cancer management

Question 1

What is metastasis in cancer?

Answer 1

Metastasis refers to the process in which malignant tumors spread from their site of origin (the primary tumor) to form secondary tumors at distant sites in the body. It is responsible for approximately 90% of cancer-related mortality and has a significant impact on patient prognosis and treatment.

Question 2

What is prognosis in the context of cancer?

Answer 2

Prognosis refers to the anticipated course of the disease in terms of cure, remission, or the fate of the patient. It is a prediction of the patient’s outcome. Prognosis may be influenced by medical or surgical intervention.

Question 3

What factors are considered in predicting cancer prognosis for a patient?

Answer 3

Predicting cancer prognosis involves considering factors such as the type of tumor (classification), grade of the tumor, stage of the tumor, patient age and general health (performance status), and how the tumor is predicted to respond to treatment. This prediction is based on data from research studies that include large groups of people with the same tumor type who have undergone treatment, often comparing current and new treatments.

Question 4

What is adjuvant therapy?

Answer 4

Adjuvant therapy refers to treatment given to patients who are at risk of recurrence from micrometastases after treatment for the primary lesion. It is administered in the absence of macroscopic evidence of metastases.

Question 5

What is neoadjuvant therapy?

Answer 5

Neoadjuvant therapy is given before primary surgery with the aim of shrinking the tumor to improve local excision and treating any micrometastases as early as possible.

Question 6

What is the goal of palliative treatment?

Answer 6

Palliative treatment is administered when cure is no longer possible. Its purpose is to provide relief from tumor-related symptoms, preserve the patient’s quality of life, and prolong their life.

Question 7

What are the three original pillars of cancer treatment?

Answer 7

The three original pillars of cancer treatment are surgery, radiotherapy, and chemotherapy.

Question 8

What are some additional drug therapies used in cancer treatment?

Answer 8

In addition to chemotherapy, other drug therapies used in cancer treatment include endocrine therapies, targeted therapies, and immunotherapy. Patients may receive a combination of these treatments.

Question 9

What is one of the main treatments for cancer?

Answer 9

Surgery is still one of the main treatments for cancer. It can potentially cure cancer that is localized and has not spread to other parts of the body. Early detection is important for successful surgical intervention. New techniques, such as robot-assisted keyhole surgery (Da Vinci Robot-assisted surgery), have made surgeries less invasive.

Question 10

When can surgery cure cancer?

Answer 10

Surgery can potentially cure cancer when it is completely contained in one area and has not spread to other parts of the body.

Question 11

What is the role of radiotherapy in cancer treatment?

Answer 11

Radiotherapy is an important modality in the treatment of cancer. It is used in various ways: radical radiotherapy aims to deliver a curative treatment dose to a well-defined target volume while sparing surrounding normal tissues, adjuvant radiotherapy reduces the risk of tumor recurrence after primary surgery, and palliative radiotherapy is used to alleviate symptoms of local disease or distant metastases.

Question 12

What types of radiation are used in radiotherapy?

Answer 12

Radiotherapy utilizes electromagnetic radiation such as X-rays (generated by a machine) and gamma rays (emitted from radioactive decay sources). It also utilizes particulate radiation, which includes subatomic particles like alpha particles, protons, and neutrons.

Question 13

What are the biological effects of radiotherapy?

Answer 13

The biological effects of radiotherapy are caused by the ionization of water molecules. This ionization leads to the production of free radicals and reactive oxygen species, which can damage DNA and other cellular components, ultimately inhibiting the growth and division of cancer cells.

Question 14

What are the two main ways to deliver radiotherapy?

Answer 14

The two main ways to deliver radiotherapy are external radiation therapy and internal radiation therapy. External radiation therapy involves delivering a focused beam of radiation in fractions separated by several hours, while internal radiation therapy (brachytherapy) involves placing a radiation source in close contact with the tissue to provide intense exposure over a short distance to a restricted volume.

Question 15

What is the treatment strategy behind radiotherapy?

Answer 15

Radiotherapy is delivered in fractions based on the differing biological properties of cancer cells compared to surrounding normal tissues. The treatment regimes aim to amplify the survival advantage of normal tissues over cancer cells by taking advantage of the better repair capacity of normal cells for sub-lethal radiation damage. Normal cells proliferate more slowly than cancer cells, allowing them more time to repair damage before replication.

Question 16

What are the three original “Pillars of Cancer Treatment” for solid tumors?

Answer 16

The three original pillars of cancer treatment for solid tumors are surgery, radiotherapy, and chemotherapy (drug therapy).

Question 17

What are some additional drug therapies used in cancer treatment?

Answer 17

In addition to chemotherapy, other drug therapies used in cancer treatment include endocrine therapies (hormonal therapies), targeted therapies (drugs that specifically target cancer cells), and immunotherapy (stimulating the immune system to fight cancer). Other treatments such as stem cell transplant, gene therapy, and oncolytic viruses may also be used in specific cases.

Question 18

What are the two types of cancer drugs?

Answer 18

The two types of cancer drugs are chemicals in the form of small molecules and biopharmaceuticals (also known as biologicals or biologics). Biopharmaceuticals are living organisms or substances derived from living organisms, or laboratory-produced (recombinant) versions of such substances. They can include antibodies, viruses, and vaccines.

Question 19

What is the primary mode of action of chemotherapy?

Answer 19

Chemotherapy, specifically cytotoxic chemotherapy, operates by interfering with the synthesis, structure, or function of DNA or the mechanics of cell division. This often leads to DNA damage in cancer cells.

Question 20

What is the treatment strategy for chemotherapy?

Answer 20

Chemotherapy is often given intravenously (i.v.) over a period of a few days, followed by a rest period of a few weeks. Normal tissues have better DNA repair capabilities compared to cancer cells, so the rest period allows normal tissues to recover while the chemotherapy depletes the tumor. Common side effects of chemotherapy include nausea and vomiting, hair loss, myelosuppression (reduced blood cell production in the bone marrow), mucositis (inflammation/ulceration of mucous membranes in the digestive tract), and fatigue.

Question 21

What is endocrine therapy (hormone therapy)?

Answer 21

Endocrine therapy is a type of treatment used for cancers that are dependent on hormones for growth and survival. It involves the use of drugs that block the activity or reduce the level of hormones in the body. Cancers that can be hormone-sensitive/dependent include breast cancer, prostate cancer, ovarian cancer, and uterine cancer.

Question 22

What is targeted therapy (molecularly targeted drugs)?

Answer 22

Targeted therapy refers to the use of drugs that specifically interfere with molecules (targets) involved in the growth, progression, and spread of cancer. These drugs are deliberately designed to act on specific molecular targets associated with cancer development.

Question 23

How does targeted therapy differ from standard chemotherapy?

Answer 23

Targeted therapies differ from standard chemotherapy in that they are designed to act on specific molecules involved in cancer growth, progression, and spread. In contrast, many standard chemotherapies were identified because they kill proliferating cells by causing DNA damage.

Question 24

Can you provide an example of targeted therapy?

Answer 24

One example of targeted therapy is Vemurafenib (Zelboraf®), which is used in the treatment of malignant melanoma. Approximately 50% of malignant melanomas have a specific point mutation in the BRAF gene, with the most common mutation being V600E. Vemurafenib, a small molecule drug, binds and blocks the activity of the V600E BRAF kinase, acting as a BRAF inhibitor.

Question 25

What is the significance of HER2 in breast cancer?

Answer 25

HER2 (Human Epidermal Growth Factor Receptor 2) is a receptor tyrosine kinase that sends signals into the cell to promote cell growth and division. Approximately 20% of all breast cancers have high levels of HER2. High HER2 cancers are known to be more aggressive.

Question 26

What is the role of Trastuzumab (Herceptin®) in breast cancer treatment?

Answer 26

Trastuzumab is an antibody drug that binds to and blocks the activity of the HER2 protein, acting as a HER2 inhibitor. It is used in the treatment of breast cancers that overexpress HER2. Trastuzumab helps to inhibit the growth and proliferation of HER2-positive breast cancer cells.

Question 27

What is immunotherapy?

Answer 27

: Immunotherapy is a cancer treatment that harnesses the power of the immune system to fight cancer. It works by stimulating or enhancing the immune response against cancer cells. Immune cells are often found in and around tumors, and their presence indicates that the immune system is recognizing and responding to the tumor. Some new cancer treatments are designed to assist the immune system in fighting cancer.

Question 28

What is the role of immune checkpoints in cancer and their inhibition?

Answer 28

Immune checkpoints are mechanisms that regulate the immune response to prevent excessive activation and damage to normal tissues. However, some cancer cells can exploit these checkpoints to evade the immune system. For example, in malignant melanoma, the expression of PD-L1 on cancer cells can interact with PD-1 on T cells, suppressing T cell-induced tumor death. Immune checkpoint inhibitors, such as Nivolumab (Opdivo®), target and block the interactions between PD-1 and PD-L1, reactivating T cells and promoting T cell-induced tumor death.

Question 29

What is cancer drug resistance, and what are its causes?

Answer 29

Cancer drug resistance can be classified as intrinsic or acquired. Intrinsic resistance occurs when patients show no initial response to a cancer therapy. Acquired resistance, on the other hand, happens when patients initially respond to therapy but later relapse and progress. Cancer drug resistance can be caused by changes in our DNA, including genetic mutations or alterations that allow cancer cells to bypass or counteract the effects of the treatment.

Question 30

What is Vemurafenib used for in the treatment of melanoma?

Answer 30

Vemurafenib is approved for the treatment of patients with unresectable or metastatic melanoma that carries the BRAFV600E mutation. This mutation hyperactivates the BRAF kinase and drives the malignant behavior of melanoma cells.

Question 31

What is acquired drug resistance?

Answer 31

Acquired drug resistance refers to the development of resistance to a specific drug after an initial response to the treatment. In the context of Vemurafenib, some patients initially respond to the drug, but over time, they can develop resistance and experience disease progression.