Therapeutic options in cancer

Question 1

Is diet a good therapeutic option?

Answer 1

colorectal cancer: probably a link with red meat consumption

breast cancer : probably a link with saturated fat intake

physical activity decreases risk

Question 2

Is screening a good therapeutic option?

Answer 2

high quality research evidence available
Cervical cancer: regular smear tests
CRC : faecal occult blood the most commonly used test
16% reduction in CRC mortality
breast cancer : mammography

• more controversial
  prostate cancer : PSA blood test
  lung cancer : MR / CT scanning
  breath test

Question 3

Genetics?

Answer 3

CRC & familial adenomatous polyposis coli (FAP)
- autosomal dominant
- screen families for APC mutations
- regular colonoscopy
- offer panprotocolectomy when adenomas found

breast cancer & BRCA1 & BRCA2
- also important in therapeutic area

Question 4

chemo prevention?

Answer 4

more controversial

primary: oesophageal cancer
- high rates in parts of China
- supplement diet with anti-oxidants

primary: breast cancer
- known at risk women
- prophylactic tamoxifen

secondary: previous H&N or lung cancers
- give anti-oxidant supplements
- no benefit

Question 5

Give examples of local or regional treatments?

Answer 5

surgery
radiotherapy
ablation (freezing, radiofrequency, etc)
isolated limb perfusion

Question 6

Give examples of systemic treatments?

Answer 6

-hormonal therapy
- chemotherapy
- biological therapy
- immunotherapy
- CAR T-cell therapy
- whole body irradiation (for BMT)

Question 7

How do we find where cancer is?

Answer 7

examination
- use of radiology / imaging
- CT , MRI, USS, PET etc

Question 8

How do we know what kind of cancer?

Answer 8

pathology / cytology
- classification, risk factors etc
- genomics now plays a role & will increase
- immune / stromal environment will also have a role

Question 9

Give characteristics of radiotherapy?

Answer 9

needs anatomical coverage
can treat inoperable lesions
can make surgery become possible
can maintain function and / or appearance
can be combined with chemotherapy
important role in palliation

Question 10

What are the 5 R’s of radiobiology?

Answer 10

• radiosensitivity
• repair
• re-population
• re- oxygenation
• re-assortment

Question 11

What is reassortment?

Answer 11

at any one time, a proportion of cancer cells are going to be in G1, S phase, G2 etc…
go from sensitive to insensitive phase

Question 12

What stages are cells most sensitive?

Answer 12

G-2 and M

Question 13

What stage are cells least sensitive to doses of radiation?

Answer 13

late S phase

Question 14

Give characteristics of systemic treatment?

Answer 14

beneficial for widespread disease
- can result in widespread toxicity
-now mixture of chemotherapy and now targeted agents
-targeted agents have potential to be very specific

Question 15

Describe what non specific immune therapy means?

Answer 15

not targeting any particular receptors or it can be targeting receptors but response of body is more general

Question 16

Describe specific immune therapy?

Answer 16

monoclonal antibodies
CAR t cells

Question 17

When you cut yourself , what initially deals with pathogens?

Answer 17

innate system- macrophages, neutrophils and natural killer cells

Question 18

What does blocking of PD-1 do?

Answer 18

allows t cell killing of tumour cell

Question 19

Describe (CAR) T-cell therapy?

Answer 19

take the patient’s own t cells and then in vitro fuse them with synthetic t cell receptors that you’ve created. Which are targeting something unique on surface of cancer.
Reinject and the t cell see the abnormalities and they’re stimulated to not only attack cancer but to grow more of those cells.