onc background, FN, CINV, TLS, hyperCa (NAPLEX)

ABCDE warning signs for melanoma

• Asymmetry

• Border

• Color

• Diameter

• Evolving

Reapply sunscreen every ___ hours

2

Breast cancer screening

• 45-54 years old = yearly mammogram

• ≥55 years old: mammogram every 2 years or continue yearly

Cervical cancer screening

• 25-65 years

• Pap smear every 3 years

• HPV test every 5 years

• Pap smear + HPV test every 5 years

Colorectal cancer screening

• 50-80 years old

• Colonscopy every 10 years

• Flexible sigmoidoscopy every 5 years

Prostate cancer screening

• PSA blood test

• +/- digital rectal exam`

TMN staging

• Tumor

• Node

• Metastasis

Forms in the epithelial cells that line internal & external surfaces of the body

A. Carcinoma

B. Leukemia

C. Lymphoma

D. Multiple myeloma

E. Sarcoma

A. Carcinoma

Originates in the bone marrow and usually affects leukocytes

A. Carcinoma

B. Leukemia

C. Lymphoma

D. Multiple myeloma

E. Sarcoma

C. Lymphoma

Begins in the cells of the lymphatic system

A. Carcinoma

B. Leukemia

C. Lymphoma

D. Multiple myeloma

E. Sarcoma

D. Multiple myeloma

Arises from plasma cells of the bone marrow

A. Carcinoma

B. Leukemia

C. Lymphoma

D. Multiple myeloma

E. Sarcoma

D. Multiple myeloma

Develops in connective or supportive tissue (muscle, bone, cartilage)

A. Carcinoma

B. Leukemia

C. Lymphoma

D. Multiple myeloma

E. Sarcoma

E. Sarcoma

What is neoadjuvant therapy?

• Used before surgery to shrink the tumor and make complete resection more likely

• Radiation, chemo

What is adjuvant therapy?

• Additional cancer treatment given after the primary treatment (surgery) to eradicate residual disease

What are examples of rapidly dividing cells? (3)

GIT, hair, bone marrow

BSA EQUATION

Nadir typically occurs at ___-___ days

7-14 days

Lifespan of RBC

120 days

Neutropenia is ANC < ______ cells/mm3

Severe neutropenia is ANC < ______ cells/mm3

<1,000

<500

G-CSF's

• Filgrastim

• Pegfilgrastim

Used PPX after chemo to reduce duration and severity of neutropenia

Dosed daily until post-nadir recovery

A. Filgrastim

B. Pegfilgrastim

A. Filgrastim

Dosed once per chemo cycle

A. Filgrastim

B. Pegfilgrastim

B. Pegfilgrastim

Has extended half-life

A. Filgrastim

B. Pegfilgrastim

B. Pegfilgrastim

pegylated form

G-CSF adverse effects (2)

• Bone pain

• Splenic rupture

T/F: G-CSF should be stored in the refridgerator

True

Febril neutropenia diagnostic criteria (2)

• Temp ≥ 38.3 deg C

• ANC <500

What is the most important agent to cover with FN?

• Gram negative pseudomonas

• Low risk use PO, high risk use IV

Acute CINV occurs within ___ hours of starting chemo

24

Delayed CINV occurs > ____ hours after chemo

>24

What is anticipatory CINV?

Occurs before TX; develops as a conditioned response from a past negative experience

Drug classes for CINV (4)

• NK1RA: aprepitant, fosaprepitant, rolapitant

• 5-HT3RA: ondansetron, palonestron

• DA-RA: olanzapine

• Other: dexamethasone, dronabinol, lorazepam

High emetic risk CINV regimen

Preferred regimen: NK1RA + 5HT3RA + olanzapine + dexamethasone

What agent can be used for anticipatory n/v the evening prior to chemo?

Lorazepam

Vaccinations during chemo

• AVOID during chemo

• Administration can precede chemo by ≥ 2 weeks

• Avoid live vaccines should be avoided in immunocompromised

TLS labs you will see! (5)

• HyperK

• HyperPhos

• HypoCa

• Hyperuricemia

• Acute renal failure

TLS prevention

• IV hydration with normal saline

• Allopurinol (preventing uric acid from forming)

TLS TX

Rasburicase to decrease UA that is already formed

Rasburicase is contraindicated in _____ deficiency

G6PD

Hypercalcemia of malignancy TX (3)

• Hydration with normal saline

• IV Bisphosph (zoledronic acid, pamidronate)

• Calcitonin

• Denosumab SC

Prevent treatment with calcitonin to ____ hours due to tachyphylaxis

48