Oncology: General Cancer Treatment

General Cancer Treatment

Types of Therapy

  • Chemotherapy: Chemical Medications Used to Kill Rapidly-Growing Cells
  • Radiation Therapy: High-Doses of Radiation Used to Fight Cancer
  • Immunotherapy: Medications Help the Immune System Fight Cancer
  • Hormone (Endocrine) Therapy: Uses Hormones Fight or Slow Cancer

Timing of Therapy

  • Neoadjuvant: Before Surgery
  • Adjuvant: After Surgery
  • Salvage: If Failed to Respond to Initial Chemotherapy
  • Definitive: Nonoperative Candidate Treated Only with Chemotherapy or Radiation

Response

  • Mets Most Likely to Be Cured with Surgery: Germ Cell Tumors (Seminoma)
  • Best Spontaneous Regression: Melanoma, Neuroblastoma & Testicular Tumors

Tumor Lysis Syndrome (TLS)

  • Cause: Release of Purines/Pyrimidines from Tumor Lysis
  • Effects: Electrolyte Abnormalities
    • Increases K, PO4, Uric Acid & Lactic Acid (From Intracellular Release)
    • Decreases Ca (PO4 Precipitates Calcium Phosphate)
  • Tx: IV Fluids (#1), Allopurinol & Rasburicase (Metabolize Uric Acid)
    • Dialysis if Needed

Cancer Staging

  • TNM Staging Established Through the American Joint Committee on Cancer (AJCC)
  • Can Have Clinical or Pathologic Staging
    • Clinical Staging – Based on Preoperative Imaging, Tests & Studies
      • Denoted with a “c” Before Each of the TNM Elements
    • Pathologic Staging – Determined by Surgical Pathology After Resection
      • Denoted with a “p” Before Each of the TNM Elements
    • Patients that Have Neoadjuvant Therapy Will Have an Additional “y” Before the “p”
      • For Example: ypT2, ypN0
  • Overall Stage: Based on TNM Status
    • Four Stages (1-4)
    • ‘in situ’ Cancers are Considered Stage 0
  • T-Stage: Based on Tumor Characteristics
    • Can be Based on Size, Depth or Extent of Disease Depending on Cancer Type
    • Stages: T1-4 & ‘in situ’ May Be Notated as Tis
  • N-Stage: Based on Nodal Involvement
    • Can be Based on Number of Nodes or Lymph Node Basin Involved
    • Stages: N0-N3
  • M-Stage: Based on Distant Metastases
    • Stages: M0 or M1

NCCN Guidelines

  • Found at nccn.org
  • Generally Considered the Gold Standard in Cancer Management