Devita, Hellman, and Rosenberg's Cancer

LWBK1006-44 LWW-Govindan-Review November 24, 2011 11:30

558 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

infection, and decreased chemotherapy metabolism. Oral factors such

as periodontal disease, microbial flora, chronic low-grade mouth infec-

tion, salivary gland secretory dysfunction, ill-fitting dental prostheses,

and exposure to oral stressors including alcohol and tobacco can also

contribute to risk of stomatitis.

Answer 44.14. The answer is B.

Chlorhexidine gluconate, saline rinses, sodium bicarbonate rinses, acy-

clovir, amphotericin B, and ice are common prophylactic measures used

in the prevention of stomatitis. Viscous lidocaine and Carafate suspension,

dicyclomine hydrochloride, opioids, and mixtures (including ingredients

such as diphenhydramine, Maalox, viscous lidocaine, and nystatin) are

commonly used in the treatment of stomatitis-related pain.

Answer 44.15. The answer is B.

Patients undergoing radiation therapy for head and neck cancer should

be advised to drink plenty of fluids and rinse their mouth with saltwater

or baking soda solution to prevent xerostomia. Amifostine is beneficial

in prevention of xerostomia; however, the role of pilocarpine for prophy-

laxis of xerostomia is less clear. Because of toxicity related to glaucoma

and cardiac issues, pilocarpine is used with caution in patients with xeros-

tomia.

Answer 44.16. The answer is C.

Patients with radiation pneumonitis typically present with dyspnea, self-

limited or progressive. They can also present with cough, fever, chest pain,

tachypnea, and cyanosis. Corticosteroids are not used as a prophylactic

measure or in the treatment of radiation fibrosis; however, prednisone is

commonly used in the treatment of radiation pneumonitis, but data are

mixed.

Answer 44.17. The answer is D.

Many factors are associated with increased risk of chemotherapy-induced

pulmonary toxicity. Bleomycin, for example, is associated with increased

risk of pulmonary toxicity in terms of total dose, advanced age, oxygen

therapy, simultaneous or prior radiation therapy to the lungs, combina-

tion with other drugs, and renal dysfunction.

Answer 44.18. The answer is D.

Radiation-induced heart disease covers a wide clinical spectrum, includ-

ing pericardial disease, acute pericarditis, pericardial effusion, constric-

tive pericarditis, myocardial dysfunction, valvular heart disease, electrical

conduction abnormalities, and congestive heart disease.

Answer 44.19. The answer is A.

Early detection of cardiac dysfunction is important in the prevention

of overt cardiomyopathy during the administration of chemotherapy.