Pre-placement Flashcards
1
Q
What are the most common cancers for men in England?
A
- Prostate
- Lung
- Colorectal
- Bladder
- Non-Hodgkin Lymphoma
2
Q
What are the most common cancers for women in England?
A
- Breast
- Lung
- Colorectal
- Uterus
- Ovary
3
Q
What is palliative treatment in oncology?
A
Therapy where the aim is to improve QoL but where the cure is not possible. This could include most cancer treatments (chemotherapy, radiotherapy, surgery) and symptomatic treatment.
4
Q
What is the course of radiotherapy?
A
- Given as a course to give healthy tissue a chance to recover in between
- Given in fractions: 1-10 usually palliative, 20-33 usually radical/curative
- Can give alone or concurrently with chemo
- Takes 15-30 mins, usually once per day
- Patient is seen in clinic and written info is given then consent > planning scan taken and then treatment within a few days for palliative, 10-14 days if radical
- Planning methods - CT stimulator or clinical mark-up (if cancer is on the skin)
5
Q
What can be used for positioning in radiotherapy?
A
- Immobilisation shells
- Breast/lung boards
- Radiotherapy tattoos
- Lasers
6
Q
What are the early side effects of radiotherapy?
A
- Normal tissue gets inflamed
- Fatigue
- Pain flare
- Oesophagitis
- Pneumonitis
- Skin reaction
- Diarrhoea
- Nausea
- Cystitis
- Increased ICP
- Hair loss
7
Q
What are the late side effects of radiotherapy?
A
- Fibrosis
- Stricture
- Osteonecrosis
- Rib fracture
- Second malignancy
8
Q
What is radical radiotherapy?
A
- Given with curative intent e.g. prostate, larynx, cervix, lung
- Treat whole tumour: extra margins for microscopic spread, extra margin for set up error, organ motion
- Keep normal soft tissues to safe limit
- Planning is complex
9
Q
How do you manage motion in radiotherapy?
A
- Bladder protocol e.g. empty bladder before treatment
- Stomach protocol - don’t eat for 2 hours before
- Breath hold
- 4D CT scan
10
Q
What is brachytherapy?
A
Typically done on prostate/cervix»_space; radioactive seeds placed within the target tissue, so treats cancer from the inside out.
11
Q
What is proton treatment?
A
Protons minimise exit dose to normal tissues especially useful if target near sensitive structures/in paediatric patients.
12
Q
What is palliative radiotherapy?
A
- Not curative, given to relieve symptoms e.g. pain, SOB, bleeding, obstruction
- Don’t need to treat whole tumour, only the part that’s causing symptoms
- Late effects less of an issue - not as concerned about normal tissue
- Planning more simple - priority to plan and treat quickly
13
Q
What are the classes of chemotherapy?
A
- Platinum and other classical alkylating agents
- Anthracycline abx
- Non-anthracycline abx e.g. bleomycin, actinomycin D
- Antimetabolites e.g. methotrexate, purine analogues, pyrimidine analogues
- Topoisomerase inhibitors e.g. irinotecan, toptecan, etoposide
- Toxanes e.g. paclitaxel and docetaxel
- Vinca alkaloids e.g. vincristine, vinblastine, vinorelbine
14
Q
What are the roles of chemotherapy?
A
- Curative - to cure chemo-sensitive tumours: lymphoma, germ cell tumours, leukaemia
- Adjuvant: to reduce risk of relapse, neo-adjuvant in stomach/oseophagus, adjuvant in breast/colon/lung
- Radio-sensitise: low doses to increase efficacy of radical radiotherapy
- Palliation: relieve symptoms from wide-spread incurable tumours
15
Q
What is the nomenclature of chemotherapy?
A
- Chemotherapy is normally administered over a few hours once every 2-3 weeks in cycles (to allow patient/organ/blood count recovery)
- Hence cycle 2 day 15 would be a time of FBC nadir
- Multiple drugs given together are known as a regimen
- Treatment for relapse is 2nd or in haematoncology, salvage
- Most lines of therapy would consist of no more than 6 cycles over 5 months of treatment
16
Q
What are the side effects of chemotherapy?
A
- Bone marrow: neuropenia, thrombocytopenia
- GI tract: mucositis, n+v, diarrhoea
- Skin: alopecia, hand-foot syndrome
- Heart: heart failure, angina/MI
- Lungs: pulmonary fibrosis
- Kidney: renal impairment
- Nerves: peripheral neuropathy, hearing loss
- Endometrium and reproductive organs: infertility
17
Q
What are chemotherapy emergencies?
A
- Febrile neutropenia/neutropaenic sepsis (biggest killers
- Thrombocytopaenic haemorrhage (rare outside of haematological cancer)
- Tumour lysis syndrome - complication of success, rapid cell breakdown leads to severe biochemical abnormalities
18
Q
What can be done to help with preservation of fertility?
A
- Should be discussed with patients as follows - males from adolescance onwards, females of reproductive age, pre-pubertal females are a special case dealt by paediatricians
- Semen crypopreservation is typically successful, oocyte less so
- Embryo preservation is optimal for female patients in stable relationships
19
Q
What are side effects of immunotherapy?
A
- Infusion Related Reaction (IRR) - anaphylactoid in nature and are treated similarly, through adrenaline is reserved later in treatment pathway
- CPIs (immune checkpoint inhibitors) may cause immune activation against normal tissues - essentially autoimmunity (-itis) (treat with steroids ~1 month)
20
Q
What are the side effects of tyrosine kinase inhibitors?
A
- Diarrhoea
- Rash
- LFT abnormalities - drug-drug interactions)
- Cytopenias possible in haematological cancers
- Typically managed by holding the drug and reintroducing at a lower dose
21
Q
What is the ECOG Performance Status Scale?
A
0 Fully active, able to carry out all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about >50% of waking hours.
3 Capable of only limited self care, confined to bed/chair >50% of waking hours
4 Completely disabled and confined to bed/chair. No self-care
5 Deceased
22
Q
What are the options for breast cancer treatment?
A
- Hormone treatment
- Surgery - wide local excision (lumpectomy) or mastectomy (prognosis very similar)
- Chemotherapy - neo-adjuvant (prior to definitive treatment)
- Radiotherapy - adjuvant after wide local excision
23
Q
What are the indications for a mastectomy?
A
- Multifocal tumour
- Central tumour
- Large lesion in small breast
- DCIS >4cm
- If multiple lumpectomies haven’t been successful
- If can’t have radiotherapy after e.g. pregnant
- Genetic predisposition (BRCA 1 + 2) - bilateral
24
Q
What are the indications for a wide local excision?
A
- Solitary lesion
- Peripheral tumour
- Smal lesion in large breast
- DCIS <4cm
25
What does the grade of cancer mean?
- Grade 1: cancers are generally slow growing and similar to healthy cells
- Grade 2: intermediate
- Grade 3: fast growing cancer cells
26
What would be in a pathology report for a tumour?
- Grade
- Ki-67: mitotic index, proportion of cells under active division (>10% is significant) - high % then may need adjuvant therapy
- Clear margins: no cancer cells at the edge of the specimen, don't need to operate again
- No. of lymph nodes the cancer was found in - usually take them all out but may require additional radiotherapy to the area to ensure there are no cancer cells left behind.
27
What lymph nodes drain from the breast?
- Axillary
- Supraclavicular
- Internal mammary chain
28
What are the side effects of axillary node clearance?
- Lymphodema - heavy arm, enlarged, painful, cellulitis, lose feeling in hand
- Tx: compression sleeves, physiotherapy
29
What can be given in HER2+ cancers?
Traztuzumab or pertuzumab - monoclonal antibodies which target the HER2 receptor to prevent its activation and arrest growth
30
What treatment would be used in pre-menopausal women for breast cancer?
Tamoxifen (SERM) which blocks oestrogen receptors in the breast, preventing growth. Used in pre-menopausal women as they continuously produce oestrogen (from ovaries).
31
What treatment would be used in post-menopausal women for breast cancer?
Anastrozole is an aromatase inhibitor. This drug blocks the conversion of peripheral fat into oestrogen. Post-menopausal women do not produce oestrogen from their ovaries, this is their main source of oestrogen.
32
When would radiotherapy be offered after a mastectomy?
- T3-4 tumours
- >/= 4 positive axillary nodes - also include the supraclavicular fossa and potentially the axilla if >10 nodes but no distant mets
33
Why are bisphosphonates used in breast cancer?
Reduce risk of bone related events e.g. metastatic disease
34
What investigations would you do for oesophageal cancer?
- CT thorax, abdomen and pelvis
- PET - metastatic disease
- Endoscopy - visualise and biopsy
- Upper 1/3 oesophagus - bronchoscopy, lower 1/3 - laparoscopy
35
What are the side effects of capecitabine and cisplatin?
- Capecitabine - vasospasm and increases risk of angina, heart attack and stroke. This risk is higher with prior hx of IHD.
- Cisplatin - requires a large volume of fluid due to renal excretion and risk of toxicity, so good cardiac function is important. Poor cardiac function may lead to acute HF/pulmonary oedema
36
What are the early side effects of radiotherapy?
- Tiredness
- Skin soreness, redness and itching in treatment area
- Increased saliva or mucous production
- Loss of appetite > weight loss
- Oesophagitis - odynophagia/dysphagia
- Indigestion or heartburn
- N+v
- Abdo discomfort or bloating
- Hair loss in treatment area
- Pneumonitis - cough, SOB
- May require feeding via tube into stomach/small intestine
37
What are the late side effects of radiotherapy?
- Oesophageal stricture
- Fibrosis (scarring) of underlying lung - SOB, cough or changes on XR
- Risk of damage to heart - risk depends on position of tumour in oesophagus
- Skin changes in treatment area including: altered colour (lighter or darker), scarring, telangiectasia (small visible blood vessels, look like spidery marks)
- Oesophageal or gastric ulceration or perforation (tear) > surgery
- Oesophageal fistulation: abnormal connection between oesophagus and airways
- Myelitis: inflammation of nerves which may cause a change in muscle power or sensation
- Risk of rib fracture after an injury
- A different cancer in the treatment area - not related to the current cancer, may occur yrs later
38
Why is the rule around radiotherapy and food?
Do not eat for 2 hours before radiotherapy, digestion of food can move tumour so it's not as targeted therapy and will increase exposure of the stomach to radiation.
39
What are the differentials for further dysphagia after treatment of oesophageal cancer?
- Recurrence of cancer
- Benign oesophageal stricture (radiotherapy SE)
- Achalasia
- Oesophageal dysmotility
