This document discusses cancer and cancer chemotherapy. It begins by defining cancer and describing how cancers can progress from benign to metastatic. It then discusses various risk factors for cancer like genetics, lifestyle, environment, and viruses. The document outlines the cell cycle and how chemotherapy works to target rapidly dividing cancer cells. It categorizes and describes common chemotherapeutic agents like alkylating agents, antimetabolites, plant-derived products, and monoclonal antibodies. In particular, it focuses on how alkylating agents like cyclophosphamide and nitrosoureas function to cross-link and damage DNA.
Cancer biology and its clinical relevance ver 2.0Vivek Verma
Cancer is characterized by uncontrolled cell growth and spread. It is caused by both external and internal factors that lead to genetic mutations in cells. These mutations affect cancer genes like oncogenes and tumor suppressor genes, altering cell cycle regulation and enabling malignant characteristics. There are several treatment modalities for cancer including surgery, radiation, chemotherapy, targeted therapy, hormone therapy, and immunotherapy. Chemotherapy drugs work by damaging rapidly dividing cells, and can be classified based on their mechanism and cell cycle specificity. Targeted therapies interfere with specific molecular pathways involved in cancer growth. Immunotherapy aims to stimulate the immune system to attack cancer cells.
This document provides an overview of cancer and the responsibilities of nurses in cancer care. It defines cancer, describes the pathophysiology and characteristics of malignant cells and tumors. It also outlines the nurse's role in supporting patients, assessing needs, planning and implementing care, and collaborating with a multidisciplinary team. Prevention, screening, diagnostic tests, treatment options including radiation therapy are also summarized.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
Cancer Survivorship Challenges and OpportunitiesGaynorOncology
This document discusses cancer survivorship challenges and opportunities. It provides statistics on cancer survivors such as over 60% being over age 65 and the most common cancer sites being breast, prostate, and colorectal. It then discusses trends in improved 5-year survival rates for many cancer sites from 1975-2003. The document outlines goals for cancer survivors including monitoring biomarkers, maintaining wellness through lifestyle factors like nutrition and exercise, and becoming active participants in their care. Biomarkers discussed include fasting insulin levels, IGF-1, and drug metabolism biomarkers. The roles of lifestyle factors like meditation, yoga, exercise, music, spirituality, and nutrition including soy and vitamin D are also summarized.
This document discusses tumor dormancy and mechanisms by which cancer cells can evade immune detection and elimination. It describes how some cancer cells enter a dormant state after disseminating from primary tumors and residing long-term in bone marrow niches without proliferating. These dormant disseminated tumor cells can later reactivate and form metastases. The document also outlines a mouse model using E0771 breast cancer cells expressing a model antigen (ovalbumin) to study interactions between dormant tumor cells in bone marrow and antigen-specific T cells, with the goal of developing non-toxic therapies to eliminate dormant tumor cells or prevent their outgrowth into metastases.
Cancer is caused by rapid growth of abnormal cells that grow beyond their usual boundaries and can invade other parts of the body. Cancer is characterized by mutated genes called oncogenes that cause uncontrolled cell growth. Tumors can be benign if they remain confined or malignant if they invade other tissues and metastasize to spread to other organs through the bloodstream and lymph nodes. Cancer treatment may include surgery, radiation therapy to damage DNA, and chemotherapy to impair cell division using cytotoxic drugs. Pharmacogenomics aims to tailor treatments based on individual genetic profiles to increase drug effectiveness and reduce side effects.
The document discusses principles of cancer management and treatment options. It outlines current standard treatments like surgery, radiotherapy, and chemotherapy. It also discusses newer treatments and the process of clinical trials, from phase 1 safety trials to phase 3 trials that compare new treatments to standard therapies. An example is given of problems that can occur in phase 3 trials if factors like surgical debulking are not properly controlled for. Complementary treatments are discussed, along with examples of treatments that originated from plant and animal extracts.
This document discusses strategic planning for cancer prevention. It provides information on various dietary and environmental factors that can increase cancer risk such as high glycemic diets, oxidative overload, inflammation, and exposure to toxins like PBDEs and BPA. It summarizes several studies that show relationships between certain foods/supplements and reduced cancer rates, such as broccoli consumption being associated with lower prostate cancer risk and green tea supplementation correlating with fewer prostate cancer cases. The document advocates for lifestyle changes like plant-based diets, exercise, and detoxification to potentially prevent or slow cancer progression.
Cancer biology and its clinical relevance ver 2.0Vivek Verma
Cancer is characterized by uncontrolled cell growth and spread. It is caused by both external and internal factors that lead to genetic mutations in cells. These mutations affect cancer genes like oncogenes and tumor suppressor genes, altering cell cycle regulation and enabling malignant characteristics. There are several treatment modalities for cancer including surgery, radiation, chemotherapy, targeted therapy, hormone therapy, and immunotherapy. Chemotherapy drugs work by damaging rapidly dividing cells, and can be classified based on their mechanism and cell cycle specificity. Targeted therapies interfere with specific molecular pathways involved in cancer growth. Immunotherapy aims to stimulate the immune system to attack cancer cells.
This document provides an overview of cancer and the responsibilities of nurses in cancer care. It defines cancer, describes the pathophysiology and characteristics of malignant cells and tumors. It also outlines the nurse's role in supporting patients, assessing needs, planning and implementing care, and collaborating with a multidisciplinary team. Prevention, screening, diagnostic tests, treatment options including radiation therapy are also summarized.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
Cancer Survivorship Challenges and OpportunitiesGaynorOncology
This document discusses cancer survivorship challenges and opportunities. It provides statistics on cancer survivors such as over 60% being over age 65 and the most common cancer sites being breast, prostate, and colorectal. It then discusses trends in improved 5-year survival rates for many cancer sites from 1975-2003. The document outlines goals for cancer survivors including monitoring biomarkers, maintaining wellness through lifestyle factors like nutrition and exercise, and becoming active participants in their care. Biomarkers discussed include fasting insulin levels, IGF-1, and drug metabolism biomarkers. The roles of lifestyle factors like meditation, yoga, exercise, music, spirituality, and nutrition including soy and vitamin D are also summarized.
This document discusses tumor dormancy and mechanisms by which cancer cells can evade immune detection and elimination. It describes how some cancer cells enter a dormant state after disseminating from primary tumors and residing long-term in bone marrow niches without proliferating. These dormant disseminated tumor cells can later reactivate and form metastases. The document also outlines a mouse model using E0771 breast cancer cells expressing a model antigen (ovalbumin) to study interactions between dormant tumor cells in bone marrow and antigen-specific T cells, with the goal of developing non-toxic therapies to eliminate dormant tumor cells or prevent their outgrowth into metastases.
Cancer is caused by rapid growth of abnormal cells that grow beyond their usual boundaries and can invade other parts of the body. Cancer is characterized by mutated genes called oncogenes that cause uncontrolled cell growth. Tumors can be benign if they remain confined or malignant if they invade other tissues and metastasize to spread to other organs through the bloodstream and lymph nodes. Cancer treatment may include surgery, radiation therapy to damage DNA, and chemotherapy to impair cell division using cytotoxic drugs. Pharmacogenomics aims to tailor treatments based on individual genetic profiles to increase drug effectiveness and reduce side effects.
The document discusses principles of cancer management and treatment options. It outlines current standard treatments like surgery, radiotherapy, and chemotherapy. It also discusses newer treatments and the process of clinical trials, from phase 1 safety trials to phase 3 trials that compare new treatments to standard therapies. An example is given of problems that can occur in phase 3 trials if factors like surgical debulking are not properly controlled for. Complementary treatments are discussed, along with examples of treatments that originated from plant and animal extracts.
This document discusses strategic planning for cancer prevention. It provides information on various dietary and environmental factors that can increase cancer risk such as high glycemic diets, oxidative overload, inflammation, and exposure to toxins like PBDEs and BPA. It summarizes several studies that show relationships between certain foods/supplements and reduced cancer rates, such as broccoli consumption being associated with lower prostate cancer risk and green tea supplementation correlating with fewer prostate cancer cases. The document advocates for lifestyle changes like plant-based diets, exercise, and detoxification to potentially prevent or slow cancer progression.
Cancer is characterized by uncontrolled cell growth and spread. Some key points:
- Lung cancer is the most common cancer in men and breast cancer is most common in women.
- Risk factors include tobacco use, obesity, viruses, chemicals, radiation, and genetic mutations.
- Prevention focuses on healthy behaviors like not smoking, diet, exercise and limiting sun exposure.
- Treatment involves surgery, radiation, chemotherapy and other approaches depending on cancer type and stage. Combined therapies are often used but all treatments can cause side effects.
A data driven nomogram for breast cancer survivalLisa Federer
This document describes the development of a nomogram to predict breast cancer survival using demographic, diagnostic, and treatment data from the SEER database. The authors selected 13 variables related to survival time, age, race, cancer stage and other factors. Different classification models were tested including logistic regression, naive bayes, decision trees, and random forests. Cox proportional hazards and Aalen's additive regression models were also used. The results were used to build a "calculator" or nomogram to estimate survival time for individuals based on their characteristics. Limitations include the nomogram not being a substitute for medical advice and potential missing or incomplete data in the SEER database.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
1. Cancer therapies are becoming more precise and personalized by taking into account a patient's unique genetic profile and molecular alterations in their tumor.
2. Lipid metabolism is altered in cancer to sustain tumor growth and progression. Certain gene expression patterns related to lipid metabolism are biomarkers for colon cancer prognosis and response to treatment.
3. Natural compounds like rosemary extracts show potential for targeting lipid metabolism genes and sensitizing chemoresistant cancer cells, representing personalized nutritional interventions for colon cancer prevention and treatment.
This document discusses cancer incidence in Jaffna, Sri Lanka and the need to improve cancer care services there. It finds that breast and cervical cancer have the highest incidence. While a cancer center was begun in Jaffna in 1981, radiation services were not consistently available until 2004. The author calls for building a new comprehensive cancer center in Jaffna to better treat and prevent cancer through multidisciplinary care and early detection programs. Support is needed from foreign organizations to help the region's cancer patients.
Common complications of cancer and its treatment include neurological issues, infections, and spinal cord compression. Spinal cord compression occurs when a tumor compresses the spinal cord, which is most often caused by direct extension of cancer from nearby vertebrae through the bone. Symptoms include severe back pain exacerbated by lying down that improves with sitting or standing, weakness of the legs, and sensory loss. Magnetic resonance imaging is the best way to diagnose spinal cord compression. Treatment involves high-dose corticosteroids, radiation therapy, and possibly surgery to relieve pressure on the spinal cord.
The document discusses cancer awareness in India. Cancer is a major cause of death in India, responsible for about 6.8 lakh deaths annually. Several factors are contributing to higher rates of cancer in India, including increasing life expectancy, adoption of Western lifestyles, and lack of early detection and treatment services. National Cancer Awareness Day is observed on November 7th to raise awareness about cancer prevention through healthy lifestyle choices and the importance of early detection and treatment.
The document discusses cancer prevention through chemoprevention using phytochemicals. It provides examples of studies showing associations between fruit and vegetable consumption and reduced cancer risk. It also summarizes several large clinical trials investigating the efficacy of potential chemopreventive agents like antioxidants, vitamins, and drugs in reducing cancer incidence or progression. The mechanisms of action of various phytochemicals are discussed, including their effects on phases of carcinogenesis and cellular defense pathways.
The document provides an overview of the history and development of oncology. It discusses how cancer was first documented in ancient Egypt and treated by cauterization. It then covers key developments like Hippocrates naming cancer, the first autopsy being performed in 1761, and the establishment of the TNM staging system. The summary concludes by briefly mentioning common modern cancer treatment modalities like surgery, radiation therapy, chemotherapy, and their goals of cure, palliation, or prevention.
Cancer is caused by uncontrolled cell growth that can spread to other parts of the body. It is a complex disease with many potential causes, including tobacco use, certain infections, radiation, poor diet and environmental pollutants. These factors can directly damage genes or combine with genetic faults to cause cancer. While cancer risks increase with age, environmental exposures account for the majority of cancer cases worldwide. Determining the exact cause of an individual's cancer is difficult as most cancers have multiple potential contributing factors.
This document provides an overview of breast cancer including its epidemiology, risk factors, anatomy, natural history, workup, histology and screening guidelines. Breast cancer is the most common cancer in women. Risk increases with age and factors like family history, early menarche/late menopause, and dense breast tissue. It typically spreads first to axillary lymph nodes then may metastasize to bone, lungs, liver or brain. Diagnosis involves mammography, ultrasound and biopsy. Treatment and prognosis depend on tumor size, grade and lymph node involvement.
World Cancer Day aims to reduce the global burden of cancer through collective and individual action. Collectively, we can prevent cancer by avoiding risks, creating healthy environments in schools, workplaces and cities, supporting cancer survivors to return to work, improving access to care, and shaping policies. Individually, we can make healthy choices, seek early detection, ask for support, take control of our cancer journey, and advocate for others. The goal is to educate about effective interventions and change perceptions so that all people have access to high quality cancer treatment and support.
The document discusses various cancer treatment methods including surgery, radiotherapy, immunotherapy, hormone therapy, chemotherapy, and combination/adjuvant chemotherapy. It provides details on each method such as how surgery is used for diagnosis and removal of tumors, how different types of radiation are used in radiotherapy, and how chemotherapy works by destroying cancer cells. The document also covers natural compounds that can induce apoptosis in cancer cells, including plant extracts, flavonoids, and curcumin which suppresses prostaglandin formation through COX-2 inhibition. Nanoparticles are also discussed as a means of targeted drug delivery to cancer cells to reduce side effects.
Cancer is characterized by uncontrolled growth and spread of abnormal cells. If left untreated, cancer can result in death. The document discusses several types of cancer including lung cancer, the leading cause of cancer death, and colon cancer, the second most common cancer. It also covers cancer statistics, risk factors, screening, treatment milestones, and specific cancers like lung and colon cancer. Preventable lifestyle factors contribute to nearly 1/3 of cancer deaths in the US. Early detection through screening improves diagnosis and survival rates.
This presentation provides an overview of cancer and therapeutics. It discusses key areas that will be covered, including cell and molecular biology of cancer development, genetic pathways, cancer diagnosis and pathology, principles of cancer chemotherapy, drug discovery and delivery, and the future of cancer research. Recent papers and discussions are also mentioned.
A review on cancer therapy immunotherapy perspectivePushkar Sathe
This is a presentation on a review on present available cancer treatments. This presentation covers all the line of treatment in short. Emphasis is given on present immunotherapy and recent advances to cure cancers.
General awareness of cancer and statistic of severity in India Kamlakar More
The document discusses cancer and its general awareness. It provides information about an orientation program on cancer awareness from September 14th to October 12th presented by Mr. K.C. More. It then discusses what cancer is, symptoms of cancer, types of cancers, causes of cancer including tobacco, alcohol, viruses, sunlight and diet. It emphasizes the importance of early detection and notes that cancer is 100% curable if detected early. It also provides statistics on cancer patients and shortage of oncologists in India. The document aims to increase awareness about cancer prevention and importance of screening and early diagnosis.
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
Cancer and its types - an introduction to cancerAshish Jawarkar
This document discusses the history and current state of cancer. It notes that cancer occurs when cells grow out of control and details some key events in cancer's history such as the first descriptions in ancient Egypt and Greece. The document outlines several causes of cancer like tobacco, viruses, and radiation. It discusses how cancer spreads and common screening tests for early detection of breast, cervical, prostate, colon, and lung cancers. The takeaway message is that cancer has affected humanity for millennia but screening and research into molecular mechanisms can help control and potentially cure cancer at early stages.
Cancer is caused by genetic changes that cause uncontrolled cell growth. There are over 100 types of cancer. Treatment may include chemotherapy, radiation, and surgery. Chemotherapy drugs work by different mechanisms, such as alkylating DNA, inhibiting DNA synthesis, or preventing cell division. Understanding how cancer develops and treatments work helps researchers develop new targeted therapies.
General principle of cancer and cervix cancerVivek Verma
Cancer is characterized by uncontrolled cell growth and spread. It is caused by both external factors like chemicals and lifestyle as well as internal factors such as hormones and inherited mutations. The diagnosis of cancer involves biopsy of suspicious tissue followed by examination under a microscope. Staging then determines how far the cancer has spread. Treatment depends on the type and stage of cancer but may include surgery, radiation, chemotherapy, hormone therapy, targeted therapy, or palliative care. Cervical cancer diagnosis involves tests such as Pap smears, HPV testing, colposcopy, and biopsy of the cervix. Additional tests determine if the cancer has spread from the cervix.
Cancer is characterized by uncontrolled cell growth and spread. Some key points:
- Lung cancer is the most common cancer in men and breast cancer is most common in women.
- Risk factors include tobacco use, obesity, viruses, chemicals, radiation, and genetic mutations.
- Prevention focuses on healthy behaviors like not smoking, diet, exercise and limiting sun exposure.
- Treatment involves surgery, radiation, chemotherapy and other approaches depending on cancer type and stage. Combined therapies are often used but all treatments can cause side effects.
A data driven nomogram for breast cancer survivalLisa Federer
This document describes the development of a nomogram to predict breast cancer survival using demographic, diagnostic, and treatment data from the SEER database. The authors selected 13 variables related to survival time, age, race, cancer stage and other factors. Different classification models were tested including logistic regression, naive bayes, decision trees, and random forests. Cox proportional hazards and Aalen's additive regression models were also used. The results were used to build a "calculator" or nomogram to estimate survival time for individuals based on their characteristics. Limitations include the nomogram not being a substitute for medical advice and potential missing or incomplete data in the SEER database.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
1. Cancer therapies are becoming more precise and personalized by taking into account a patient's unique genetic profile and molecular alterations in their tumor.
2. Lipid metabolism is altered in cancer to sustain tumor growth and progression. Certain gene expression patterns related to lipid metabolism are biomarkers for colon cancer prognosis and response to treatment.
3. Natural compounds like rosemary extracts show potential for targeting lipid metabolism genes and sensitizing chemoresistant cancer cells, representing personalized nutritional interventions for colon cancer prevention and treatment.
This document discusses cancer incidence in Jaffna, Sri Lanka and the need to improve cancer care services there. It finds that breast and cervical cancer have the highest incidence. While a cancer center was begun in Jaffna in 1981, radiation services were not consistently available until 2004. The author calls for building a new comprehensive cancer center in Jaffna to better treat and prevent cancer through multidisciplinary care and early detection programs. Support is needed from foreign organizations to help the region's cancer patients.
Common complications of cancer and its treatment include neurological issues, infections, and spinal cord compression. Spinal cord compression occurs when a tumor compresses the spinal cord, which is most often caused by direct extension of cancer from nearby vertebrae through the bone. Symptoms include severe back pain exacerbated by lying down that improves with sitting or standing, weakness of the legs, and sensory loss. Magnetic resonance imaging is the best way to diagnose spinal cord compression. Treatment involves high-dose corticosteroids, radiation therapy, and possibly surgery to relieve pressure on the spinal cord.
The document discusses cancer awareness in India. Cancer is a major cause of death in India, responsible for about 6.8 lakh deaths annually. Several factors are contributing to higher rates of cancer in India, including increasing life expectancy, adoption of Western lifestyles, and lack of early detection and treatment services. National Cancer Awareness Day is observed on November 7th to raise awareness about cancer prevention through healthy lifestyle choices and the importance of early detection and treatment.
The document discusses cancer prevention through chemoprevention using phytochemicals. It provides examples of studies showing associations between fruit and vegetable consumption and reduced cancer risk. It also summarizes several large clinical trials investigating the efficacy of potential chemopreventive agents like antioxidants, vitamins, and drugs in reducing cancer incidence or progression. The mechanisms of action of various phytochemicals are discussed, including their effects on phases of carcinogenesis and cellular defense pathways.
The document provides an overview of the history and development of oncology. It discusses how cancer was first documented in ancient Egypt and treated by cauterization. It then covers key developments like Hippocrates naming cancer, the first autopsy being performed in 1761, and the establishment of the TNM staging system. The summary concludes by briefly mentioning common modern cancer treatment modalities like surgery, radiation therapy, chemotherapy, and their goals of cure, palliation, or prevention.
Cancer is caused by uncontrolled cell growth that can spread to other parts of the body. It is a complex disease with many potential causes, including tobacco use, certain infections, radiation, poor diet and environmental pollutants. These factors can directly damage genes or combine with genetic faults to cause cancer. While cancer risks increase with age, environmental exposures account for the majority of cancer cases worldwide. Determining the exact cause of an individual's cancer is difficult as most cancers have multiple potential contributing factors.
This document provides an overview of breast cancer including its epidemiology, risk factors, anatomy, natural history, workup, histology and screening guidelines. Breast cancer is the most common cancer in women. Risk increases with age and factors like family history, early menarche/late menopause, and dense breast tissue. It typically spreads first to axillary lymph nodes then may metastasize to bone, lungs, liver or brain. Diagnosis involves mammography, ultrasound and biopsy. Treatment and prognosis depend on tumor size, grade and lymph node involvement.
World Cancer Day aims to reduce the global burden of cancer through collective and individual action. Collectively, we can prevent cancer by avoiding risks, creating healthy environments in schools, workplaces and cities, supporting cancer survivors to return to work, improving access to care, and shaping policies. Individually, we can make healthy choices, seek early detection, ask for support, take control of our cancer journey, and advocate for others. The goal is to educate about effective interventions and change perceptions so that all people have access to high quality cancer treatment and support.
The document discusses various cancer treatment methods including surgery, radiotherapy, immunotherapy, hormone therapy, chemotherapy, and combination/adjuvant chemotherapy. It provides details on each method such as how surgery is used for diagnosis and removal of tumors, how different types of radiation are used in radiotherapy, and how chemotherapy works by destroying cancer cells. The document also covers natural compounds that can induce apoptosis in cancer cells, including plant extracts, flavonoids, and curcumin which suppresses prostaglandin formation through COX-2 inhibition. Nanoparticles are also discussed as a means of targeted drug delivery to cancer cells to reduce side effects.
Cancer is characterized by uncontrolled growth and spread of abnormal cells. If left untreated, cancer can result in death. The document discusses several types of cancer including lung cancer, the leading cause of cancer death, and colon cancer, the second most common cancer. It also covers cancer statistics, risk factors, screening, treatment milestones, and specific cancers like lung and colon cancer. Preventable lifestyle factors contribute to nearly 1/3 of cancer deaths in the US. Early detection through screening improves diagnosis and survival rates.
This presentation provides an overview of cancer and therapeutics. It discusses key areas that will be covered, including cell and molecular biology of cancer development, genetic pathways, cancer diagnosis and pathology, principles of cancer chemotherapy, drug discovery and delivery, and the future of cancer research. Recent papers and discussions are also mentioned.
A review on cancer therapy immunotherapy perspectivePushkar Sathe
This is a presentation on a review on present available cancer treatments. This presentation covers all the line of treatment in short. Emphasis is given on present immunotherapy and recent advances to cure cancers.
General awareness of cancer and statistic of severity in India Kamlakar More
The document discusses cancer and its general awareness. It provides information about an orientation program on cancer awareness from September 14th to October 12th presented by Mr. K.C. More. It then discusses what cancer is, symptoms of cancer, types of cancers, causes of cancer including tobacco, alcohol, viruses, sunlight and diet. It emphasizes the importance of early detection and notes that cancer is 100% curable if detected early. It also provides statistics on cancer patients and shortage of oncologists in India. The document aims to increase awareness about cancer prevention and importance of screening and early diagnosis.
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
Cancer and its types - an introduction to cancerAshish Jawarkar
This document discusses the history and current state of cancer. It notes that cancer occurs when cells grow out of control and details some key events in cancer's history such as the first descriptions in ancient Egypt and Greece. The document outlines several causes of cancer like tobacco, viruses, and radiation. It discusses how cancer spreads and common screening tests for early detection of breast, cervical, prostate, colon, and lung cancers. The takeaway message is that cancer has affected humanity for millennia but screening and research into molecular mechanisms can help control and potentially cure cancer at early stages.
Cancer is caused by genetic changes that cause uncontrolled cell growth. There are over 100 types of cancer. Treatment may include chemotherapy, radiation, and surgery. Chemotherapy drugs work by different mechanisms, such as alkylating DNA, inhibiting DNA synthesis, or preventing cell division. Understanding how cancer develops and treatments work helps researchers develop new targeted therapies.
General principle of cancer and cervix cancerVivek Verma
Cancer is characterized by uncontrolled cell growth and spread. It is caused by both external factors like chemicals and lifestyle as well as internal factors such as hormones and inherited mutations. The diagnosis of cancer involves biopsy of suspicious tissue followed by examination under a microscope. Staging then determines how far the cancer has spread. Treatment depends on the type and stage of cancer but may include surgery, radiation, chemotherapy, hormone therapy, targeted therapy, or palliative care. Cervical cancer diagnosis involves tests such as Pap smears, HPV testing, colposcopy, and biopsy of the cervix. Additional tests determine if the cancer has spread from the cervix.
This document reviews the evolution of cancer treatment therapies from chemotherapy, surgery, and radiation to more recent immunotherapies, gene therapies, and nanomedicines. It discusses the historical development of chemotherapy in the early 20th century and major advances in targeted therapies. Recent developments discussed include immunotherapy, gene therapy, and the use of nanotechnology for controlled drug delivery, hyperthermia, and targeted therapies. The review provides an overview of the arrival and promises of modern therapeutic approaches while acknowledging ongoing challenges.
1) The document discusses cancer statistics in the United States, noting that over 500,000 Americans died of cancer in 2001, with 1.3 million new cases diagnosed.
2) It explores the causes of cancer including exposure to carcinogens, cellular mutations from environmental and lifestyle factors, genetics, and certain viruses.
3) The types and risks of several common cancers are examined, like lung cancer which is strongly linked to smoking, as well as breast, colon, prostate, and skin cancers. Detection methods and lifestyle prevention strategies are also reviewed.
This document summarizes a presentation on personalized medicine approaches for ovarian cancer patients. It discusses how inherited mutations, molecular abnormalities in tumors, and components in blood can be used to design personalized treatment plans. It provides examples of clinical trials targeting BRCA mutations, p53 pathways, folate receptors, and immunotherapy. While personalized medicine holds promise, challenges remain due to tumor heterogeneity, redundant pathways, and limitations of current methods like xenografts. Improved validation of genetic risk loci and minimizing toxicity are areas for future work.
Nursing management of patients with oncological conditionsANILKUMAR BR
Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells.
Cancer is caused by external factors and internal factors which may act together to initiate or promote carcinogenesis.
External Factors - chemicals, radiation, viruses, and lifestyle.
Internal Factors – hormones, immune condition, and inherited mutations.
Oncology branch of medicine deals with etiology, diagnosis, treatment and prevention of cancer.
Onco - is a Greek word meaning tumor .
Cancer arises from abnormal cell growth and can be caused by genetic and environmental factors. Biotechnology plays an important role in cancer management through targeted treatments, immunotherapy, and screening technologies. Recent advances include using computer programs to select personalized treatments, compounds from plants and marine organisms that inhibit cancer growth, and herbal supplements that enhance standard therapies. Ongoing research seeks more effective and less toxic approaches to combat cancer.
2021 World Cancer Day Campaign
World Cancer Day aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease.
#IAmAndIWill
Prevention and early detection of cancer ver 3.0Vivek Verma
Cancer is caused by both external and internal factors and can progress from a benign tumor to metastatic cancer if mutations accumulate in cancer genes. Two-thirds of cancer deaths can be prevented by avoiding risk factors like smoking, obesity, poor diet, and lack of exercise. Early detection through screening tests is important because treatment is more effective for early-stage cancers. Common cancer screening tests include mammograms for breast cancer, Pap tests and HPV tests for cervical cancer, and colonoscopies for colorectal cancer. Modifying lifestyle risk factors can significantly reduce cancer risk.
Cancer 101 provides an overview of cancer including definitions, statistics, risk factors, and lifestyle measures for prevention. It reviews that cancer is abnormal cell growth, the second leading cause of death, and risk is increased by certain lifestyle behaviors like poor nutrition, lack of exercise, stress, sleep issues, and toxic exposures. Maintaining a healthy lifestyle through diet, exercise, managing stress, adequate sleep, and avoiding toxins can help lower cancer risks.
Precision Medicine in Oncology InformaticsWarren Kibbe
Precision medicine in oncology aims to provide targeted cancer treatments based on a patient's individual tumor characteristics. The presentation discusses precision oncology initiatives including NCI-MATCH clinical trials which assign cancer therapies based on a tumor's molecular abnormalities rather than location. It outlines plans to expand genomically-based cancer trials, understand and overcome treatment resistance through molecular analysis, and establish a national cancer database integrating genomic and clinical data to accelerate cancer research. Cloud computing platforms are being developed to provide researchers access to large cancer genomic and clinical datasets. The goal is to advance precision cancer treatment by incorporating individual patient genetics and biomarkers into therapeutic decision making.
This document provides an overview of cancer biology. It discusses the history of cancer discovery, epidemiology, carcinogenesis and the hallmarks of cancer. It describes the cell cycle, apoptosis, cancer genes and genetic lesions. Enabling factors of cancer like genomic instability and tumor-promoting inflammation are explained. The clinical presentation, screening, prevention and management of cancer are also summarized. Key topics covered include the cell cycle, tumor suppressor genes, oncogenes, angiogenesis, invasion and metastasis, and evasion of immune surveillance. Grading and staging of cancer as well as laboratory diagnosis are also outlined.
This document provides an overview of cancer biology. It discusses the history of cancer research, epidemiology, carcinogenesis and the hallmarks of cancer. It describes the cell cycle, apoptosis, genetic changes involved in cancer development, and enabling factors like inflammation. Precursor lesions, cancer genes, and genetic lesions are explained. The hallmarks of cancer such as growth self-sufficiency, evading growth suppression, altered metabolism, evading cell death, limitless replication, sustained angiogenesis, invasion and metastasis, and evading immune destruction are summarized. Finally, it briefly discusses cancer diagnosis, grading and staging, screening, prevention and treatment.
Cancer chemotherapy and treatment involves several methods. Chemotherapy uses drugs to prevent or treat cancer by killing cancer cells. Common chemotherapies include fluorouracil, capecitabine, and cytarabine which are pyrimidine analogues that interfere with DNA synthesis in cancer cells. These drugs have similar mechanisms of action but different routes of administration and toxicity profiles. Combination chemotherapy uses multiple agents to increase effectiveness while reducing resistance. Careful dosing and administration is needed due to the narrow therapeutic index of chemotherapy drugs.
This document discusses oral cancer awareness and prevention. It begins with an introduction to cancer in general and then focuses on oral cancer statistics globally and in India. India has the highest rates of oral cancer in the world. Tobacco use, including smoking and smokeless tobacco, is a major risk factor and accounts for over 30% of cancers. Diet high in fruits and vegetables can help prevent cancer. Screening and early detection of potentially malignant disorders like leukoplakia are important for diagnosis and treatment.
Lenalidomide is an immunomodulatory drug used to treat multiple myeloma, myelodysplastic syndromes, and mantle cell lymphoma. It works by inhibiting tumor growth and immune system modulation. For multiple myeloma, it is used in combination with dexamethasone or as maintenance after stem cell transplantation. Clinical trials showed continuous lenalidomide and dexamethasone improved progression-free and overall survival compared to other regimens. Common side effects include diarrhea, rash, and fatigue. Special precautions are needed due to risks of birth defects and blood clotting issues.
Tumor markers are biological substances that can be detected in cancer patients that are produced either by the tumor itself or by the body in response to a tumor. An ideal tumor marker would be produced specifically by the tumor, present at detectable levels even in small tumors, and correlate with tumor size and activity. While tumor markers have potential uses in screening, diagnosis, staging, prognosis, and monitoring treatment, they also have drawbacks like lack of specificity and sensitivity. Different types of cancer are associated with different tumor markers.
Sickle cell disease (SCD) describes a group of inherited red blood cell disorders where individuals have abnormal hemoglobin called hemoglobin S. There are several forms of SCD. It is one of the most common genetic disorders globally, affecting millions, particularly in sub-Saharan Africa, India, and the Middle East. Left untreated, more than half of children with SCD in resource-poor countries will die before age five. Management involves treatment of pain crises, infections, chronic anemia, and complications through hydration, antibiotics, pain medications, transfusions, hydroxyurea and folic acid supplementation.
Selection of surgical procedure for esophageal cancer ver 3.0Vivek Verma
Esophageal cancer is typically treated through surgical resection, which involves removing part of the esophagus. The type of surgery depends on the location and stage of the cancer. Common procedures include McKeown esophagectomy, transhiatal esophagectomy, and Ivor Lewis esophagectomy. While esophagectomy is a major surgery with risks of complications, minimally invasive techniques and extensive lymph node dissection may improve short and long-term outcomes for patients.
Role of primary physicians in early detection of cancerVivek Verma
India faces a serious public health challenge from cancer due to high incidence rates and low detection rates. The reported cancer incidence in India is estimated to increase substantially by 2020 and mirror rates seen in other developing countries like China. Several factors contribute to India's high mortality rates from cancer, including poor public awareness that results in delayed diagnosis, a lack of screening programs, and limited training for primary care physicians in early detection. Strengthening the role of primary care physicians in areas like cancer screening, education, and establishing fast-track referral systems can help reduce cancer diagnoses at late stages and improve outcomes.
This document provides information on post-chemotherapy care and management of side effects. It discusses extravasation, which is when chemotherapy leaks from the vein into surrounding tissue. It classifies extravasation reactions and describes how to recognize and manage it. It also covers chemotherapy-induced nausea and vomiting (CINV), discussing pathophysiology and providing recommendations for preventing nausea based on emesis risk. The document further addresses febrile neutropenia, defining it and outlining management strategies. It then discusses anemia as a side effect of chemotherapy and radiation, describing treatment goals and options. Finally, the document defines mucositis as inflammation of mucosal surfaces throughout the body.
Patient autonomy and truth telling ver 2.0Vivek Verma
The document discusses several key issues regarding patient autonomy and truth telling in medical ethics:
1. There are two main theoretical positions on medical ethics - consequentialism, which focuses on results, and deontology/Kantianism, which focuses on absolute rules and duties like respecting patient autonomy.
2. Respecting patient autonomy sometimes conflicts with doing what is best for the patient based on a doctor's judgment. Theories of medical ethics provide different approaches to resolving this conflict.
3. Informed consent is an important aspect of respecting patient autonomy but determining what information to disclose and how to ensure understanding involves ongoing discussion. Individualizing the informed consent process based on each patient's preferences is an approach gaining
Optimum approach to patients with gynecological malignancies ver 3.0Vivek Verma
This document discusses the optimum approach to treating patients with gynecological malignancies. It covers risk factors, clinical presentation, diagnosis and diagnostic tests, therapeutic goals, and management including surgery, radiation, and drug therapy for the three main gynecological cancers: endometrial cancer, cervical cancer, and ovarian cancer. National Comprehensive Cancer Network guidelines from 2016 are referenced for treatment recommendations. Supportive care is also discussed to manage side effects from treatment.
This document discusses minimal residual disease (MRD) in chronic lymphocytic leukemia (CLL). It provides background on CLL and the importance of achieving complete remission and being MRD-negative for improved outcomes. The document discusses different methods for detecting MRD, including flow cytometry and PCR-based techniques, and their sensitivity levels. It reviews studies showing that achieving MRD-negative status after treatment is associated with superior progression-free and overall survival. The document also discusses using MRD results to guide treatment decisions, such as consolidation therapy or stopping treatment early if MRD is eliminated from the bone marrow.
The document discusses the interpretation of prothrombin time (PT) and activated partial thromboplastin time (APTT) test results in daily clinical practice. It describes how the PT and APTT tests work, what factors they measure, and how to interpret abnormal results, including whether a factor deficiency or inhibitor is present, using mixing studies. Prolonged coagulation times can indicate issues like liver disease, vitamin K deficiency, coagulation factor deficiencies, or coagulation inhibitors. The reference ranges for PT and APTT tests are also discussed.
Blood & blood products in burns ver 1.0Vivek Verma
Burn injuries can cause significant blood loss and anaemia. While blood transfusion is often necessary, it can have risks. There is no consensus on the optimal transfusion strategy for burn patients. Some studies support a restrictive approach with lower transfusion thresholds of 7-8 g/dL hemoglobin, while others support a more liberal approach for certain critical patients. Proper evaluation of blood volume status and end-organ perfusion is important when determining transfusion need. Potential transfusion risks include infections, reactions, and errors. Further research is still needed to determine the best practice for blood transfusion in burns.
Colorectal cancer is the third most common cancer worldwide. Risk factors include age, family history, inflammatory bowel disease, diet, obesity, smoking, and diabetes. Staging involves endoscopy, CT, PET, and CEA levels. Treatment depends on stage - surgery alone for early stages, while later stages may involve chemotherapy and targeted agents. Neoadjuvant therapy can potentially downstage borderline resectable tumors. Adjuvant chemotherapy improves outcomes for stage III, while its benefit in stage II depends on risk factors. Advanced disease is typically treated with chemotherapy plus targeted agents like bevacizumab or anti-EGFR antibodies.
Metastatic breast cancer remains a major unmet medical need, with over 1.7 million new cases diagnosed globally in 2012. Several new therapeutic targets and agents are in development to treat metastatic breast cancer and its subtypes. These include agents targeting intra-tumoral drivers like HER2, IGF, HGF, PI3K/AKT/mTOR, PARP, and AR. Agents also target the tumor microenvironment, such as anti-angiogenics targeting VEGF and agents targeting immune cells. Many of these novel agents are currently in Phase II or III clinical trials alone or in combination with standard therapies. Developing strategies to optimize targeted treatments and combinations holds promise to improve outcomes for patients with advanced breast cancer.
Anemia is common in children and can have many causes. A systematic approach is needed for diagnosis. This involves taking a thorough history, physical exam, and testing including a complete blood count, reticulocyte count, and peripheral smear. Anemias can be classified morphologically as microcytic, normocytic, or macrocytic based on red blood cell size. Determining iron, B12, or folate levels and bone marrow examination may be needed to identify the underlying cause, such as iron deficiency, thalassemia, or megaloblastic anemia. A careful analysis considering the child's age, gender, ethnicity, nutrition, medications, infections and family history helps guide the diagnostic process
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
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2. Stats…
2Siegel et al: CA Cancer J Clin 2014
http://www.neeman-medical.com/sites/default/files/files/Cancer%20in%20India.pdf Accessed on 28.4.16
3. What Is Cancer?
• Cancer/Neoplasia – a large group of diseases characterized
by the uncontrolled growth and spread of abnormal cells
• Malignant - cancerous
• Benign - noncancerous
3Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
4. What Is Cancer? – cont.
• Metastasis – malignant tumors that are not enclosed in a
protective capsule have the ability to spread to other
organs
• Mutant cells – disruption of RNA and DNA within normal
cells may produce cells that differ in form, quality and
function from the normal cell
4Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
5. Cancer Progression
5
Benign Tumour
In situ cancer
Invasive cancer
Metastatic
cancer
Mutations in multiple cancer genes are required for the
development and progression of a single cancer
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
6. What Causes Cancer?
• External Factors – chemicals, radiation, viruses, and
lifestyle
• Internal Factors – hormones, immune conditions, and
inherited mutations
• Theories
• Cellular change/mutation theories
• Carcinogens
• Oncogenes/ protooncogenes
6Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
7. Factors Believed to Contribute to Global Causes of Cancer
7Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
8. Risks For Cancer
• Lifetime risk – the probability that an individual, over the course
of a lifetime, will develop cancer or die from it
• Relative risk – measure of the strength of the relationship
between risk factors and a particular cancer
• Smoking – 30% of all cancer deaths, 87% of lung cancer deaths
• Obesity – 50% higher risk for breast cancer in postmenopausal
women, 40% higher risk in colon cancer for men
8Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
9. Biological Factors
• Some cancers such as breast, stomach, colon, prostate,
uterus, ovaries and lung appear to run in families
• Hodgkin’s disease and certain leukemia's show similar
patterns
• University of Utah research suggests that a gene for breast
cancer exists
• A rare form of eye cancer appears to be transmitted
genetically from mother to child
9Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
10. Reproductive And Hormonal Risks For Cancer
• Pregnancy and oral contraceptives increase a woman’s
chances of breast cancer
• Late menarche, early menopause, early first childbirth,
having many children have been shown to reduce risk of
breast cancer
10Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
11. Occupational And Environmental Factors
• Asbestos
• Nickel
• Chromate
• Benzene
• Arsenic
• Radioactive substances
• Cool tars
• Herbicides/pesticides
11Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
12. Social And Psychological Factors
• Stress has been implicated in increased susceptibility to
several types of cancers
• Sleep disturbances, diet, or a combination of factors may
weaken the body’s immune system
12Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
13. Chemicals In Foods
• Sodium nitrate when ingested forms a potential
carcinogen, nitrosamine
• Sodium nitrate is still used because it is effective in
preventing botulism
• Pesticide and herbicide residues
13
14. Viral Factors
• Herpes-related viruses may be involved in the development
of leukemia, Hodgkin’s disease, cervical cancer, and
Burkitt’s lymphoma
• Epstein-Barr virus, associated with mononucleosis, may
contribute to cancer
• Human papillomavirus (HPV), virus that causes genital
warts, has been linked to cervical cancer
• Helicobacter pylori causes ulcers which are a major factor
in the development of stomach cancer
14Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
15. Medical Factors
• Some medical treatments actually increase a person’s risk
for cancer
• Diethylstilbestrol (DES) used 1940 to 1960 to control
bleeding during pregnancy, the daughters of mothers that
used DES were found to have an increased risk for cancers
of the reproductive organs
• Estrogen supplementation
• Chemotherapy used to treat one form of cancer may
increase risk for another type of cancer
15Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
16. Cancer’s Seven Warning Signals
16Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
17. Cancer treatment modalities
• Can be used alone or in
combination
• Outcome measured in
terms of survival rates and
response rates
17Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
18. Target Areas for Therapeutic Interventions
18
Invasivity
Motility
Aneuploidy
Angiogenesis
Imune Defense
Evasion
Deregulated
Proliferation
Altered Energy
Metabolism
Immortalization
(Anti-Apoptosis)
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
19. 19
Paul Ehrlich 1854 - 1915
•Father of Chemotherapy
• Salvarsan for Treatment of Syphilis
• Nobel Prize 1908
• “Magic Bullet Concept”
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
20. History of chemotherapy development
20
• 1946 Nitrogen mustard given to
treat lymphomas
• 1947 Antifolates introduced
• 1949 Methotrexate introduced
• 1950s 5-Fluoro-uracil synthesised
• 1952 6-mercaptopurine
described
• 1954 Actinomycin D introduced
• 1960s Combination chemo cured
childhood ALL and HD
• Recent Years Many new agents Focus
changes to optimising timing and
usage and modulating toxicity
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
21. The cell cycle
21Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
22. Phases of the cell cycle
• G0 resting phase
• G1 early growth
phase
• S DNA synthesis
• G2 later growth phase
• M Mitosis
22Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
23. Cell division – mitosis (1)
• Prophase
• Chromatin condenses into
chromosomes. Each
chromosome duplicates and
consists of 2 sister chromatids.
Nucleus breaks down
• Metaphase
• Chromosomes align and are
held by microtubules attached
the mitotic spindle and to the
centromere
23Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
24. Cell division – mitosis (2)
• Anaphase
• The centromeres divide. Sister
chromatids separate and move
toward the corresponding poles
• Telophase
• Daughter chromosomes arrive at
the poles and the microtubules
disappear. The condensed
chromatin expands and the
nuclear envelope reappears
• The cytoplasm divides, the cell
membrane pinches inwards and
two daughter cells are produced
24Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
25. The Cell Cycle and Tissue Growth
• The rate of cell division in human tumours varies
considerably from one disease to another
• Majority of common cancers increase in size slowly
compared to sensitive normal tissues such as BM and GI
epithelium
• The relationship between cell cycle and cell death affects
tumour growth
25Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
26. Chemotherapy Effects
• Cytotoxic drugs produce their effects by damaging the
reproductive potential of cells
• The more rapidly growing tumours are more likely to
respond to drug treatment
• this accounts for leukaemias, lymphomas and testicular cancers
being more responsive than colonic / pancreatic cancers
26Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
27. Growth Fraction
• At a given time, the number of cells in a population that
are actively passing through the cell cycle divided by the
total number of cells in the population = growth fraction
• The greater the growth faction, the more likely the
treatment will produce cell death
27Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
28. Kinetics of cell killing
• Fractional Cell kill hypothesis
• A given dose of cytotoxic drug kills
a given proportion of cells, not a
given number
• Smaller tumours require fewer
cycles of chemotherapy than larger
ones
• Pulsed intermittent therapy
• Maximises tumour cell killing whilst
allowing normal tissues damaged
by the drug to recover
28Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
29. Cytotoxic Drug Classification based on cell cycle specificity
• Cell Cycle Phase-Specific Agents
• active in a particular phase of cell cycle
• Depend on the production of some type of unique biochemical
blockade of a particular reaction occurring in a single phase of the cell
cycle
• Cell Cycle Phase-Non-specific Agents
• Cytotoxic effect exerted irrespective of cell cycle state
• equally effective in large tumours in which cell growth is low
• dose dependent
• single dose has same effect as repeated fractions totalling the same
amount
29Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
30. Classification of Chemotherapeutic Agents
• Alkylating agents
• Nitrogen Mustards: Cyclophosphamide,. Chlorambucil,
Melphalan,
• Alkyl Sulfonate: Busulfan
• Nitrosoureas : Carmustine, Lomustine,semustine
• Ethylenimines: Thiotepa
• Triazenes : Dacarbazine
• Antimetabolites
• Folate antagonist: methotrexate and gemcitabine
• Purine analogues: thioguanine, mercaptopurine, pentostatin
• Pyrimidine analogues: fluorouracil, cytarabine
30Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
31. Classification of Chemotherapeutic Agents
• Plant-derived products
• Vinca alkaloids( vincristine, vinblastine) epipodophyllotoxins (
etoposide) taxanes: (paclitaxel)
• Antibiotics
• doxorubicin , daunorubicin , bleomycin, mitomycin, dactinomycin
• Hormones and related drugs :
• tamoxifen estramustine, flutamide , progestins
• Miscellaneous agent :
• hydroxyurea, cisplatin , mitoxantrone, levamisole, interferon alfa
and aldesleukin.
31Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
32. Classification of Chemotherapeutic Agents
• Drugs that alters hormonal milieu
• Glucocorticoids: Prednisolon, Prednisone
• Estrogen: Diethylstilbestreol
• Anti-estrogen: Tamoxifen
• Androgen: Testosteron
• Progestin: Medroxy Progesteron Acetate
• Monoclonal Antibodies
• Trantuzumab –anti HER 2
• Rituximab –CD 20
• Imatinib – TKI
• Cetuximab – EGFR
• Bevacizumab-VEGFR
32Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
33. Alkylating Agents
• Contain chem grps that covalently bind cell nucleophiles
• Impt properties of drugs
• Can form carbonium ions
• C w/ 6 electrons highly reactive
• React w/ -NH2, -OH, -SH
• Bifunctional (2 reactive grps)
• Allow cross-linking
33
34. Alkylating Agents
• Impt targets
• G N7 – strongly nucleophilic
• A N1, A N3, C N3 also targets
• DNA becomes cross-linked w/ agent
• Intra- or inter-strand
• Decr’d transcr’n, repl’n
• Chain scission, so strand breaks
• Inappropriate base pairing (alkylated G w/ T)
• Most impt: S phase repl’n (strands unwound, more
susceptible) G2 block, apoptosis
34
36. Nitrogen Mustards
• Loss Cl intramolec cyclization of side chain
Reactive ethylene immonium derivative
36
37. Cyclophosphamide
• Most common
• Prodrug – liver metab by CYP P450 MFO’s
• Effects lymphocytes
• Also immunosuppressant
• Oral or IV usually
• SE’s: n/v, bone marrow dpression, hemorrhagic cystitis
• Latter due to acrolein toxicity; ameliorated w/ SH-donors
37
41. Cisplatin
• Cl- dissoc’s reactive complex that reacts w/ H2O and
interacts w/ DNA intrastrand cross-link (G N7 w/
adjacent G O6) denaturation DNA
• Nephrotoxic
• Severe n/v ameliorated w/ 5-HT3 antagonists (decr gastric
motility)
• Carboplatin – fewer above SE’s, but more myelotoxic
42. Antimetabolites
• Mimic structures of normal metabolic mol’s
• Inhibit enz’s competitively OR
• Inc’d into macromol’s inappropriate structures
• Kill cells in S phase
• Three main groups
• Folate antagonists
• Pyr analogs
• Pur analogs
42
43. Folic Acid Analogs
• Folic acid essential for synth purines, and thymidylate
• Folate: pteridine ring + PABA + glutamate
• In cells, converted to polyglutamates then tetrahydrofolate
(FH4)
43
44. • Folate FH4 cat’d by
dihydrofolate reductase in
2 steps:
• Folate FH2
• FH2 FH4
• FH4 serves as methyl grp
donor (1-C unit) to
deoxyuridine (dUMP
dTMP), also regenerating
FH2
45. Methotrexate
• Higher affinity for enz than does FH2
• Add’l H or ionic bond forms
• Depletion FH4 in cell depl’n dTMP “thymine-less
death”
• Inhib’n DNA synth
• Uptake through folate transport system
• Resistance through decr’d uptake
• Metabolites (polyglutamate deriv’s) retained for weeks,
months
45
50. Pyrimidine Analogs
• 5-Fluorouracil – dUMP analog also works through dTMP
synthesis pathway
• Converted “fraudulent” nucleotide FdUMP
• Competitive inhibitor for thymidylate synthetase active site, but
can’t be converted to dTMP
• Covalently binds thymidylate synthetase
• Mech action uses all 3routes decr’d DNA synthesis, also
transcr’n/transl’n inhib’n
50
51. • Gemcitabine
• Phosph’d tri-PO4’s
• “Fraudulent nucleotide”
• Also inhib’s ribonucleotide reductase decr’d nucleotide synth
• Capecitabine is prodrug
• Converted to 5FU in liver, tumor
• Enz impt to conversion overexpressed in cancer cells (?)
51
52.
53. • Cytosine arabinoside
• Analog of 2’dC
• Phosph’d in vivo cytosine arabinoside triphosphate
• Inhibits DNA polymerase
• Gemcitabine – araC analog
• Fewer SE’s
53
57. Cytotoxic Antibiotics
• Substances of microbial origin that prevent mammalian cell
division
• Anthracyclines
• Doxorubicin
• Intercalates in DNA
• Inhibits repl’n via action at topoisomerase II
• Topoisomerase II catalyzes nick in DNA strands
• Intercalated strand/topoisomerase complex stabilized permanently
cleaved helix
57
58. • Epirubicin, mitozantrone structurally related
• SE’s: cardiotoxicity (due to free radical prod’n), bone
marrow suppression
58
Mitozantrone
59. • Dactinomycin
• Intercalates in DNA minor groove between adjacent GC pairs
• Interferes w/ RNA polymerase movement decr’d transcr’n
• Also may work through topoisomerase II
• Bleomycin
• Glycopeptide
• Chelates Fe, which interacts w/ O2
• Gen’n superoxide and/or hydroxyl radicals
• Radicals degrade DNA fragmentation, release of free bases
• Most effective in G2, also active against cells in G0
• Little myelosuppression BUT pulmonary fibrosis
59
61. Plant Alkaloids
• Work at mitosis
• Effect tubulin, therefore microtubule activity
• Prevention spindle form’n OR
• Stabilize (“freeze”) polymerized microtubules
• Arrest of mitosis
• Other effects due to tubulin defects
• Phagocytosis/chemotaxis
• Axonal transport in neurons
61
66. Chemotherapy Side Effects
• Chemotherapy targets cells which are dividing rapidly.
• Chemotherapy cannot distinguish between normal cells
and cancer cells
• Healthy Cells which have a high rate of growth and
multiplication include cells of the bone marrow, hair, GI
mucosa and skin.
• Side effects may be drug specific e.g. anthracyclines and
cardiotoxicity, vinca alkaloids and neuropathy/constipation,
bleomycin and pulmonary fibrosis
• Severity of side effects varies between drugs.
• Side effects often occur 7-14 days post treatment.
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67. Side Effects: Acute
• Tumour Lysis Syndrome
• A Metabolic Emergency.
• Occurrs due to rapid cell lysis (death) & large amounts of cell
metabolites in blood.
• If untreated can lead to acute renal failure, cardiac arrest and
death
• Neutropenic Sepsis
• Occurs due to Bone Marrow Failure and
• poor immune response to infection.
• Predisposing factors include:
• Neutropenia
• Underlying disease
• Chemotherapy
• Venous access devices
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68. Side Effects: Acute
• Haemorrhage
• Invading tumours e.g gastric MALT
• lymphomas
• Haemorrhagic Cystitis related to high dose Cyclophosphomide
• Anaphylactic Reaction
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69. Side Effects: Bone Marrow
• Neutropenia:
• Increased risk of infection.
• Anaemia:
• Tiredness, lethargy & breathlessness
• Thrombocytopenia:
• Increased risk of bleeding
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70. Side Effects: Gastro-Intestinal
• Nausea & Vomiting
• Diarrhoea & constipation
• Loss of appetite
• Taste Changes
• Mucositis
70
Grade 4 Mucositis
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71. Side Effects: Body Image and Others
• Body Image
• Hair Loss
• Weight Loss/ Weight Gain
• Long term central venous catheters
• Skin changes (colour, rashes, sensitivity to sunshine/chlorine, dry)
• Others
• Fatigue: Often multi-factorial
• Peripheral neuropathy
• Altered Kidney Function
• Changes in hearing (high dose Cisplatin)
• Cardiac Toxicity (Doxorubicin/ Idarubicin)
• Late Effects: Infertility, secondary malignancy, growth retardation.
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72. Aim Of Combination Chemotherapy
72
INCREASED EFFICACY
Different mechanisms of action Compatible side effects
Different mechanisms of resistance
ACTIVITY SAFETY
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73. Principles of combination chemotherapy
• Combination chemotherapy accomplishes three important
objectives not possible with single-agent therapy:
• It provides maximum cell kill within the range of toxicity tolerated
by the host for each drug
• It offers a broader range of coverage of resistant cell lines in a
heterogeneous tumor population
• It prevents or slows the development of new drug-resistant cell
lines.
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74. Selection of drugs for combination regimens
• Following principles have been established to guide drug
selection in combination regimens:
• Drugs known to be active as single agents
• Drugs with different mechanisms of action
• Drugs with differing dose-limiting toxicities
• Drugs should be used in their optimal dose and schedule.
• Drugs should be given at consistent intervals. The treatment-free
interval between cycles should be the shortest possible time for
recovery of the most sensitive normal tissue.
• Drugs with different patterns of resistance should be combined to
minimize cross-resistance.
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75. Modes of Chemotherapy
• Primary Chemotherapy
• Used as the sole anti-cancer treatment in a highly sensitive tumor
types, E.g. CHOP for Non-Hodgkins lymphoma
• Adjuvant Chemotherapy
• Treatment is given after surgery to “mop up” microscopic residual
disease. E.g. Adriamycin, cyclophosphamide for breast cancer
• Neoadjuvant Chemotherapy
• Treatment is given before surgery to shrink tumor and increase
chance of successful resection, E.g. Adriamycin, ifosfamide for
osteosarcoma
• Concurrent Chemotherapy
• Treatment is given simultaneous to radiation to increase
sensitivity of cancer cells to radiation. E.g. Cisplatin, 5-
fluourouracil, XRT for head and neck tumors
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76. Deciding which chemotherapy drugs to use
• Factors to consider in choosing which drugs to use include:
• Type of cancer
• Stage of the cancer (how far it has spread)
• Patient’s age
• Patient’s overall health
• Other serious health problems (such as heart, liver, or kidney diseases)
• Types of cancer treatments given in the past
• Considering the side effects
• Avoiding drug interactions
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77. Planning Drug Doses And Schedules
• Doses
• Based on body surface area
• Differ between children and adults
• Adjusted for people
• Who are elderly
• Having poor nutritional status
• Who have already taken or taking other medications
• Who have already received or are currently receiving radiation therapy
• Who have low blood cell counts
• Who have liver or kidney diseases
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78. Planning Drug Doses And Schedules
• Schedule (Cycles)
- A cycle = one dose followed by several days or weeks
without treatment for normal tissues to recover from the
drug’s side effects
The number of cycles = based on the type and stage of
cancer, and side effects
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79. Hematological Considerations For Dose Scheduling
• Lifespan
• Platelet - 7-10 days
• Red blood cell - 120 days
• Neutrophils - 6-12 hours
• Time from Stem Cell to Mature Neutrophil
• ~7-10 days
79
80. How chemo is given
• In most cases, chemo drugs are put right into the bloodstream
or taken as pills. They then travel throughout the body to kill
cancer cells
• Regional chemo include drugs given into these parts of the
body:
• Intra-arterial – injected into an artery that goes to a certain area of the
body
• Intravesical – put into the bladder
• Intrapleural – put into the chest cavity between the lung and chest wall
• Intraperitoneal – put into the belly (abdomen) around the intestines
and other organs
• Intrathecal – put into the central nervous system (brain and spinal cord)
• Intralesional/intratumoral – injected right into the tumor
• Topical – applied to the skin as a cream or lotion
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81. Deciding On Treatment Intervals
• As short as possible
• Recovery of bone marrow
• Supplies mature cells for 8-10 days
• Onset 9-10th days
• Lowest (nadir) 14-18th days
• Recovery by day 21-28.
• Usual schedule is q21-28 days.
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82. Dose-dense chemotherapy
• A chemotherapy treatment plan in which drugs are given
with less time between treatments than in a standard
chemotherapy treatment plan.
• Gompertzian growth curve:
• Tumor growth follows a mathematically predictable growth
curve, with rapid growth initially, then leveling off to slower
growth
• Cells are most sensitive to chemotherapy when they are rapidly
dividing
• The rationale for dose-dense therapy stems from the
Norton-Simon hypothesis:
• Sequential, consecutive dosing of chemotherapy using single or a
combination of agents increases the dose density over
alternating dosing , improving results
82Citron et al, Breast Care 2008;3:251–255
84. CALGB 9741: Trial Specifically Testing Dose Density
Intergroup C9741/CALGB 9741 was a prospective randomized trial that
tested the dose density with chemotherapy doses that could be used in
the outpatient setting
84
DFS and OS were significantly greater with the dose-dense regimens
(risk ratio = 0.74; p = 0.010, and 0.69; p = 0.013, respectively) and
were not affected by the number of positive nodes, tumor size,
menopausal status, or tumor estrogen receptor status
Citron et al, Breast Care 2008;3:251–255
85. E1199: Paclitaxel vs Docetaxel Weekly vs Q 3 Week
85Citron et al, Breast Care 2008;3:251–255
87. Making The Decision Based on Toxicity ECOG 1199 (Grade 3-4)
87Citron et al, Breast Care 2008;3:251–255
88. Hormonal Therapy
• It involves the manipulation of the endocrine system
through exogenous administration of specific hormones
• Which inhibit the production or activity of such hormones
(hormone antagonists)
• Hormonal therapy is used for several types of cancers
derived from hormonally responsive tissues
• Breast, prostate, endometrium, and adrenal cortex
88Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
89. Inhibitors of hormone synthesis
• Aromatase inhibitors
• Used for the treatment of breast cancer in postmenopausal
women
• When the action of aromatase is blocked, estrogen levels in post-
menopausal women can drop to extremely low levels, causing
growth arrest and/or apoptosis of hormone-responsive cancer
cells
• Letrozole and anastrozole are aromatase inhibitors which have
been shown to be superior to tamoxifen for the first-line
treatment of breast cancer in postmenopausal women
• Exemestane is an irreversible "aromatase inactivator" which is
superior to megestrol acetate for treatment of tamoxifen-
refractory metastatic breast cancer, and does not appear to have
the osteoporosis-promoting side effects of other drugs in this
class
89Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
90. Inhibitors of hormone synthesis
• GnRH analogs
• Analogs of gonadotropin-releasing hormone (GnRH)
• Can be used to induce a chemical castration
• Leuprolide and goserelin are GnRH analogs which are used
primarily for the treatment of hormone-responsive prostate
cancer
90Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
91. Hormone receptor antagonists
• Hormone receptor antagonists bind to the normal receptor
for a given hormone and prevent its activation.
• Selective estrogen receptor modulators (SERMs)
• Used primarily for the treatment and chemoprevention of breast cancer
• Tamoxifen
• Partial agonists
• Raloxifene
• Partial agonist
• Used primarily for chemoprevention of breast cancer in high-risk
individuals, as well as to prevent osteoporosis
• Toremifene and fulvestrant
• Used for treatment of metastatic breast cancer
91Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
92. Hormone receptor antagonists
• Antiandrogens
• Bind and inhibit the androgen receptor
• Blocking the growth- and survival-promoting effects of testosterone on
certain prostate cancers
• Flutamide and bicalutamide
• Used in the treatment of prostate cancer
92Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
93. Hormone supplementation
• Progestogens
• Progestins (progesterone-like drugs)
• Megestrol acetate and medroxyprogesterone acetate
• Used for the treatment of hormone-responsive, advanced breast
cancer, endometrial cancer, and prostate cancer
• Used in the treatment of endometrial hyperplasia, a precursor to
endometrial adenocarcinoma
• Androgens
• Fluoxymesterone is occasionally used for the treatment of advanced
breast cancer
93Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
94. Hormone supplementation
• Estrogens
• Diethylstilbestrol (DES) is occasionally used to treat prostate
cancer through suppression of testosterone production
• Estrace is an estrogen which was also formerly used for anti-
androgen therapy of prostate cancer
• Polyestradiol phosphate is a long-acting derivative of estradiol
that is applied as an intramuscular injection.
• Somatostatin analogs
• Octreotide is an analog of the peptide hormone somatostatin
• Used for
• Zollinger-Ellison syndrome of gastrinoma
• Chronic hypoglycemia of insulinoma
• Treatment of severe diarrhea caused by 5-fluorouracil chemotherapy or
radiation therapy
94Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition
95. Targeted Therapies
• Definition
• Allow the cancer treatment to “target” a certain cancer cell by
interfering with the natural functions of tumor growth
• How they work
• They “target” specific parts of a cancer cell or its actions
95
Dietel M et al, Targeted therapies in cancer,
96. Biology of Targeted Therapy
96
These drugs act on rapidly dividing cells,
which include normal tissues (e.g., hair,
gastrointestinal epithelium, bone marrow)
in addition to cancer cells
Mechanisms of traditional chemotherapy Mechanisms of targeted therapies
Gerber D E, 2008, American Family Physician
97. Classification of Targeted therapies
• Targeted cancer agents are broadly classified as
• Therapeutic monoclonal antibodies
• Target specific antigens found on the cell surface, such as transmembrane
receptors or extracellular growth factors
• In some cases, monoclonal antibodies are conjugated to radio-isotopes or
toxins to allow specific delivery of these cytotoxic agents to the intended
cancer cell target
• Small molecules
• Penetrate the cell membrane to interact with targets inside a cell
• Usually designed to interfere with the enzymatic activity of the target protein.
97
Gerber D E, 2008, American Family Physician
Intra-arterial chemo
An intra-arterial infusion allows a chemo drug to be given right to the tumor through a
small, flexible tube (catheter) that’s put in the main artery that supplies blood to the
tumor. This method is used to treat disease in an organ such as the liver (this is called
isolated hepatic perfusion), or to treat an extremity such as the leg (called isolated limb
perfusion).
The goal is to concentrate the drug in the area of the tumor and decrease systemic side
effects. The catheter is attached to an implanted or portable pump. Although this
approach sounds like a good idea, most studies have not found it to be as useful as
expected. This approach is being studied for many types of cancer in clinical trials.
Except for clinical trials, it’s rarely available outside of specialized cancer centers.
Intracavitary chemo
Intracavitary is a broad term used to describe chemo given right into a body cavity. The
chemo drug is given through a catheter that’s put into one of the areas as described
below.
Intravesical chemotherapy is often used for early stage bladder cancer. The chemo is
usually given weekly for 4 to 12 weeks. For each treatment, a soft, flexible tube (called a
urinary catheter) is put into the bladder to give the drug. The drug is kept in the bladder
for about 2 hours and then drained. The catheter is taken out after each treatment.
Intrapleural chemotherapy is not used very often but may be helpful for some people
with mesothelioma (cancer that develops in the lining of the lung), and those with lung or
breast cancers that have spread to the pleura (the membrane around the lungs and lining
the chest cavity). Intrapleural chemotherapy is given through soft, flexible tubes called
chest catheters. These catheters can be used to give drugs and to drain fluid that can build
up in the pleural space when cancer has spread to that area.
Intraperitoneal chemotherapy has become one of the standard treatments for certain
stages of ovarian cancer. It may also be used to treat some colon cancers that come back
after treatment, as well as mesotheliomas and cancers of the appendix, liver, or stomach
that have spread throughout the belly (abdomen). Intraperitoneal chemo is given through
a Tenckhoff catheter (a soft tube specially designed for removing or adding large
amounts of fluid from or into the abdominal cavity) or through an implanted port (a small
drum-like device) attached to a catheter. Chemo injected into the port travels through the
catheter into the abdominal cavity where it’s absorbed into the affected area before
entering the bloodstream. This approach can work very well, but it can also have more
severe side effects than chemo put into the bloodstream (IV chemo). The higher doses
that are used, along with more gradual absorption of the drug into the body, may be part
of why the side effects may be worse.
Intrathecal chemotherapy is given right into the fluid surrounding and cushioning the
brain and spinal cord (called the cerebrospinal fluid or CSF) to reach cancer cells in the
fluid and the central nervous system (brain and spinal cord). Most chemo drugs that are
put into the bloodstream are unable to cross the barrier between the bloodstream and the
central nervous system, called the blood-brain barrier. Intrathecal chemotherapy gets the
drug directly to the central nervous system.
Intrathecal chemotherapy is given in 1 of 2 ways:
· The chemo can be given by a lumbar puncture (spinal tap) done daily or weekly. This
is when a thin needle is placed between the bones of the lower spine and into the
space through which the CSF flows around the spinal cord.
· A special device called an Ommaya reservoir can be used. It’s a small, drum-like port
that’s placed under the skin of the skull. An attached catheter goes through the skull
into a ventricle (a space inside the brain filled with CSF). A special needle is put
through the skin and into the port to give the chemo.
Chemo is given this way when it’s needed to treat cancer cells that have entered the
central nervous system. This is seen most commonly in leukemias, but also may happen
with some lymphomas and advanced solid tumors like breast and lung cancers.
Intrathecal chemotherapy does not help when tumors have already started growing in the
brain or spinal cord.
Intralesional chemo
Intralesional chemo refers to the drug being injected directly into the cancerous tumor. It
may be used for tumors that are in or under the skin, and rarely for tumors that are on an
organ inside the body. It’s only possible when the tumor can be safely reached by a
needle, and is most often used when surgery isn’t an option.
Topical chemo
In this use, chemo is put on the skin in the form of a cream or lotion. Most often, it’s used
to treat basal cell or squamous cell skin cancers. It’s also used to treat pre-cancerous
growths on the skin. The patient or a family member usually puts on the chemo cream.
It’s important to understand the schedule, know exactly how to use these potent drugs,
and know what kinds of precautions to use.
In a
2 × 2 design, this study compared sequential doxorubicin, paclitaxel,
and cyclophosphamide (A→T→C) with concurrent
doxorubicin and cyclophosphamide followed by paclitaxel
(AC→T), using a dose-dense (q14d) and a conventional
(q21d) schedule
Figure 1. Mechanisms of traditional chemotherapy. These drugs act
on rapidly dividing cells, which include normal tissues (e.g., hair, gastrointestinal
epithelium, bone marrow) in addition to cancer cells.
Alkylating agents interfere with DNA base pairing, leading to strand
breaks and arresting DNA replication. Topoisomerase inhibitors prevent
DNA uncoiling. Taxanes and vinca alkaloids interfere with microtubule
function required for cell mitosis. Antimetabolites block the
formation and use of nucleic acids essential for DNA replication.
Figure 2. Mechanisms of targeted therapies. The molecular targets
in this figure are not overexpressed in a single cell type, but rather
on various malignant and normal tissues. For example, CD 20 is present
on lymphoma and normal lymphoid cells, HER2/neu is present on
25 percent of breast cancer cells, and VEGFR is present on normal and
tumor-associated vasculature. Downstream intracellular signaling
molecules, some of which are targeted by small molecule inhibitors,
are not depicted. Some drugs (e.g., sorafenib [Nexavar], sunitinib
[Sutent], imatinib [Gleevec], dasatinib [Sprycel]) have multiple targets,
most of which are not depicted. (CD = cluster of differentiation;
BCR-ABL = breakpoint cluster region-Abelson; EGFR = epithelial
growth factor receptor; VEGFR = vascular endothelial growth factor
receptor; VEGF = vascular endothelial growth factor.)