Neoplastic Disease: Principles Of Screening And Management

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Cancer treatments
Local

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radiotherapy
surgery.

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Cancer treatments
Local + regional

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(regional in this context means the lymph nodes that drain the site of the primary tumour)
radiotherapy
surgery.

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Cancer treatments
Systemic

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chemotherapy
hormone treatment
‘biological’ treatments.

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Palliative treatment

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“Ideally, palliative treatment should relieve symptoms without, itself, producing any side-effects. This ideal is often difficult to achieve

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Radical treatment

Radical treatment is given in the hope that it might be possible to cure the patient.

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Radical treatments can be divided into definitive and adjuvant.

Definitive treatment

Definitive treatment is intended to extirpate the known tumour, for example mastectomy for breast cancer or chemotherapy for leukaemia.

Adjuvant treatment

This is treatment given in addition to definitive treatment in an attempt to lower the risk of relapse.

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Adjuvant (subsequent)
Treatment which is given after definitive local treatment: e.g.

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chemotherapy for node positive breast cancer; postoperative radiotherapy for head and neck cancer. The aim is to treat any residual disease

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Neoadjuvant
Treatment which is given before any local or loco-regional treatment: e.g.

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treating large breast cancers with chemotherapy before surgery;
preoperative radiotherapy for rectal cancer

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Total body irradiation

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Low doses of total body irradiation can be given using external beams. This is often used, in combination with chemotherapy, in the management of leukaemias and lymphomas.

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Brachytherapy

The term brachytherapy implies that

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the radiation source is placed near to the treatment target

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Chemotherapy

Cytotoxic drugs act in a variety of ways to

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interfere with cell division

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Antimetabolites prevent the

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synthesis of DNA Examples
methotrexate, (5FU)

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Alkylating agents form cross links between DNA base pairs so that

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separation of the DNA strands cannot occur Examples
cyclophosphamide chlorambucil

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Spindle poisons prevent the formation of the mitotic spindle and thereby prevent the segregation of

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chromosomes that is essential for mitosis

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Intercalating agentinsert themselves into the coils of the DNA double helix to that

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separation of the DNA strands cannot occurs Examples Adriamycin, (doxorubicin

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Oncogenes

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Oncogenes are genes involved in producing cancer
Oncogenes were first identified in viruses known to be associated with malignant disease

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Deranged proto-oncogenes, or cellular oncogenes, could cause cancer through a variety of mechanisms

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by stimulating growth
by failing to suppress abnormal growth

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Failure of suppression of abnormal growth

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Tumour suppressor genes inhibit abnormal growth. Failure of these may give rise to malignancy.