15: CA Treatment And Prevention

Question 1

Three main goals in treating cancer

Answer 1

1. Cure
2. Prevent
3. Palliate

Question 2

5th leading cause of CA death among women in the US

Answer 2

Ovarian CA

Question 3

What % of ovarian CA is dxed at an early stage?

Answer 3

About 20%

Question 4

Using CA-125 and TVUS to screen for Ovarian CA

Answer 4

No improvement in mortality + 9.6% false positive rate, leading to unnecessary surgical intervention and harm

Question 5

What to do for women who are higher risk for ovarian CA, like women with BRCA mutations and Lynch syndrome

Answer 5

Individualized screening plan and heightened urgency for symptoms + can have risk-reducing bilateral salpingo-oophorectomy

Question 6

Leading CA among men in the US

Answer 6

Prostate CA

Question 7

What is the risk of being dxed with prostate cancer as a male at some point in life?

Answer 7

11-12%

Question 8

DRE for prostate screens

Answer 8

Falling out of favor bc low sensitivity and specificity

Question 9

Two major reasons cervical cancer has declined by about 70% in the last 40 years

Answer 9

1. Pap smears

2. HPV vaccine

Question 10

Why is effective screening so important for cervical CA?

Answer 10

Its hard to treat

Question 11

Prevention of endometrial CA

Answer 11

Counseling women at menopause to report any vaginal bleeding

Question 12

Most common type of non-skin cancer

Answer 12

Breast cancer

Question 13

Three prevention methods for breast CA in women who are BRCA positive

Answer 13

1. Prophylactic surgery: double mastectomy, bilateral salpingo-oophorectomy
2. Chemoprevention meds: hormone therapy
3. Increased screening and self exam

Question 14

Third leading cause of death for men and women in US

Answer 14

Colon cancer

Question 15

What is the key to choosing the correct screening modality for patients

Answer 15

Informed decision making

Question 16

Leading cause of non-skin cancer in the US

Answer 16

Lung cancer

Question 17

Biggest prevention of lung cancer

Answer 17

Smoking cessation

Question 18

What’s the point of treatment for palliative care?

Answer 18

Even if cure cannot be achieved, can we make the pt feel better with local therapy?

Question 19

Three CA types commonly treated with local therapy

Answer 19

1. Sarcomas
2. Non-melanoma skin CA
3. In situ carcinoma

Question 20

When is neoadjuvant therapy usually used?

Answer 20

On a large mass where surgery would not be as effective up front -> shrinking the tumor with radiation first will make surgery safer and more effective

Question 21

Three instances where surgery will not be indicated for CA treatment

Answer 21

1. Metastatic disease
2. Leukemia and lymphoma
3. Systemic therapy is so effective that surgery is unnecessary

Question 22

How does radiation therapy with I131 work?

Answer 22

Drink radioactive iodine -> absorbed into the body and taken up by thyroid -> neoplastic and normal thyroid cells will metabolize it and will be killed by radioactivity

Question 23

Four instances where radiation therapy is useful

Answer 23

1. Adjuvant therapy
2. Neoadjuvant therapy
3. When surgery is contraindicated
4. To palliate

Question 24

Three instances where radiation therapy can be palliative but not necessarily curative

Answer 24

1. Spinal mets compressing the spinal cord
2. ENT carcinoma to prevent suffocation
3. Pelvic sidewall to prevent pain

Question 25

4 steps to Explain CAR-T Therapy

Answer 25

1. WBCs are taken from pt
2. T cells are engineered to find and kill CA cells
3. CAR T cells are placed back into pt’s blood
4. T cell receptors are attracted to specific targets on CA cells -> kill them

Question 26

What does CAR-T stand for?

Answer 26

Chimeric Ag receptor therapy

Question 27

Therapeutic index for a drug formula

Answer 27

TI = TD50 / ED50 (toxic dose / effective dose)

Question 28

Does a good drug have a high or low therapeutic index?

Answer 28

High TI