Cancer management 1

What are the 5 standard treatment options

• surgery

  • removing prostate and surrounding tissue

• radiation

  • high energy rays to kill. cancer

• hormone therapy

  • reduce testosterone to control cancer growth

• chemotherapy

  • target cancer cells throughout body

• immunotherapy

  • boosts immune system to fight cancer

When is surveillance typically chosen

• indolent cancers

  • unlikely to spread or cause harm

• asymptomatic presentation

  • no symptoms and cancer found incidentally

• localised, early-stage disease

  • cancer is small and strictly confined to its organ or area of origin

• avoiding severe side effects

  • when standard treatments carry substantial risks of long term complications

• patient health and age

  • physical toll of treatment may pose a greater danger than the cancer

What is prophylaxis / elective

• removing pre-cancerous colon polyps

• prophylactic total colectomy & ileoanal pouch in familial polyposis coli patients

• prophylactic gastrectomy – E-cadherin mutation

• prophylactic Thyroidectomy- familial medullary carcinoma

• prophylactic bilateral mastectomy/hysterectomy for individuals
  carrying a high-risk mutation like BRCA1 or BRCA2

What is diagnosis and staging

• biopsy

  • surgical removal of tissue sample for pathological analysis to confirm malignancy, cancer type and grade

• surgical staging

  • exploring abdominal cavity

  • nodal excision → clinical staging or performing a sentinel lymph node biopsy to evaluate stage

What are the 4 stages of cervical cancer

• stage 1

  • cancer only in neck of womb → surgery or chemotherapy & radiotherapy

• stage 2

  • cancer gone further and beyond cervix → surgery or chemotherapy & radiotherapy

• stage 3

  • cancer advances into pelvic area and vaginal canal → chemoradiotherapy

• stage 4

  • cancer spread to bladder and recturm → surgery, radiotherapy, chemotherapy and cancer drugs

What is loop electrosurgical excision (LEEP)

• thin wire loop with electric current to remove the transformation zone of the cervix

  • cuts the tissue and seals the wound at the same time

What is primary curative treatment

• resection

  • remove entire primary tumour along with healthy surrounding tissue to ensure no microscopic cancer cells are left behind

• debulking (cytoreductive surgery)

  • tumour cannot be remove because its attached to or enveloping vital organs, blood vessels or nerves

  • reducing tumour burden for adjuvant therapy

  • immediate symptom relief

What are the 6 approaches to brain surgery

• craniopharyngioma

• endoscopic brain surgery

• stereotactic biopsy

• awake craniotomy

• laser interstitial thermal therapy

• stereotactic surgery

What are the benefits of a mastectomy and lumpectomy + EBRT

What is transoral robotic surgery

• allows removal of oropharyngeal & laryngeal cancers through the mouth

• minimally invasive & without affecting the external muscles

• computer assisted

  • robotic surgery directed by the surgeon

What is acute emergency & pallitation

• surgery is utilised to improve a patients remaining quality of life

• relieves pain, reduces internal bleeding, learning dangerous blockages in vital pathways

What is reconstruction and restoration

• following extensive invasive resections

  • function

  • structural integrity

  • cosmetic appearance

What is a implant based reconstruction

• inserting saline or silicone pouches under chest skin or muscle to recreate a breast mound after a mastectomy

What is a DIEP flap (Deep Inferior Epigastric Perforator)

• transferring skin and fat from the lower abdomen to the chest using microsurgery while leaving abdominal muscle intact

What is an LD flap (Latissimus dorsi)

• moving muscle, fat and skin from the upper back to the chest, often combined with an implant

What is lip-modelling (fat transfer)

• injecting purified fat taken from areas like the thighs or tummy into partial defects or lumpectomy it’s to smooth contours

What are the 4 steps of breast reconstruction

• breast tissue and nipple removed

• tissue expander placed and gradually filled with sterile water

• expander is exchanged for a permanent breast implant in a second surgery

• breast heals with a scar

What is systemic anti-cancer therapy

• encompasses different types of drug treatments that travel through the blood stream to treat cancer throughout body

• hormone therapy

  • Block or reduce the hormones that certain cancers need to grow

• chemotherapy

  • kill cancer cells

• targeted therapy

  • drugs designed to find and attack specific cancer cells

• immunotherapy

  • helps immune system to fight cancer

What is hormone therapy

• blocks or reduces hormones that cancers need to grow

• subtractive hormone therapy

  • surgical removal

  • radiation inhibition, isotope injection

• additive hormone therapy

  • tamoxifen → breast cancer

  • zoladex → prostate cancer

What is prostate cancer

• prostate is a gland that make semen

• androgens are required for prostate function and growth

• androgen receptors stimulate the expression of specific genes that cause prostate cell growth

• prostate cancers are androgen dependent because they decrease androgen levels and block androgen activity to inhibit growth

• can become castration resistant → continue to grow when androgen levels are low / undetectable

What is LHRH agonist ( leutenizing hormone releasing hormone agonist)

• prevent LH secretion

• synthetic proteins bind to the LHRH receptor in pituitary gland

• zolodex

What are androgen synthesis inhibitiors

• prevent adrenal glands from making androgens

• lowers testosterone levels to a greater extent than any other known treatment

• blocks testosterone production by inhibiting CYP17

  • allows body to produce testosterone from cholesterol

• flutamide

How does hormonal therapy treat breast cancer

• blocks the receptors

• reduces growth

• metastases of tumour

• reduce risk of new primary breast cancer

What is subtractive hormone therapy

• removal of ovaries

  • no oestrogen production

• some oestrogen still made in body fat using an enzyme

  • aromatase

How is hormonal therapy (tamoxifen) given

• tamoxifen

  • oral tablet

  • 5 years

• given after surgery

• can be started during EBRT

• can be given for recurrence

How is hormonal therapy (Herceptin) given

• controls the growth of cancer cells that have one or high number of HER2

• IV drip or subcutaneous injection

What are the side effects of breast cancer treatment

• hot flushes

• vaginal dryness

• meopause

• weight gain

• loss of interest in sex

• nausea

• mood changes

• fatigue

What are the side effects of prostate cancer treatment

• hot flushes

• loss of libido

  • interest in or ability to have sex

• weakened bones

• diarrhoea

• nausea

• enlarged and tender breasts

  • gynecomastia