... 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 ... (Fig. 81-2). Plotting the fraction of surviving cells against doses of x-rays or
gamma radiation, the curve has a shoulder that reflects the cell's repair of sublethal
damage, followed by...
... endogenous regulators of the cell death
pathway are activated (Fig. 81-3).
Figure 81-3
Chapter 081. Principlesof
Cancer Treatment
(Part 9)
Following demonstration of activity in animal ... 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 ...
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 ... 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 ... action of particular
pathways. For example, the p210
bcr-abl
fusion protein tyrosine kinase drives chronic
myeloid leukemia (CML), and HER-2/neu stimulates the proliferation of certain
breast cancers....
... 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, ... this "organ-like" behavior of tumors may provide additional clues to
cancer control and treatment.
treatment has the potential to cause harm, and treatment may be given that
produces...
...
Principles ofCancer Surgery
Surgery is used in cancer prevention, diagnosis, staging, treatment (for both
localized and metastatic disease), palliation, and rehabilitation.
Prophylaxis
Cancer ...
in those with pancolonic involvement with ulcerative colitis), the presence of
Chapter 081. Principlesof
Cancer Treatment
(Part 2)
Figure 81-1
... incisional biopsy is the procedure of
second choice. A wedge of tissue is removed, and an effort is made to include the
majority of the cross-sectional diameter of the tumor in the biopsy to minimize...
... 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 ... resection of certain tumors that would otherwise not be
possible.
Chapter 081. Principlesof
Cancer Treatment
(Part 3)
Staging
As noted in Chap. 77, an important component of patient ... including local control of tumor,
preservation of organ function, debulking that permits subsequent therapy to work
better, and staging information on extent of involvement. Cancer surgery aiming...
... 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 ... 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 ... 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...
... 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 ... dose of therapeutic radiation exists below which the
incidence of second cancers is decreased. High rates of second tumors occur in
people who receive as little as 1000 cGy.
Chapter 081. Principles ... Principlesof
Cancer Treatment
(Part 6)
Application to Patients
Teletherapy
Radiation therapy can be used alone or together with chemotherapy to
produce cure of localized tumors and control of...
... uncontrolled proliferation through the
Chapter 081. Principlesof
Cancer Treatment
(Part 7)
Karnofsky was among the first to champion the evaluation of a
chemotherapeutic agent's benefit by ... providing a basis for patients to make sensible
choices.
Cancer Drugs: Overview and Principles for Use
Cancer drug treatments are of four broad types. Conventional
chemotherapy agents were ... 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"...
...
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 ... 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. ... metastatic cancers. If a tumor is localized to a single site, serious
consideration of surgery or primary radiation therapy should be given, as these
treatment modalities may be curative as local treatments....
... 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 ... cause profound myelosuppression,
alopecia, and pulmonary toxicity but is relatively "lymphocyte sparing." Its routine
case. Thiotepa can be used for intrathecal treatmentof neoplastic ... nonenzymatic hydrolysis in
tumors and is bioavailable orally.
use in treatmentof CML has been curtailed in favor of imatinib (Gleevec)or
dasatinib, but it is still employed in transplant...
... 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 ...
sarcoma and ovarian cancer.
Bleomycin refers to a mixture of glycopeptides that have the unique feature
of forming complexes with Fe
2+
while also bound to DNA. Oxidation of Fe
2+
gives
rise ... 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...
... 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, ...
lead to progress of the replication fork off the end of a DNA strand. The DNA
damage is a potent signal for induction of apoptosis. Camptothecins promote the
stabilization of the DNA linked...
... 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 ... 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 ... clotting function abnormalities. Close monitoring of clotting functions should
accompany use of asparaginase. Paradoxically, owing to depletion of rapidly
turning over anticoagulant factors,...