Clinical Strategies for Cancer Treatment and Prevention (Part 1 of 2)

Question 1

What are 5 examples of local cancer treatments?

Answer 1

surgery, radiation, ablation, cryosurgery, and radiofrequency

Question 2

What are 4 examples of systemic cancer treatments?

Answer 2

chemotherapy- cytotoxic, hormone, or biologic

Question 3

what are three things to ask prior to pursuing local therapy?

Answer 3

can you remove all of the cancer? are there limited options for systemic therapy? If cure cannot be achieved, could treatment palliate?

Question 4

what are three examples of commonly treated cancers with local therapy?

Answer 4

sarcomas, non-melanoma skin cancer, and in situ carcinomas

Question 5

what are three different approaches to local therapy?

Answer 5

local only, adjuvant, and neoadjuvant

Question 6

what is adjuvant therapy?

Answer 6

you have your surgery to provide cytoreduction and then after surgery you add chemotherapy or radiation therapy to fully eliminate those tumor cells

Question 7

what is neoadjuvant therapy?

Answer 7

surgery is not as effective upfront; cytoreduction is initially provided via chemotherapy and radiation and then surgical removal; and then after surgery you add more adjuvant therapy with chemo and/or radiation therapy

Question 8

what is neoadjuvant therapy usually applied to?

Answer 8

a very large mass- most commonly seen in lung cancer patients

Question 9

what is the sequential cancer treatment?

Answer 9

neoadjuvant therapy–> primary therapy–> adjuvant therapy

Question 10

what is the purpose of neoadjuvant therapy?

Answer 10

reduce the primary tumor size; eliminate cancer cells that spread to other locations

Question 11

what is the purpose of primary therapy?

Answer 11

eliminate the tumor

Question 12

what is the purpose of adjuvant therapy?

Answer 12

eliminate the remaining cancer cells

Question 13

what are the treatment options for neoadjuvant therapy?

Answer 13

chemotherapy, hormone therapy, targeted therapy, radiation therapy

Question 14

what are the treatment options for primary therapy?

Answer 14

surgery, radiation therapy

Question 15

what are the treatment options for adjuvant therapy?

Answer 15

chemotherapy, hormone therapy, targeted therapy, radiation therapy

Question 16

when is surgery not indicated in local therapy?

Answer 16

metastatic disease removes the advantage of surgery; leukemia/lymphoma; systemic therapy is so effective that surgery is unnecessary

Question 17

what are the three different types of radiation therapy?

Answer 17

external beam radiation, brachytherapy, systemic radionucleotides

Question 18

what is the most common form of radiation therapy?

Answer 18

external beam radiation

Question 19

how does external beam radiation work?

Answer 19

there is a linear accelerator delivering direct radiation beams to affected sites

Question 20

what are two forms of external beam radiation?

Answer 20

intensity modulated radiotherapy (IMRT) and cyberknife

Question 21

what is brachytherapy?

Answer 21

a very localized high-dose therapy delivered continuously for a prolonged time through implanted devices

Question 22

when is brachytherapy most commonly used?

Answer 22

prostate cancer; putting radioactive seeds into the prostate through a needle- over time that radiation will kill off the malignant cells

Question 23

what is systemic radionucleotides?

Answer 23

a patient ingests a radioactive iodine and the thyroid takes it up and it will destroy cancerous and normal thyroid cells

Question 24

when is systemic radionucleotides commonly used?

Answer 24

most common in people with a hot thyroid nodule/ thyroid cancer

Question 25

when might you use radiation therapy? (4)

Answer 25

adjuvant therapy, neoadjuvant therapy, when surgery is contraindicated (e.g. patient of advanced age with prostate cancer), or palliative care

Question 26

how can radiation therapy be used for palliative care?

Answer 26

in cases of spinal metastasis to prevent cord compression, in cases of ENT carcinoma to prevent suffocation, and in cases of pelvic sidewall to prevent pain

Question 27

what is the conventional form of systemic therapy for cancer?

Answer 27

cytotoxic chemotherapy

Question 28

what is the therapeutic index like of cytotoxic chemotherapy?

Answer 28

it is very low--> your patients WILL have adverse side effects--> therefore it is important to cycle the medications and drugs

Question 29

a good drug has what kind of TI?

Answer 29

a high TI

Question 30

all members of the treatment team for a patient with cancer need to understand/ know what things about a patient?

Answer 30

the cancer the patient has, the treatment regiment and its side effects, and the cycle (including what cycle and day the patient is currently on)

Question 31

what could a common adverse side effect of hydroxydaunorubicin (doxorubicin) be?

Answer 31

cardiotoxicity

Question 32

what do you need to order before a patient is started on hydroxydaunorubicin (doxorubicin)?

Answer 32

an echocardiogram

Question 33

how would you treat a tumor dependent on hormone stimulation?

Answer 33

hormone therapy (look at the receptor status and inhibit (antagonize))

Question 34

what cancers are associated with hormone therapy?

Answer 34

breast and prostate

Question 35

how would you treat a tumor dependent on other growth factors?

Answer 35

look at the receptor status and inhibit (antagonize)

Question 36

what are two common growth factors that some tumors are dependent on?

Answer 36

epidermal growth factor and VEGF

Question 37

how would you treat a cancer with CD20 antigens on its surface? and what cancer has CD20 on its surface?

Answer 37

B Cell lymphomas; use recombinant antibodies (like rituximab)

Question 38

how would you treat a tumor that has PD-1 or CTLA on its surface that is diminishing our tumor immunity?

Answer 38

use immune checkpoint inhibitors

Question 39

what is another immune approach to treating tumors?

Answer 39

CAR-T therapy (chimeric antigen receptor therapy)

Question 40

how does CAR-T therapy work?

Answer 40

you take T cells out of a patient and expose them to a retrovirus, which is a vector that inserts itself into the T cells, the T cells then make these chimeric receptors; these chimeric antigen receptors will be the driven force to killing the tumor cells once they have multiplied and have been reinserted into the patient

Question 41

what is the current problem with CAR-T therapy?

Answer 41

cytokine release syndrome; however, it has been approved for ALL

Question 42

when is stem cell transplantation indicated?

Answer 42

when therapy involves ablation of the bone marrow (as seen in hematopoietic neoplasms and in advanced solid tumors needing high dose cytotoxic chemotherapy)

Question 43

What are the three types of stem cell transplantation?

Answer 43

allogenic (someone else), syngeneic (identical twin) and autologous (from oneself)