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Oncology > Treatment In Specific Malignancies > Flashcards

Treatment In Specific Malignancies Flashcards

1
Q

Breast cancer - general treatments

A 
• Surgery
- Total/partial mastectomy, breast conserving (lumpectomy, quadrantectomy), axillary surgery (LN)
• Chemo
- Anthracyclines, Paclitaxel
• Targeted therapy
- Traztuzumab
• Hormonal
- Tamoxifen, Anastrozole, Fulvestrant (ER inhibitor)
• Radiotherapy
- always after partial mastectomy.
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2
Q

Breast cancer In situ

A

• LCIS
- Observation w/eventual preventive measure (Tamoxifen, mastectomy)
• DCIS
- Local excision or total mastectomy + adjuvant RT

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3
Q

Early Breast cancer

A
  • Local excision, mastectomy or radikal mastectomy. + adjuvant RT. Adjuvant chemo.
  • in ER+ & PrR+, adjuvant Tamoxifen and Anastrozole.
  • alternative is neoadjuvant anthracyclines and anastrozole in ER+
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4
Q

Locally invasive breast cancer

A
  • Often inoperable, total mastectomy with LN dissection if possible.
  • Chemo + hormonal in inoperable.
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5
Q

Metastatic breast cancer

A
  • Tamoxifen, anastrozole, fulvestrant.
  • Chemo in high risk patients
  • Traztuzumab, Bevacizumab
  • RT, denosumab and bisphosphonates for bone metastasis
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6
Q

NSCLC

A 
• Surgery
- complete surgical excision if stage 1-3. Segmental resection, Lobectomy or Pneumonectomy.
• RT
- only in small early stage tumors if surgery is CI. CHART, comb with Chemo.
• Chemo
- platinum based.
• Targeted
- Ceftuximab or Bevacizumab
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7
Q

SCLC

A

• Surgery
- Not indicated!
• Chemoradiotherapy
- platinum based, RT and prophylactic cranial irradiation.

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8
Q

Mesothelioma pleurae

A
  • No standard treatment. Surgery, platinum Chemo, RT, Pleurodesis
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9
Q

Thymoma

A
  • Thymectomy + neoadjuvant chemoradiotherapy
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10
Q

Basal and Squamous cell carcinoma

A
  • Low risk tumors-> Electrodissection, cryosurgery, curettage.
  • High risk tumors-> Excisional surgery with neoadjuvant RT. Topical 5-FU and photodynamic therapy.
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11
Q

Mesenchymal tumors (Sarcomas)

A
  • Generally quite Chemoresistant, except in rhabdomyosarcoma, synovial sarcoma or Ewing’s sarcoma. Otherwise treatment is very similar.
  • Surgery (wide margin resection, often grows along fascia), adjuvant/neoadjuvant RT. Amputation is last case scenario.
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12
Q

Malignant melanoma

A

• Surgery
- Local excision and node excision if suspicion of metastasis.
• RT and Chemo
- Relatively resistant
• Biologicals
- IFNa, Dacarbazine, Ipilimumab (anti-CTLA4 of cytotoxic T-ly) as adjuvants.

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13
Q

Endometrial cancer

A

• Surgery
- Total abdominal hysterectomy + bilateral salpingo-oophorectomy are treatment of choice.
• CRT
- in advanced stages. Paclitaxel, Platins, Doxorubicin + external beam or brachytherapy.

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14
Q

Cervical cancer

A 
• CIS
- Local excision, conisation.
• Stage 1
- Total/Radical hysterectomy with LN dissection. Adjuvant RT
• Stage 2-3
- Chemoradiotherapy (Cisplatin)
• Palliative
- Cisplatin and RT for Local bleeding and pain
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15
Q

Ovarian cancer

A

• Surgery
- Is primary modality. Radical surgical resection, hysterectomy, bilateral salpingo-oophorectomy, omentectomy. + Adjuvant chemo (carboplatin, paclitaxel)
• Targeted therapy
- Bevacizumab

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16
Q

Prostate carcinoma

A

• Active surveillance
- in low risk patients w/low PSA and Gleason. • Radical prostatectomy
• Radical radiotherapy
• Hormone therapy
- Orchidectomy, anti-androgens (flutamide), GnRH analogues (Goserelin)
• Palliative therapy
- Hormone therapy and Paclitaxel

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17
Q

Testicular cancer

A
  • All initially need Orchidectomy.
    •Stage 1
    a) Seminomas -> surveillance or single dose Carboplatin
    b) Teratomas -> Intense surveillance w/ serum markers and CT
    • Stage 2,3,4
    a) Seminomas -> Cisplatin, Carboplatin + Etopside
    b) Teratomas -> BEP (Bleomycin, Etopside, Cisplatin
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18
Q

Bladder cancer

A

• CIS and Non-muscle-invasive bladder cancer:
- TURBT (transurethral resection of bladder tumor) + adjuvant intravesical Mitomycin. Intravesical BCG vaccine

• Muscle invasive bladder cancer:

  • Radical cystectomy + neoadjuvant/adjuvant chemotherapy.
  • Trimodal bladder sparing approach -> TURBT + chemo + RT

• Metastatic bladder cancer:
- MVAC chemo (MTX, Vinblastine, Doxorubicine, Cisplatin)

19
Q

Renal cancer

A

• Localized/locally advanced
- Active surveillance if low grade. Partial (nephron sparing) nephrectomy, Radical Nephrectomy. Emblization before surgery.

• Metastatic
- Cytoreductive nephrectomy, IFNa, IL-2 and Bevacizumab.

20
Q

Head and neck cancer

A
  • Surgery and RT (brachytherapy, CHART) as prim modalities. Cetuximab as adjuvant.
  • Chemo (Cisplatin, 5-FU) in advanced and metastatic disease
21
Q

Tumors of CNS

A

• Surgery
- Therapy of choice.
• Radiotherapy:
- curative and adjuvant settings.
- Stereotactic radiosurgery (gamma knife or linear accelerator with invasive stereotactic frame) or Stereotactic radiotherapy (linear accelerators with non invasive mask or body frame.
• Chemotherapy:
- Ex Lomustine or Carmustine. But are not curative, used in adjuvant or palliative setting.

22
Q

Gastric carcinoma

A 
• Early Stage
- Locally resected endoscopically
• Tumor in cardia
- Total gastrectomy
• Tumor in distal stomach
- Partial gastrectomy
• Metastasis to LNs
- Gastrectomy + extended LN dissection
  • Adjuvant Chemo(5-FU)/RT in high staged. Traztuzumab as neoadjuvant in HER2+
23
Q

Esophageal cancer

A 
•Stage 1
- Endoscopic mucosal resection
• Stage 2-3
- Esophagectomy, trimodal therapy.
• Stage 4
- Palliative therapy w/ RT, Chemo and stenting
  • Surgery if in lower 1/3, RT in upper 1/3.
  • Targeted therapy incl Trastuzumab and Ramucirumab (anti-VEGF)
24
Q

Colon and Rectal cancer

A

• Surgery - the only curative

  • a) Local excision (endoscopically)
  • b) Bowel resection (most common)
  • c) Colostomy or Ileostomy (temporary or terminal)
  • d) Pelvic exenteration (Palliative. Removal of rectum, reproductive organs, LN etc)
  • e) Lower anterior resection (For rectal cancer. Removal of rectum + colo-anal anastomosis).
  • f) Abdominoperineal resection (Removal of terminal part of intestine + terminal stoma. In tumors close to rectum. Mesentary + LNs also resected).
• Chemotherapy
- 5-FU, Platinum derivatives. Adjuvant in early stages, alone in Stage 4.
• Chemoradiotherapy
- Neoadjuvant in Stage 1-3
• Targeted therapy
- Bevacizumab, Cetuximab, in Stage 4
25
Q

Palliative therapy in colon and rectal cancer

A 
• Surgery
- Bypass with stoma. Partial hepatic resection if metastasis. Stenting.
• Radiotherapy
- For local pain, bleeding and mucorrhoea 
• Chemo
- 5-FU based comb therapies
• Biological therapy
- Bevacizumab, Cituximab, Imatinib
26
Q

Hepatocellular carcinoma

A

• Surgery
- Transplant > partial resection > Total resection
• Palliative
- Ligation of hepatic artery, radio frequency ablation, regional chemotherapy into hepatic artery, brachytherapy.

27
Q

Cholangiocarcinoma

A

• Surgery
- Complete surgical resection is the only curative option. In proximal tumors it’s done liver transplant or lobectomy, in distal tumors pancreaticoduodenectomy.
• Radiation therapy
- Brachytherapy via ERCP
• Chemotherapy
- Gemcitabine + Cisplatin as radiosensitizers
• Stenting and bypass in unresectable patients

28
Q

Gallbladder carcinoma

A
  • Complete cholecystectomy + portal LNs + wide margin of surrounding liver.
  • Adjuvant RT, 5-FU or gemcitabine
29
Q

Pancreatic tumors

A

• Endocrine pancreatic tumors
- Surgery is only curative option. Radical excision. Somatostatin is Palliative.

• Exocrine pancreatic tumors

  • a) Surgery: head (whipple), body (Total pancreatectomy), tail (distal pancreatectomy).
  • b) chemotherapy: neoadjuvant chemoradiotherapy with 5-FU.
  • c) Palliative therapy: FOLFOXIRI
30
Q

Bone sarcomas

A

• Osteosarcoma
- Intense chemo (MTX, Doxorubicin, Cisplatin), removal of affected bone, RT if Surgery is not possible
• Chondrosarcoma
- Surgery
• Ewing Sarcoma
- Systemic chemo, RT and Surgery
• Soft tissue sarcomas
- wide surgical resection, RT, isolated limb perfusion with Melphalan
- In metastasis, only Surgery is effective

31
Q

Thyroid cancer

A
  • Total thyroidectomy, LN resection, radioiodine I131 and external beam RT.
    • Anaplastic thyroid cancer
  • Neoadjuvant + adjuvant RT and chemo (doxorubicine, Bevacizumab)
32
Q

Adrenal adenocarcinoma

A
  • Total excision of adrenal gland is curative. Neoadjuvant chemo. If Surgery is not possible -> systemic chemo (Cisplatin, Doxorubicine, Etopside and Mitotane which decr steroid synth),
  • symptomatic treatment (antihypertensives, diuretics, potassium).
33
Q

Pheochromocytoma

A
  • Total adrenectomy after stabilization of patient
34
Q

Carcinoid tumors

A
  • Radical Surgery, debunking Surgery, Ocreotide (somatostatin analogue that decr serotonin).
35
Q

Acute lymphoblastic leukemia

A

• Chemotherapy
- a) Remission induction -> 8 weeks of Vincristine, Anthracyclines and Prednisone
- b) Consolidation -> MTX and low cranial irradiation
- c) Maintenance -> 2-3 years of MTX and 6-MP
• Allogenic BM transplant

36
Q

Acute myeloblastic leukemia

A
  • a) Remission induction -> Anthracyclines + Cytarabine. Retinoids in APL.
  • b) Consolidation -> further chemo or allogenic transplant
  • c) Maintenance -> Not very efficient in AML.

NB! Tumor lysis syndrome can occur, use hydration and rasburicase.

37
Q

Chronic myelogenous leukemia

A 
• Chronic phase
- Imatinib, allogenous (younger), autologous (older) transplant.
- Chemotherapy in unresponsive patients
- Splenic irradiation
• Acute phase
- Treated as acute leukemia
38
Q

Chronic Lymphocytic leukemia

A
  • RCHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).
  • Transplant is not used
39
Q

Hairy cell leukemia

A
  • Cladribine (purine analogue) For 7 days
40
Q

Myeloproliferative syndrome

A
  • Therapy only indicated in symptomatic patients. Autologous HSCT is the only curative therapy in high risk patients.
  • Therapy is based on low to high risk patients:
    1) Supportive care, transfusions
    2) Immunosuppression
    3) Arsenic trioxide
    4) Low dose chemo
    5) Epigenetic Therapy
    6) Allogenic HSCT, intensive chemo
41
Q

Hodgkin lymphoma

A

• Advanced disease
- Long course chemo ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine). RT if Complete Remission is not achieved.
- Tumor lysis syndrome is common.
• Localized disease
- short course chemo ABVD and RT.
• Relapse Therapy
- Autologous HSCT and/or aggressive chemo

42
Q

Non-Hodgkin lymphoma

A

• Low grade lymphoproliferations
- RT in Stage 1-2 (may be curative), RCHOP in advanced disease and Allogenic HSCT in relapse.
• High grade lymphoproliferations
- Need intense chemo to be curative. RCHOP is often golden standard

43
Q

Multiple myeloma

A
  • If indolent, wait and see. Solitary lesions treated with RT.
  • Chemo VAD (Vincristine, Adriamycin, Dexamethasone)
  • Supportive treatment (blood transfusions, antibiotics, hydration & bisphosphonates For hypercalcemia, dialysis if renal failure, bisphosphonates and fixation for pathological fractures, analgesics).

Oncology (12 decks)

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