Treatment of Cancer - Modalities & Purpose (TG) Flashcards
STATS
People diagnosed with cancer in 2013
Lifetime risk in 2010
350,000
4 in 10
What is a key societal reason for the increased lifetime risk / incidence?
Patients are not dying from other organic / chronic diseases
How can the risk of cancer in general, be reduced?
Improved diagnosis that is quicker and more accurate, quicker referral and treatment
What are the 3 most common cancers?
Prostate / Bowel
Lung
Bowel
NHS Cancer Guidelines and Timelines
All patients with suspected cancer should be referred to specialist from the GP within 2 weeks of referral.
Cancer patients should wait no more than 31 days from the decision to treat to the start of their first treatment.
All patients should be seen within 62 days of their urgent GP referral (including from screening programmes)
How is cancer diagnosed?
Non-invasive or invasive (BIOPSY)
- minor or major procedure
- least invasive procedure should be used
Cytology
- body fluids; plueral, sputum etc
- tissure scrapings or superficial smear
- fine needle aspiration (easy to miss cancerous cells)
Incision or excision (totally removed) biopsy
- liquid biopsies (new development, DNA excretion or leaching into blood) so a blood sample can be used and may also help to pick up resistant mutations too.
How is staging of a cancer determined?
After diagnosis
Define the local and distant extent of the disease
Optima treatment determination from staging
Provides a baseline to measure a response to treatment
Provides prognostic information
TNM Staging - what does TNM stand for?
Tumour Node / Metastases
First used in the 1940s
A formalised a universally applied scheme
T= primary tumour
N= regional lymph nodes
M= distant mestases
Each of these categories is assigned a number based on the extent of the disease.
What is the staging range and interpretation of TNM staging?
Will be written as T 3 N0 M0 (M is either 0 or 1 based on metastases
Stage 0 - carcinoma in stiu
Stage I-III Higher numbers indicate a more extensive disease (beyond organ)
Stage IV The cancer has spread to distant tissues or organs
What is the GRADE of a cancer?
Microscopic assessment of the degree of differentiation which the cells show. Either well differentiated (grade 1) or poorly differentiated (grade 3). Well differentiated tumours are low
Anaplastic - no differentiation, aggressive and very hard to treat
What factors affect treatment chosen?
Performance status ; the WHO performance scale measures a patients general health performance
0 all normal activity no restriction
1 mobile and light work
2 mobile and self caring
3 only limited to self care and confined to a bed or chair for >50% of waking hours
4 completely disabled and confined to bed or chair
TNM Stage and Grade
Prognosis
Tumour genetics (EGFR mutation for example)
Co-morbities (hepatic or renal problems)
NICE guidelines (NICE approval may be needed if new and not on the NHS already)
Patient choice
What kind of treatment is surgery ?
Invasive Tx
Patient is only treated when the cancer progresses
Surgery may be the only intervention in some early tumours or may be carried out in palliative care to make a patient more comfortable or survive for longer.
It can be very complex with major reconstruction of bone and soft tissue needed.
With radiotherapy pre or post operative
What is the role of radiotherapy in treatment?
pre or post operative, or palliative care
not suitable for all tumours
several Tx falls under the radiotherapy category
- external beam RT
- brachytherapy
- radioisotope therapy
Dose and course varies between tumour type and treatment intent
What are the steps in external beam RT? +s and -s
Complicated to plan
- MRI to plan tarfet and a planning CT scan
Software used to calculate the dose and beam positioning
Patient remains still
Can be treated as an outpatient
What is Brachytherapy?
Radioactive sources placed either in or close to the tumour
- mould treatment
- intra-cavitary tx (cervical cancer tx - radioisotope removed and replaced)
- interstitial tx (needles / pellets)