1.4 Basics - Cancer Management

Question 1

Which team looks after cancer patients

Answer 1

Multi Disciplinary team
MDT

Question 2

What are 4 benefits of an MDT

Answer 2

The aims of an MDT are to:

1. Earlier diagnosis leading to earlier treatment
2. Co-ordinated care led by the right HCPs at the right time
3. Improved chances of survival
4. Improved patient satisfaction with the treatment

Question 3

What are the factors which need to be considered when planning a SACT Treatment plan?

Answer 3

Disease
- Location
- Staging
- Grade
- Spread
- Biomarkers

Treatment
- Efficacy
- Safety
- Drug interactions
- Availability/Access

Patient factors
- Patient preference
- Patient co morbidity
- Patient general health - Performance Score.

Question 4

In an ideal world what are the 3 priorities for cancer management?

Answer 4

• Prevention…Vaccines
• Early detection
• Total eradication

Question 5

What are the 4 aims of cancer management in the real world?

Answer 5

• Cure
• Remission
• Symptomatic control
• Terminal care

Question 6

Neo Adjuvant etc (DNAS)

What are the 4 different settings for cancer management?

Answer 6

Definitive
- Sole treatment modality
- e.g. Radiotherapy or Surgery or SACT

Neo adjuvent
- Treatment given befor the preimary treatment
- e.g.Neo adjuvant chemoradiation, prior to surgery for oesopohageal cancer

Adjuvant
- Treatment given after the primary treatment
- e.g. Adjuvant radiation following surgery

Salvage
- Treatment give after oter therapy has failed

Question 7

What are the 3 ways doctors manage cancer?

Answer 7

• Surgery
• Radiation
• SACT

Question 8

What is SACT an abbreviation for?

Answer 8

Systemic Anti Cancer Treatment

Question 9

What are the 6 different classes of drugs which fall under the SACT umbrella?

Answer 9

• Chemotherapy
• Targeted therapy
• Immune therapy
• Hormone therapy
• Cellular therapies
• Supportive therapy

Question 10

How is surgery used in cancer care?

Answer 10

Diagnosis
- via biopsy for example

**Treatment **
- Which can be Curative, Palliative, Emergency, Prophylactic

Question 11

What adverse events ar associated with surgery in cancer patients?

Answer 11

The adverse events associated with surgery typically depend upon:

• The location of the cancer
• The size of the cancer

The adverse effects of surgery can include:

• Pain
• Inflammation
• Bleeding/Bruising
• Fatigue
• Anorexia

What other factors need to be considered

• Altered body image
• Sexual & reproduction issues

Question 12

What is the role of radiation therapy in the management of cancer patients

Answer 12

Radiation therapy uses ioising radiation to treat patients with cancer
- It an be used in a curative, palliative, emergency or prophylactic scenarios
- it can be used as definitive, neo-adjuvant, ajuvant or salvage therapeutic regimen

Question 13

What is the most common form of radiation therapy

Answer 13

External beam radation therapy
- A machine exerts beams of ionising radiation directly to the tumour site

Question 14

What is another type of radiation therapy?

Answer 14

Brachytherapy
- A radio active source is inserted near or in the tumour on a permanent or temporarary basis
- Can be used in cervical or prostate cancer.

Question 15

What is the mode of action of radiotherapy?

Answer 15

Ionsing radiation stopes cancer cells growting or dividing in 2 ways
- Drectly breaks DNA strands
- Creats unstable free radiaclas in the intracellular fluid which damages the cells DNA

Question 16

Can cancer cells or normal cells overcome the damage caused by radiation?

Answer 16

• ## Cancer cells cannot overcome the damage caused by radiation
• Normal cells can overcome the damage caused by radiation

Question 17

What are the 3 types of side effects associated with radiation therapy?

Answer 17

Acute reactions
- Appear shortly after the first administration e.g. Skin reactions

Sub acute reactions
- e.g. occur after the radiation therapy is complete e.g. pneumonitis

Late
- e.g. occurs years after radiation therapy is complete e.g. Cataracts

Question 18

What factor typically determines the nature of radiation side effects

Answer 18

The part of the body which is targeted for radiation therapy

Question 19

What does the abbreviation SACT stand for

Answer 19

Systemic
Anti
Cancer
Treatment

Question 20

How is SACT prescribed

Answer 20

SACT is typically prescribed as a combination of drugs,
- with different modes of action,
- that target different phases of the cell cycle, to get a optimal effect.

HCPS also consider side effects when selecting combination therapy
- To ensure that drugs with similar side effect profiles are not duplicated

In addition supportive medication may also be given to manage nausea and vomiting and pain for example.

Question 21

What are the 3 advantages of combination therapy in cancer management?

Answer 21

• Increases patient response rates by targeting different phases of the cell cycle
• Reduces the likelihood of cellular resistance by working on different cellular pathways and targets
• Limits toxicity by avoiding combination of drugs which have similar toxicity profiles