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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Factors affecting RT results
Host
Age
Performance status
Other diseases
Anemia
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Factors affecting RT results
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.
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