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Oncology I-I
Oncology Overview & Chemotherapy -Induced Myelosuppression
| Term | Definition |
|---|---|
| What are the most common Oncology guideline ? | - ACS - NCCN - ASCO |
| What is the definition of Cancer/ Malignancy? | 1- uncontrolled growth 2- spread of abnormal cells |
| What dose the term " metastasis" mean? | - the spread of the abnormal cells to other parts of the body |
| What are the causes of cancer? | - internal factors - external factors |
| What is the origin of the cancer type name? | - the organs/ tissues - lung cancer, bladder cancer etc |
| What is the origin of the malignancy name? | - tissue TYPE - epithelium, lymphoid etc |
| What is the role of biopsy in diagnosis ? | - malignant tissue retain some of their origin tissue characteristics -- > helps identifies the origin tissue |
| What are the seven warning signs of cancer in adult? | - " CAUTION" 1- C: change in bowel/ bladder habits 2- A: A sore with no heal 3- U: Unusual bleeding 4- T:Thickening/ lump in breast 5-I:Indigestion/ difficulty swallowing 6- O: obvious change in wart/mole 7- N: Nagging cough/ hoarseness |
| What is the screening recommendations for mammograms breast cancer in average risk patients ? | - screening starts at aga 45 y/r - once/ year - *** pt older than 55 can get it once/yr or 2x/yr |
| What is the screening recommendations for Pap smear cervical cancer in average risk patients? | - starts age 21-65 - every 3 y/r *** pt 30-65 other option: Pap smear + HPV every 5y/r |
| What is the screening recommendations for colon cancer? | - pt >50 y/r - frequency depends on the testing: 1- Q10 yr colonoscopy 2- Q 5 yr sigmoidoscopy, double contrast barium enema, CT colonoscopy 3- Q3 yr Stool DNA test 4- Q 1yr fecal occult blood, fecal immunochemical test |
| Which of colon cancer screening methods find both polyps and cancer? | 1- Q10 yr colonoscopy 2- Q 5 yr sigmoidoscopy, double contrast barium enema, CT colonoscopy |
| what is the screening recommendations for low dose CT chest scan ? | - 55-74 yr - Q1 yr if: 1- good health 2- h/o of 30 -pack yr 3- smokes or stop in past 15 yr |
| what is the screening recommendations for prostate? | - >50 - PSA prostate specific antigen + DRE digital rectal exam |
| What are the causes of skin cancer? | - external - internal |
| What are the types of skin cancer? | - melanoma - non- melanoma : basal ad squamous cells |
| What is the warning signs of melanoma skin cancer? | ABCDE: 1- A: asymmetry: the half not match 2- B: border: irregular notched 3- C: color not the same 4- D: diameter: > 6 mm 5- Evolving: changes over time ( size, color, shape) and/or sxs ( itch, bleed, tender) |
| what are some factors determine cancer tx? | 1- cancer type 2- stage ( size + spreading) 3- pt characteristics 4- tumor markers 5- |
| What is the main characteristic of stage IV cancer? | ** Metastasis - the spreading of cancer cells to nearby tissue and/or enter lymphatic/ blood system - the spreading of cancer to distance organs via lymphatic/blood system |
| What is the goal of tx cancer? | **** depends on prognosis 1- MAY attempt to achieve remission ( with cure intent) 2- palliative ( reduce size/ sxs) |
| what are cancer -free survivors? | pt received treatment with intention to cure --> remained cancer free for 5 yrs |
| what are the different types of response to treatment? | 1- complete: no evidence of ds for min of 1 month 2- partial: >30% reduction in tumor size, 3- stable : <30% reduction in the tumor size or <20% increases in size 4- progression: > 20% increases in size or growth in new size |
| What is the primary treatment of cancer if resectable? | - surgery |
| what is the difference between neo adjuvant and adjuvant chemotherapy? | - neo adjuvant: prior to surgery --> shrinks the tumor size - adjuvant: after surgery --> eradicate residual ds/ decreases recurrence |
| what are some examples of neoadjuvant and adjuvant therapies? | - radiation - chemo therapy |
| What are the recommendations to reduce the risk of cancer? | - avoid smoking - healthy wt - exercise - health food ( veggie and fruits) - limit alcohol - protect against UV - assess family and person h/o - regular checkups/screenings - LOW DOSE ASPRIN |
| Which patients should receive LOW DOSE ASPIRIN AS COLORECTAL CANCER PREVENTION? | - age 50-59 -ASCVD > 10 - > 10 y/r life expectancy - low risk bleeding |
| What is the major difference between curative, palliative, adjuvant, neoadjuvant therapies? | - curative: curing the cancer - Palliative: reduces the sxs +/- reduces the growth - adjuvant: after surgery for eradication - neo adjuvant before surgery shrinks the tumor |
| What is the main concept behind chemotherapeutic regimens? | - designed for synergism - different MOAs acts independently at different target - effective at rapidly dividing cells via interfering with DNA replication |
| What are some of the chemotherapeutic regiments off targets? | - mostly the normal cell that highly active/ dividing - GI--> diarrhea - Bone marrow --> bone marrow suppression --> meylosuppression - hair follicle --> alopecia |
| what are some factors to consider while selecting the chemotherapy regimen? | - ds factors: type, stage, markers - Pt factors: physical functioning, performance status, tolerability to the regimen QOL , age , co-morbidities , and previous tx |
| What are some of the tools to assess physical functioning and performance status of the patient ? | physical functioning: Karnofsky Performance status: EGOG |
| which chemotherapeutic drug causes pulmonary toxicity ? | - bleomycin |
| what is the max dose of belomycin? | - Lifetime Cumulative dose - 400 units |
| which chemotherapeutic drug causes cardiotoxicity ( cardiomyopathy) ? | - doxorubicin |
| what is the max dose of doxorubicin? | - 440-550 mg/m2 - lifetime cumulative dose |
| Which chemotherapeutic drug causes nephrotoxicity? | cisplatin |
| what is the max dose of cisplatin? | - 100 mg/m2 - per cycle |
| Which chemotherapeutic drug causes neuropathy ? | - Vincristine - single dose capped 2mg |
| Which chemotherapeutic drug causes neurotoxicity ? and what's the proposed MOA? | - lomustine - carmustine MOA: penetration via BBB |
| Which chemotherapeutic drug causes oral ulceration known as mucositis? | methotrexate |
| Which chemotherapeutic drug causes ototoxicity? | cisplatin carboplatin |
| Which chemotherapeutic drug causes nephrotoxicity? | cisplatin carboplatin |
| Which chemotherapeutic drug causes cardiotoxicity? | doxorubicin **** - RUBICIN FAMILY ( anthracycline) 1- Daunorubicin. 2- Doxorubicin. 3- Epirubicin. 4- Idarubicin. 5- Mitoxantrone. 6- Valrubicin. |
| Which chemotherapeutic drug causes hemorrhagic cystitis? and what's the proposed MOA? | - ifosfamide - cyclophosphamide the drugs don't cause hemorrhagic cystitis, the active metabolites accumulation Acrolein dose it. |
| which chemotherapeutic drug(s) cause(s) peripheral neuropathy? | - Vinca alkaloids: 1- vincristine 2- vinblastine 3- vinorelbine - Taxanes 1- paclitaxel 2- docetaxel |
| which adjunctive medication is used as cisplatin induced nephrotoxicity prophylaxis? | Amifostine ( ethyol) ) ام فستان بحمي الكليه( |
| Which adjunctive medication is used as doxorubicin induced cardiomyopathy PROPHYLAXIS? | - dexrazoxane ( zinecard, totect) |
| Which adjunctive medication is used as doxorubicin induced extravasation TREATMENT ? | dexrazoxane ( zinecard, totect) |
| What is the main two uses of leucovorin ( fusilev) as an adjuvant medication to the chemotherapy regimen | - Leucovorin + fluotouracil = enhance efficacy of FU - Leucovorin + methotrexate = reduce the risk of meylosuppression/ mucositis - Leucovorin + high dose methotrexate = antidote in acute renal failure 2/2 high dose/ conc |
| Which medication ( antidote) should be started on pt with acute renal failure 2/2 to high dose of methotrexate? | leucovorin |
| which medication should be used within 96 hours to treat fluorouracil or capecitabine ( FU pro-durg) overdose induced toxicity? | Uridine triacetate ( vistogard) |
| Which adjunctive medication is used as ifosamide induced hemorrhagic cystitis prophylaxis? | mesna ( mesnex) |
| Which adjunctive medication is used to treat or prevent Irinotecan induced ACUTE diarrhea ? | Atropine |
| Which adjunctive medication is used to treat Irinotecan induced DELAYED diarrhea ? | loperamide |
| Which adjunctive medication is used to reduce methotrexate induced myelosuppression and mucositis ? | leucovorin levoleucovorin glucarpidase |
| Which adjunctive medication is used to treat ( antidote) high-dose methotrexate induced acute renal failure? | leucovorin levoleucovorin glucarpidase |
| What is the main cause of myelosupprassion in pt receiving chemotherapy? | - 2/2 to the suppression of bone marrow |
| Which blood cells are often affected? | - neutrophils ( WBC) - platelets 2/2 short 1/2 life span and rapid turnover |
| What is the main sxs a myelosupprassion pt experience ? | - neutropenia: infection - Thrombocytopenia: bleeding - Anemia: SOB, fatigue, |
| Which term is used to describe the lowest point of cells ( myelosupprassion)? | nadir |
| what is the duration at which RBC nadir starts to appear? WBC nadir and Platelets nadir? | - for WBC and platelets: during the 1-2 weeks ( short 1/2 life/rapid turnover) - For RBC: several months ( life cycle 120 days) |
| How long dose it take the WBC and/or Platelets to recover post chemotherapy? | - 3-4 weeks |
| what should be considered prior to the next cycle of chemotherapy? | - that both WBC and platelet have returned to safe level - if not/ delay of next cycle |
| What are some option to restore RBC safe level? | - Transfusion ( in case of severe anemia) |
| What is the main risk a neutropenic patient may experience? | infection 2/2 inability to fight pathogens( low neutrophilic cells) |
| What is ANC? and how ANC is calculated? | - ANC: is the absolute neutrophilic count - ANC = WBC * ( band%+ segmented%) * 10 |
| What is the cutoff for the following: 1- neutropenia 2- severe neutropenia 3- profound neutropenia | 1- neutropenia: < 1000 cell/mm3 2- severe neutropenia: <500 cell/mm3 3- profound neutropenia: < 100 cell/mm3 |
| what is the drug of choice in patient with neutropenia ? what's the rational behind using it? | - CSF: colony stimulating factor( myeloid growth factors--> granulocyte precursor cells - The rational: CSF doesn't prevent/treat neutropenia; it just shorten the time of recovery |
| Which pt population CSF indicated for? whats the rational? | - for high risk of febrile neutropenia patient (>20% chance of developing FN) - Given CSF as a prophylaxis--> shorten the duration at which pt is at risk of infection --> reduce risk of infection and infection mortality |
| What are the three primary types of CSF? what's their uses? | - GM-CSF( Granulocyte/ macrophage) and G-CSF ( Granulocyte) - GM-CSF: sargramostim only for stem cell transplantation - G-CSF: filgrastim and peg-filgrastim |
| What is the effect of CSF prophylaxis on the duration of chemo-induced neutropenia? | - with CSF: shortened duration - withOUT CSF: longer duration |
| what is the different in dosing between filgrastim and peg-filgrastim? | - filgrastim: dosed DAILY after 24-48 hr of 1st cycle of chemotherapy; stop when ANC > 2000-3000 cell/mm3 - peg-filgrastim: ( longer duration of action) --> ONCE after 24hr of 1st cycle of chemotherapy |
| filgrastim vs. peg filgrastim? | once/day till reach 2000-3000 ANC vs. once post 1st cycle |
| what is filgrastim dosing in most cases vs. bone marrow transplant? | - dosed per mcg/kg - SC/IV - 5mcg/kg/day vs 10 mcg/kg/day in bone marrow - ANC goal >2000-3000 cell/mm3 |
| what is the peg-filgrastim dosing and duration? | - fixed dose of 6mg ONCE - SC ONLY |
| What is sargramostim dosing and duration? | - indicated ONLY In STEM CELL transplant - dosed per mcg/m2 - IV/SC - daily - 250mcg/m2/day |
| what is the difference in dosing between filgrastim, pegfilgrastim vs sargramostim? | - mcg/kg/day vs. fixed dose once vs. mcg/m2/day - IV/SC vs. SC ONLY vs. IV/SC |
| what is the main side effects of using filgrastim and pegfilgratim? | - bone pain - fever - other ( gloerulonephritis, rash , site reaction) |
| what is the main side effects of using sargramostim? | - bone pain - fever - arthralgia ( joint pain) - myalgia ( muscle pain) - rash - other( dyspnea) - CV : peripheral edema, pericardial effusion, HNT and chest pain |
| What are some of filgrastim monitoring parameters ? | - CBC -- assess ANC - Pulmonary function -2/2 dyspnea and respiratory distress - wt & Vital |
| What is the recommended time to dose filgrastim ? | - 24 hr post 1st chemo cycle - up to 72 hrs |
| What are some considerations for the use of pegfilgrastim ( long acting) ? | - one dose of pegfilgrastim = 14 dose of filgrastim - avoid giving it 14 days prior to the next chemo cycle |
| what are some factors that increases the risk of infection? | - neutropenia following chemo-toxic regimen - skin flora - Central venous access device - |
| what is the main cause of death in neutropenic patient ? | - neutropenic --> high risk infection --> can't defense self against pathogens --> sepsis |
| What is the first and most critical sign of infection in neutropenic patient post chemo-toxic regimen? | fever |
| which pathogens are isolated from neutropenic pt ? | - both gram + & gram - bacteria - Pseudomonas aeruginosa |
| which pathogens are the main cause of sepsis in neutropenic patients? | - gram -; pose the pt to greater risk of sepsis |
| What are the two factors that determine if patient is at risk of developing febrile neutropenia? | - fever - neutropenia |
| What are the cutoffs for fever & neutropenia for pt to be diagnosed with febrile neutropenia? | fever: oral > 38.3 ( 101 F) or > 38 ( 100.4 f) for more than 1 hr neutropenia: ANC < 500 or ANC expected to drop < 500 in the next 2 days |
| What are some risk factors that determine the empirical antibiotics therapy in neutropenic patients? | - Duration of the neutropenia ( > 7 days or <= 7 days) - Comorbidities - Renal CrCl < 30 / hepatic function LFTs >5x UNL |
| Which patients with febrile neutropenia are considered LOW RISK? | - ANC < 500 for 7 days or LESS - NO Comorbidities |
| What is the empiric antibiotics in febrile neutropenic patient with low risk? 1- ANC <= 7days with no complications | *** ORAL ANTIBIOTICS *** Covers pseudomonas aeruginosa - levofloxacin OR - ciprofloxacin with 1- amoxicillin clavulanate ( Augmentin) 2- +/- clindamycin |
| what is the empiric antibiotic treatment in febrile neutropenic patient with high risk? 1- ANC > 7 days + complication or eGFR < 30 or LFTs>5X normal level | *** IV ANTIBOTICS ** Covers pseudomonas aeruginosa --- beta lactams 1- cefepime ( سيف بيم) 2- ceftazidime ) سيف تا زديم) 3- meropenem 4- immipenem 5- piperacillin-tazobactam (Zosyn) |
| What is the thrombocytopenia? | - is defined as low platelets counts |
| what is the main risk associated with thrombocytopenia? | - uncontrolled spontaneous bleeding |
| what is the normal range of normal platelets count? | - 150K-450K |
| When is the thrombocytopenic patient considered to be at high risk of bleeding? | if platelets count is less than 10K cells/mm3 |
| What is the cut off of thrombocytopenia that requires blood transfusion? | - less than 10k - 20K + active bleeding |
| what are some other considerations in thrombocytopenic patient? | - hold the next chemo therapy cycle - reduce the dose of the chemo agent - d/c any drugs that interfere with platelets function: NSAIDs |
Created by:
Smoham38
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