treatment of cancer

Question 1

what is the approach to cancer treatment?

Answer 1

stratified medicine - this is phenotype or molecular characteristics consideration - occurs within a MDT

Question 2

what is the process of stratifying patients based on phenotype and molecular characteristics?

Answer 2

first there is patient selection - ensuring they are eligible
then there is molecular selection - looking at response to chemo
then there is a trial period to see the primary outcomes and compared to group from randomisation

Question 3

what are main signs and symptoms of cancer?

Answer 3

lethargy, weight loss, back and abdo pain, social, family and past medical history, shortness of breath, change in bowel habits, contraception pill, pale, tender, low Hb and albumin and high Alk phosphate and calcium, hypodense lesions on the liver

Question 4

what shows a cancer is invasive?

Answer 4

if it has pushed through layers

Question 5

what is the result of infiltration??

Answer 5

worse prognosis, especially if into the muscularis propria layer in CRC

Question 6

what are the investigations in cancer suscpicion?

Answer 6

CXR, USS, colonoscopy, biopsy, pathology, DNA extraction and FISH, microscopic examination, genetic testing

Question 7

what will happen if there is a positive result for cancer?

Answer 7

referral to oncology

Question 8

what does pathology look at?

Answer 8

infiltration, gland formation, immunohistochemistry for factors such as TTF1 and mismatch repair proteins

Question 9

what is the final destination for a terminally ill patient?

Answer 9

palliative care

Question 10

what is the prevalence of microsatellite instability in CRC?

Answer 10

15%

Question 11

what are the microsatellite cases of CRC comprised of?

Answer 11

12% are somatic events - epigenetic silencing of MLH1 for example
3% are due to germline mutations in one of the MMR genes

Question 12

what is the result of MI in CRC?

Answer 12

better prognosis but less benefit from chemotherapy

Question 13

what is the result of Lynch syndrome?

Answer 13

there is a high risk of recurrent neoplasia - 40% at 30y/o

this can occur in multiple sites

Question 14

what is the resulting Lynch syndrome treatment?

Answer 14

may need to alter standard surgical treatment which would usually be a local resection - total protocolectomy or hysterectomy

Question 15

what further investigations need to be done for Lynch syndrome?

Answer 15

offer testing to the family

screening for further lesions such as in the colon through colonscopy