cancer treatment Flashcards
the main approaches used in cancer management:
1- — local
2- —- local/regional
3- —- systemic/targetd
4- —- includes immunotherapy and gene therapy
- role of each depends on — of tumor , — of its development and patients —
- increasingly used in —
surgical excision
radiotherpay
chemotherapy
biologic therapy
type
stage
medical history
combination
cancer treatment modalities may be:
1- —- curative intent
2- — given in non-curative setting to optimize symptom control,
improve quality of life, and sometimes to improve survival
3- —- systemic therapy used in patients with primary tumour removed but who are at high risk of metastatic disease
4- — treatment given prior to local therapy e.g. to shrink tumour before
surgery
primary
palliative
adjuvant
neoadjuvant
— is the oldest treatment of cancer and is used to diagnose, stage and treat cancer & certain cancer-related symptoms and its part of the — plan
- Surgeon - part of multidisciplinary care team( biopsy techniques, optimal image guidance, likelihood of achieving clear margins, & role, if any, for surgical mgt of advanced disease)
- Determine if resectable - diagnostic and imaging studies performed and surgical approach planed.
* Due to improved — many patients
have disease that is curable with– alone at diagnosis
surgery
curative
screening techniques
surgery
-surgical exision goal is to remove – and an area of — surronding it aka clear margin which is to prevent cancer —
- Sometimes not possible to remove whole tumour - a — surgery removes as much as possible( to relieve symptoms e.g. pain, airway obstruction, or bleeding)
* Types of surgeries depend on – and– of tumour, patient — and — for surgery
– continue to evolve as surgical techniques advance e.g. breast
cancer
cancer n healthy tissue
recurring aka local recurrence
debunking
stage , location , anatomy , fitness
- Excision of lymph nodes (glands) in the area of tumour at the time of surgery, depending on the — of cancer
- Information regarding lymph
node status (i.e. do they contain
cancer cells or not?) can help
determine — as well as further — options
type
prognosis
treatment
example on evolution of surgical technique in management of breast cancer:
1- * 1890, Dr. Halsted pioneered the —
– removed the whole breast, all draining nodes & pectoral muscles
– extreme procedure, poor cosmetic outcomes & long-term issues
2- * 1970s, introduction of — quadrantectomy - less extensive surgery.
- Nowadays, smaller — followed with breast — ( cosmetically successful, still maintaining excellent cancer control)
- — therapy
- Oncoplastic — techniques increasingly used:
– — or — reconstruction
– — or — procedures e.g. —
radical mastectomy
breast conserving surgery
lumpectomies
breast radiation
intraoperative radiation
oncoplastic reconstructive
immediate or delayed
implant or flap as DIEP ( DIEP (deep inferior epigastric perforating vessels) flap = the skin and fat (from the lower abdomen) with blood
supply provided by the deep inferior epigastric artery (DIEA) and the deep inferior epigastric vein (DIEV).)
- All breast cancer patients used to have surgery to remove — (glands) in underarm, which is — dissection
- Ax dissection can result in arm—,—, and/or limited —-
- Now, for diagnostic staging of the axilla, sentinel lymph node dissection (removing only the first draining node) is done.
- Axillary dissection is reserved for situations where the sentinel node is – for tumour, or if a sentinel node— be found.
lymph nodes
axially
swell pain limited range of motion
postive
cant
- A —- is the first lymph
node to receive lymphatic drainage from a tumor. - It can be detected by injection of a – or — around the primary tumor, which travels to and identifies the first draining (sentinel) node.
- — of a sentinel lymph node can
reveal whether there are lymphatic
metastases, thereby eliminating the
need for extensive dissection of the
regional lymph-node basin.
sentinel lymph node
blue dye
radioactive colloid
biposy
- Uses — to kill or slow the growth of cancer cells
- — invasive than surgery
- Targeted therapy used when tumour anatomically –
- Can be used as — treatment e.g. prostate cancer, H&N, cervix, bladder (in place of surgery)
- Also used after — or — with other modalities
- Good —
- Common — of cancer patients receive RT at some point e.g. 80% breast cancer patients
high energy rays
less
localised
primary
after surgery or combined
palliation
>50%
different ways to give radiotherapy:
1- from outside the body aka — by using — by which its a course that can last —- and is a – treatment
2- from inside aka — by using:
- — :a delivery system that provides
high dose radiation to a small volume of tissue
* —- e.g. radiation ingested, or I 131
external
external beam radiotherapy EBRT
4-8 weeks
daily
internally
brachytherapy
systemic therapy
- The aim of radiotherapy is to kill — and spare —
- In external beam and brachytherapy one inevitably delivers some dose to normal tissue
- The probability of tumour cure increases with increasing — but so does adverse effects
tumour cells
spare normal cells
radiation dose
mechanism of radiation induced cell kill through direct n indirect action:
If any form of radiation is
absorbed in biologic material,
it can:
1- Either interact — with the
critical — in the cell (30%)
2- Or with other — or —
in the cell (particularly — ),
forming — which is –
(70%)
directly
target
cells or molecules
water
free radicals
indirect
- —- breaks are the main event leading to radiation indeed cell kill
- by which the – is the main target
- Double Strand Breaks lead to broken piece of DNA!
- —- is the major cell death mechanism in solid tumours
- Deficiencies in — genes underlie many forms of cancer
dna double strand break
dna
mitotic catastrophe
dna repair gene
true or false:
Radiation pneumonitis: (inflammation of thelungs) radiation-induced lung disease (RILD) is
relatively common following radiotherapy for
chest wall or intrathoracic malignancies
trueeee
principles of chemotherapy:
* Depends on existence of exploitable biochemical differences between – and – cells
* Ideal chemotherapy drugs would be selective for the — cells and leave host cells — aka — therapy
– Rarely achieved with classical cytotoxics
tumour n host cells
malignant cells
unharmed targeted
