Cancer Treatment & Risk Factors

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What is the approximate percentage of cancers that are potentially preventable?

40%

What is the primary goal of the Language Matters campaign in the context of cancer treatment?

To use non-judgmental language when discussing cancer risk with patients

What is the approximate lifetime risk of getting a cancer diagnosis for those born in 1961?

1 in 2

What is the primary role of pharmacists in cancer treatment according to the text?

To identify those at risk and raise awareness about cancer prevention Signup and view all the answers

What is the approximate percentage of cancers caused by inherited or acquired genetic defects?

5% Signup and view all the answers

What is the primary reason for the increasing cost to the NHS in cancer treatment?

The development of new cancer drugs Signup and view all the answers

What is the primary goal of curative treatment?

To get rid of the cancer forever Signup and view all the answers

What is the primary focus of palliative care?

To relieve symptoms and improve quality of life Signup and view all the answers

What does the 'T' in the TNM staging system represent?

Tumour size from 1-4 Signup and view all the answers

What is the primary mechanism of action for cytotoxics?

Interfering with DNA replication Signup and view all the answers

What is the main difference between adjuvant and neo-adjuvant therapy?

Adjuvant therapy is used after surgery, while neo-adjuvant therapy is used before surgery Signup and view all the answers

What is the purpose of hormone therapy in cancer treatment?

To block hormone production and 'starve' the tumour Signup and view all the answers

What is the term for the 'round' of treatment or chemotherapy?

Cycle Signup and view all the answers

What is the primary goal of concurrent treatment?

To improve survival rates Signup and view all the answers

What is the term for the removal of healthy tissue to reduce the risk of cancer?

Prophylactic surgery Signup and view all the answers

What is the purpose of the ECOG system in cancer treatment?

To assess the patient's performance status Signup and view all the answers

What is the primary mechanism of action of CISPLATIN?

Binding to DNA, interfering with mitosis Signup and view all the answers

What is the main function of the kinetochore microtubules during mitosis?

To attach to kinetochores and regulate chromosome movement Signup and view all the answers

Which of the following is NOT a side effect of VINCRISTINE?

Nephrotoxicity Signup and view all the answers

What is the primary mechanism of action of PALBOCICLIB?

Inhibition of CDK4/6 Signup and view all the answers

What is the primary function of the Hedgehog pathway during embryonic development?

Regulation of cell signaling and growth Signup and view all the answers

What is the primary mechanism of action of DARATUMUMAB?

Binding to CD38 and provoking an immune response Signup and view all the answers

What is the primary mechanism of action of OLAPARIB?

Inhibition of PARP Signup and view all the answers

What is the primary function of the pharmacist in the traditional role?

Clinical check of prescription and checking blood results Signup and view all the answers

What is the primary function of the cyclin-dependent kinase (CDK) 4/6 inhibitor in cancer treatment?

Prevention of the passage of the checkpoint, preventing cell division Signup and view all the answers

What is the primary mechanism of action of VISMODEGIB?

Inhibition of the Hedgehog pathway Signup and view all the answers

What is the primary purpose of calculating a patient's Body Surface Area (BSA) in cancer treatment?

To determine the appropriate dosage of IV SACT Signup and view all the answers

What is the main reason for performing DPD testing in cancer treatment?

To determine the patient's suitability for 5-FU/capecitabine treatment Signup and view all the answers

What is the primary method of managing acute nausea and vomiting in cancer treatment?

All of the above Signup and view all the answers

What is the primary action to take if a patient on SACT develops possible toxicity?

Contact a 24-hour chemo helpline Signup and view all the answers

What is the primary reason for reducing the dose or changing the treatment regimen in cancer treatment?

To manage severe adverse effects Signup and view all the answers

What is the primary purpose of running clinics in the pharmacist's role in cancer treatment?

To run clinical trials Signup and view all the answers

What is the approximate number of new cancer cases reported in the UK every day?

1,000 Signup and view all the answers

What percentage of cancers are potentially preventable?

40% Signup and view all the answers

What is an example of a modifiable risk factor for cancer?

Smoking Signup and view all the answers

What is the purpose of the Language Matters campaign in the context of cancer treatment?

To use appropriate language when communicating with patients Signup and view all the answers

What is an example of an inherited genetic defect that can increase the risk of cancer?

BRCA1/2 Signup and view all the answers

What is the approximate percentage of people who will survive for 10+ years after a cancer diagnosis?

50% Signup and view all the answers

What is the main goal of palliative treatment?

To relieve symptoms and improve quality of life Signup and view all the answers

What does the 'M' in the TNM staging system represent?

Metastasis Signup and view all the answers

What is the purpose of neo-adjuvant therapy?

To shrink tumours before surgery Signup and view all the answers

What is the main mechanism of action of cytotoxics?

Interfering with DNA replication Signup and view all the answers

What is the purpose of hormone therapy?

To block hormone production Signup and view all the answers

What is the main purpose of the ECOG system?

To measure patient functioning Signup and view all the answers

What is the main difference between adjuvant and neo-adjuvant therapy?

Adjuvant therapy is used after surgery, while neo-adjuvant therapy is used before surgery Signup and view all the answers

What is the main goal of concurrent treatment?

To improve survival rates by combining two or more treatments Signup and view all the answers

What is a 'cycle' in the context of cancer treatment?

A round of treatment or chemotherapy Signup and view all the answers

What is the main goal of curative treatment?

To get rid of cancer forever Signup and view all the answers

What is the purpose of calculating a patient's Body Surface Area (BSA) in cancer treatment?

To determine the optimal dosage of SACT Signup and view all the answers

What is the primary action to take if a patient on SACT develops possible toxicity?

Contact the 24-hour chemo helpline or A&E Signup and view all the answers

What is the primary goal of pharmacist-led clinics in cancer treatment?

To provide patient counselling and education Signup and view all the answers

What is the purpose of performing DPD testing in cancer treatment?

To identify patients at risk of 5-FU/capecitabine toxicity Signup and view all the answers

What is the primary mechanism of managing acute nausea and vomiting in cancer treatment?

Dexamethasone and 5-HT3 antagonists Signup and view all the answers

What is the primary reason for reducing the dose or changing the treatment regimen in cancer treatment?

To reduce the risk of toxicity Signup and view all the answers

What is the primary way that myosin 2 and actin filament rings contribute to the cell cycle?

Cleaving the cell in two Signup and view all the answers

Which stage of the cell cycle is characterized by the condensation of chromatin into chromosomes?

Prophase Signup and view all the answers

What is the primary mechanism by which PARP inhibitors, such as OLAPARIB, exert their therapeutic effect?

Preventing the repair of DNA damage Signup and view all the answers

What is the primary role of kinetochore microtubules during mitosis?

Invading the nuclear space and attaching to kinetochores Signup and view all the answers

What is the primary mechanism of action of VINCRISTINE?

Inhibiting the formation of microtubules Signup and view all the answers

What is the primary mechanism of action of CISPLATIN?

Binding to DNA and interfering with mitosis Signup and view all the answers

What is the primary role of the pharmacist in the traditional role?

Performing clinical checks on prescriptions Signup and view all the answers

What is the primary mechanism of action of VISMODEGIB?

Blocking the Hedgehog pathway Signup and view all the answers

What is the primary mechanism of action of DARATUMUMAB?

Provoking an immune response against cancer cells Signup and view all the answers

What is the primary mechanism of action of PALBOCICLIB?

Inhibiting the CDK4/6 pathway Signup and view all the answers

What percentage of people born in 1961 are likely to get a cancer diagnosis in their lifetime?

1 in 2 Signup and view all the answers

Which of the following is a modifiable risk factor for cancer?

Smoking Signup and view all the answers

What is the approximate number of new cancer cases reported in the UK every day?

1000 Signup and view all the answers

What is the main goal of the Language Matters campaign in the context of cancer treatment?

To promote empathy and understanding in communication with patients Signup and view all the answers

What percentage of cancers are potentially preventable?

40% Signup and view all the answers

What can pharmacists do to contribute to cancer treatment?

Identify those at risk and raise awareness Signup and view all the answers

What is the primary purpose of calculating a patient's Body Surface Area (BSA) in cancer treatment?

To determine the dosage of chemotherapy Signup and view all the answers

Why is echocardiography used in cancer treatment?

To monitor the patient's heart function Signup and view all the answers

What is the primary reason for performing genetic testing, such as DPD testing, in cancer treatment?

To determine the patient's risk of toxicity Signup and view all the answers

What is the primary goal of managing neutropenia in cancer treatment?

To reduce the risk of infection Signup and view all the answers

What is the primary action to take if a patient on SACT develops possible toxicity?

Call the 24-hour chemo helpline Signup and view all the answers

What is the primary role of pharmacists in cancer treatment, according to the text?

To provide patient counselling Signup and view all the answers

What is the primary goal of palliative treatment?

To relieve symptoms and improve quality of life Signup and view all the answers

What does the TNM staging system represent?

Tumour size, lymph node involvement, and metastasis Signup and view all the answers

What is the difference between adjuvant and neo-adjuvant therapy?

Adjuvant therapy is used after surgery, while neo-adjuvant therapy is used before surgery Signup and view all the answers

What is the primary mechanism of action of chemotherapy?

Interfering with DNA replication or cell division Signup and view all the answers

What is the purpose of hormone therapy in cancer treatment?

To block the action of hormones Signup and view all the answers

What is the term for the removal of healthy tissue to reduce the risk of cancer?

Prophylactic removal Signup and view all the answers

What is the primary goal of curative treatment?

To get rid of cancer forever Signup and view all the answers

What is the term for the 'round' of treatment or chemotherapy?

Cycle Signup and view all the answers

What is the purpose of the ECOG system in cancer treatment?

To guide treatment choices Signup and view all the answers

What is the primary mechanism of action of radiotherapy?

Direct effect on DNA, leading to cell death Signup and view all the answers

What happens to the nuclear membrane during the prophase of mitosis?

It breaks down Signup and view all the answers

What is the primary mechanism of action of CISPLATIN?

It binds to DNA and interferes with mitosis Signup and view all the answers

What is the role of kinetochore microtubules during mitosis?

They invade the nuclear space and attach to kinetochores Signup and view all the answers

What is the primary mechanism of action of VINCRISTINE?

It binds to tubulin and prevents microtubule formation Signup and view all the answers

What is the primary goal of targeted therapy?

To exploit differences in cancer cells Signup and view all the answers

What is the role of the pharmacist in the traditional role?

To screen prescriptions and check blood results Signup and view all the answers

What is the primary mechanism of action of OLAPARIB?

It prevents DNA repair Signup and view all the answers

What is the primary mechanism of action of DARATUMUMAB?

It binds to CD38 and provokes an immune response Signup and view all the answers

What is the primary goal of growth blockers?

To inhibit cell signalling and growth Signup and view all the answers

What is the primary mechanism of action of PALBOCICLIB?

It inhibits the cyclin-dependent kinase 4/6 Signup and view all the answers

Study Notes

Here are the study notes based on the provided text:

Cancer Treatment

1,000 new cancer cases are diagnosed in the UK every day
Almost 1 in 2 people have a lifetime risk of getting a cancer diagnosis (for those born in 1961)
~50% of cancer patients will survive for 10+ years
~40% of cancers are potentially preventable
Cancer treatment requires a multidisciplinary team (MDT) approach

Risk Factors

Non-Modifiable:

Age
Genetics
Infections

Modifiable:

Smoking
Alcohol
Infection
Materials
Radiation
Obesity
Medication
Co-morbidities

Genetics and Cancer

Inherited or acquired genetic defects can increase cancer risk
Examples: BRCA1/2 defects (breast/ovarian/prostate/pancreatic cancer), Lynch syndrome (mainly bowel cancer), TP53 (Li-Fraumeni syndrome) (various cancers)
These genetic defects are relatively rare compared to other cancers (~5%)

Infections and Cancer

Chronic infections can increase cancer risk
Examples: HPV (leading cause of cervical cancer), EBV, Hepatitis B/C, HIV
Modifiable risk factors: vaccinations, public health campaigns, protected sex

Pharmacist's Role

Identify those at risk
Opportunistic questioning
Use the right language - Language Matters campaign
Avoid attribution of fault
Not all modifiable risks will be under control of the patient
Raise awareness

Treatment

Surgery

Removal of tumour
'Prophylactic' removal (e.g. breast reduction in high-risk patients)
Healthy vs tumour tissue sometimes hard to distinguish

Radiotherapy

High energy external beam therapy
Internal radiation (e.g. brachytherapy)
Caution: risk to young people/pregnant women!

Chemotherapy (SACT)

Systemic Anti-Cancer Therapy
Falls into three categories: Hormone therapy, Cytotoxics, Targeted therapy
Drug(s) prescribed will depend on various factors (e.g. cancer staging, tumour site, tumour pathology, previous treatment, patient factors)

Naming Conventions

Combination regimens often have acronyms
Letters might relate to drug or original brand name
Examples: CX - Cisplatin and capecitabine (Xeloda), FOLFIRI - Folinic acid, fluorouracil, irinotecan

Treatment Decisions

Hormone Therapy

Used for hormone-sensitive tumours
Blocks hormones to 'starve' the tumour
Examples: Tamoxifen, Anastrozole, Clomifene
Not usually curative when used alone
Adjuvant or palliative treatment options

Cytotoxics

Literally meaning toxic to cells
Variety of mechanisms → cell death
Typically involve interference with DNA replication or other aspect of cell division
Examples: Cisplatin, Vincristine

Targeted Therapy

Treatments that exploit differences in cancer cells
Three main categories: Monoclonal antibodies, Growth blockers, Cell or endothelial growth, PARP inhibitors
Examples: Daratumumab, Vismodegib, Olaparib### Aims of Treatment
Curative treatment aims to eliminate cancer forever, with a chance of recurrence
Palliative treatment aims to relieve symptoms and improve quality of life, suitable for patients at any stage of illness

Staging

Cancer staging systems: TNM (Tumor size, Node involvement, Metastases) and Number staging
Staging criteria relates to grades: T (Tumor size 1-4), N (Node involvement 0-3), M (Metastases 0-1)
Stage meanings:
- I: Small size, contained
- II: Larger, possibly some local spread
- III: Larger, usually some spread and lymph node involvement
- IV: Metastatic cancer, spread to other organs

Treatment Timing

Adjuvant treatment: happens after another intervention, e.g., chemotherapy after tumor removal surgery
Neoadjuvant treatment: happens before another intervention, e.g., hormone therapy before prostate surgery
Concurrent treatment: two or more treatments happening at the same time

Cycles

Each 'round' of treatment/chemotherapy is called a cycle
Cycles vary in length, treatment may be: a set number of cycles, continuous until a certain point, or different depending on the cycle number

Performance Status

Measure of patient 'functioning', using various systems of scoring, e.g., ECOG system
Can guide treatment choices

Treatments

Surgery: removal of tumor, 'prophylactic' removal, e.g., breast reduction in high-risk patients
Radiotherapy: high energy external beam therapy, internal radiation (e.g., brachytherapy), caution for young people and pregnant women
Chemotherapy (SACT): Systemic Anti-Cancer Therapy, normally falls into one of three categories: hormone therapy, cytotoxics, and targeted therapy

Naming Conventions

Combination regimens often have acronyms, e.g., CX (Cisplatin and capecitabine), FOLFIRI (Folinic acid, fluorouracil, irinotecan), FEC-T (Fluorouracil, epirubicin, cyclophosphamide, docetaxel)

Treatment Decisions

Hormone therapy: used for tumors that are hormone-sensitive, blocking hormones can 'starve' the tumor
Cytotoxics: literally meaning toxic to cells, aim to kill cancer cells more quickly than healthy cells
Targeted therapy: treatments that exploit differences in cancer cells, divided into three main categories: monoclonal antibodies, growth blockers, and cell or endothelial growth

Examples of Treatments

Cisplatin: platinum-based, wide range of cancers, binds to DNA, interferes with mitosis, adverse effects: nephrotoxicity, highly emetogenic, ototoxicity, neurotoxicity
Vincristine: primarily used in hematological cancers, binds to tubulin, prevents formation of microtubules, leads to apoptosis, adverse effects: peripheral neuropathy, hair loss, sleep disorders, pancytopenia
Palbociclib: treatment of ER+ HER2-ve breast cancer, used in combination with letrozole/similar, CDK4/6 inhibitor, prevents passing of checkpoint, adverse effects: neutropenia, GI effects, fatigue

Role of Pharmacists

Identifying those at risk, opportunistic questioning, using the right language, avoiding attribution of fault
Raising awareness, providing vaccination, cessation services, and medication review
Screening, clinical check of prescription, checking blood results, and ensuring it's safe to proceed
Running clinics, pharmacist prescribers, consultant posts, trial PIs, and ACP roles

Screening SACT

Common set of information for all prescriptions, including height, CRCL, and imaging
Treatment/disease history, lifetime maximum dose of some agents, funding requirements, and genetic testing
Drug-specific blood tests, e.g., FBC, LFTs, U+Es, and possibly others

Toxicity

Neutropenia, common side effect, can reduce dose or delay cycle, but effect on cancer, can boost WCC with ...
Nausea and vomiting, often abbreviated to CINV, individual drug risk varies, mainstay treatments: dexamethasone, 5-HT3 antagonists, metoclopramide, and aprepitant
Other common effects, e.g., fatigue, infections, hair loss, GI system problems, oral mucosa problems, and others

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