Straregies for Cancer Tx and Prevention

Question 1

What is adjuvant therapy?

Answer 1

Therapy that requires multiple modalities such as surgery removing a tumor and then following that with chemo or radiation

Question 2

What is neoadjuvant therapy?

Answer 2

Applied to large masses. Radiation is used to shrink a tumor down before surgery to reduce risk and then after surgery adjuvant therapy is used. It is commonly used for patients with lung cancer

Question 3

External bean radiation?

Answer 3

Linear accelerator delivering direct radiation to the affected site

Question 4

IMRT?

Answer 4

CT scan that reconstructs a 3D image of the mass allowing you to target it directly without as much collateral damage

Question 5

Cyberknife?

Answer 5

Stereotactic technique to get the image of a brain malignancy where they map out vectors of radiation therapy to make sure they all converge on the point of interest in order to spare as much of the brain as possible. Neurosurgical

Question 6

Brachytherapy?

Answer 6

Localized high dose therapy delivered continuously for prolonged time via implanted devices. Commonly used for prostate cancer, where a needle implants “seeds” into the gland and it continuously releases chemo.

Question 7

Systemic radionucleotides?

Answer 7

Common for those with thyroid cancer. They ingest radioactive iodine which gets to the thyroid and kills the cancerous (and some healthy) thyroid cells. The downside is these patients are radioactive and have to be isolated for 3-4 days. Their bodily fluids need to be properly disposed of as they are also radioactive

Question 8

what is conventional chemotherapy?

Answer 8

Cytotoxic chemo that doesn’t discriminate against healthy and cancer cells. Very low TI, which increases side effects so give in cycles to allow patient to recover

Question 9

What does it mean for a treatment to be a biologic?

Answer 9

It is a targeted therapy towards a specific receptor or antigen, this therapy decreases the toxic side effects

Question 10

What is Rituximab used for?

Answer 10

CD20 B cell lymphomas

Question 11

Why is a pelvic exam NOT an effective screening for ovarian cancer?

Answer 11

You can’t detect masses until they are large, which usually indicates a later stage

Question 12

What is CA-125? Is it an effective screening tool?

Answer 12

Tumor marker for ovarian cancer, however it is not a good tool to use for screening. By the time it shows up positive it is usually beyond cure.

Question 13

What is TVUS? Is it an effective screening tool?

Answer 13

Transvaginal ultrasound, it does not improve mortality for ovarian cancer

Question 14

What screening tests were previously used for prostate cancer and why are they falling out of favor?

Answer 14

• PSA: it has a high false positive rate especially after a DRE or with other inflammatory conditions
  
  • After undergoing biopsy 2/3 of the men who had a + PSA did NOT have prostate cancer
• DRE: low swnsitivity and specificity

Question 15

What does the screening for Cervical cancer entail?

Answer 15

• HPV vaccine and testing which decreased the incidence of cervical cancer by ~70%
• Pap smear: great for detecting pre malignant cells and malignant cells
  
  • start at 21 repeat every 3 yrs stop at 65

Question 16

What is the only “screening” for endometrial cancer?

Answer 16

• Counseling women at menopause about reporting vaginal bleeding

Question 17

What is the gold standard for breast cancer screening?

Answer 17

Mammogram

Question 18

When does screening for colon cancer begin?

Answer 18

• 50-75 is considered a Grade A
• 45-49 is Grade B

Question 19

What are the 5 colon cancer screening tests?

Answer 19

• High sensitivity guaiac based fecal occult blood: this requires dietary restriction, 3 samples, not as sensitive as other stool tests, done annually
• Fecal immunochemical test: single stool sample done annually
• Fecal DNA: Most sensitive stool based test requires entire bowel movement, has a high false postitive rate, repeat 1-3 yrs
• CT Colonography: requires bowel prep, can find extracolonic pathology and does not require sedation, every 5 yrs
• Colonoscopy: Most invasive, requires sedation and bowel prep, can perform biopsies during procedure, done every 10 yrs
  
  • If any of the others are positive you do this next

Question 20

What is the screening for lung cancer?

Answer 20

• Low dose CT scan annually ages 50-80