Cancer treatment.

Dr.Huda abd-alkarim.Dr.Huda abd-alkarim.Assistant prof.& consultant oncologist.Assistant prof.& consultant oncologist.

Objective of the lecture:

Identify the different modality of cancer Identify the different modality of cancer therapy.therapy.

Modalities of treatment:

1-local therapy:1-local therapy: -surgery.-surgery. -radiation therapy.-radiation therapy.

2-systemic treatment:2-systemic treatment: chemotherapy.chemotherapy. Hormonal therapy.Hormonal therapy. Monoclonal antibodies.Monoclonal antibodies. Radioactive material.Radioactive material.

3-supportive care.3-supportive care. 4-non-conventional therapy.4-non-conventional therapy.

Surgery:

Surgery was the first modality used Surgery was the first modality used successfully in the treatment of cancer.successfully in the treatment of cancer.

It is the only curative therapy for many It is the only curative therapy for many common solid tumors.common solid tumors.

The most important determinant of a The most important determinant of a successful surgical therapy are the absence successful surgical therapy are the absence of distant metastases and no local of distant metastases and no local infiltration.infiltration.

Cont:

Microscopic invasion of surrounding normal Microscopic invasion of surrounding normal tissue will necessitate multiple frozen section.tissue will necessitate multiple frozen section.

Resection or sampling of regional lymph node is Resection or sampling of regional lymph node is usually indicated.usually indicated.

Surgery may be used for palliation in patients for Surgery may be used for palliation in patients for whom cure is not possible.whom cure is not possible.

Has significant role in cancer prevention.Has significant role in cancer prevention. E.g familial polyposis coli.E.g familial polyposis coli.

Surgery for prevention:

Patients with conditions that predispose Patients with conditions that predispose them to certain cancers or with genetic traitsthem to certain cancers or with genetic traitsAssociated with cancer can have normal life Associated with cancer can have normal life span with prophylactic surgery. span with prophylactic surgery.

-colectomy .-colectomy .-oophorectomy.-oophorectomy.-thyroidectomy.-thyroidectomy.-removal of premalignant skin lesion .-removal of premalignant skin lesion .

Radiation therapy:

Radiation therapy:

Radiation therapy: is a local modality used in the Radiation therapy: is a local modality used in the treatment of cancer .treatment of cancer .

Success depend in the difference in the radio Success depend in the difference in the radio sensitivity between the tumor and normal tissue.sensitivity between the tumor and normal tissue.

It involves the administration of ionizing radiation It involves the administration of ionizing radiation in the form of x-ray or gamma rays to the tumor in the form of x-ray or gamma rays to the tumor site.site.

Method of delivery: External beam(teletherapy).Method of delivery: External beam(teletherapy).Internal beam therapy(Brachytherapy). Internal beam therapy(Brachytherapy).

Cont:

Radiation therapy is planned and performed Radiation therapy is planned and performed by a team of nurses, dosimetrists,physician by a team of nurses, dosimetrists,physician and radiation oncologist.and radiation oncologist.

A course of radiation therapy is preceded by A course of radiation therapy is preceded by a simulation session in which low-energy a simulation session in which low-energy beam are used to produce radiograghic beam are used to produce radiograghic images that indicate the exact beam images that indicate the exact beam location. location.

Cont:

Radiation therapy is usually delivered in Radiation therapy is usually delivered in fractionated doses such as 180 to 300 cGy per fractionated doses such as 180 to 300 cGy per day,five times a week for a total course of 5-8 day,five times a week for a total course of 5-8 weeks. weeks.

Radiation therapy with curative intent is the main Radiation therapy with curative intent is the main treatment in limited stage Hodgkin’s disease,some treatment in limited stage Hodgkin’s disease,some NHL,limited stage ca prostate,gynecologic NHL,limited stage ca prostate,gynecologic tumors&CNS tumor .tumors&CNS tumor .

Also can use in palliative &emergency setting.Also can use in palliative &emergency setting.

Complication of radiation:

There is two types of toxicity ,acute and long term There is two types of toxicity ,acute and long term toxicity.toxicity.

Systemic symptoms such as Fatigue,local skin Systemic symptoms such as Fatigue,local skin reaction,GI toxicity,oropharyngeal reaction,GI toxicity,oropharyngeal mucositis&xerostomia.myelosuppression.mucositis&xerostomia.myelosuppression.

Long-term sequelae:may occur many months or years Long-term sequelae:may occur many months or years after radiation therapy.after radiation therapy.

Radiation therapy is known to be Radiation therapy is known to be mutagenic,carcinogenic,and teratogen,and having mutagenic,carcinogenic,and teratogen,and having increased risk of developing both secondary leukemia increased risk of developing both secondary leukemia and solid tumor.and solid tumor.

Nuclear medicine

Radionuclides:

For decades have been used systemically to treat For decades have been used systemically to treat malignant disorders.malignant disorders.

They are administer by specialists in nuclear They are administer by specialists in nuclear medicine or radiation oncologist.medicine or radiation oncologist.

Radioactive iodine:in the from of Radioactive iodine:in the from of 131131I is effective I is effective therapy for well differentiated thyroid ca therapy for well differentiated thyroid ca

Strontium-89. Is used for the treatment of body Strontium-89. Is used for the treatment of body metastasis.it is an alkaline earth element in the metastasis.it is an alkaline earth element in the same family as calcium same family as calcium

Chemotherapy:

Chemotherapy:

Systemic chemotherapy is the main Systemic chemotherapy is the main treatment available for disseminated treatment available for disseminated malignant diseases.malignant diseases.

Progress in chemotherapy resulted in cure Progress in chemotherapy resulted in cure for several tumors.for several tumors.

Chemotherapy usually require multiple Chemotherapy usually require multiple cycles.cycles.

Classification of cytotoxic drug:

Cytotoxic agent can be roughly categorized Cytotoxic agent can be roughly categorized based on their activity in relation to the cell based on their activity in relation to the cell cycle.cycle.

phase nonspecific. phase specific

cyto toxic drug

Cont :

What is the difference between phase specific & What is the difference between phase specific & phase non specific?…..phase non specific?…..

Phase non-specific: Phase non-specific: The drugs generally have a linear dose-The drugs generally have a linear dose-

response curve(response curve( the drug administration ,the the drug administration ,the the fraction of cell killed).the fraction of cell killed).

Phase specific:Phase specific: Above a certain dosage level,further increase in Above a certain dosage level,further increase in

drug doesn’t result in more cell killing.but you drug doesn’t result in more cell killing.but you can play with duration of infusion. can play with duration of infusion.

What are the chemotherapeutic agent?…..

Chemotherapeutic agents:

Alkylating agents:Alkylating agents: Antimetabolites:Antimetabolites: Antitumor antibiotic:Antitumor antibiotic: Plant alkaloids:Plant alkaloids: Other agentsOther agents Hormonal agent:Hormonal agent: Immunotherapy: Immunotherapy:

Complication of Chemotherapy:

Every chemotherapeutic will have some Every chemotherapeutic will have some deleterious side effect on normal tissue .deleterious side effect on normal tissue .

E.G; Myelosuppression,nausea&vomiting,E.G; Myelosuppression,nausea&vomiting,

Stomatitis,and alopecia are the most Stomatitis,and alopecia are the most frequently observed side effects.frequently observed side effects.

Criteria used to describe response are: Complete response (complete remission)is the (complete remission)is the

disappearance of all detectable malignant disease.disappearance of all detectable malignant disease. Partial response:is decrease by more than 50% in the :is decrease by more than 50% in the

sum of the products of the perpendicular diameters of sum of the products of the perpendicular diameters of all measurable lesions.all measurable lesions.

Stable disease:no increase in size of any lesion nor the :no increase in size of any lesion nor the appearance of any new lesions.appearance of any new lesions.

Progressive disease:means an increase by at least 25% :means an increase by at least 25% in the sum of the products of the perpendicular in the sum of the products of the perpendicular diameters of measurable lesion or the appearance of diameters of measurable lesion or the appearance of new lesions.new lesions.

Endocrine therapy:

Endocrine therapy:

Many hormonal antitumor agents are functional agonist or Many hormonal antitumor agents are functional agonist or antagonist of the steroid hormone family.antagonist of the steroid hormone family.

Adrenocorticoids:Adrenocorticoids: Antiandrogen:Antiandrogen: Estrogen:Estrogen: Antiestrogen:Antiestrogen: ProgestinsProgestins Aromatase inhibitor:Aromatase inhibitor: Gonadotropin-releasing hormone agonists:Gonadotropin-releasing hormone agonists: Somatostatin analogues: Somatostatin analogues:

Adrenocorticosteroid:

Are frequently used in combination regimen for Are frequently used in combination regimen for the treatment of lymphocytic leukemia and the treatment of lymphocytic leukemia and lymphoma.lymphoma.

They function by binding to glucocorticoid-They function by binding to glucocorticoid-specific receptors present in lymphoid cells and specific receptors present in lymphoid cells and initiate programmed cell deathinitiate programmed cell death

They most commonly used agent are They most commonly used agent are prednisone,methylprednisone,dexamethosone. prednisone,methylprednisone,dexamethosone.

Antiandrogens:

Flutamide :Flutamide :

Effectively blocks the binding of androgen to Effectively blocks the binding of androgen to its receptor in the periphral tissue .its receptor in the periphral tissue .

It is used in the treatment of disseminated It is used in the treatment of disseminated prostate caprostate ca

Biological therapy:

Biologic therapy:

Immunotherapy:Immunotherapy: CytokinesCytokines Cellular therapy.Cellular therapy. Tumor vaccine:Tumor vaccine:

Hematopoietic growth factors. Hematopoietic growth factors.