Cancer Clinical Therapy Flashcards
Main modalities of cancer therapy’s
- sx
- chemo
- radiation
- multimodality (combo of 2 or more)
approaches and goals of cancer therapy
definitive or palliative
definitive
long term tumor control (can cure some cancers but for most common v aggressive cancers this is just trying for longer period of survival)
palliative
focus on patient comfort not extended survival
Therapy guidlines
Local treatment for local dx systemic treatment for systemic dx
local dx
solid tumors (carcinoma, sarcoma, some round cell tumors)
- Sx (highest chance of cure and probably most commonly used method)
- Radiation (linear accelerator lets you target specific area)
systemic dx
- metastatic
- systemic caners (lymphoma, leukemia, multiple myeloma)
- chemotherapy (will travel throughout body and hopefully kill cancer cells)
Must understand __ to provide adequate care to cancer patients
biological behavior of a tumor
- predict how tumor will behave locally (invasive or non invasive)
- predict likely hood of metastasis (will it metastasize and what will pattern of metastasis be)
Goal of sx
may be therapeutic (excision biopsy) or diagnostic (incisional biopsy if not enough info from cyto)
- This is mainstay therapy for many tumors, remove primary tumor and remove metastatic regional LNs in the area (decrease amount of cancer cells in patient to make future therapies more effective)
- Before proceeding to surgery know what you are taking off (ie cancer or benign; may do cytology, incisional biopsy, FNA before hand; may do advanced medical imaging to see course of tumor (CT scan, MRI)
chemotherapy
- achieve and maintain remission
- slow down progression of metastatic dx
- maintain QOL
- prolong survival
- main goal with chemo is maintain quality of life which is different then in people get less cures but keep patients from being sick in hospital
- chemo mainly for control of metastatic or systemic cancer
- most chemo acts non-specifically by targeting rapidly dividing cells (tumor cells) (but also effect GI and hematopoietic cells -> side effects); there are few targeted therapies other than Paladia available for vet patients
routes of administration for chemo in systemic use
IV, SQ Oral
Local Use of chem
In rare cases used for localized dx; more used in lg animal than small this way
- intralesional
- topical
- intracavitary
Use of chemo in metastatic dx
- slow down progression of metastasis
- efficacy will depend on tumor type and the extend of the dx (regional vs distant)
- determine by staging tests (blood work, FNA/ cytology particularly LNs), imagine (rads, u/s, CT)
- chemo works best with microscopic cd
- look at diagnostics to see how far progressed and decide treatment path from there balancing QOL vs treatment
Intralesional chemotherapy
- chemo mixed with vehicle that allows it to slowly release into tumor; used for select localized tumors and delivers drugs at v high concentrations, this minimizes system drug levels but maximizes it in tumor
- usually used for equine cutaneous tumors (sarcoids, shamus cell carcinoma) rarely used for canine/ feline tumors
- have to consider administrator safety when administering intralesional chemo
- often used in conjunction with debunking target cells
Intracavitary chemotherapy
- Often used in mesotheliomas or carcinomas (usually intraperiotneal)
- Use with tumors confined to single cavity
- increases local drug delivery
- limited profusion so only works up to ~3mm deep on lesions
- minimizes systemic exposure
