Management of Cancer: Points for the Undergraduate

7/29/2019 Management of Cancer: Points for the Undergraduate

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PRINCIPLES OF ONCOLOGY

An outline

Dr. V N Bhattathiri MD PhDProfessor of Radiology

Academy of Medical Sciences

Pariyaram Medical College POKannur-670503

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Pathologic Classificationof diseases

Congenital

Traumatic Inflammatory

Specific

Non-specific

Degenerative

Neoplastic



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Cancer

Neoplastic condition

Abnormal proliferation of cells Arise from a single clone

Ability to invade and metastasize

Self origin: from bodys own cells

Exception:



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Aim of treatment

Curative

Cure: Disease free life expectancy equalto normal population

Usually intense

Symptom control

Usually less intense



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Factors affecting decision Tumour

Site & Histology

Solid Hematogenous

Extent Localised

Metastatic

Host Performance status

Age, organ function



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Treatment Modalities

Surgery

Radiotherapy Chemotherapy

Biological therapy

Hyperthermia



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Surgery

Solid tumours

Principle: Remove macroscopic as well asmicroscopic (ie potentially involved)

tumour

Limited by site and extent of tumour

Repair at time of surgery

Curative; Emergency



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Surgery

Main curative role in

Adenocarcinomas

Breast; Stomach, Colorectal, Ovarian, Uterus

Salivary gland, Thyroid

Squamous cell carcinomas

Head and neck; Uterine cervix; Skin, Lung

Oesophagus

Sarcomas

CNS Tumours



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Radiotherapy

Use of ionising radiation

Produce ions/free radicals which damage

DNA/kinetic structures

Leads to death by apoptosis/mitotic

catastrophe



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Radiotherapy Radiation

Electromagnetic: X-rays or-rays

Only differ in source

Particulate: Electrons, Neutrons, Alpharays, etc

Source

Machines: Linear accelerators, cyclotrons

Radioactive isotopes: Cobalt, Iridium, Cesium, etc.



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Factors affecting RT results

Tumour

Site: Critical organs: Eye, Spinal cord

Growth rate: Potential doubling time

Size: number of cells; growth rate; blood

supply

Histology: intrinsic radiosensitivity



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Host

Age

Performance status

Other diseases

Anemia



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Treatment factors

Fraction size

Interruptions

Dose

Radiation used

Planning



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Radiotherapy

Delivered by

Teletherapy

Brachytherapy

Internal therapy



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Radiotherapy

Teletherapy

Source kept at a distance from body

Irradiates all tissues between skin and tumour

Use multiple fields



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Radiotherapy

Brachytherapy

Radioactive Source kept close to or inside body

Intracavitary, intraluminal, interstitial, etc

High tumour dose, low normal tissue dose



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Radiotherapy Internal therapy

Injected or ingested unsealed radionuclides

Radioiodine : Thyroid; Strontium: Bone mets



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Radiotherapy Curative

Head and neck cancers

Uterine cervix

Lymphomas

Adjuvant

To surgery: Breast, brain, sarcomas, etc

Symptomatic

Bone mets, lung,



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Chemotherapy

DNA damagers:

Alkylating agents, Bleomycin

Antimetabolites:

Methotrexate, 5FU, 6MPMitotic spindle inhibitors:

Vinca alkaloids, Taxanes,

Topoisomerase inhibitors:

Etoposide, Adriamycin, Actinomycin-D

Tyrosine kinase inhibitor: Imatinib



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Biological therapy Interferons

Antiproliferative, Differentiating; Alter cell

surface antigens; Immunostimulation

Interleukins

Immune stimulator, induce cytokines (TNF,lymphotoxin, etc.)



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Biological therapy Hormonal agents

Estrogens, Antioestrogens, Progesterones,

Antiandrogens, Hormone replacement

Differentiating agents

ATRA & Arsenic trioxide-APL;13cisRetinoicacid-Mycosis fungoides



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Biological therapyMonoclonal antibodies

Anti-CD20 (Rituximab): Low grade NHL

Anti-HER2/neu (Trastuzumab): Breast

Angiogenesis inhibitors

Thalidomide-Myeloma



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Gene therapy Suicide gene

HSV-TK, cytosine deaminase

Brain trs, mesothelioma

Use retro and adenoviruses

Tr suppressor gene

P53, BRCA1, retinoblastoma, p16

Lung, colon, ovarian

Use retro and adenoviruses



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Hyperthermia Temperatures of 42-450 C

Perfusion: local, body cavities

Microwave

Radiofrequency

With chemotherapy, radiotherapy,

immunotherapy



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Other techniques Photodynamic therapy

Laser surgery

Cryosurgery



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Combined modalities Needed in most of the cancers

Increase cure

Decrease morbidity



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Team management Cancer best managed as a team

Before any treatment is offered

Consisting of Surgeon, Radiotherapist,

Medical Oncologist, Rehabilitation

specialist, etc.

Management of Cancer: Points for the Undergraduate

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