Treatment In Specific Malignancies Flashcards
(43 cards)
Breast cancer - general treatments
• Surgery - Total/partial mastectomy, breast conserving (lumpectomy, quadrantectomy), axillary surgery (LN) • Chemo - Anthracyclines, Paclitaxel • Targeted therapy - Traztuzumab • Hormonal - Tamoxifen, Anastrozole, Fulvestrant (ER inhibitor) • Radiotherapy - always after partial mastectomy.
Breast cancer In situ
• LCIS
- Observation w/eventual preventive measure (Tamoxifen, mastectomy)
• DCIS
- Local excision or total mastectomy + adjuvant RT
Early Breast cancer
- Local excision, mastectomy or radikal mastectomy. + adjuvant RT. Adjuvant chemo.
- in ER+ & PrR+, adjuvant Tamoxifen and Anastrozole.
- alternative is neoadjuvant anthracyclines and anastrozole in ER+
Locally invasive breast cancer
- Often inoperable, total mastectomy with LN dissection if possible.
- Chemo + hormonal in inoperable.
Metastatic breast cancer
- Tamoxifen, anastrozole, fulvestrant.
- Chemo in high risk patients
- Traztuzumab, Bevacizumab
- RT, denosumab and bisphosphonates for bone metastasis
NSCLC
• Surgery - complete surgical excision if stage 1-3. Segmental resection, Lobectomy or Pneumonectomy. • RT - only in small early stage tumors if surgery is CI. CHART, comb with Chemo. • Chemo - platinum based. • Targeted - Ceftuximab or Bevacizumab
SCLC
• Surgery
- Not indicated!
• Chemoradiotherapy
- platinum based, RT and prophylactic cranial irradiation.
Mesothelioma pleurae
- No standard treatment. Surgery, platinum Chemo, RT, Pleurodesis
Thymoma
- Thymectomy + neoadjuvant chemoradiotherapy
Basal and Squamous cell carcinoma
- Low risk tumors-> Electrodissection, cryosurgery, curettage.
- High risk tumors-> Excisional surgery with neoadjuvant RT. Topical 5-FU and photodynamic therapy.
Mesenchymal tumors (Sarcomas)
- Generally quite Chemoresistant, except in rhabdomyosarcoma, synovial sarcoma or Ewing’s sarcoma. Otherwise treatment is very similar.
- Surgery (wide margin resection, often grows along fascia), adjuvant/neoadjuvant RT. Amputation is last case scenario.
Malignant melanoma
• Surgery
- Local excision and node excision if suspicion of metastasis.
• RT and Chemo
- Relatively resistant
• Biologicals
- IFNa, Dacarbazine, Ipilimumab (anti-CTLA4 of cytotoxic T-ly) as adjuvants.
Endometrial cancer
• Surgery
- Total abdominal hysterectomy + bilateral salpingo-oophorectomy are treatment of choice.
• CRT
- in advanced stages. Paclitaxel, Platins, Doxorubicin + external beam or brachytherapy.
Cervical cancer
• CIS - Local excision, conisation. • Stage 1 - Total/Radical hysterectomy with LN dissection. Adjuvant RT • Stage 2-3 - Chemoradiotherapy (Cisplatin) • Palliative - Cisplatin and RT for Local bleeding and pain
Ovarian cancer
• Surgery
- Is primary modality. Radical surgical resection, hysterectomy, bilateral salpingo-oophorectomy, omentectomy. + Adjuvant chemo (carboplatin, paclitaxel)
• Targeted therapy
- Bevacizumab
Prostate carcinoma
• Active surveillance
- in low risk patients w/low PSA and Gleason. • Radical prostatectomy
• Radical radiotherapy
• Hormone therapy
- Orchidectomy, anti-androgens (flutamide), GnRH analogues (Goserelin)
• Palliative therapy
- Hormone therapy and Paclitaxel
Testicular cancer
- All initially need Orchidectomy.
•Stage 1
a) Seminomas -> surveillance or single dose Carboplatin
b) Teratomas -> Intense surveillance w/ serum markers and CT
• Stage 2,3,4
a) Seminomas -> Cisplatin, Carboplatin + Etopside
b) Teratomas -> BEP (Bleomycin, Etopside, Cisplatin
Bladder cancer
• CIS and Non-muscle-invasive bladder cancer:
- TURBT (transurethral resection of bladder tumor) + adjuvant intravesical Mitomycin. Intravesical BCG vaccine
• Muscle invasive bladder cancer:
- Radical cystectomy + neoadjuvant/adjuvant chemotherapy.
- Trimodal bladder sparing approach -> TURBT + chemo + RT
• Metastatic bladder cancer:
- MVAC chemo (MTX, Vinblastine, Doxorubicine, Cisplatin)
Renal cancer
• Localized/locally advanced
- Active surveillance if low grade. Partial (nephron sparing) nephrectomy, Radical Nephrectomy. Emblization before surgery.
• Metastatic
- Cytoreductive nephrectomy, IFNa, IL-2 and Bevacizumab.
Head and neck cancer
- Surgery and RT (brachytherapy, CHART) as prim modalities. Cetuximab as adjuvant.
- Chemo (Cisplatin, 5-FU) in advanced and metastatic disease
Tumors of CNS
• Surgery
- Therapy of choice.
• Radiotherapy:
- curative and adjuvant settings.
- Stereotactic radiosurgery (gamma knife or linear accelerator with invasive stereotactic frame) or Stereotactic radiotherapy (linear accelerators with non invasive mask or body frame.
• Chemotherapy:
- Ex Lomustine or Carmustine. But are not curative, used in adjuvant or palliative setting.
Gastric carcinoma
• Early Stage - Locally resected endoscopically • Tumor in cardia - Total gastrectomy • Tumor in distal stomach - Partial gastrectomy • Metastasis to LNs - Gastrectomy + extended LN dissection
- Adjuvant Chemo(5-FU)/RT in high staged. Traztuzumab as neoadjuvant in HER2+
Esophageal cancer
•Stage 1 - Endoscopic mucosal resection • Stage 2-3 - Esophagectomy, trimodal therapy. • Stage 4 - Palliative therapy w/ RT, Chemo and stenting
- Surgery if in lower 1/3, RT in upper 1/3.
- Targeted therapy incl Trastuzumab and Ramucirumab (anti-VEGF)
Colon and Rectal cancer
• Surgery - the only curative
- a) Local excision (endoscopically)
- b) Bowel resection (most common)
- c) Colostomy or Ileostomy (temporary or terminal)
- d) Pelvic exenteration (Palliative. Removal of rectum, reproductive organs, LN etc)
- e) Lower anterior resection (For rectal cancer. Removal of rectum + colo-anal anastomosis).
- f) Abdominoperineal resection (Removal of terminal part of intestine + terminal stoma. In tumors close to rectum. Mesentary + LNs also resected).
• Chemotherapy - 5-FU, Platinum derivatives. Adjuvant in early stages, alone in Stage 4. • Chemoradiotherapy - Neoadjuvant in Stage 1-3 • Targeted therapy - Bevacizumab, Cetuximab, in Stage 4
