EMQs in Clinical Medicine.pdf - Peshawar Medical College

68 Haematology and oncology
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A young man treated with an antibiotic for acute leukaemia develops
arrhythmias and heart block shortly after the administration of
chemotherapy.
Doxorubicin, an anthracycline antibiotic, is widely used for the treatment
of acute leukaemias, lymphomas and solid tumours. Cardiotoxicity is a
well-recognized adverse effect and can be manifested as acute arrhythmias,
developing shortly after drug administration or as chronic
cardiomyopathy. The cumulative dose is usually limited to reduce risk
of cardiomyopathy and consequent congestive heart failure.
Alopecia is a very common adverse effect of doxorubicin treatment and
can be counteracted to some extent by scalp cooling.
A patient treated with an antibiotic for lung cancer develops pulmonary
fibrosis.
Progressive pulmonary fibrosis is a dose-related adverse effect of
bleomycin treatment.
A 55-year-old man on treatment for prostate cancer complains of
gynaecomastia.
Hormonal treatment of advanced metastatic prostate cancer involves
targeting the androgen dependence of those tumour cells.
Gonadotrophin-releasing hormone analogues, e.g. goserelin, stimulate
and then reduce pituitary follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) release. The initial rise in FSH/LH gives rise to
a ‘tumour flare’, with progression of cancer and worsening of symptoms.
Cyproterone acetate and flutamide are dihydrotestosterone receptor
blockers used to treat the ‘tumour flare’ associated with treatment with
gonadotrophin-releasing hormone analogues.