Strategies Of Cancer Treatment And Prevention - Dr. Pence

Question 1

Radiofrequency therapy

Answer 1

Small microwaves to target a cancer usually in liver lesions

Question 2

Future of chemotherapy involves

Answer 2

Biological approach targeting a specific cell receptor and cell

Question 3

Adjuvant therapy is what

Answer 3

1. Cytoreduction : remove tumor

2. Then do radiation and chemo therapy

Question 4

Neoadjunctive therapy

Answer 4

Usually for large tumors, like lung cancer
1. Chemo and radiation to reduce size
2. Surgically remove more of the tumor
3, chemo and radiation again / hormone systemic therapy

Question 5

External Beam radiation

Answer 5

Linear accelerator delivering direct radiation beams to the affected site on the body

Question 6

IMRT

Answer 6

Intensity Modulated Radiation Therapy : get CT image of brain and then you get a very localized picture of what to hit with radiation
Cyberknife is similar to this

Question 7

Brachytherapy

Answer 7

Very localized high dose continuously to site
= implant radiation devices into the tissue (usually into prostate) which continually kills off the tumor cells
= so you don’t have to surgically remove anything

Question 8

Systemic radiation

Answer 8

Systemic radionucleotides are injected of I 131 (iodine) which the thyroid takes in readily and this Iodine is radioactive and kills the cells in the thyroid 
Pretty effective (pt should be isolated as well as all their utensils and bodily fluids)

Question 9

Palliative care to pt with massive tumor

Answer 9

Give radiation to shrink the mass for example lung, throat, ENT, spinal cord compression, pelvic sidewall pain

Question 10

Conventional cytotoxic chemotherapy

Answer 10

You basically kill all cells

Question 11

Biological chemotherapy

Answer 11

Uses target agents :
H or tumor mediated (targeting the tumor cells themselves), immuno-regulatory mediated (trigger immune system to attack the tumor), AB-conjugate (give cytotoxic drug that has the Ab to attach to a specific cell type)

Question 12

Theraputic window

Answer 12

TI = TD50 / ED50
Toxic dose over effective dose
SAFEST DRUG = high toxic dose and low effective does = longer theraputic window

Question 13

TI of cytotoxic therapy and how to work with this

Answer 13

Low TI
Hit them with just enough and then let the normal cells recover (cancer cells take longer to recover) and then hit them again until cancer cells are no longer there

Question 14

How to list the TX regime of a patient receiving cytotoxic chemotherapy

Answer 14

R-CHOP
R : Rituximab 
C : Cyclophosphamide 
H : Hydroxydaunorubicin
O : Oncovin (vincristine)
P : Prednisone

Question 15

Side effect of Rituximab (BOARDS)

Answer 15

Cytopenia , hypersensitivity

Question 16

Side effect for Cyclophosphamide

Answer 16

Alopacia + HEMORRHAGIC CYSTITIS

Question 17

Side effect of Hydroxydaunorubicin BOARDS

Answer 17

Cardiotoxicity ** NEED TO CHECK ECHO CARDIOGRAM BEFORE DURNG AND AFTER

Question 18

Side effects oncovin

Answer 18

Alopecia, neuro toxic, weakness

Question 19

Prednisone side effects

Answer 19

Increased appetite, insomnia, anxiety , HTN, hyperglycemia

Question 20

Cycle of giving chemotherapy (R-CHOP)

Answer 20

21 days (5 days of chemo + 16 days of recovery) for 6 cycles 
****cytopenia usually happens day 8 or 9 , neutropenic fever

Question 21

Immune checkpoint inhibitors

Answer 21

PD-1 and CTLA on tumor cells (inhibits T-cells from killing tumor cells) , so you add inhibitor of this marker and then it cant signal anything to t-cells and get killed

Question 22

CAR-T therapy

Answer 22

1. Take T-cells and expose them to retrovirus
2. T-cells make CARs or receptors on surface that signal to kill the tumor cells
   80% get Cytokine storm (only approved for ALL at this time) (TX cytokine storm with IL-6 inhibitor Tusalibsomab)

Question 23

Allogenic stem cell transplant

Answer 23

From another person (G vs H can happen)

BM transplant is important for patients who are undergoing chemotherapy

Question 24

Synergetic

Answer 24

Transplant from identical twin

Question 25

Autologous

Answer 25

From yourself (risk of cancer coming back)

Question 26

how I need to stay up to date on therapies no recommendations

Answer 26

USPSTF (US preventative service task force)* | ACS (American cancer society)

Question 27

Which grades do I use a specific therapy to a patient

Answer 27

Grade A : high benefits over risks Grade B : recommended still, moderate benefic over risks Grade C : based on patient and need to be discussed the risks and benefits We dont do any grade D or I

Question 28

Ovarian Cancer general facts about this

Answer 28

5th leading cause of women death (14,000 per year) | 95% over age 45yo (20% not at early stage) - not good screening

Question 29

Screening for over ovarian cancer | How good are they

Answer 29

1. Physical exam (not good) 2. CA-125 : not good since not all cancer cells emit this 3. Transvaginal US (TVUS) : not good and very hard to see early 4. Multimodal (CA-125, TVUS) : NOT GOOD (10% false +)

Question 30

Who should have more screening and heightened awareness of pelvic pain as a sign of ovarian cancer

Answer 30

Pt with BRCA or Lynch syndrome (high risk, Family history)

Question 31

Prostate cancer general facts

Answer 31

25% of men get this 80yo median time of death from this (2.5% chance) Most men die from something else

Question 32

Screening for prostate cancer and how good is it

Answer 32

1. PSA (Prostate Specific Ag) : HIGH FALSE+ 60% not good, can show + if inflammation or benign processes 2. DRE (Digital rectal exam) : 50% sensitivity only so not good

Question 33

PSA is what grade

Answer 33

GradeC : need to talk to pt and if over 55yo-69yo and for high risk and good reasons only GradeD : if pt is over 70yo

Question 34

Cervical Cancer facts

Answer 34

Has decreased a lot due to screening

Question 35

Cervical cancer screening

Answer 35

1. Pap smear 2. HPV Testing 3. Co-Testing (PAP and HPV)

Question 36

Pap smear should be done when and how

Answer 36

At age 21yo start and every 3 years Stop at age 65yo (grade D) If you have the HPV test + over 30yo (every 5 years) GRADE A

Question 37

Tx if Pap smear shows cervical cancer

Answer 37

Local excision | Cryoblation (before any spread)

Question 38

Endometrial cancer screening is what

Answer 38

Council post-menopausal women that bleeding of any kind is not normal report any vaginal bleeding

Question 39

Breast cancer facts

Answer 39

2nd cause of cancer death behind lung cancer

Question 40

Breast Cancer screening and how good are they

Answer 40

Self breast exam Clinical breast exam Mammography : gold standard ALL ARE GOOD however the first 2 are lower grade

Question 41

Mammogram should be done when and grade

Answer 41

50yo-74yo To eliminate false + GRADE B

Question 42

Self breast exam

Answer 42

``` Check axilla Look for skin changes Avoid during or right before period Start at early age 1 time a month Top and bottom, semi-circle, circular motions of pads of fingers ```

Question 43

BRCA-1 and BRCA-2 genetic testing guidelines

Answer 43

If there is family history of this you should screen for this

Question 44

BRCA + TX brief overview

Answer 44

Prophylactic surgery (remove breasts) Bilateral salpingo-oophorectomy E lowering chemotherapy

Question 45

Colon Cancer facts

Answer 45

3rd eading cause of death most common in 65yo-74yo | 10% before 50yo

Question 46

Colon cancer screening and how good are they

Answer 46

1. Guaiac-based fecal blood test 2. Fecal immunochemical test 3. Fecal DNA 4. CT Colonography 5. Colonoscopy : GOLD STANDARD

Question 47

Colonoscopy

Answer 47

Age 50yo-75yo GRADE A 45yo-49yo GRADE B

Question 48

Lung cancer

Answer 48

200,00 people a year get this 150,000 deaths per year Prevent this form smoking

Question 49

Lung cancer screening

Answer 49

Low-Dose CT scan annually - for people who actively smoke + 20 pack-year smoking - for people who smoked and quit less then 15yo ago GRADE B