Therapeutic Options

Question 1

What two approaches are there to therapeutic options?

Answer 1

Preventative and Treatment measure

Question 2

What four main aspects of preventative options are there?

Answer 2

Diet, screening, genetics and medication

Question 3

What are the current three parts of advice concerning diet?

Answer 3

• Eat five or more pieces of fruit a day
• Avoid obesity
• Take regular exercise

Question 4

Describe three examples of high quality research evidence in screening programmes

Answer 4

Cervical cancer - smear tests

Colo-rectal cancer (CRC) - Faecal occult blood tests

Breast cancer - mammography

Question 5

What percentage decrease in mortality has been seen as a result of faecal occult blood testing for CRC?

Answer 5

16%

Question 6

What are two more controversial screening methods concerning prostate and lung cancer?

Answer 6

Prostate - Prostate-specific antigen (PSA) blood test

Lung - MR/CT scanning and breath test

Question 7

Describe genetic links/predispositions for CRC and breast cancer respectively

Answer 7

CRC is associated with familial adenomatous polyposis coli (FAP)

Breast cancer is associated with BRCA1 and BRCA2 genes

Question 8

Outline a chemo-preventative measure for primary breast cancer

Answer 8

Prophylactic tamoxifen

Question 9

Outline a chemo-preventative measure for primary oesophageal cancer

Answer 9

Diet supplemented with anti-oxidants

Question 10

Outline a chemo-preventative measure for development of secondary cancers having previously developed H&N/lunch cancers

Answer 10

Dietary anti-oxidant supplementation

Question 11

Treatment is divided into two categories - what are they?

Answer 11

Local/Regional treatment and Systemic treatment

Question 12

What proportion of cancers are cured by surgical intervention?

Answer 12

50%

Question 13

Outline the five R’s of radiobiology

Answer 13

Radiosensitivity 
Repair
Re-population 
Re-oxygenation 
Re-assortment

Question 14

What proportion of cancers are cured by radiotherapy?

Answer 14

40%

Question 15

Radiotherapy causes some nasty side effects and this effects palliation - explain this

Answer 15

Palliation is related to alleviating symptoms without curing the pathology - radiotherapy causes sickness, pain, bleeding etc.

Question 16

What proportion of cancers are cured by chemotherapy?

Answer 16

3%

Question 17

Systemic treatment is beneficial to what type of cancer?

Answer 17

Widespread/late-stage (metastasised)

Question 18

What are the four indications for the the use of cytotoxic drugs?

Answer 18

Curative, Adjuvant, Neoadjuvant and Palliative

Question 19

Outline the function of adjuvant and neoadjuvant drugs

Answer 19

Improve survival/reduce morbidity

Question 20

What are the benefits of hormone therapy?

Answer 20

Its a specific response

Question 21

Outline a chemo-preventative hormone therapy in ER+ breast cancer

Answer 21

Tamoxifen

Question 22

What hormone therapy is useful in the fight against prostate cancer?

Answer 22

Luteinizing-hormone releasing hormone (LHRH) antagonists

Question 23

What are the benefits of immunotherapy?

Answer 23

Can be a highly specific response

Question 24

What three immunological approaches are there to cancer treatment?

Answer 24

Monoclonal antibodies, Programmed cell death pathway and chimeric antigen receptors T-cell activation

Question 25

What is trastuzumab?

Answer 25

Naked Monoclonal antibody used to stimulate an immune response against cancerous cells

Question 26

Describe how cancer cells are able to hide from our immune system and how this can be interrupted in cancer treatment

Answer 26

T-cells express PD-1 antigens to probe other cells and recognise them as self; cancer cells express the PDL-1 antigen to give the all clear - interruption of either of these proteins may result in an immune response against cancerous cells

Question 27

Describe the action of Chimeric Antigen Receptor T-cell (CAR)

Answer 27

Artificial T-cell receptors, using retroviral vectors to give a specific cell killing function - these can then be used to mount an immune response to cancerous cells

Question 28

What two aspects determine cancer staging?

Answer 28

Where the cancer is and what type it is

Question 29

How can we determine were the location of a tumour?

Answer 29

Examination and use of radiology/imaging