Introduction to Cancer Medicine Flashcards
What have the improvements in cancer medicine?
Prevention - Smoking cessation - Sun smart Screening Diagnosis Treatment Holistic approach
What is the uptake of mammography screening?
40-50%
What is the uptake of faecal occult blood screening?
1 in 3
What are the hallmarks of cancer?
Evading apoptosis Self-sufficiency in growth signals Insensitivity to anti-growth signals Tissue invasion and metastasis Limitless replicative potential Sustained angiogenesis
What does the doctor need to do when a woman presents with a breast lump?
Take full history - Family history of cancer - History of lump Perform full examination Assess breast mass itself Imaging - Ultrasound - Mammography Referral to breast surgeon
How can a breast lump be orientated?
Like clock face
Distance from nipple
How do you describe a breast lump?
Orientation Fixed/mobile Texture Skin changes Pain Nipple retraction
What does nipple retraction suggest?
Advanced mass
What are the available local therapies?
Surgery
Radiotherapy
What are the available systemic therapies?
Chemotherapy
Hormone therapy
Immunotherapy
Molecular therapy
How does molecular therapy work?
Only acts if there’s a target
What is the role of clinical trials in cancer care?
Important aspect
Only 5-10% of patients get onto clinical trials
What sort of therapy does a local problem require?
Local
What sort of therapy does a systemic problem require?
Systemic
What is sentinel node biopsy?
Inject blue dye/radioactive material into tumour bed
Visualise movement of injected fluid
First lymph node to pick up fluid = sentinel node
What is Her-2?
Growth factor receptor
Why is a breast tumour assessed for the presence of Her-2?
In 20-25% of patients, Her-2 amplified > more aggressive cancer
Target therapy available: herceptin binds to EC domain of Her-2
In which stages of the tumour is it not necessary to do a full body CT scan?
Stage 1-2
What does it mean if a cancer is locally advanced?
Big in terms of tumour size, or involvement of regional lymph nodes
What is adjuvant therapy?
Therapy that aims to improve chance of cure to prevent chance of relapse
What is neo-adjuvant therapy?
Given before surgery to decrease size of tumour
In which cancers is adjuvant treatment common?
Breast
Colon
Lung
Sarcoma
What sorts of risks does adjuvant therapy decrease?
Risk of local recurrence
Risk of systemic recurrence
Improves overall survival
Is adjuvant therapy finite or ongoing?
Finite - 3-6 months
Why is some toxicity tolerated in adjuvant therapy?
Because looking at long-term cure
Level of toxicity tolerated higher than that for palliative therapy
Where does breast cancer commonly metastasise to?
Bone
Liver
Brain
How does treatment intent change when a cancer goes from being curable to incurable?
Treatment now palliative
Emphasis on quality of life
Why is breast cancer relapse often treated, provided the patient is well?
Because quite chemosensitive
What is the ECOG scale of performance status?
Describes patient’s level of functioning in terms of their ability to
- Care for themselves
- Daily activity
- Physical ability
What are some examples of metastatic cancers that can be cured?
Stage 4 lymphoma
Metastatic bowel cancer - to liver only
Germ cell cancer with lung metastasis
Sarcoma with lung metastasis
What are some examples of local cancers that can’t be cured?
Glioblastoma
Stage 3 primary lung cancer
Stage 3c cervical cancer
Peritoneal cancer
Why is it important to discuss treatment goals with patients?
So they have realistic expectations
What are some guiding principles in cancer medicine?
Biopsy critical Refer to appropriate clinicians Define disease extent What is intention of treatment? Performance status more important than age Multi-disciplinary care
Is palliative care synonymous with terminal care?
No
Name the molecular target and the cancer in which it used for the following drug: glivec/imatinib?
Bcr-Abl in chronic myeloid leukaemia
C-kit in gastrointestinal stromal tumours
Name the molecular target and the cancer in which it used for the following drug: iressa/gefitinib?
Anti-EGFR in lung cancer
Name the molecular target and the cancer in which it used for the following drug: bevacizumab?
VEGFR in colon cancer
Name the molecular target and the cancer in which it used for the following drug: sunitinib?
VEGFR in renal cancer
Name the molecular target and the cancer in which it used for the following drug: herceptin/trastuzumab?
Her-2 in breast cancer
Name the molecular target and the cancer in which it used for the following drug: mabthera/rituximab?
Anti-CD20 in lymphoma
Name the molecular target and the cancer in which it used for the following drug: vemurafenib?
B-Raf in melanoma
Name the molecular target and the cancer in which it used for the following drug: crizotinib?
ALK in lung cancer
