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Year 4 Cancer Care and Haem > Systemic Cancer Management > Flashcards

Systemic Cancer Management Flashcards

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1
Q

Antimetabolites are a class of chemotherapy drug. How do they work?

A

Target S phase of cell cycle

Antagonises folic acid/purine synthesis or pyrimidine synthesis

Prevents either Thymidine or Nucleotide formation

Generally affects synthesis phase of other rapidly dividing cells

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2
Q

Give three examples of Antimetabolite agents and a common use

A

Methotrexate (inhibits dihydrogen folate reductase) - Leukaemia

Mercaptopurine - Acute Leukaemias

5FU - Wide Range

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3
Q

Give four examples of anti tumour antibiotics

A

Dactinomycin
Doxorubicin
Bleomycin
Mitomycin C

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4
Q

Give a use and a side effect of Doxorubicin

A

Breast Cancer

Permanent Cardiotoxicity

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5
Q

Give a use and a side effect of Bleomycin

A

Testicular Cancer

Pulmonary Toxicity

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6
Q

Give a use and a side effect of Mitomycin C

A

Intravesicle bladder cancer

Myelosupression

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7
Q

What is an Alkylating agent?

A

Alkyl groups interact with and cross link DNA

Can be monofunctional or bifunctional depending if one or two alkyl groups

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8
Q

Name two examples of Alkylating agents and their respective side effects

A

Mechlorethamine - Myelosupression

Cyclophosphamide - Haemorrhagic Cystitis

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9
Q

What are Anti-Microtubule agents? Describe the broad subtypes

A

Disrupt mitotic spindle disruption (targeting M phase)

Vinca Alkaloids - Blocks polymerisation of microtubules and stops mitotic metaphase

Taxanes - Promote and overstabilise microtubules which then becomes dysfunctional

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10
Q

Give an example of a Vinca Alkaloid and a side effect

A

Vincristine

Neurotoxicity

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11
Q

Give an example of a Taxane

A

Docetaxel

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12
Q

How do Platinum Agents work? Give an example

A

Similar to Alkylating agents as they cross link DNA

Cisplatin

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13
Q

How to Topisomerase work?

A

Inhibits nuclear enzymes which normally decline the supercoils in DNA to allow replication

Targets S Phase

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14
Q

Give two examples of Topisomerase inhibitors and respective uses

A

Irinotecan - Metastatic Colon Cancer

Etopiside - Lymphoma

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15
Q

Name four subtypes of Hormonal Therapies

A

SERM
Aromatase Inhibitors
GnRH Agonists
GnRH Antagonists

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16
Q

How are Glucocorticoids used as a Hormonal Therapy?

A

Can be used in combination for leukaemias and lymphomas

Reduces lymphoid mass and increases lymphocyte breakdown

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17
Q

How do SERMs work?

A

Can be an agonist, antagonist or partial agonist against oestrogen receptors

Tamoxifen is an antagonist in breast tissue
Tamoxifen is an agonist in endometrium
Raloxifene is a partial agonist in breast only

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18
Q

What is an Aromatase Inhibitor?

A

Post menopausal women produce a lot of oestrogen via aromatase pathway, which this inhibits

SE: Hot Flush, Reduced Bone Density

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19
Q

What are GnRH Agonists?

A

Eg Goserelin

Used for prostate cancer, constant stimulation of GnRH leads to desensitisation

Leads to an initial androgen flare

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20
Q

How are androgen flares treated during GnRH agonist therapies?

A

Anti Androgens such as Flutamide

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21
Q

Name a GnRH ANTagonist and give two side effects

A

Degarelix

Hot flushes
Impotence

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22
Q

How can biological/targeted therapies kill cancer cells?

A 
Block cell surface receptors
Receptor Ligand
Induce Immune Cells
Activating complement system
Delivering chemo straight to cancer cells
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23
Q

What is Herceptin? Give a side effect

A

Used in HER2 positive breast cancers

IgG Antibody that blocks receptor

Risk of Cardiotoxicity

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24
Q

What is Cetuximab? Give a Side Effect

A

A Mab that binds to VEGF used for metastatic colon cancer

Side effect is bleeding

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25
What is Imatinib? Name a side effect
Tyrosine Kinase inhibitor active against BCRABL and used in CML SE:Myelosupression
26
Biological/Targetted therapies can present with infusion reactions. How does it present?
Fever Chills Nausea
27
Other than infusion reactions, name some side effects of biological therapies
Haemolytic Anaemia Eosinophilia Hepatitis/Dermatitis/Neuropathies Often reversible with steroids
28
What is Chemotherapy?
Systemic therapy used to kill cancer cells by causing apoptosis or cytotoxicity Targets rapidly dividing cells Can be cell cycle specific or cell cycle non specific
29
Name five different uses of Chemotherapy
Induction therapy Neoadjuvant to shrink before surgery/radio Adjuvant (after surgery/radio) Maintenance in lower doses (maintain remission) Palliative (addressing symptoms)
30
How is dosing of chemotherapy calculated?
Based on patients surface area Cycles need to be the correct length to allow healthy cells to recover (but not cancer cells)
31
Name seven common side effects of chemotherapy
``` Alopecia Nausea and Vomiting Neutropenia Oral Mucositis Weight Loss Peripheral Neuropathy Secondary Cancers ```
32
Describe the side effect ‘Alopecia’ in Chemotherapy
Onset usually 7-10 days after chemotherapy Managed with wigs and reassurance that it will return
33
Describe the time frame of side effect ‘Nausea’ in Chemotherapy
Acute - within a few hours Delayed - more than 24 hours Anticipatory - conditioned response
34
Describe the non pharmacological management of CINV
Small light meals several times a day Dry Starchy food Avoid vestibular stimulation Sleep
35
Describe the pharmacological options for management of CINV
Ondansetron Aprepitant Dexamethasone Olanzepine
36
Describe the side effect ‘Neutropenia’ in Chemotherapy
Neutrophils <1.5 (or <0.5 if severe) Can consider G-CSF as prophylaxis Antibiotics and sepsis 6 if any suspicion of neutropenic sepsis
37
Describe the side effect ‘Oral Mucositis’ in Chemotherapy
Inflammation or ulceration of oropharyngeal mucosa which can interfere with eating/swallowing/speech Onset peaks 7d after chemotherapy
38
Describe the non pharmacological management of Oral Mucositis
8-12 cups of fluid Avoid Spicy/Acidic Foods Maintain good oral hygiene Cryotherapy (such as ice chips)
39
Describe the pharmacological management of Oral Mucositis
Mouth Rinses (not containing alcohol)
40
Describe the management side effect ‘Weight Loss’ in Chemotherapy
Small frequent meals and nutrient supplementation
41
Define Cachexia
Hypercatabolic state leading to weight loss despite nutritional supplementation
42
Describe the side effect ‘Peripheral Neuropathy’ in Chemotherapy
Stocking and glove distribution Managed by changing/adjusting dose, and trialing Gabapentin/Duloxetine
43
What are the common secondary cancers
Myelodysplastic Syndromes | Acute Myeloid Leukaemia
44
What is Radiotherapy?
Electromagnetic spectrum used to treat cancer (normally in XRay/Gamma Ray range) It works by causing direct damage to DNA and or Indirect damage (by radical formation) Targets rapidly dividing cells in M phase
45
What are the four Rs that affect the efficacy of Radiotherapy ?
Repair of DNA by the cell (using fractionation wisely) Repopulation of tumour cells in between fractions Reassortment (solved by giving over many fractions to ensure all cells have been hit in M Phase) Reoxygenation (cells further away from O2 supply are less radiosensitive)
46
What are the three types of Radiotherapy?
External Beam Radiotherapy Brachytherapy Stereotactic Radiosurgery
47
What is Brachytherapy?
Radioactive pellets inserted into tumour either temporarily (HDR) or permanently (LDR)
48
What is Stereotactic Radiotherapy?
Uses either linear accelerators or specialises gamma knife
49
What investigations are used to mark out tumour size and volume?
CT | PET
50
How is chemotherapy often useful as a Radiotherapy adjunct?
It can be used as a radiosensitiser
51
How can Radiotherapy be used palliatively?
``` Bone Mets Lung Mets Brain Mets Spinal Cord Compression SVCO ```
52
Lymphoedema is one of the long term complications of systemic therapy. What is it?
Swelling due to the obstruction of lymph fluid outflows causing build up in tissues Progresses over two to four years causing pitting/thickening/achiness
53
How is the severity of Lymphoedema determined?
Difference in circumference between affected and unaffected limb Stage 1: 2-3cm difference Stage 2: 3-5cm difference Stage 3: >5cm difference
54
Give one protective factor and one risk factor for Lymphoedema
Protective - Good skin care | Risk - LN dissection
55
How is Lymphoedema managed?
Avoid tight clothes Compression Physio
56
Radiation dermatitis and fibrosis is one of the long term complications of systemic therapy. What is it?
Fibrotic transformation due to repeated inflammation and healing Can result in skin thickening, ulcers, dysphagia and urethral strictures
57
How can radiation dermatitis/fibrosis be avoided?
Loose fitting clothes Unscented water based moisturisers avoided pre therapy Topical steroids after each session
58
Describe the effect of chemotherapy on fertility
Can affect central or peripheral pathways Can reduce sperm count Chemotherapy is less toxic to oocytes than to follicular development (meaning temporary Amenorrhoea rather than early menopause)
59
How does Radiotherapy affect fertility?
More damaging than chemotherapy Can affect implantation as well as eggs/sperm
60
How can fertility in systemic therapy be managed?
Pre-emptive preservation Administering preserving medications during therapy
61
How is Neuropathy secondary to chemotherapy managed?
Physiotherapy Electrostimulation Neuropathic Pain drugs
62
How does Chemotherapy affect cognition and memory?
Chemotherapy- generally mild but can persist for months/years after
63
How does Radiotherapy affect cognition and memory?
Biphasic Temporary decline followed by permanent decline

Year 4 Cancer Care and Haem (16 decks)

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