Introduction to Cancer Medicine

Question 1

What have the improvements in cancer medicine?

Answer 1

Prevention
- Smoking cessation
- Sun smart
Screening
Diagnosis
Treatment
Holistic approach

Question 2

What is the uptake of mammography screening?

Answer 2

40-50%

Question 3

What is the uptake of faecal occult blood screening?

Answer 3

1 in 3

Question 4

What are the hallmarks of cancer?

Answer 4

Evading apoptosis
Self-sufficiency in growth signals
Insensitivity to anti-growth signals
Tissue invasion and metastasis
Limitless replicative potential
Sustained angiogenesis

Question 5

What does the doctor need to do when a woman presents with a breast lump?

Answer 5

Take full history
- Family history of cancer
- History of lump
Perform full examination
Assess breast mass itself
Imaging
- Ultrasound
- Mammography
Referral to breast surgeon

Question 6

How can a breast lump be orientated?

Answer 6

Like clock face

Distance from nipple

Question 7

How do you describe a breast lump?

Answer 7

Orientation
Fixed/mobile
Texture
Skin changes
Pain
Nipple retraction

Question 8

What does nipple retraction suggest?

Answer 8

Advanced mass

Question 9

What are the available local therapies?

Answer 9

Surgery

Radiotherapy

Question 10

What are the available systemic therapies?

Answer 10

Chemotherapy
Hormone therapy
Immunotherapy
Molecular therapy

Question 11

How does molecular therapy work?

Answer 11

Only acts if there’s a target

Question 12

What is the role of clinical trials in cancer care?

Answer 12

Important aspect

Only 5-10% of patients get onto clinical trials

Question 13

What sort of therapy does a local problem require?

Answer 13

Local

Question 14

What sort of therapy does a systemic problem require?

Answer 14

Systemic

Question 15

What is sentinel node biopsy?

Answer 15

Inject blue dye/radioactive material into tumour bed
Visualise movement of injected fluid
First lymph node to pick up fluid = sentinel node

Question 16

What is Her-2?

Answer 16

Growth factor receptor

Question 17

Why is a breast tumour assessed for the presence of Her-2?

Answer 17

In 20-25% of patients, Her-2 amplified > more aggressive cancer
Target therapy available: herceptin binds to EC domain of Her-2

Question 18

In which stages of the tumour is it not necessary to do a full body CT scan?

Answer 18

Stage 1-2

Question 19

What does it mean if a cancer is locally advanced?

Answer 19

Big in terms of tumour size, or involvement of regional lymph nodes

Question 20

What is adjuvant therapy?

Answer 20

Therapy that aims to improve chance of cure to prevent chance of relapse

Question 21

What is neo-adjuvant therapy?

Answer 21

Given before surgery to decrease size of tumour

Question 22

In which cancers is adjuvant treatment common?

Answer 22

Breast
Colon
Lung
Sarcoma

Question 23

What sorts of risks does adjuvant therapy decrease?

Answer 23

Risk of local recurrence
Risk of systemic recurrence
Improves overall survival

Question 24

Is adjuvant therapy finite or ongoing?

Answer 24

Finite - 3-6 months

Question 25

Why is some toxicity tolerated in adjuvant therapy?

Answer 25

Because looking at long-term cure | Level of toxicity tolerated higher than that for palliative therapy

Question 26

Where does breast cancer commonly metastasise to?

Answer 26

Bone Liver Brain

Question 27

How does treatment intent change when a cancer goes from being curable to incurable?

Answer 27

Treatment now palliative | Emphasis on quality of life

Question 28

Why is breast cancer relapse often treated, provided the patient is well?

Answer 28

Because quite chemosensitive

Question 29

What is the ECOG scale of performance status?

Answer 29

Describes patient's level of functioning in terms of their ability to - Care for themselves - Daily activity - Physical ability

Question 30

What are some examples of metastatic cancers that can be cured?

Answer 30

Stage 4 lymphoma Metastatic bowel cancer - to liver only Germ cell cancer with lung metastasis Sarcoma with lung metastasis

Question 31

What are some examples of local cancers that can't be cured?

Answer 31

Glioblastoma Stage 3 primary lung cancer Stage 3c cervical cancer Peritoneal cancer

Question 32

Why is it important to discuss treatment goals with patients?

Answer 32

So they have realistic expectations

Question 33

What are some guiding principles in cancer medicine?

Answer 33

``` Biopsy critical Refer to appropriate clinicians Define disease extent What is intention of treatment? Performance status more important than age Multi-disciplinary care ```

Question 34

Is palliative care synonymous with terminal care?

Answer 34

No

Question 35

Name the molecular target and the cancer in which it used for the following drug: glivec/imatinib?

Answer 35

Bcr-Abl in chronic myeloid leukaemia | C-kit in gastrointestinal stromal tumours

Question 36

Name the molecular target and the cancer in which it used for the following drug: iressa/gefitinib?

Answer 36

Anti-EGFR in lung cancer

Question 37

Name the molecular target and the cancer in which it used for the following drug: bevacizumab?

Answer 37

VEGFR in colon cancer

Question 38

Name the molecular target and the cancer in which it used for the following drug: sunitinib?

Answer 38

VEGFR in renal cancer

Question 39

Name the molecular target and the cancer in which it used for the following drug: herceptin/trastuzumab?

Answer 39

Her-2 in breast cancer

Question 40

Name the molecular target and the cancer in which it used for the following drug: mabthera/rituximab?

Answer 40

Anti-CD20 in lymphoma

Question 41

Name the molecular target and the cancer in which it used for the following drug: vemurafenib?

Answer 41

B-Raf in melanoma

Question 42

Name the molecular target and the cancer in which it used for the following drug: crizotinib?

Answer 42

ALK in lung cancer