... benefit. One of the challenges ofcancer
treatment is to use the various treatment modalities alone and together in a fashion
that maximizes the chances for patient benefit.
Cancer treatments ... attention to minimizing the toxicity of
potentially toxic treatments becomes a significant goal. Irrespective of the clinical
scenario, the guiding principle ofcancertreatment should be primum succerrere, ...
medicine–related areas of expertise. Treatments for patients with hematologic
malignancies are often shared by hematologists and medical oncologists.
In many ways, cancer mimics an organ attempting...
...
Principles ofCancerSurgery
Surgery is used in cancer prevention, diagnosis, staging, treatment (for both
localized and metastatic disease), palliation, and rehabilitation.
Prophylaxis
Cancer ... can be prevented bysurgery in people who have premalignant
lesions resected (e.g., premalignant lesions of skin, colon, cervix) and in those
who are at increased risk ofcancer from either ...
in those with pancolonic involvement with ulcerative colitis), the presence of
Chapter 081. Principlesof
Cancer Treatment
(Part 2)
Figure 81-1
...
... information for treatment planning and may determine the extent and nature of
primary cancer treatment.
Treatment
Surgery is the most effective means of treating cancer. Today about 40% of
cancer ... defined by injecting a dye into the tumor site at operation and
if needed—may allow resection of certain tumors that would otherwise not be
possible.
Chapter 081. Principlesof
Cancer Treatment ... even when the disease is not curable bysurgery alone, the
removal of tumor can obtain important benefits, including local control of tumor,
preservation of organ function, debulking that permits...
... Chapter 081. Principlesof
Cancer Treatment
(Part 4)
Palliation
Surgery is employed in a number of ways for supportive care: insertion of
central venous catheters, control of pleural and ... for recurrent pulmonary emboli, stabilization of cancer-
weakened weight-bearing bones, and control of hemorrhage, among others.
Surgical bypass of gastrointestinal, urinary tract, or biliary ... DNA breaks produced
by single hits. The exponential component represents breaks produced by multiple
hits (Fig. 81-2). Plotting the fraction of surviving cells against doses of x-rays or
gamma...
... dose in the target volume is often the cause of
complications to tissues in the transit volume, and the minimum dose in the target
Chapter 081. Principlesof
Cancer Treatment
(Part 5)
Although ... basis of the amount of radiation absorbed in
the patient; it is not based on the amount of radiation generated by the machine.
The rad (radiation absorbed dose) is defined as 100 erg of energy ... include the D
0
of
the tumor (the dose required to deliver an average of one lethal hit to all the cells
in a population), the D
q
of the tumor (the threshold dose—a measure of the cell's...
... breast cancer, Hodgkin's disease, head and neck cancer,
prostate cancer, and gynecologic cancers. Radiation therapy can also palliate
disease symptoms in a variety of settings: relief of bone ... selectively
taken up bycancer cells by mechanisms not fully defined. When light, usually
delivered by a laser, is shone on cells containing these compounds, free radicals
dimensional treatment planning ... developing breast cancerby age 55
years. This is comparable in magnitude to genetic breast cancer syndromes.
Women treated after age 30 have little or no increased risk of breast cancer. No
data...
... sensible
choices.
Cancer Drugs: Overview and Principles for Use
Cancer drug treatments are of four broad types. Conventional
chemotherapy agents were historically derived by the empirical observation ... connotes disappearance of all
tumor; progression of disease signifies an increase in size of existing lesions by
>25% from baseline or best response or development of new lesions; and "stable" ...
expressed by the tumor cells. As described in Chapter 80, successful tumors have
activated biochemical pathways that lead to uncontrolled proliferation through the
Chapter 081. Principlesof
Cancer...
...
Neuroblastoma
Chapter 081. Principlesof
Cancer Treatment
(Part 8)
Principles of Chemotherapy
Medical oncology is the subspecialty of internal medicine that cares for and
designs treatment approaches ... metastatic cancers. If a tumor is localized to a single site, serious
consideration ofsurgery or primary radiation therapy should be given, as these
treatment modalities may be curative as local treatments. ... Chemotherapy may be
employed after the failure of these modalities to eradicate a local tumor or as part
of multimodality approaches to offer primary treatment to a clinically localized
tumor....
... improve their use.
A general view of how cancer treatments work is that the interaction of a
chemotherapeutic drug with its target induces a "cascade" of further signaling
steps. These ... Principlesof
Cancer Treatment
(Part 9)
Following demonstration of activity in animal models, conventional
chemotherapeutic agents are further evaluated to define an optimal schedule of
administration ...
Valuable cancer drug treatment strategies using conventional chemotherapy
agents, targeted agents, hormonal treatments, or biologicals have one of two
valuable outcomes. They can induce cancer...
... function of these
Chapter 081. Principlesof
Cancer Treatment
(Part 10)
Integration of cell death responses. Cell death through an apoptotic
mechanism requires active participation of the ... activate aspects of this process by damage ultimately
conveyed to the mitochondria, perhaps by activating the transcription of genes
adverse prognosis if they express high levels of p170PGP, and ... novel mechanisms of action,
combinations of drugs and targeted agents may maximize the chances of affecting
critical pathways in the tumor.
Chemotherapeutic Agents Used for CancerTreatment
Table...
... 081. Principlesof
Cancer Treatment
(Part 12)
Direct DNA-Interactive Agents
DNA replication occurs during the synthesis or S-phase of the cell cycle,
with chromosome segregation of the ...
dacarbazine but was designed to be activated by nonenzymatic hydrolysis in
tumors and is bioavailable orally.
use in treatmentof CML has been curtailed in favor of imatinib (Gleevec)or
dasatinib, ... cause profound myelosuppression,
alopecia, and pulmonary toxicity but is relatively "lymphocyte sparing." Its routine
case. Thiotepa can be used for intrathecal treatmentof neoplastic...
... incidence of anaphylaxis with early
preparations of the drug has led to the practice of administering a test dose of 0.5–
1 unit before the rest of the dose. The most feared complication of bleomycin ... metabolized by the liver, so
doses must be reduced by 50–75% in the presence of liver dysfunction.
Daunorubicin is closely related to doxorubicin and was actually introduced first
into leukemia treatment, ... p53 and Rb pathway lesions as the result
of defective checkpoint mechanisms in cancer cells. Owing to the role of
topoisomerase I in the procession of the replication fork, topoisomerase I poisons...
...
transported into cells by the folate carrier, and high concentrations of drug can
bypass this carrier and allow diffusion of drug directly into cells. These properties
treatmentof superficial transitional ... action of a DNA
damage checkpoint. Prominent clinical effects include myelosuppression, nausea,
Chapter 081. Principlesof
Cancer Treatment
(Part 14)
Mitomycin C undergoes reduction of its ... arisen shortly after exposure of patients to mitoxantrone, particularly
in the adjuvant treatmentof breast cancer. While chemotherapy-associated
leukemia is generally of the acute myeloid type,...
... refractory cancers.
Intravenous administration of 5FU leads to bone marrow suppression after short
infusions but to stomatitis after prolonged infusions. Leucovorin augments the
activity of 5FU by ... motile and secretory processes occur. Microtubules are composed of
repeating noncovalent multimers of a heterodimer of α and subunits of the protein
tubulin. Vincristine binds to the tubulin dimer ... vesicant, and infiltration can be treated by local heat and infiltration of
hyaluronidase. At clinically used intravenous doses, neurotoxicity in the form of
glove-and-stocking neuropathy is frequent....