Cancer treatments - STH
Transcript of Cancer treatments - STH
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Cancer treatments
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• Animal – chemotherapy
• Film – radiotherapy
• Music – cancer treatment
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What are the main treatments?
• Hormone therapy
• Surgery
• Chemotherapy
• Radiotherapy
• Targeted anti-cancer therapy (immunotherapy)
• Now put them in the order that they were
introduced
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Date of introduction
• Surgery – 1846
• Radiotherapy – 1896
• Hormone therapy – 1930s (prostate)
1960s (breast)
• Chemotherapy – 1950s
• Immunotherapy – 1970s
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Surgery
• What is surgery used for?
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Surgery can be used to.......
• Make a diagnosis – Biopsy to see the type of cancer and how quickly it might grow
(grade) • fine needle aspiration (FNA)
• core biopsy
• Incisional biopsy
• excisional biopsy
– Can be assisted by endoscopy, ultrasound, CT guided
• Stage cancer – size, extent and location of a cancer
• Treat cancer – If there is a complete resection/clear margins and it has not
spread it can be a curative treatment
– Regional lymph nodes can also be removed to look for cancer spread
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Surgery can be used to.......
• Debulk a cancer growth - remove some, but not all, of the cancer – done when complete resection is not possible as it could cause
too much damage to nearby organs or tissues
• Reconstruct part of the body affected by cancer or its treatment
• Prevent or reduce occurrence in high familial risk of cancer
• Control symptoms or increase quality of life (palliative surgery) – Tumour pressing on nerves or other organs causing pain
– Orthopaedic surgery to support bone affected by metastases
– Remove obstruction e.g. bowel blocked by cancer growth
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Use of surgery will depend on....
• Type of cancer
• The stage and location
• Aim of treatment
• General health
– fitness for anaesthetic,
– managing post-op rehabilitation
• Can be combined with other cancer
treatments
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Radiotherapy
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Radiotherapy
• Radiotherapy is a local treatment
– Targeted to specific sites in the body
• It uses of ionising radiation to damage DNA
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https://www.youtube.com/watch?v=Zw0pHT
47AAU
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Ionising radiation
• Radiation that is able to disrupt the chemical structure of the material that is passes through
• Molecules are basic building blocks for all living and non living things
• They are made of atoms
• Ionising radiation excites cell molecules and changes their atomic and molecular structure
• These changes cause damage to the cell
• The target of damage with radiotherapy is the cells DNA
• Cells that are dividing are more prone to damage from radiotherapy
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How is it given?
• External beam
– Linear accelerator (LA)
• Treatment delivered by therapy radiographers
– Radiation is created by the machine
– No radiation present when machine switched off
– Patient does not become radioactive
• Brachytherapy
– Sealed and unsealed sources
• Sealed source – radiation is located in the source
• Unsealed sources – patient is temporarily radioactive
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Linear accelerator
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The aims of radiotherapy treatment
Maximise the damage to cancer cells while minimising the
damage to healthy cells
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How is this achieved?
• Splitting the dose into small parts and giving a little each
day
– This is called fractionation
• Increases the chances of catching cancer cells when they are sensitive to radiotherapy
• Gives normal cells a chance to recover from sub-lethal damage
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How is this achieved?
• Control of the treatment field
– planning, simulation
– accurate setting up and delivery of treatment
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Careful positioning
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Side effects of radiotherapy
• Severity related to the dose the patient receives
• Side effects are classified as – Acute and chronic
– Local and systemic
• When do side effects occur? – Start to appear in the first 2 weeks
– increase in severity over the course of treatment,
– peak 2 weeks after treatment has ended
• Effects experienced by all patients – Fatigue
– Skin reactions
• Other side effects are site specific
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Support during treatment
Times for support
• Deciding to have treatment
• The first treatment
• The treatment experience
– Arduous, requires patience, can be embarrassing
– Inconvenience - travelling, delays, waiting
• Side effects
• Consequence of diagnosis (uncertain outcomes)
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Radiation safety
• Use of ionising radiation very carefully controlled and regulated
• Measures in place to prevent exposure to radiation
• Staff are monitored if they are likely to be exposed on a regular
basis
•
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Radiation protection – safety principles
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Chemotherapy
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How does chemotherapy work?
• Chemotherapy is a systemic treatment
– This means it can effect all the cells in the body
• Chemotherapy drugs stop cells from dividing or make it difficult for them to do so
• Different chemotherapy drugs do this in different ways
• Many work at particular points when the cell is dividing
– This is often referred to as the cell cycle
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The cell cycle
Cellular content other than
Chromosomes duplicated
All of the 46
chromosomes are
duplicated
The chromosomes are
checked and repairs made if
needed
G0
Cell Cycle Arrest
S Phase Antimetabolites
G2 Phase
Bleomycin
Mitosis
Vinca alkaloids
Mitosis
G2
G1
S
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How does chemotherapy work?
• Some drugs work at specific parts of the cell cycle,
others can work at any point
• Actions include
– Stopping cell division (M phase) by fusing the old and
new cells together
– Preventing the products needed make the new DNA
from getting to where they need to be
– Directly damaging DNA
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The aims of chemotherapy Maximise the damage to cancer cells while minimising the damage to
healthy cells, getting it just right!
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How is this achieved?
• Giving combinations of drugs
– Increased cancer cell kill if more than one type of drug is given – they attack in different ways
– Giving drugs with different side effects means you can get more impact and fewer side effects
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How is this achieved?
• Cycles of administration
– Giving a small amount each time
• Increases the chance of catching cells when they are sensitive to chemotherapy
• Allows healthy cells to repair
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Side effects
• The incidence and occurrence of side effects is
drug and dose related
• It is essential to know the regime specific facts
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Side effects
• Bone marrow depression
– Infection (neutropenia)
– bruising/bleeding (low platelets)
– red blood cells (anaemia)
• Nausea and vomiting
– ematogenic potential
• Fatigue
• Sore mouth
• Hair loss
• Altered bowel habit
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Hormone therapy
• A hormone is a chemical messenger
• It is produced in one part of the body and affects
cells in another part
• Examples of hormones include insulin, steroids,
thyroxine
• The main hormones involved in cancer and
cancer treatment are oestrogen, testosterone
and progesterone
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Hormone therapy
• Some cancers are hormone dependant
• This means they use hormones to help them
divide and survive
• Prostate and breast cancer can be hormone
dependant
• Tests need to be carried out for each patient to
identify if it is hormone dependant
– If it is then hormone treatment can be started
– This can also be called endocrine therapy
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Types of hormone treatment
• Hormone treatments work by blocking the pathway
through which hormones get to the cancer • They work in one of two ways
– Stopping or lowering the secretion of the hormone
– Block the receptor on the cancer so the hormone
can’t get to it
• This can slow the growth or shrink the cancer for a time
– Not a cure but can be very effective over a long
period of time
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How do hormone therapies work?
• Surgical removal of the organ that produces the hormones – Orchidectomy, Oopherectomy
• Analogues – Copy the hormone and fool the body into thinking it
doesn’t need to make and release any more
• Antagonists – Sit on the receptors and stop the hormone from
getting to the cancer
• Hormone releasing blockers – Stop the organ that usually produces the hormone
from making and releasing it
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Side effects
• Hot flushes
• Reduced libido
• Impotence
• Osteoporosis
• Weight gain
• Fatigue
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Targeted therapies
• New treatments in cancer therapy
• Number and use are increasing
• Is it the new frontier!!!!!
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Traditional chemotherapy
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Targeted therapy
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Working together to increase effectiveness
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How do they work?
• They work in lots of different ways to
– slow or stop tumour growth
• They can
– Put up barriers to the signalling pathway that
causes cancer cell division
– Prevent the formation of tumour blood vessels
– Stop the production of growth factors and
enzymes tell the cells to divide
– Alert the immune system to the cancers
presence so it can be targeted
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When are they used?
• They are often used when a cancer “over expresses” a particular growth factor
• Tests are done to see if the growth factor is being produced by the cancer – If it is then targeted immunotherpy treatment is given
• For example some breast cancer over-express a growth factor called HER2 – Tests are done to assess the HER2 status to see if it
is over-expressed
– If it is then they may receive Herceptin as part of their treatment
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Examples of targeted therapy
• They often end in the letter MIB or MAB!
• Tyrosine kinase inhibitors (TKI’s)
– Erlotinib, imatinib, sunitinib
• Monoclonal antibodies
– Rituximab, Cetuximab, Bevacizumab
• Side effects
– As many as there are different treatments!
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The context of treatment
• The type and range of treatments patients
receive will depend on many factors
• Terms you might hear
– Curative and palliative
– Adjuvant and neo-adjuvant
• Patient’s experience of cancer and its
treatment is shaped by contextual factors
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Context of treatments
• The treatment
environment – Welcoming, friendly and
helpful
• Previous treatment
• Diagnosis/prognosis
• Knowledge and understanding
• Relationship with staff
• Symptoms and side effects
• Home situation
• Family and friends
• Stage in life
• Work and social life
• Financial situation
• Body image
• Past experience
• Physical functioning
• Other illnesses
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• Thank you for listening……
• Hope you found the journey interesting!