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Flashcards in Cancer therapeutic options + Deck (13)
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1

Prevention

  • environment / behaviour change
  • diet
  • Screening
  • genetics
  •  medication / vaccination

2

Treatment

  • surgery
  • radiotherapy
  • systemic therapy
  • immunotherapy

3

Diet

• evidence from cohort studies

 -CRC : probably a link with red meat consumption

 -breast cancer : probably a link with saturated fat intake

 -physical activity decreases risk

• current advice:

    -  eat 5 or more portions of fruits and vegetables / day

    -   avoid obesity

    -   take regular exercise (30 minutes / day)

NoteL also of benefit for reducing cardiovascular risk

  

4

Screening

• high quality research evidence available

-Cervical cancer: smear tests

 -Colorectal Cancer : Faecal Occult Blood the most commonly used test

-breast cancer :  mammography

Note: FOB refers to blood in the faeces that is not visibly apparent. 

• more controversial

 -prostate cancer : PSA blood test

 -lung cancer : MR / CT scanning

- breath test

Note: PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It's normal to have a small amount of PSA in your blood, and the amount rises as you get older and your prostate gets bigger.

5

Genetics

high quality research evidence available

CRC & familial adenomatous polyposis coli (FAP)

     - autosomal dominant

     - screen families for APC mutations

     - regular colonoscopy

     - offer panprotocolectomy when adenomas found

  breast cancer & BRCA1 & BRCA2

6

Chemo-prevention

• more controversial

  primary: oesophageal cancer

     -  high rates in parts of China

     -  supplement diet with anti-oxidants

  primary: breast cancer

    -   known at risk women

     -   prophylactic tamoxifen

secondary: previous H&N or lung cancers

     -   give anti-oxidant supplements

     -   no benefit

7

Treatnent

local or regional treatment

       -  surgery

       -  radiotherapy

         -  ablation (freezing, radio-frequency, etc)

          -  isolated limb perfusion

systemic treatment

       -  hormonal therapy

       -  chemotherapy

       -  immunotherapy

       -  whole body irradiation (for BMT)

8

Staging

•  Location of cancer?

   -  examination

   -  use of radiology / imaging

       -  CT , MRI, USS, PET etc

•  Type?

   -  pathology / cytology

       -  classification, risk factors etc

       -  genomics now plays a role & will increase

       -  immune / stromal environment will also have a role

9

Surgery & radiotherapy

• both are ‘local’ therapies

• surgery needs anatomical clearance

    -  of cancers cured about 50% by surgery

Radiotherapy

   -  needs anatomical coverage

   -  can treat inoperable lesions

   -  can make surgery become possible

    -  of cancers cured ~40% by radiotherapy

    -  can be combined with chemotherapy

    -  important role in palliation (symptom relief)

       

10

5 R's of radiobiology

• radiosensitivity-of cells

• repair-pathways

• re-population-of malignant cells 

• re- oxygenation-of malignant cells

• re-assortment

 

11

Medical treatment

• systemic treatment

        - beneficial for widespread disease

        - can result in widespread toxicity

• of cancers cured ~ 3% by chemotherapy

• palliation in about 50% of cancers

• potential to be very specific!

      -  hormone therapy : 

        -  targeted a tumour mutation : 

12

Indications for use of cytotoxic drugs

•‘curative’

• palliative - no cure, but enhanced quality of life

• adjuvant-risk of cancer coming back

•‘neoadjuvant’ -  given before surgery to shirnk cancer

13

Immune therapy

•‘non specific’ / ‘innate’

•‘specific’

monoclonal antibodies

• programmed cell death pathway  -  uses immune system to attack ‘foreign’ cancer cells

chimeric antigen receptor (CAR) T-cells-  artificial T-cell receptors, using retroviral vectors to give a specific  cell killing function directed against cancer cells