Theraputic Options

Question 1

What is CRC (colorectal cancer) linked to in terms of diet?

Answer 1

Red meat consumption

Question 2

What is

breast cancer linked to in terms of diet?

Answer 2

Saturated fat intake

Question 3

What is the current advice for diet?

Answer 3

5 or more portions of fruit or veg per day

Avoid obesity

Regular exercise every day (30 minutes)

Question 4

How do we screen for Cervical cancer, CRC and breast cancer?

Answer 4

Smear tests

Faecal occult blood the most commonly used test
- 16% reduction in CRC mortality

Mammography

Question 5

How do we screen for prostate cancer?

Answer 5

PSA blood test

Question 6

How do we screen for lung cancer?

Answer 6

MR / CT scanning

Breath test

Question 7

How do we protect families with a history of CRC & familial adenomatous polyposis coli (FAP)?

Answer 7

Screen families for APC mutations

• regular colonoscopy
• offer panprotocolectomy when adenomas found

Question 8

What is recommended for those with high risk of oesophageal cancer?

Answer 8

Supplement diet with anti-oxidants

Question 9

What is recommended for those with high risk of breast cancer?

Answer 9

Prophylactic tamoxifen

Question 10

What are the therapeutic ‘treatment options’?

Answer 10

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)

Question 11

What are the principles of staging?

Answer 11

Looking WHERE it is and examining it using radiological techniques (CT , MRI, USS, PET etc)

Determining WHAT kind of cancer it is using pathology / cytology

To determine Classification, risk factors etc
Genomics likely to play a role in the future

Question 12

What are the advantages of radiotherapy?

Answer 12

Can treat inoperable lesions (– treat things you can’t remove)

Can make surgery become possible

Can maintain function and or appearance

Important role in palliation - improving someones symptoms

Question 13

What are the 5 R’s of radiobiology?

Answer 13

Radiosensitivity
Repair
Re-population
Re-oxygenation
Re-assortment

Question 14

Define radiosensitivity

Answer 14

How sensitive the tumour is to the treatment

Question 15

What is the principle of re-oxygenation?

Answer 15

Having oxygen present makes the treatment more effective.

Question 16

What is the purpose of medical treatment of cancer?

Answer 16

Beneficial for widespread disease

3% of cancers are cured by chemotherapy
Palliation in 50% of cancers

HOWEVER - can result in widespread toxicity

Question 17

What are the indications for cytotoxic drugs?

Answer 17

Curative
Palliative

Adjuvant (applied after initial treatment for cancer, especially to suppress secondary tumour formation.)

Neoadjuvant (aims to reduce the size or extent of the cancer before using radical treatment intervention, thus making procedures easier and more likely to succeed)

Question 18

What is the aim of adjuvant chemotherapy?

Answer 18

To improve survival following surgery

Question 19

What are the factors you need to consider before giving someone an adjuvant?

Answer 19

Toxicity vs benefit

‘cost’ vs benefit

Question 20

What is the purpose of palliative chemotherapy?

Answer 20

50% of chemo use

Relieves symptoms and may improve survival

Question 21

What is the aim of neoadjuvant chemotherapy?

Answer 21

To improve survival
To reduce morbidity

PRECEDES SURGERY

Question 22

What can hormone therapy be used for?

Answer 22

Specific or targeted therapy

Used in breast cancer and prostate cancer

Question 23

What can antibodies be used for?

Answer 23

Irritable bowel disease
Cancer
Arthritis

Question 24

What is the purpose of the programmed cell death pathway?

Answer 24

Uses the immune system to attack the foreign cancer cells

Question 25

What is the purpose of CAR T-cells?

Answer 25

Chimeric antigen receptor T-cells

T cells are removed and modified so they express receptors specific to the patients particular cancer

Transfer of coding sequence os facilitated by retroviruses

Question 26

What is the purpose of monoclonal antibodies?

Answer 26

Treats cancer