Clinical Strategies for Cancer Treatment and Prevention (Part 1 of 2) Flashcards
What are 5 examples of local cancer treatments?
surgery, radiation, ablation, cryosurgery, and radiofrequency
What are 4 examples of systemic cancer treatments?
chemotherapy- cytotoxic, hormone, or biologic
what are three things to ask prior to pursuing local therapy?
can you remove all of the cancer? are there limited options for systemic therapy? If cure cannot be achieved, could treatment palliate?
what are three examples of commonly treated cancers with local therapy?
sarcomas, non-melanoma skin cancer, and in situ carcinomas
what are three different approaches to local therapy?
local only, adjuvant, and neoadjuvant
what is adjuvant therapy?
you have your surgery to provide cytoreduction and then after surgery you add chemotherapy or radiation therapy to fully eliminate those tumor cells
what is neoadjuvant therapy?
surgery is not as effective upfront; cytoreduction is initially provided via chemotherapy and radiation and then surgical removal; and then after surgery you add more adjuvant therapy with chemo and/or radiation therapy
what is neoadjuvant therapy usually applied to?
a very large mass- most commonly seen in lung cancer patients
what is the sequential cancer treatment?
neoadjuvant therapy–> primary therapy–> adjuvant therapy
what is the purpose of neoadjuvant therapy?
reduce the primary tumor size; eliminate cancer cells that spread to other locations
what is the purpose of primary therapy?
eliminate the tumor
what is the purpose of adjuvant therapy?
eliminate the remaining cancer cells
what are the treatment options for neoadjuvant therapy?
chemotherapy, hormone therapy, targeted therapy, radiation therapy
what are the treatment options for primary therapy?
surgery, radiation therapy
what are the treatment options for adjuvant therapy?
chemotherapy, hormone therapy, targeted therapy, radiation therapy
when is surgery not indicated in local therapy?
metastatic disease removes the advantage of surgery; leukemia/lymphoma; systemic therapy is so effective that surgery is unnecessary
what are the three different types of radiation therapy?
external beam radiation, brachytherapy, systemic radionucleotides
what is the most common form of radiation therapy?
external beam radiation
how does external beam radiation work?
there is a linear accelerator delivering direct radiation beams to affected sites
what are two forms of external beam radiation?
intensity modulated radiotherapy (IMRT) and cyberknife
what is brachytherapy?
a very localized high-dose therapy delivered continuously for a prolonged time through implanted devices
when is brachytherapy most commonly used?
prostate cancer; putting radioactive seeds into the prostate through a needle- over time that radiation will kill off the malignant cells
what is systemic radionucleotides?
a patient ingests a radioactive iodine and the thyroid takes it up and it will destroy cancerous and normal thyroid cells
when is systemic radionucleotides commonly used?
most common in people with a hot thyroid nodule/ thyroid cancer
when might you use radiation therapy? (4)
adjuvant therapy, neoadjuvant therapy, when surgery is contraindicated (e.g. patient of advanced age with prostate cancer), or palliative care
how can radiation therapy be used for palliative care?
in cases of spinal metastasis to prevent cord compression, in cases of ENT carcinoma to prevent suffocation, and in cases of pelvic sidewall to prevent pain
what is the conventional form of systemic therapy for cancer?
cytotoxic chemotherapy
what is the therapeutic index like of cytotoxic chemotherapy?
it is very low–> your patients WILL have adverse side effects–> therefore it is important to cycle the medications and drugs
a good drug has what kind of TI?
a high TI
all members of the treatment team for a patient with cancer need to understand/ know what things about a patient?
the cancer the patient has, the treatment regiment and its side effects, and the cycle (including what cycle and day the patient is currently on)
what could a common adverse side effect of hydroxydaunorubicin (doxorubicin) be?
cardiotoxicity
what do you need to order before a patient is started on hydroxydaunorubicin (doxorubicin)?
an echocardiogram
how would you treat a tumor dependent on hormone stimulation?
hormone therapy (look at the receptor status and inhibit (antagonize))
what cancers are associated with hormone therapy?
breast and prostate
how would you treat a tumor dependent on other growth factors?
look at the receptor status and inhibit (antagonize)
what are two common growth factors that some tumors are dependent on?
epidermal growth factor and VEGF
how would you treat a cancer with CD20 antigens on its surface? and what cancer has CD20 on its surface?
B Cell lymphomas; use recombinant antibodies (like rituximab)
how would you treat a tumor that has PD-1 or CTLA on its surface that is diminishing our tumor immunity?
use immune checkpoint inhibitors
what is another immune approach to treating tumors?
CAR-T therapy (chimeric antigen receptor therapy)
how does CAR-T therapy work?
you take T cells out of a patient and expose them to a retrovirus, which is a vector that inserts itself into the T cells, the T cells then make these chimeric receptors; these chimeric antigen receptors will be the driven force to killing the tumor cells once they have multiplied and have been reinserted into the patient
what is the current problem with CAR-T therapy?
cytokine release syndrome; however, it has been approved for ALL
when is stem cell transplantation indicated?
when therapy involves ablation of the bone marrow (as seen in hematopoietic neoplasms and in advanced solid tumors needing high dose cytotoxic chemotherapy)
What are the three types of stem cell transplantation?
allogenic (someone else), syngeneic (identical twin) and autologous (from oneself)
