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Flashcards in Principles of Cancer Management Deck (23)
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1
Q

how is cancer diagnosed ?

A

clinical
imaging - Xray, CT, MRI, PET
histopathology - fine needle aspiration, incisional biopsy

2
Q

what are the principles of cancer management ?

A
surgery,
radiotherapy,
chemotherapy,
hormonal manipulation,
palliative care
3
Q

what are the signs and symptoms of malignant disease ?

A
palpable swelling
symptoms of obstruction
heamorrhage
compression/invasion of local structures 
metastatic disease
asymptomatic incidental findings
4
Q

what are the methods of investigation for cancer ?

A

endoscopic
radiological
pathology in the investigation of malignant disease

5
Q

what are the different types of endoscopic investigation ?

A
oesophagogatroscopy,
endoscopic retrograde cholangiopancreatography,
sigmoidoscopy,
colonoscopy,
bronchoscopy,
staging laparoscopy
6
Q

what are the different types of radiological investigation ?

A
plain radiology,
contrast radiology,
ultrasound,
CT,
MRI,
isotope,
bone scans,
thyroid scan,
monoclonal antibodies
7
Q

what types of biopsy are used to investigate malignant disease ?

A

FNAC, needle biopsy, wedge biopsy, excision biopsy

8
Q

what does curative surgery for primary disease involve ?

A
'en bloc' resection
influenced by the mode of spread of disease
direct spread-
invasion of continuous structures,
into laterally placed tissue,
longitudinally along tubular structures 
spread via lymphatics
9
Q

what does curative surgery for secondary malignant disease involve ?

A

local recurrence,
regional lymph node recurrence treated with block dissection if distant metastasis excluded by CT,
second look surgery in colorectal disease,
detection of liver metastases following colorectal resection consider live resection

10
Q

what does reconstructive surgery for malignant disease involve ?

A
primary closure,
skin grafts,
skin flaps - 
random pattern flaps,
axial flaps,
myocutaneous flaps,
free flaps
11
Q

what is the purpose of palliative surgery for malignant disease ?

A

alleviation of obstructive symptoms,
diminution of transfusion requirements,
relieve pain

12
Q

how can radiotherapy be delivered ?

A

external beam radiation,
local application,
systemic radioisotope therapy

13
Q

what are the major applications of radiotherapy ?

A

primary curative, adjuvant, palliative

14
Q

what are the complication of radiotherapy ?

A
systemic side effects -
malaise and fatigue,
nausea, 
vomiting,
anorexia
side effects in irradiated tissue - 
skin - redness, itching, pain, breakdown
abdomen/pelvis - nausea, vomiting, diarrhoea, dysuria, haematuria 
head and neck - dry, painful mouth, dysphagia, mucositis, hair loss, radiation caries  
bone - osteoradionecrosis
chest - pain
15
Q

what is the purpose of palliative radiotherapy ?

A

local control with minimal side effects,
prevent impending complications,
provide symptomatic relief

16
Q

what are the indications for palliative radiotherapy ?

A

pain control - bone pain, nerve root and soft tissue infiltration
dyspnoea - shrinkage of obstructing tumour
ulcerating lesions - breast, skin, head, neck
haemorrhage - rectal and cervical bleeding
emergency complications - spinal cord compression, superior vena cava obstruction, raised intracranial pressure, tubular visceral obstruction (oesophagus, GI, ureter)

17
Q

how does chemotherapy work ?

A

drugs destroy tumour cells based on their increased mitotic and metabolic rates
alkylating agents bind to DNA,
some drugs cross link DNA,
some drugs disrupt the mitotic spindle

18
Q

what is adjuvant chemotherapy ?

A

chemotherapy given after surgery or radiotherapy has been used to control the primary disease

19
Q

what is neo-adjuvant chemotherapy ?

A

chemotherapy given as an initial treatment to improve local control by combining two local modalities

20
Q

what are the major applications of chemotherapy ?

A

primary curative treatment,
adjuvant chemotherapy,
general palliative treatment,
palliation of distressing local symptoms,
direct administration of the cytotoxic agents to the tumour

21
Q

what are the modes of application of chemotherapy ?

A

orally, intramuscularly, intravenously, intrathecally, implanted lumps

22
Q

what are the side effects of chemotherapy ?

A
bone marrow suppression,
immunosuppression,
nausea and vomiting,
disruption of gastrointestinal epithelial turnover,
toxicity to hair follicles,
gondal injury,
long term risk of other malignancies,
rapid tumour destruction on a massive scale
23
Q

what are the principles of palliative care ?

A

assess prognosis and sequence of terminal events,
discuss prognosis and life expectancy with patient and relatives,
arrange consultations with GP,
ensure immediate access in the event of sudden deterioration,
identify future nursing requirement,
anticipate the development of symptoms,
prevention and early treatment of pain, nausea, vomiting, diarrhoea and constipation
continually review drug therapy, minimise side effects