy
41
Q

Surgical oncology

A 
Surgical oncology (solid tumor; normally combi) 
§ The most ancient mode of treatment for cancer; It was the only treatment that could cure cancer prior to the advent of chemotherapy and radiotherapy 
Multiple roles 
§  Preventive (prophylactic) surgery 
§  Diagnostic and staging surgery 
§  Debulking surgery 
§  Palliative surgery
42
Q

Radiation Therapy (XRT)

A

Destruction of cancer cells by ionizing radiation; treats localized disease

§ Rarely used by itself with curative intent; parts of multi-modality treatment approach

Many techniques available
§ Internal Interstitial Radiation (Brachytherapy) § External Beam Radiation therapy

43
Q

Complications of XRT

A

Radiation Therapy (XRT)

Acute: Interruption of rapidly dividing tissues; patients can become fatigue, develop skin reactions, nausea, vomiting, diarrhea, dysphagia, mucositis, xerostomia, myelosuppression

Chronic: Pulmonary fibrosis, tissue edema, may induce secondary malignancies

XRT is mutageneic, carcinogenic and teratogenic

44
Q

stem Cell Transplantation

A

Stem Cell Transplantation

§  Administration of higher than usual myelosuppressive chemotherapy and/or radiation therapy to treat a malignancy or to replace a diseased bone marrow

Types of Transplants: 
§  Allogeneic (other ppl)
§  Autologous (own stem cell)
§  Syngeneic 
§  Cord Blood Transplant
45
Q

Hormonal Agents

A

Hormonal Agents

§  aka Hormonal Antagonists
§  Manipulation of the endocrine therapy through exogenous administration of specific hormones as number of cancers are driven by the hormones
§  Castration of hormones can be performed by pharmacological or surgical means

  • stop production of certain hormones
    OR
  • hormones will not bind to receptors and stimulate growth
46
Q

targeted therapies

A

§ Molecularly targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth

Two main categories
§  Monoclonal antibodies
§  Tyrosine kinase inhibitors

47
Q

Immunotherapy

A

Immunotherapy
§  Using the immune system to detect and destroy cancer

 Some examples include: 
§  Immune system modulators  
              - Interleukins and interferons 
§  Monoclonal antibodies (targeted) 
§  Immune Checkpoint Modulators 
§  Cancer Treatment vaccines 
§  Immune Cell Therapies
48
Q

chemotherapy

A
  1. Chemotherapy
    § Induction —- 1st tx that bring pt to remission (10^9)
    § Consolidation — more chemo to maintain remission
    § Maintenance – v. low dose chemo to maintain remission/cure —- after finishing consolidation tx
    (haematological cancer)

§ Adjuvant — tx given after surgery to maintain remission
§ Neoadjuvant – chemo given before surgery to shrink tumor down before cutting it—- after that can start adjuvant

49
Q

Goals of combination therapy

A

increased efficacy
balance between activity and safety (compatible side effect)

activity = different mechanism of action and resistance

only give drug that has response rate of >=30%
response rate = tumor size reduction

50
Q

Body surface area formula

A

Sq rt [ ( Height(cm) X weight (Kg) ) / 3600 ]

51
Q

Dose rounding is recommended not to exceed _________

A

Dose rounding is recommended not to exceed 5-10%

52
Q

Tumor factors that affect cell kill

A

 Heterogeneity: Tumor cells are generally unstable and tend to form different cell clones (mutation –> various response –> resistant)

§ Site —> BBB, Bone hard to penetrate

§ Size - the larger the tumor:

  • The greater the heterogeneity
  • The poorer vascularization
  • The smaller the growth fraction (Gompertzian Growth)
  • Drug resistance – many mechanisms
53
Q

Administration Sites of Chemotherapy

A

Systemic Administration
§  Intravenous
§  Intramuscular
§  Subcutaneous

Local/regional administration 
§  Intraperitoneal 
§  Intrathecal and intraventricular 
§  Intravesical 
§  Intra-arterial  (Hepatic Arterial and regional limb perfusion )
54
Q

Pros and Cons of systemic therapy

A

Pros

§ Treat micrometastasis (clinically undetectable tumor) § Prevents systemic recurrence
§ Effective for treatment of widespread tumor sites

Cons
§ Increases toxicity to a wide range of tissues and organ systems throughout the body
§ ↑ risk of life-threatening toxicity
§ ↑ risk of systemic symptoms

55
Q

Pros and Cons of Regional therapy

A 
PROS
§ Provide high dose to specific site 
§ Low risk of systemic toxicities 
§ Low rates of systemic symptoms 
§ May allow treatment in patient unable to tolerate systemic system 
CONS
§ Do not treat micrometastasis 
§ ↑ risk of systemic failure 
§ Tumors needs to be localized 
§ Technically difficult?
§ May require drugs with specific characteristics that allow for regional administration
56
Q

Evaluate of treatment response

“How do I know whether my treatment is going well or not?”

A

§ Responses – Complete Response, Partial Response, Stable Disease
§ Survival – Overall Survival, Progression Free Survival
§ Tumor markers – e.g. CA-125, CEA
§ Quality of life

57
Q

Complications of systemic anticancer therapies

A

Diarrhea
Renal failure

cystitis
local reaction 
alopecia 
myalgia
pulmonary fibrosis 
sterility

neuropathy

myelosuppression
phlebitis

cardiotoxicity

mucositis
Vomiting / nausea
cognitive impairment

58
Q

grading chemotherpay toxicities (dehydration)

A

1: dry mucous membranes and/or diminished skin turgor
2: requiring IV fluid replacement (brief)

3) requiring IV replacement (sustained)
4) physiologic consequences requiring intensive care, hemodynamic collapse.

3/4 = can cause death need interrupt tx and give supportive tx.

59
Q

adverse events

A

§  Dose limiting toxicity – can limit the amount of drug exposure to a patient

§  Hematological toxicities

  • Objective toxicities e.g. neutropenia
  • Clear guidelines to withhold or delay

§Non-hematological toxicities

  • Often subjective toxicities e.g. fatigue
  • Individual threshold varies

§  Economics of managing AE-related admissions

  • Direct Medical Costs = SGD$ 4747
  • Length of stay ~ 6.1 days
60
Q

Cancer Supportive Care Defined

Supportive care is a discipline within oncology which is devoted to the ____________ associated with cancer and anticancer treatment, with an ultimate aim to alleviate cancer patients’ symptoms and complications. This includes the management of _____________ and side effects that patients experience across the __________

A

Supportive care is a discipline within oncology which is devoted to the

prevention and treatment of toxicities

associated with cancer and anticancer treatment, with an ultimate aim to alleviate cancer patients’ symptoms and complications. This includes the management of

physical and psychological symptoms

and side effects that patients experience across the

continuum of the cancer.

Oncology (11 decks)

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