Therapeutic Options: cancer

Question 1

….. a link with red meat consumption breast cancer :

Answer 1

CRC

Question 2

….. a link with saturated fat intake

Answer 2

Breast Cancer

Question 3

Cervical cancer screening

Answer 3

smear tests

Question 4

Breast cancer screening

Answer 4

mammography

Question 5

CRC screening

Answer 5

faecal occult blood test (FOBT)

check for GIT bleeding

On 50th birthday

Question 6

prostate cancer screening

Answer 6

PSA blood test

(Not national yet)

controversial

Question 7

lung cancer screening

Answer 7

MR / CT scanning
breath test

controversial

Question 8

Genetic link between CRC & ….

Answer 8

familial adenomatous polyposis coli (FAP) -

autosomal dominant - screen families for APC(Adenomatous polyposis coli) mutations

regular colonoscopy - offer panprotocolectomy when adenomas found

remove all of the colon, rectum

Question 9

Breast cancer linked with …… genes

Answer 9

BRCA1 (better prognosis compared to BRCA2); BRCA2

Question 10

Chemo prevention for Primary oesophageal cancer

Answer 10

antioxidants

Question 11

Chemo prevention for Primary breast cancer

Answer 11

prophalytic tamoxifen

Question 12

Chemo prevention for secondary H&N or lung cancer

Answer 12

anti oxidants - no benefit

Question 13

surgery
radiotherapy
ablation (destroy by freezing, radio-frequency, etc)
isolated limb perfusion (block supply and supply treatment to that specific area) - less common

Answer 13

local or regional treatment

Question 14

hormonal therapy
chemotherapy
immunotherapy
whole body irradiation (for BMT)

Answer 14

systemic treatment

Question 15

anatomical clearance - remove all

Answer 15

Surgery

Treat 50% cancer case
Quality of surgery - success of outcome

Question 16

anatomical coverage - can treat inoperable lesions

Answer 16

Radiotherapy

can make surgery become possible
can maintain function and / or appearance

Question 17

Location of cancer

Answer 17

examination, radiology/imaging

Question 18

Type of cancer

Answer 18

histo/cytopathology

Question 19

Inoperable lesion

Answer 19

T cell NHL (Non-Hodgkin’s lymphoma)

Radiotherapy

Question 20

5 R’s of radiobiology

Answer 20

radiosensitivity 
repair
re-population
re- oxygenation
re-assortment

Question 21

Cancers cured by radiotherapy

Answer 21

head and neck, cervix / uterus, skin, lymphoma

Question 22

Radiotherapy combined with chemotherapy

Answer 22

anal cancer, rectal cancer, oesophageal cancer

Question 23

Important role of radiotherapy in palliation

Answer 23

pain, bleeding, swollen limb

Question 24

Indications for the use of cytotoxic drugs (different type of chemotherapy)

Answer 24

curative
palliative
adjuvant
neoadjuvant

Question 25

Systemic treatment is beneficial for..... , but can also result in ,,,,

Answer 25

widespread disease widespread toxicity Can be specific

Question 26

benefits in - breast cancer: ER+ve ; tamoxifen ( decreased oestrogen prod) Long term therapy - more side effects prostate cancer: LHRH antagonists (decreased testesterone) - short term therapy

Answer 26

Hormone therapy ‘specific’ or ‘targetted’ therapy prevention’ trials in high risk group

Question 27

Immune Therapy clinically used for

Answer 27

melanoma Immune Therapy ‘specific’ • monoclonal antibodies - rituximab ; B cell NHL: +/- radioactivity - trastuzumab & response in HER2 +ve breast & gastric cancer • programmed cell death pathway (PD-1) - uses immune system to attack ‘foreign’ cancer cells • chimeric antigen receptor (CAR) T-cells - artificial T-cell receptors, using retroviral vectors to give an specific cell killing function directed against cancer cells • ‘non specific’

Question 28

‘specific’, based on molecular science - intracellular growth control points

Answer 28

‘Designer’ therapies - imatinib: blocks a tyrosine kinase very useful in CML ; GISTS - ZD1839 (‘Iressa’): EGFR inhibitor - in lung cancer need to have specific mutation

Question 29

Herceptin (breast and ovarian) being to specific Ag - destruction or block GF signal

Answer 29

Mono Ab immunotherapy HER2 adjuvant treatment response in HER2 +ve breast B cell NHL: +/- radioactivity - trastuzumab

Question 30

uses immune system to attack ‘foreign’ cancer cells

Answer 30

programmed cell death pathway (PD-1) PDL 1 present on cancer cells - binds with PD1 > prevent communication to T cell - remain undetected Blocking the binding, PD1 can signal T cell to kill the cancer cell = treatment?

Question 31

artificial T-cell receptors, using retroviral vectors to give an specific cell killing function directed against cancer cells

Answer 31

chimeric antigen receptor (CAR) T-cells

Question 32

uses own body immune sys to recognise cancer cells

Answer 32

immune therapy

Question 33

specific -molecular | intracellular growth control points

Answer 33

designer therapy imatinib - CML

Question 34

chemotherapy (reduce tumour size) and then surgery

Answer 34

neoadjuvant

Question 35

Chk inhibitor .... radio sensitivity

Answer 35

Increases