CANCER TREATMENTS
Ellen Bellairs, M.D.
May 22, 2000
- This lecture covered three specific cancers that have already been
discussed.
- You will need to know, in detail, the specific treatments.
Breast Cancer (most common in women)
· Incidence Rate (per 100,00 women):
- Sweden 129.5
- U.S. 108.8
- Italy 108.6
- Netherlands 106.8
- United Kingdom 94.3
- France 84.3
- Germany 76.4
- Spain 60.1
- Japan 37.0
· Local Manifestations: Signs & Symptoms at Presentation:
- o
Palpable mass
o Thickening
o Pain
o Mass or pain in the axilla
o Nipple discharge
o Nipple retraction
o Edema or crythema of the skin
· Warning Signals:
o Scaly skin around the nipples
o Change in skin color
o Changes in skin color or texture (e.g. "orange peel"
skin)
o Limp under the arm
· Therapeutic Options:
Surgery
Radiotherapy
Chemotherapy
Hormonal therapy
Immunotherapy
New therapies
Supportive care
· Surgical Options:
o Local excision – only tumor is removed
o Wide excision – tumor plus some normal tissue is removed
o Quadrantectomy – quadrant of tumor is removed
Patient Selection for Conservative Surgery & Radiotherapy:
Early stage breast cancer T1 & T2
Only 1 lesion in the breast
No involvement of skin, chest wall
No collagen Vascular Disease
No prior radiation
Patients who do NOT want mastectomy
Radiation therapy for Early Breast Cancer:
Consultation
Set up/ simulation/ dosimetry
Daily treatment
Follow up
Side Effects Associated with Radiation therapy to the Breast:
Short Term (acute) -
Skin irritation, erythema
Increase sensitivity in the breast
Slight fatigue
NOT -
Nausea/vomiting
Hair loss
Long Term (late) -
Scarring/ fibrosis of the breast
Swelling/ edema of the arm
Scarring of the lung
NOT -
Increase incidence of cancer in other breast
Increase incidence of secondary cancer
Prostate Cancer (Most common in men)
Early Detection (yearly - men >50:
PSA blood test
Digital rectal examination (DRE)
Gleason Grading of Prostate Cancer
Treatment Options:
Many different approaches
Not all recommended for each patient
Depends on stage, grade, PSA level, general health, status of patient
Depends on individual patient preference
Getting the Correct Match:
Stage
Gleason score
PSA level
Health status/ age
Patient preference
Informed Decision:
Surgery
Radiation
Brachytherapy
Cryotherapy
Neoadjuvant hormonal therapy
Watchful waiting
Investigational Rx
Lung Cancer (most common cause of death in both men and women)
Staging/Grouping:
- Occult Tx N0 M0
- Stage 0 T1s N0 M0
- Stage 1 T1 N0 M0
- T2 N0 M0
- Stage 2 T1 N1 M0
- T2 N1 M0
- Stage 3A T1 N2 M0
- T2 N2 M0
- T3 N0 M0
- T3 N1 M0
- T3 N2 M0
- Stage 3B Any T N3 M0
- T4 Any N M0
- Stage 4 Any T Any N M1
Number of Patients Diagnosed (1994):
Stage I, II - 37,000
Stage III - 66,000
Stage IV - 48,000
Multidisciplinary:
Pulmonologist
Thoracic surgeon
Medical oncologist
Radiation oncologist
Sequential Therapy - CALGB 8433:
Randomized:
60 Gy thoracic radiotherapy (TRT)
Chemotherapy - 60 Gy TRT
Induction Therapy (Stage IIIA NSCLC, Rosnell):
Stratify:
Histology
Size and location
Number of possible N2
Levels
Randomized:
Chemotherapy X 3, surgery, radiotherapy (50 Gy)
Surgery, radiotherapy (50 Gy)
Cost of Some Common Chemotherapy Agents:
Drug: Cost per dose ($):
Paclitaxel 200 mg/m2 1502.78
Germoitabine 1000 mg/m2 470.73
Vinorelbine 30 mg/m2 178.93
Cisplatin 80 mg/m2 25.57
Mannitol 12.5 mg 4.10
Will Radiation Make Me Radio Active?
NO
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