Therapeutic Options

Question 1

How can cancer be prevented or treated?

Answer 1

• Prevented: diet, screening, genetics, stop people smoking, medication
• Treatment: surgery, radiotherapy, systemic therapy

Question 2

What do the studies on diet say?

Answer 2

• inconsistent
• lots of confounding factors
• CRC probably a link with red meat consumption
• Breast cancer probably link with saturated fat intake
• physical activity decreases risk

Question 3

What screening is available?

Answer 3

• smear tests for cervical cancer
• faecal occult blood for CRC
• mammography for breast cancer
• PSA blood test fro prostate cancer
• MR/CT scanning or breath test for lung cancer

Question 4

What can be offered to families with histories of CRC and FAP?

Answer 4

• they are autosomal dominant conditions
• screen families for APC mutations
• regular colonoscopy
• offer panprotocolectomy when adenomas found

Question 5

What controversial chemo-preventions are there?

Answer 5

• primary oesophageal cancer= supplement diet with anti-oxidants
• primary breast cancer= prophylactic tamoxifen
• secondary previous H&N or lung cancers= give anti-oxidant supplements

Question 6

What are local/regional treatment options?

Answer 6

• surgery
• radiotherapy
• ablation
• isolated limb perfusion

Question 7

What are the systemic treatment options?

Answer 7

• hormonal therapy
• chemotherapy
• immunotherapy
• whole body irradiation

Question 8

How is cancer staged?

Answer 8

• where it is according to examination and use of radiology

- what kind of cancer according to pathology/cytology

Question 9

What does surgery require?

Answer 9

anatomical clearance

Question 10

What does radiotherapy require?

Answer 10

-anatomical coverage

Question 11

What are the 5 Rs of radiology?

Answer 11

• radio sensitivity
• repair
• re-population
• re-oxygenation
• re-assortment

Question 12

What role does radiotherapy play in cancer treatment?

Answer 12

• of cancers cured 40% are cured by radiotherapy
• can be combined with chemotherapy
• important role in palliation

Question 13

Why would cytotoxic drugs be used?

Answer 13

• curative
• palliative
• adjuvant
• neoadjuvant

Question 14

Describe adjuvant chemotherapy.

Answer 14

• accounts for an increasing amount of chemotherapy use
• aim is to improve survival
• follows surgery

Question 15

Describe palliative chemotherapy.

Answer 15

• accounts for about 50% of chemotherapy use
• main aim is to relieve symptoms
• may improve survival
• needs careful assessment

Question 16

Describe neoadjuvant chemotherapy.

Answer 16

• more recent use of chemotherapy
• aims to either improve survival or reduce morbidity
• precedes surgery or radiotherapy

Question 17

When does hormone therapy prove beneficial?

Answer 17

• Breast cancer= ER=ve and tamoxifen

- Prostate cancer= LHRH antagonists

Question 18

What immune therapies are there?

Answer 18

SPECIFIC
-monoclonal antibodies: (rituximab and B cell NHL: +/- radioactivity) (trastuzumab and response in HER2 +ve breast and gastric cancer)
-programmed cell death pathway PD-1 (uses immune system to attack foreign cancer cells)
-chimeric antigen receptor CAR T-cells (artificial T-cell receptors, using retroviral vectors to give an specific cell killing function directed against cancer cells)
NON-SPECIFIC