Breast: Navigation Resources Treatment modalities "Invasive breast cancer" Histology - pos/neg margin Triple neg breast ca
- Navigation: through surgery, through radiation/chemo/hormone therapies
- 5-10% are due to BRCA1 and BRCA2
- Treatment modalities:
1. Surgery
2. Chemotherapy: doxorubicin, cytoxan, “Taxanes”, “Platin”
3. Radiation: lumpectomy=always radiation, mastectomy=no radiation
4. Hormone therapy: tamoxifen, no soy
5. Targeted therapy: HER2-herceptin - “Invasive”- has penetrated and grown into adjacent tissue, greater than 1cm, at least 2 regional lymph nodes, metastisized
- Positive margin: cancer cells DONT touch margin/edges
- Negative margin: cancer cells touch edges, need local tx like radiation
- Triple neg: HER2, Progesterone, Estrogen
Lung: SCL vs NSCLC Sites of mets Symptoms Treatment Targeted therapies
- SCLC: rare, but most aggressive, radiation is the best therapy
- NSCLC: most common, neuroendocrine type of ca, grows everywhere above diaphragm
- Sites of mets: bone/liver/brain
- Symptoms: cough, SOV, hemoptysis, weight loss, pain at site
- Treatment: Chemo (neoadjuvant)+surgery or radiation - etoposide+cisplatin, paclitaxel+carboplatin
- Targeted tx: EGFR nolotnib AE skin rash
Bladder: Treatment used Metastatic sties Acute toxicities Late toxicities
- Tx: surgery, chemo directly into bladder called BCG therapy, cisplatin, gemcitabine
- Men: pelvic bone mets
- Acute tox: cytis
- Late: GI effects
Prostate: Treatment used Metastatic sties Acute toxicities Late toxicities Prostatectomy post op
-Tx: surgery, radiation (brachytherapy-high dose rad to local spot), watch and wait, hormone therapy-testosterone blocking drug.
Docetaxel Cabazitaxel
Mitoxantrone
Estramustine
- Men: bone mets all over
-AE: impotence, GI and neighboring organs
-Post op monitor urine output
Ovarian, Endometrial, Cervical: Symptoms Treatment Side effects from Tx Sites of mets Chemoprevention Target Pregnancy and chemo
- Endometrial has the higher incidence
- Cervical highest in latina, common risk factor HPV16
- Ovarian- associated with malignant ascites
- Symptoms; ovarian bloating, endometrial vaginal bleeding
- Tx all: surgery (main) - hysterectomy uterus or total uterus+cervix, oopherectomy ovaries, salpingo fallopian tubes, IV or IP chemo adjuvant-carboplatin, paclitaxel
- Tx endometrial: also radiation
- Tx cervical: radiation brachytherapy, cisplatin
- AE: acute-constipation, nausea, pain, dehydration, late-fistulas
- Mets in abdominal cavity
- Chemoprevention: to prevent from getting cancer, birth control pills
- Target: CA125
- After 1st trimester, can receive full dose chemo
Melanoma:
Treatment
Common sites
Side effects of Tx
- Tx: traditional chemo not used. OLD: IFN-like flu, IL-2-septic shock, NEW: PD1 inhib: pembro or novolimab, MOHS surgery microscopic skin layers are removed
- can be found everywhere on the skin, if closer to the core then likely to have bone mets
- Metastatic melanoma tx: high dose IL-2
- AEs are immunologic
- Melanoma can spread from mother to fetus
- Other types of skin cancer: Basal cell and squamous cell carcinoma
Lymphoma: Types Treatment Common sites of spread Immediate vs late side effects Red streak Relapse
- Types: Hodgkins (HL) and non-hodgkins (NHL more common)
- Tx: NOT SURGERY, systemic/targeted chemo EPOCH CHOP, ABVD (doxorubicin, vinblastine,belomycin,dacarbazine) vincristine cyclophosamide, auto SCT
- Sites: anywhere CNS lymph (IT chemo)
- AE: early myelosuppression
- ABVD- red streak up vein is a doxorubicin specific ax inflammatory rx
- pts dont become infertile
- G0 phase of the cell cycle is the least responsive to chemo
- Relapse-Auto SCT
- newly dc unfavorable if ALC <600
Basal cell carcinoma
Raised, pearly lesion
Minute
Well-defined margin
Has telangiectasia
Astrocytoma
Type of cancer occur in brain or spinal cord
Carcinoid syndrome
S/s GI
weight loss Abd pain Diarrhea that offen interrupts sleep Flushing Less frequently - heart failure,vomiting, bronchoconstrictikn
Hx of relative with prostate cancer
- para-neoplasticism syndrome
Oligodendroglial Tumors
Nerve says
Originate from cell that maintain the function of the myelin sheath
Bladder cancer
Best surgical treatment is a radical cholecystectomy done by experienced surgeon
Renal cell cancer
Temsirolimus
Metastatic renal: high dose IL-2
Colorectal cancer
elevated CEA=reccurrence
Hepatocellular cancer
elevated AFP
Hep B leading cause in world
Hep C leading cause in US, Europe, Japan
Pancreatic cancer
RAS gene mutations found in 90%
