Strategies for Cancer Treatment Flashcards
3 possible goals of cancer treatment?
- Cure
- Cure and prevent
- Palliate (relieve pain/symptoms)
Local cancer treatment options?
- Surgery
- Radiation
ex. of cancers that can be cured with local treatment?
Sarcomas
Non-melanoma skin cancer
In situ carcinomas
Local cancer treatment options?
- Surgery
- Radiation
Systemic treatment options?
Chemotherapy - cytotoxic, hormone, biologic
Adjuvant Therapy
Surgery -> Chemo and/or Radiation
With Adjuvant Therapy, what provides cytoreduction?
Surgery
Neoadjuvant Therapy
Chemo and/or Radiation -> Surgery -> Chemo and/or Radiation
With Neoadjuvant Therapy, surgery is not ______ uprfront
NOT as effective upfront
With Neoadjuvant Therapy, what provides cytoreduction?
Initial chemo and/or radiation
What will shrinking the tumor prior to surgery do with Neoadjuvant Therapy?
Makes the surgery more effective and safe
What are 3 reasons that surgery/local treatment would be contraindicated?
- Metastatic disease
- Leukemia/Lymphoma
- Systemic therapy is so effective that surgery is unnecessary
3 types of Radiation Therapy?
External Beam Radiation
Brachytherapy
Systemic Radionucleotides
Linear accelerator delivering direct radiation beams to affected sites
External Beam Radiation Therapy
Very localized high dose therapy delivered continuously for a prolonged time through an implanted device
Brachytherapy
When is Brachytherapy usually used?
Prostate cancer
Describe how Systemic Radionucleotides can treat Thyroid cancer
- Ingestion of radioactive Iodine
- Iodine absorbed into blood stream and into thyroid cells
- Radiation kills cancerous and normal thyroid cells
When should you use radiation therapy?
- When surgery is contraindicated
- To palliate masses that are compressing structures
2 main types of Systemic Treatment?
Conventional Cytotoxic Chemotherapy
Targeted agents - hormonal/biologic
Why is Conventional cytotoxic chemotherapy harmful?
It does NOT discriminate between healthy and malignant cells
Describe CAR-T Therapy
- T cells are manipulated ex vivo to express a binding domain for a tumor antigen
- This includes transmembrane and intracellular domains
= Intensifies immune attack against tumor cells
What is an indication for a Stem Cell Transplantation?
When the therapy involves ablation of bone marrow
Allogeneic, Syngeneic and Autologous stem cell transplant types
Allogeneic = someone else Syngeneic = identical twin Autologous = from self
4 screening options for ovarian cancer?
- Physical exam
- CA-125
- Transvaginal ultrasound (TVUS)
- Multimodal (CA-124 + TVUS)
Are the screening options for ovarian cancer effective?
NOOOOO
CA-125 is not specific for?
Malignant ovarian tumors
Why is a transvaginal ultrasound not great for detecting ovarian cancer?
Observer dependent
This screening option showed no improvement in mortality from ovarian cancer and had many false (+)s that lead to unneeded interventions
Multimodal (CA-125 + TVUS)
High risk patients for ovarian cancer can?
Remove distal fallopian tubes
What exam is such low sensitivity and specificity that it is losing relevance for prostate cancer?
Digital Rectal Exam
What is the main screening option for prostate cancer?
Prostate Specific Antigen (PSA)
PSA has a ______
High false (+) rate
Between what ages may PSA benefit a small number of patients and past what age does it show NO benefits?
55-69 = may benefit a small # of patients
> 70 = NO benefits
What 2 things have decreased the incidence of cervical cancer?
Screenings and HPV vaccination
Between what ages are pap smears suggested?
21-65
_____ are excellent at detecting pre-malignant and malignant cells
Pap smears
Recommendations for PAP or PAP + HPV testing if results are good
PAP - every 3 years
PAP + HPV - every 5 years
Only thing to look for with Endometrial cancer?
Women at menopause with vaginal bleeding
Women at menopause with vaginal bleeding could indicate?
Endometrial cancer
What is the Gold standard for detecting breast cancer?
Mammography
Mammography guidelines change with each organization, however there is a push to wait until when to have a mammogram unless you’re high risk?
6th decade of life
In resource rich settings, clinical and self breast exams are not recommended, however if you do them what should you do?
Do them every month
- Look for skin changes
- Check axilla
Options for those that are BRCA-1/2 Positive?
Double mastectomy
Chemoprevention hormone medications
Increased screening
To do BRCA-1/2 genetic testing, what types of things must be in your family history?
- Multiple, young relatives affected with breast/ovarian cancer
- Possibly a male affected
- Personal diagnosis before age 45
Annual stool sample tests for colon cancer?
- Guaiac-based fecal occult blood test
- 3 stool samples; not as sensitive - Fecal immunochemical test
- single stool sample
What is the most sensitive stool sample test for colon cancer?
Fecal DNA test
- higher false (+) though
How often can you perform Fecal DNA tests?
Every 1-3 years
CT colonography is performed how often?
Every 5 years
What does a CT colonography require?
Bowel prep but NO sedation
How often can you perform Colonoscopys?
Every 10 years
What does a Colonoscopy require?
Bowel prep and sedation - most invasive
What is a good thing about performing a colonoscopy?
You can perform a biopsy during the procedure if necessary
What is the best prevention for lung cancer?
Smoking cessation
What test can you order for lung cancer screening and how often?
Low-dose CT annually
Who should get a low-dose CT annually for lung cancer screening?
- Those between the ages of 50-80 with:
- 20 year pack history
- Actively smoke
- Have quit in the last 15 years
