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principles of disease > therapeutic options in cancer > Flashcards

therapeutic options in cancer Flashcards

1
Q

therapeutic options can be …

A

preventative or treatments

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2
Q

prevention

A 
environment/behaviour
diet
screening
genetics
medication/vaccination
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3
Q

treatment

A

surgery
radiotherapy
systemic therapy
immunotherapy

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4
Q

diet

A

inconsistent evidence and lots of confounding factors
CRC: probably linked with red meat consumption
breast cancer: probably a link with saturated fat intake
physical activity decreases risk
also a benefit for reducing CVD

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5
Q

environment

A

○ Smoking in public places
○ Minimal alcohol pricing
○ Water and air quality: electric cars, renewable energy
○ Vaccination: HPV/Hep B
○ Opportunities via school: physical activity, school meals
○ Income and housing policies

For medical profession: importance of public health specialists and GPs

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6
Q

screening

A

high quality research evidence available

Age of screening varies with cancers

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7
Q

cervical cancer screening

A

regular smear tests (should become rarer due to introduction of HPV vaccine in young girls(13y/o))

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8
Q

CRC cancer screening

A

faecal occult blood the most commonly used test

16% reduction in CRC mortality

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9
Q

breast cancer screening

A

mammography

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10
Q

problems with screening

A

sometimes gives false reassurance to patients, investigations also come with risk which needs to be considered

Population that take part in screening tend to be healthier and wealthier (i.e. people who don’t turn up tend to be more at risk and this can lead to health inequalities)

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11
Q

genetics

A
  • More targeted than screening
  • High quality research evidence available
    ○ CRC and FAP (familial adenomatous polyposis coli)

○ Breast cancer and BRCA1/2:

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12
Q

CRC and FAP (familial adenomatous polyposis coli)

A

§ autosomal dominant
§ screen families for APC mutations
§ regular colonoscopy
§ offer panprotocolectomy when adenomas found - remove colon and rectum to prevent cancer as one of the polyps is almost guaranteed to become cancerous

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13
Q

breast cancer and BRCA1/2

A

§ These genes increase risk of breast cancer

§ also important in therapeutic area

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14
Q

Chemo-prevention

A
  • More controversial - give people medication to prevent them getting cancer
    limited effectiveness
  • Primary: oesophageal cancer
  • Primary: breast cancer
  • Secondary: previous H&N or lung cancers
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15
Q

chemo - prevention: oesophageal cancer

A

○ High rates in parts of China and Iran
○ Thought to be related to diet (particularly in Iran)
○ Supplement diet with anti-oxidants - didn’t make a lot of difference

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16
Q

chemo-prevention: breast cancer

A

○ Known at risk women

○ Prophylactic tamoxifen - tamoxifen has side effects which need to be considered

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17
Q

chemo-prevention: previous H&N or lung cancers

A

○ Give anti-oxidant supplements

○ No benefit

18
Q

treatment can be …

A

local, regional or systemic

19
Q

local or regional treatment

A

○ Surgery
○ Radiotherapy
○ Ablation (freezing, radio-frequency etc)
Isolated limb perfusion

20
Q

systemic treatment

A 
○ Hormonal therapy 
○ Chemotherapy 
○ Biological therapy 
○ Immunotherapy 
○ CAR T-cell therapy 
Whole body irradiation (BMT)
21
Q

define cancer staging

A

Staging is a way of describing the size of a cancer and how far it has grown

22
Q

cancer staging process

A
  • Where is cancer
    • Examination
  • Uses of radiology/imaging
    ○ CT, MRI, USS, PET etc
  • What kind of cancer
  • Pathology/cytology
    ○ Classification, risk factors etc
    ○ Genomics now plays a role and will increase
    ○ Immune/stomal environment will also have a role - this can effect the variety of treatment options that are possible
23
Q

surgery needs anatomical …

A

clearance

must go round the ‘holy plane’ to reduce chances of recurrence

24
Q

radiotherapy needs anatomical …

A

coverage

25
Q

radiotherapy benefits (over surgery)

A
  • Can treat inoperable lesions
    • Can make surgery become possible - or can avoid the option of surgery completely
      Can maintain function and appearance
26
Q

5 R’s of radiotherapy

A

radiosensitivity
repair and repopulation
re-oxygenation
reassortment

27
Q

radiosensitivity

A

some tumours are more sensitive than others meaning certain treatment options can be excluded (i.e. avoiding treating something with something that may not even work)

28
Q

repair and repopulation

A

e.g. H&N cancer, treat 3x per day, no breaks can improve survival

29
Q

re-oxygenation

A

if cells are low in oxygen they are much more resistant to treatment

30
Q

reassortment

A

at different stages of the cell cycle, cells are more sensitive to different agents

31
Q

systemic treatment

A

Beneficial for widespread disease, can result in widespread toxicity, now mixture of chemotherapy and now targeted agents

32
Q

Targeted agents in systemic treatment

A

potential to be very specific
Tamoxifen and ER +ve breast cancer
EGFR mutations and TKI agents

33
Q

Indications for the use of systemic therapies

A
  • Curative
  • Adjuvant - where someone has had a successful operation but they have a statistical risk of recurrence
  • Neoadjuvant - common with rectal cancer, give someone the treatment upfront with the view of getting them to surgery
  • Palliative - improve and maintain QOL
34
Q

chemotherapy and therapeutic index

A

trials find dose regimen to balance anti-cancer activity versus toxicity

35
Q

targeted therapies

A
  • Specific based on molecular science
    • Imatinib: blocks a tyrosine kinase, very useful in CML and GISTS
    • EGFR inhibitors - EGFR mutation in lung cancer, don’t give chemotherapy w/ EGFR mutation as it has little effect, more beneficial to give targeted therapy
      In lung cancer need to have a specific mutation
36
Q

immune therapies are either

A

specific or non-specific

37
Q

non-specific immune therapies

A

○ Innate: macrophages, NK cells

Programmed cell death pathway (PD1): uses immune system to attack foreign cancer cells (cancer cells hide from the immune system), agents strip away mask from cancer cells so they are identified as FOREIGN

38
Q

specific immune therapies

A

○ Monoclonal antibodies: rituximab and B cell NHL: +/- radioactivity; trastuzumab and response in HER2 +ve breast and gastric cancer
§ Also used in non-cancerous conditions e.g. AI, arthritis

Chimeric antigen receptor (CAR) T cells: artificial T cell receptors, using retroviral vectors to give a specific cell killing function directed against cancer cells

39
Q

mechanisms of checkpoint blockade

A
  • PD1 and PDL1 antagonists
  • Now in clinical use (melanoma and lung cancer)
  • Success depends on:
    ○ Mutation burden of cancer
    ○ Immunogenicity of neoantigens

Most people have minimal side effects

40
Q

monoclonal antibodies

A
  • Not confined to cancer - can be used in the treatment of other conditions
    • Humanised so they can be used in the human body - generally very well tolerated and allergic reactions are rare
    • Cancer:
      ○ CRC and cetuximab
      ○ Breast and trastuzumab
      NHL and rituximab
41
Q

chimeric antigen receptor T cell therapy

A
  • Used at the moment in haematological cancers

Opportunity to be used in other cancers - need to find stable cancer antigen as it is very specific

principles of disease (40 decks)

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