Lecture 9: Oncology case studies Flashcards
What are the general principles of cancer treatment?
How advanced is the cancer (grade and stage)
Aim of treatment (cure verses palliation)
Patient fitness and willingness to undergo treatment
What is curative treatment a range of?
surgery
radiotherapy
systemic anticancer therapy (type of cancer dependent):
chemotherapy
endocrine manipulation (if responds to hormones)
targeted biological agents
explain case study 1: testicular cancer
- Generally curative (95% of cases)
- type of germ cell tumour
- Things to consider: type of tumour, how far has it spread, is treatment aimed at cure or palliation, specific prognostic factors for prognosis
Case
25yr old male
painless lump on scrotum from last three months
fit
no medical history
examination of 3cm mass on left testicle
staging investigations
What were the stages of investigation for case study 1: testicular cancer
- CXR (Chest X-ray)
- CT CAP (CT scan)
- Bloods including tumour markers
alphaFP
BhCG
LDH - Inguinal orchidectomy
What was the result of the screening of case study 1: testicular cancer before and after the operation?
- Pre op
LDH - 1680
alphaFP - 25.5
BHCG - 87.5 - Post op
LDH - 973
alphaFP - 25.5
BHCG - 1.1 - Histology
Poorly differentiated teratoma with embryonal and yolk sac elements
What was the diagnosis and treatment of case study 1: testicular cancer
- Intermediate prognosis germ cell tumour
- treated with chemo
- 4x cycles of BEP chemo
- Tolerated treatment relatively well but beginning to become breathless toward the end
- markers returned to normal during treatment
What are the cons of chemo?
Emesis
Neutropoenia
Skin toxicity
Mucositis
Kidney toxicity
Peripheral neuropathy
Cardiac events
Pulmonary emboli
Pulmonary fibrosis
Leukaemia - ANOTHER CANCER FROM MUTATIONS!
Explain case study 2: non curative biological treatment
Renal Cell Carcinoma
66yr old
Initial presentation cough and haemoptysis
CXR
Staging CT chest abdomen and pelvis
PS 0 (good fitness)
Bloods normal
How was case study 2: renal cell carcinoma managed?
Not curable
So questions were to how can we improve quality of life:
1. perform cytoreductive nephrectomy? (removal)
2. Likely prognosis?
3. What treatment?
What was the treatment for case study 2: renal cell carcinoma?
- Surgery in metastatic kidney cancer - improved survival by a few months
- not clear if this is still true
- Normally operate if majority of tumour is in kidney
What are the prognostic features of MSCC?
KPS < 80%
Time from diagnosis to systemic therapy <12 months
HB < LNN
High calcium
LDH > 1.5ULN
What are the different levels of different MSKCC prognostic scores?
Low risk: 0 = 26 months
Intermediate risk: 1-2 = 14.4 months
High risk: 3-5 = 7.3 months
What was case study 2: renal cell carcinoma MSKCC prognostic scores?
intermediate risk metastatic kidney cancer
went on to have cytoreductive nephrectomy
Started treatment with tyrosine kinase inhibitor sunitnib
How can targeted therapy of Vascular Endothelial Growth Factor be done
Von Hippel Lindau mutation results in up regulation of angiogenesis promoting proteins VEGF and PDGF
VEGF promotes angiogenesis
PDGF signalling proteins for pericytes, support blood vessels
IMPORTANT BECAUSE: without blood vessel support tumours can only get to 2mm in size THEREFORE inhibiting angiogenesis could help limit or inhibit tumour growth and metastasis
What is mTORC1?
A protein that stimulates proliferation. Researhc into inhibitors (Kapour and Figlin Cancer 2009)
