Chemotherapy

Question 1

Radical vs primary

Answer 1

Radical = curative intent

Primary = alone for cure

Question 2

Neo-adjuvant/ adjuvant/ chemoradiation

Answer 2

Neo-adjuvant = before an operation Adjuvant = after an operation Chemoradiation = with radiotherapy

Question 3

Palliative vs high dose - what is given in high dose to help?

Answer 3

Palliative = incurably advanced disease

High dose = with bone marrow transplant of stem cell support

Question 4

What are the consequences of chemo targeted at cells with low rate of renewal?

Answer 4

SE can increase over time eg cardiomyopathy, neuropathy, deafness

Carboplatin = more you have it, more likely you are to have a reaction

Question 5

How to manage N+V with chemo?

Answer 5

Prevent with ondansetron + dexamethasone IV

Post dose = metoclopramide, dexamethasone

Beware effects of steroids on blood sugars

Question 6

How many cancer patients require chemo?

Answer 6

60-70%

Question 7

What is the mechanism of action of chemo?

Answer 7

Usually targets DNA

Toxic towards actively proliferating cells

Question 8

What cancers are treated with neo-adjuvant chemo?

Answer 8

Used in osteosarcoma

Breast cancer

Question 9

When is prophylactic chemo used + give an example?

Answer 9

Before overt malignancy appears eg tamoxifen used for in-situ breast cancer before invasive cancer is recognised

Question 10

Which cells in the body are usually affected by chemo + what occurs?

Answer 10

Haematopoietic stem cells

Lining of GI tract

Causes myelosuppression + mucositis

Question 11

How long is the average course of chemo?

Answer 11

6 sessions in 6 months

Question 12

What supportive care can be given during high dose treatment?

Answer 12

Bone marrow support with growth factors of blood stem cells/ bone marrow

Question 13

What cancers are treated with high dose chemo?

Answer 13

Hodgkins + Ewings Sarcoma

Question 14

When is chemo given intravesically?

Answer 14

For superficial bladder cancer

Question 15

When is chemo given intraperitoneally?

Answer 15

Tumours that have spread trans-coelomically (ovarian)

Question 16

When is chemo given intra-arterially?

Answer 16

For tumours with well-defined bloody supply eg hepatic artery infusion for liver mets

Question 17

How is chemo dose calculated + what are the exceptions to this rule?

Answer 17

Using body surface area (BSA) Formula of DuBois + DuBois Carboplatin is calculated according to renal function Trastuzumab is calculated on body weight alone

Question 18

SE of chemo

Answer 18

N+V, GI side effects, GU - nephrotoxicity + bladder toxicity, hepatic toxicity

Skin + soft tissue toxicity - hand foot syndrome, extravasation, photosensitivity

Lethargy + myalgia, myelosuppression, alopecia

Peripheral neuropathy

Question 19

Why does chemo cause myelosuppression?

Answer 19

Kills haematopoietic progenitor cells

Leads to leucopenia + thrombocytopenia

Question 20

What is the nadir?

Answer 20

Lowest point of neutrophil drop (drops 10-14 days after chemo)

Question 21

What are the GI SE with chemo + why do they happen?

Answer 21

Oral mucositis = reflects damage to epithelium

Diarrhoea due to colitis or small bowel mucosal inflammation

Constipation due to dehydration = can develop into paralytic ileus caused by autonomic neuropathy

Question 22

How is alopecia caused + what can be done about it?

Answer 22

Due to damage to rapidly dividing cells in hair follicle

Use of cold cap to reduce blood flow to scalp

Question 23

What neurological SE are there?

Answer 23

Peripheral + autonomic neuropathy

CNS toxicity

Ototoxicity - cochlear damage causing high tone hearing loss

Question 24

What is extravasation?

Answer 24

Highly vesicant drugs cause tissue damage

Question 25

What is palmar plantar erythema?

Answer 25

Hand foot syndrome