NUR2229 > Week 2 - Prerequisite knowledge > Flashcards

Week 2 - Prerequisite knowledge Flashcards

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1
Q

What are the main pillars of cancer treatment modalities?

A
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted agents
  • Immunotherapy
  • Hormone therapy
  • Transplant (stem-cell rescue)

These modalities are often combined to improve tumor control while limiting toxicity.

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2
Q

What is neoadjuvant therapy used for?

A

To shrink a tumor before primary treatment (e.g., chemo/radiation before surgery)

This approach aims to improve surgical outcomes.

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3
Q

What is adjuvant therapy?

A

Given after primary treatment to eradicate microscopic disease and reduce recurrence risk

It complements the primary treatment.

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4
Q

When might surgery dominate in cancer treatment?

A

When resection is feasible and offers the best chance of cure/control

Surgery is often the first line of treatment in such cases.

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5
Q

When is radiation therapy indicated?

A
  • When local control is needed (definitive or palliative)
  • To downsize tumors pre-op

Radiation can be used to manage symptoms or prepare for surgery.

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6
Q

What are the types of systemic therapies used in cancer treatment?

A
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Hormone therapy

These therapies are used for micrometastatic disease and tumor biology-driven strategies.

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7
Q

What does the cell-kill hypothesis state?

A

A given chemotherapy concentration kills a constant fraction of cancer cells

This means repeated cycles are required to progressively reduce tumor burden.

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8
Q

What are the classifications of chemotherapy agents based on cell-cycle activity?

A
  • Cell-cycle specific drugs
  • Cell-cycle non-specific drugs

Specific drugs act at defined phases, while non-specific drugs act in any phase.

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9
Q

What are the routes of administration for antineoplastics?

A
  • Oral (tablets/capsules)
  • Topical (skin)
  • Intravenous (IV)
  • Intramuscular (IM)
  • Subcutaneous (SC)
  • Intra-arterial
  • Intrathecal
  • Intrapleural
  • Intraperitoneal
  • Intravesical
  • Intralesional

The choice of route balances disease site, pharmacokinetics, and safety.

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10
Q

What are common treatment toxicities to expect in cancer therapy?

A
  • Myelosuppression
  • GI/mucosal injury
  • Fatigue
  • Skin changes
  • Alopecia

Recognizing these toxicities is crucial for patient safety and therapy continuation.

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11
Q

What is the purpose of radiotherapy?

A

To damage tumor DNA and prevent replication while preserving normal tissue

It uses ionizing radiation delivered by a linear accelerator (LINAC).

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12
Q

What are the big five oncology emergencies?

A
  • Febrile neutropenia
  • Spinal cord compression (SCC)
  • Tumor lysis syndrome (TLS)
  • Superior vena cava obstruction (SVCO)
  • Hypercalcemia of malignancy

Recognizing and acting fast on these emergencies is critical.

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13
Q

What is chemotherapy?

A

Cytotoxic drugs used to treat cancer

It is one of the main treatment modalities.

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14
Q

What is radiation therapy?

A

External beam, brachytherapy, or systemic radioisotopes

It is used to target cancer cells while minimizing damage to normal cells.

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15
Q

What is targeted therapy?

A

Medicines designed to act on specific cancer pathways

This approach limits collateral damage to normal cells.

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16
Q

What is the role of immunotherapy?

A

Modulates the immune system to overcome tumor immune evasion

It helps the body recognize and fight cancer cells.

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17
Q

What does hormone therapy do?

A

Blocks tumor-stimulating hormonal signals (e.g., estrogen, androgen)

It is particularly useful in hormone-sensitive cancers.

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18
Q

What is stem-cell collection/transplant?

A

Autologous or allogeneic stem-cell rescue to reconstitute marrow after high-dose therapy

This procedure is critical for patients undergoing intensive cancer treatments.

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19
Q

List the seven main cancer treatment pillars.

A

Surgery; radiation therapy; chemotherapy; targeted therapy; immunotherapy; hormone therapy; stem‑cell transplant (rescue).

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20
Q

Define neoadjuvant vs adjuvant therapy.

A

Neoadjuvant: given before the primary modality to downstage. Adjuvant: given after to eradicate micrometastases and reduce recurrence.

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21
Q

When is surgery the dominant modality?

A

When complete resection is feasible and offers best chance of cure or durable control.

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22
Q

When is radiation the dominant modality?

A

For definitive local control, organ preservation, palliation, or pre‑op downsizing.

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23
Q

When do systemic therapies dominate?

A

For micrometastatic disease, radiosensitisation, or biology‑driven indications (e.g., HER2, PD‑1, hormone‑sensitive tumours).

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24
Q

Name two patient factors that influence sequencing.

A

Performance status and comorbidities (also goals of care, social supports, fertility plans).

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25
Core idea of the cell‑kill hypothesis.
A given dose over time kills a constant fraction—not a constant number—of tumour cells.
26
Why are multiple cycles required?
Because each cycle removes only a fraction of cells; repeated cycles progressively reduce tumour burden.
27
Define cell‑cycle–specific drugs with an example phase.
Agents active in certain phases (e.g., S or M phase) and best for rapidly dividing tumours.
28
Define cell‑cycle–non‑specific drugs.
Active in any phase—including G0—useful for slow‑growing tumours and broader fractional kill.
29
Why combine agents from different classes?
To target different cell‑cycle phases/mechanisms and increase total fractional kill.
30
Why schedule rest periods between cycles?
To allow normal tissue recovery (e.g., marrow) while maintaining cumulative tumour kill.
31
List five systemic routes for antineoplastics.
Oral, IV, IM, SC, intra‑arterial.
32
Purpose of intra‑arterial chemotherapy.
Regional delivery to maximise tumour exposure while limiting systemic dose.
33
Purpose of intrathecal chemotherapy.
Treat or prevent CNS disease where IV drugs poorly cross the blood–brain barrier.
34
Name two serosal cavity routes and an indication.
Intrapleural/intraperitoneal—for malignant effusions or peritoneal carcinomatosis.
35
Define intravesical therapy and typical use.
Drug instilled into the bladder—e.g., for non‑muscle‑invasive bladder cancer.
36
Two factors that drive route choice.
Disease site/burden and pharmacokinetics/safety of the agent.
37
Three components of myelosuppression and one nursing action each.
Anaemia→energy conservation; neutropenia→daily temps & prompt ED for ≥38 °C; thrombocytopenia→bleeding precautions.
38
Define nadir.
The post‑chemotherapy low point in neutrophil count when infection risk peaks.
39
Two key patient instructions for neutropenia.
Check temp daily; present urgently to ED for fever ≥38 °C or if feeling unwell/septic.
40
Common GI/mucosal toxicities of chemo.
Nausea/vomiting, diarrhoea or constipation, mucositis.
41
Two strategies for mucositis.
Regular saline/bicarbonate rinses; soft toothbrush and analgesic mouthwashes as ordered.
42
Two strategies for chemotherapy‑related fatigue.
Activity pacing with short, frequent walks; prioritise sleep routine and energy budgeting.
43
Alopecia counselling point.
Hair loss can be sudden; scalp cooling may help with some regimens but expectations should be realistic.
44
Peripheral neuropathy early signs and action.
Tingling/numbness/weakness; report early and assess for dose adjustments/safety risks.
45
One purpose of symptom diaries.
Track temperature, intake, bowel habits, pain/sleep to enable early intervention.
46
Key pre‑cycle labs and why.
Full blood count to confirm marrow recovery; renal/hepatic function for dosing/safety.
47
Primary goal of radiotherapy.
Damage tumour DNA to prevent replication while sparing normal tissue.
48
What delivers external beam radiotherapy?
A linear accelerator (LINAC).
49
Two universal radiotherapy side effects.
Fatigue and local skin reactions within the treatment field.
50
Head and neck radiotherapy: two expected effects.
Xerostomia and dysphagia/mucositis; plan oral care and swallowing support.
51
Thoracic radiotherapy: key risk and monitor for?
Pneumonitis risk—watch for cough, dyspnoea, low‑grade fever.
52
Abdominal radiotherapy: common effects and care focus.
Nausea/diarrhoea—antiemetics, hydration, electrolyte monitoring.
53
Pelvic radiotherapy: two effects to anticipate.
Bowel/urinary irritation and sexual/reproductive effects; discuss fertility and symptom supports.
54
One radiotherapy skin‑care teaching point.
Gentle washing and moisturising per protocol; avoid friction/heat in the field.
55
First three actions in febrile neutropenia.
Sepsis pathway: broad‑spectrum IV antibiotics immediately, cultures, IV fluids (then review and escalate).
56
Two clues suggesting spinal cord compression.
New/worsening back or band‑like pain worse supine; new motor/sensory or autonomic changes.
57
Immediate management steps for suspected SCC.
Urgent steroids, MRI/CT, radiation oncology/surgical review; falls and retention precautions.
58
When does tumour lysis syndrome most often occur?
Typically within ~3 days after starting cytotoxic therapy in high‑burden/rapidly dividing tumours.
59
Key laboratory pattern in TLS.
↑Uric acid, ↑K+, ↑Phosphate, ↓Calcium (risk of AKI/arrhythmias/seizures).
60
First‑line TLS prophylaxis.
Aggressive IV hydration, strict fluid balance, allopurinol; frequent bloods.
61
Drug of choice for established TLS hyperuricaemia.
Rasburicase (plus ongoing monitoring/correction of electrolytes).
62
Classic presentation of SVCO.
Facial/periorbital and upper‑limb swelling with venous distension and dyspnoea.
63
Initial management focus in SVCO.
Urgent review; treat obstruction (often radiotherapy/surgery) and evaluate for CVAD‑related thrombosis.
64
Two symptoms of hypercalcaemia of malignancy.
Confusion and dehydration (also GI upset, constipation, ECG changes).
65
First‑line treatment for hypercalcaemia of malignancy.
IV hydration; consider antiresorptives (e.g., bisphosphonates) for sustained control.
66
Two discharge teaching points to prevent delayed presentations.
Know fever threshold (≥38 °C) and ED plan; written red‑flag list with on‑hours and after‑hours contacts.
67
Define targeted therapy in one line.
Agents designed to act on specific tumour pathways, limiting off‑target damage.
68
Define immunotherapy in one line.
Therapies that modulate the immune system to overcome tumour immune evasion.
69
Define hormone therapy in one line.
Blocks tumour‑stimulating hormonal signals (e.g., oestrogen, androgen).
70
Stem‑cell transplant purpose in oncology.
Reconstitute marrow after high‑dose therapy (autologous or allogeneic).
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