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Oncology I-I

Oncology Overview & Chemotherapy -Induced Myelosuppression

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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