Flashcards in treatment of cancer Deck (15)
what is the approach to cancer treatment?
stratified medicine - this is phenotype or molecular characteristics consideration - occurs within a MDT
what is the process of stratifying patients based on phenotype and molecular characteristics?
first there is patient selection - ensuring they are eligible
then there is molecular selection - looking at response to chemo
then there is a trial period to see the primary outcomes and compared to group from randomisation
what are main signs and symptoms of cancer?
lethargy, weight loss, back and abdo pain, social, family and past medical history, shortness of breath, change in bowel habits, contraception pill, pale, tender, low Hb and albumin and high Alk phosphate and calcium, hypodense lesions on the liver
what shows a cancer is invasive?
if it has pushed through layers
what is the result of infiltration??
worse prognosis, especially if into the muscularis propria layer in CRC
what are the investigations in cancer suscpicion?
CXR, USS, colonoscopy, biopsy, pathology, DNA extraction and FISH, microscopic examination, genetic testing
what will happen if there is a positive result for cancer?
referral to oncology
what does pathology look at?
infiltration, gland formation, immunohistochemistry for factors such as TTF1 and mismatch repair proteins
what is the final destination for a terminally ill patient?
what is the prevalence of microsatellite instability in CRC?
what are the microsatellite cases of CRC comprised of?
12% are somatic events - epigenetic silencing of MLH1 for example
3% are due to germline mutations in one of the MMR genes
what is the result of MI in CRC?
better prognosis but less benefit from chemotherapy
what is the result of Lynch syndrome?
there is a high risk of recurrent neoplasia - 40% at 30y/o
this can occur in multiple sites
what is the resulting Lynch syndrome treatment?
may need to alter standard surgical treatment which would usually be a local resection - total protocolectomy or hysterectomy