Treatment of cancer

Question 1

Radiotherpay can be…

Answer 1

Direct

Indirect

Question 2

Indirect radiotherpay forms

Answer 2

Super oxide free radicals

Question 3

Aim of radiotherapy =

Answer 3

damage DNA/double-strand break –> apoptosis

Question 4

Radiotherapy is usually delivered via a

Answer 4

Linear accelerator

Question 5

Types of particle radiation =

Answer 5

Photon
Electron
Proton

Question 6

Photon therapy advantages =

Answer 6

Skin sparing

Beam uniformity

Question 7

Gray =

Answer 7

A unit of absorbed radiation equal to the dose of 1 joule of energy absorbed per 1 kg of matter (1 J/Kg)

Question 8

SABR =

Answer 8

Stereotactic ablative radiotherapy

Question 9

Stereotactic ablative radiotherapy

Answer 9

Specialised way of delivering radiotherapy. Uses small, very precisely targeted treatments. Minimises damage to surrounding tissue.

Question 10

Brachytherapy =

Answer 10

Internal radiotherapy

Question 11

Conditions needed for brachytherapy =

Answer 11

• Accessible, well-demarkated tumour w/o high risk of regional lymph node metastasis

Question 12

2 types of complications of radiotherapy:

Answer 12

1. Acute tissue reactions

2. Late tissue reactions

Question 13

Acute tissue reactions usually occur =

Answer 13

In the middle of a long radiotherapy schedual

Question 14

Acute toxicity in radiotherapy =

Answer 14

2nd week = mucosal reactions (e.g. mucositis)

5th week = skin reactions

Question 15

Mucositis =

Answer 15

An intensity-limiting side effect for aggressive schedules. May mean patient can’t feed themselves during rounds

Question 16

Late toxicity tends to be

Answer 16

Permanent

Question 17

Late toxicity in radiotherapy occurs in cells with:

Answer 17

Low turnover (fibroblasts, neurons)

Question 18

Late toxicity develops within

Answer 18

Months - years

Question 19

Most common late side effect of radiotherapy

Answer 19

Xerostomia

Question 20

Xerostomia

Answer 20

Dry mouth

Question 21

Ex of late toxicity reactions to radiotherapy:

Answer 21

• Xerostomia
• Dental caries
• Fibrosis
• Soft-tissue necrosis
• Nerve tissue damage
• Ocular: catarcts, optic neuropathy, retinopathy
• otological
• CNS

Question 22

At what weight do tumour cells become clinically apparent?

Answer 22

1g

Question 23

Log-kill hypothesis of chemotherapy =

Answer 23

For a given dose of chemo in a given tumour, only a fraction of tumour is killed. Therefore, several courses is needed.

Question 24

Chemotherapy works in cells that’re…

Answer 24

Cycling

Question 25

Chemo works more rapidly on

Answer 25

Proliferating areas

Question 26

Ex of proliferating areas:

Answer 26

- Hair - Skin - GI mucosa - Bone marrow

Question 27

Uses of chemotherapy:

Answer 27

- Curative - Adjuvant - Neoadjuvant - Palliative

Question 28

Curative chemo:

Answer 28

Chemo is main treatment

Question 29

Adjuntive chemo:

Answer 29

Used to mop up cancer cells after treatment

Question 30

Neoadjuvant chemo:

Answer 30

Given before surgery

Question 31

Palliative chemo:

Answer 31

Improve QOL

Question 32

2 types of chemo toxicity:

Answer 32

1. Acute: due to effects on normal proliferating cells | 2. Chronic: end organ damage

Question 33

Common acute side effects of chemo:

Answer 33

- Bone marrow: decrease WBC, RBC, platelet - Alopecia - Stomatitis, mucositis, nausea, vomiting - Extraversion

Question 34

Extraversion =

Answer 34

Leakage of IV drugs into surrounding tissues.

Question 35

Drug resistance can be:

Answer 35

Primary or secondary

Question 36

Primary drug resistance:

Answer 36

Tumour grows from start/never responds to chemo

Question 37

Secondary drug resistance:

Answer 37

Intital response to chemo, tumor then grows again

Question 38

MDR-1 gene is involved in:

Answer 38

Drug reflux

Question 39

Drugs that reverse MDR

Answer 39

Verapamil Guanidine Cyclosporine

Question 40

Ex of alkylating agents:

Answer 40

Nitrogen mustard gases

Question 41

Alkylating agents MoA

Answer 41

Add alkyl group to guainine. Covalent bond/cross link - arrest cell cycle

Question 42

Ex of antimetabolite

Answer 42

Methotrexate

Question 43

Methotrexate disrupts

Answer 43

Folate metabolism (DHFR)

Question 44

Cisplatin has a similar effect to

Answer 44

Alkylating agents

Question 45

Tyrosine kinases are involved in...

Answer 45

Growth factor replication signal transduction