CP: Treatment Modalities + Purpose

Question 1

NHS Cancer Guidelines

Answer 1

• All patients referred by GP with suspected cancer should be seen by specialist within 2 weeks
• Cancer patients should wait no more than 31 days from decision to treat to the start of first treatment
• All patients should wait no more than 62 days from urgent GP referral to the start of treatment

Question 2

How can cancer be diagnosed?

Answer 2

Non-invasive or invasive

• Cytology
  
  • Bodily fluids
  • Tissue scrapings
  • Fine needle aspiration
• Incision/excision biopsy
  
  • Liquid biopsies

Question 3

After diagnosis is confirmed, why does the stage of cancer disease need to be established?

Answer 3

* Define the local + distant extent of disease

• Help determine optimal treatment
• Provides a baseline
• Provides prognostic information

Question 4

Describe the TNM staging system

Answer 4

Categories:

• T = primary tumour
• N = regional lymph nodes
• M = metastases

Each category assigned a number according to extent of cancer disease

TNM used to determine the stage:

• 0 = carcinoma in situ
• 1-3 = more extensive disease
• 4 = cancer has spread to distant tissues/organs

Cannot measure metastases (M0-M1)

Staging varies between cancers

Question 5

What is grade?

Answer 5

Macroscopic assessment of the degree of differentiation which the cells show

• Usually described
• Well differentiated tumours = lower grade, less aggressive
• Anaplastic = no differentiation, most aggressive + difficult to treat

Question 6

What factors influence treatment decisions?

Answer 6

1. Performance status - WHO performance scale
2. TNM Staging + Grade
3. Prognosis
4. Tumour Genetics
5. Co-Morbidities
6. NICE Guidelines
7. Patient Choice

Question 7

List the treatments of Cancer?

Answer 7

1. Surgery
2. Radiotherapy
3. External bean RT
4. Brachytherapy
5. Radioisotope
6. Chemotherapy

Question 8

List the intentions of treatment

Answer 8

• Radical
• Neoadjuvant
• Adjuvant
• Palliative
• Clinical trials

Question 9

Haematological cancers refer to treatment phases.

Can you list them?

Answer 9

1. Induction
2. Consolidation
3. Intensification
4. Salvage
5. Maintenance

Question 10

List routes of administration

Answer 10

• Oral
• IV
• IA
• IM
• SC
• IC
• Topical
• IT
• Wafer

Question 11

What are the frequency of cycles?

Answer 11

Every 21 days

• WCC lowest 10 days post-chemo
• WCC + ANC need to recover before next cycle of chemotherapy