Oncology investigations and management Flashcards
(47 cards)
What are the key tumour markers for the following cancers:
- Colorectal
- Breast
- Ovarian
- Prostate
- Liver
- Thyroid
- Bladder/kidney
Colorectal:
- Carcinoembryonic antigen (CEA), blood test
Breast + ovarian:
- BRCA1 + BRCA2, gene mutations
- HER2, gene mutation
Breast:
- Oestrogen + progesterone receptor, tumour genetics
Ovarian:
- CA125, blood test
Prostate:
- Prostate-specific antigen (PSA), blood test
- Prostatic Acid Phosphatase (PAP), blood test
Liver:
- Alpha-fetoprotein (AFP), blood test
Thyroid:
- Calcitonin, blood test
- Thyroglobulin, blood test
Bladder/kidney:
- Bladder Tumour Antigen (BTA, urine test
How do you investigate X cancer?
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ANYTHING ABOUT CANCER SCREENING PROGRAMS HERE?
THERE IS SOME STUFF IN GYNAE ALREADY
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What investigations do you use to stage cancers?
Ix e.g. CT, MRI-PET; some tumour markers etc.
MORE
What staging systems exists for cancer?
Malignant tumours are graded as: well, moderately, and poorly differentiated
- Well = resembling parent tissue, slow growing
- Poor = don’t resemble parent tissue and often grow rapidly/behave aggressively
TNM system:
- T = size/extent of primary tumour; TX = tumour cannot be measured, T0 = tumour cannot be found, T1-4 +/- a’s/b’s - higher number = larger/more invading of tissues
- N = number of nearby lymph nodes that have cancer; NX = lymph node involvement cannot be measured, N0 = no cancer in lymph nodes, N1-3 = number and location of nodes with cancer
- M = whether or not cancer has mets; Mx = mets cant be measured, M0 = no mets, M1 = mets
TNM maps to ‘stage 1-4’:
- Stage 0/carcinoma-in-situ = not a cancer but may become a cancer
- Stage 1-3 = cancer present,
greater the number the more locally invasive
- Stage 4 = distant mets
Generally the greater the stage, the more aggressive the cancer and the poorer the prognosis
Staging will dictate the treatment required for most optimal management
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What are the definitions of the following treatment intents:
- Neoadjuvant
- Radical
- Adjuvant
- Palliative
Neoadjuvant – given before curative treatment e.g. shrink the tumour before resection, reduce the micro-metastatic burden that would lead to increased risk of recurrence; not without its risks – needs weighing up whether risk of disability/mortality is worth it, especially as this isn’t the curative part
Radical – curative; often surgery but sometimes high levels of radiotherapy (aiming for long term control)
Adjuvant – given after radical treatment e.g. chemo/radio after surgery, again to reduce the risk of primary/local recurrence (radiotherapy) or micro-metastatic disease (chemotherapy)
Palliative – to preserve QoL, increase life expectancy and symptom control; palliative patients may life years – (palliation isn’t end of life!)
What is performance status and how is it measured?
Eastern Cooperative Oncology Group (ECOG) Performance Status:
0 = fit and well, intact ADLs
1 = restricted in strenuous physical activity,, but ambulatory and can do light housework etc
2 = ambulatory + capable of self care but not work activities; up and about for more than 50% of waking hours
(most treatment considered + more successful up to grade 2)
3 = only limited self care possible, up and about for <50% waking hours otherwise in bed or chair
4 = completely disabled, no self care, confined to bed/chair
5 = dead…
Score is used as part of a holistic assessment of wellness - for treatment etc.
What are the principles in cancer treatment?
Appropriate treatment for the cancer
a. Tumour grade, size, biological features, lymph node involvement, treatment intent (curative vs palliative/symptom improvement)
Appropriate treatment for patient fitness
a. Age, comorbidity, performance status, contraindications to treatment
Appropriate treatment for patient wishes
a. Do they want treatment? Does this have to be done now?
How does cytotoxic chemotherapy work?
Alkylating agents:
- Adds an alkyl group to guanine base of DNA -> formation of crosslinks between them -> disruption in DNA synthesis; occurring in any phase of cell cycle, most active in resting phase (G0)
- E.g. Cyclophosphamide, Chlorambucil
Antimetabolites:
- Work during the synthetic/’S’ phase of cell cycle, very little effect in G0
- Most effective against rapidly growing tumours
- Inhibit enzymes or metabolites involved in DNA/RNA synthesis
- E.g. 5-Fluorouracil (5-FU)
6-Mercaptopurine (6-MP), hydroxyurea, methotrexate, hydroxycarbamide
DNA linking agents:
- Contain platinum complexes which produce DNA crosslinks, preventing replication
- Cell cycle non-specific
- E.g. cisplatin, carboplatin
Natural products:
- Multiple compounds with different mechanisms e.g. cytotoxic antibiotics, mitotic inhibitors, enzymes etc
- e.g. Bleomycin, epirubicin, vincristine, vinblastine
Often given neo-adjuvantly or adjuvantly in order to reduce the burden of micro-metastases e.g. bits of tumour circulating systemically that might become secondary tumours if left to implant
Why do chemotherapies fail?
Drug resistance:
- Tumours may have natural resistance to some agents or it may develop over time
- May occur due to a change in drug concentration i.e. if the number of drug-activating enzymes decreases over time
- Mutation in drug target or excess excretion of the medication from target site are also other reasons
