Quiz S1

Mr SG, a 46-year-old patient, was diagnosed with colon cancer several months ago.
Since then, he has undergone a left hemicolectomy. He is currently receiving

capecitabine monotherapy as adjuvant treatment. He telephones the pharmacy
department for advice on how to cope with the side effects he is currently
experiencing.
Questions
1. What side effects are commonly associated with capecitabine?
2. How do these differ from those associated with intravenous 5FU?
3. What advice should Mr SG be given?
Mrs PQ, a 59-year-old woman, has non-small-cell lung cancer. She has had a course
of gemcitabine combined with carboplatin and now requires second-line
chemotherapy. The doctor has suggested
erlotinib.
Questions
1. What type of treatment is erlotinib, and how is it given?
2. What common side effects should Mrs PQ be informed about when she is giving
consent for treatment?
3. What other treatments should be considered for Mrs PQ?
Mrs GH is a 64-year-old woman with lung cancer. She has had several
cycles of chemotherapy and had her third cycle of cisplatin/vinorelbine 7
days ago. She is due her day 8 vinorelbine tomorrow. Mrs GH is feeling
‘a bit unwell’, and her husband thinks she is not at all her usual self and
is, therefore, worried about her.
Questions
1. What side effect may Mrs GH be suffering from?
2. How would you explain to Mrs GH how to take her oral vinorelbine?
3. What are the possible patient safety concerns regarding oral
chemotherapy?
Mrs CR, 43 years old, has been admitted to the oncology ward at your hospital after being referred
by her GP. She presents with a one-week history of drowsiness, nausea and vomiting, loss of
appetite and abdominal pain. The consultant oncologist initially reviewed her in his outpatient clinic
where a blood sample was taken and she was further examined. Her height and weight were also
recorded: height 162 cm and weight 79 kg (body surface area 1.84 m2). Her blood results were as
follows: Full blood count Hb 12.6 g/dL (12.0–14.7 g/dL) White blood cells 8.1 × 109/L (3.9–10.1 ×
109/L) Neutrophils 3.2 × 109/L (1.9–6.8 × 109/L) Platelets 514 × 109/L (150–400 × 109/L)
Biochemistry Na+ 142 mmol/L (137–145 mmol/L) K+ 4.4 mmol/L (3.6–5.0 mmol/L) Urea 3.8 mmol/L
(2.5–6.1 mmol/L) Creatinine 97 micromol/L (62–106 micromol/L) Adjusted serum Ca2+ 3.72 mmol/L
(2.1–2.55 mmol/L) Liver function tests Total bilirubin 19 micromol/L (3–22 micromol/L) ALT 181
units/L (0–52 units/L) ALP 419 IU/L (38–126 IU/L) GGT 268 units/L (12–43 units/L).
HER-2 status (previously performed) HER-2 immunohistochemistry 3+ (N/A) Her drugs on admission
were: ■ MST tablets 30 mg p.o. b.d. ■ Oramorph liquid 20 mg p.o. 4 hourly p.r.n. ■ senna 2 tablets
p.o. q.d.s. ■ tramadol 50 mg p.o. q.d.s. ■ metoclopramide 10 mg p.o. o.d. Past medical history Mrs
CR first presented 18 months previously with grade 3 invasive breast cancer which was oestrogen
receptor negative. She was initially treated with surgery (wide local excision and axillary clearance),
adjuvant anthracycline-based chemotherapy and radiotherapy. Mrs CR has no other significant past
medical history
A 48-year-old man is receiving doxorubicin and ifosfamide for a newly diagnosed osteosarcoma.
While receiving chemotherapy, he begins to complain of flank pain and hematuria. His serum
creatinine has risen from 0.8 mg/dL to 2.1 mg/dL (71 to 186 μmol/L) in the last 3 days.
What is the likely diagnosis?
What medication should always be included as part of this
regimen?
What should patients be counseled to do while receiving
ifosfamide therapy?
A 63-year-old woman with a stage IV NSCLC (adenocarcinoma) and a mutation in exon 19 of the
EGFR gene presents to the clinic. She will be receiving a new prescription for afatanib 40 mg orally,
once daily.
What education and training should be provided to the patient to ensure their understanding of safe
handling procedures as well as thorough knowledge of proper administration?
How should the patient be instructed to take this medication, in regards to meals or the time of day?
What adverse reactions would require that a holding treatment or a dose modification be made in
therapy?
A 45-year-old woman who is part owner of a local dry cleaning business comes to clinic. Except for
hypertension (controlled with lisinopril + hydrochlorothiazide) and being slightly overweight, she
has been in good health. She is happily married with two grown children in college. She has one
paternal aunt who died from breast cancer. There is no other breast or gynecologic cancer history in
the family. On routine self-examination, she detected a very small lump in her left breast. No other
breast changes were noted. Although she had screening mammography nearly a year ago which was
officially read as normal, she is still very concerned and makes an appointment to see her personal
physician as soon as possible. The following week her doctor also notes the abnormality on clinical
examination and orders a mammogram.
Compile a list of considerations integral to screening
programs.
Explain why the currently ordered mammogram is not a
screening mammogram.

Quiz S1

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Mr SG, a 46-year-old patient, was diagnosed with colon cancer several months ago.

Since then, he has undergone a left hemicolectomy. He is currently receiving

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