Oncology

• Oncology


  The study of tumours
• Cancer

  A disease caused by an uncontrolled division of abnormal cells in a part of the body
• Cancer/oncology is an all encompassing word which covers all aspects of solid tumour and haematology cancers
• There are over 100-200 different types of cancer
• The main types of cancer

  • Lung
  • Colorectal
  • Prostate
  • Breast
• Types of cells affected in cancer

  • Epithelial cells (lining cells) - carcinomas (90%)
  • Blood or lymphatic - leukaemias or lymphomas (7%)
  • Connective tissue cells - sarcomas (1%)
• Red flag symptoms or signs

  • Unintentional weight loss
  • Pain
  • Shortness of breath
  • Blood where it shouldn't be
  • Any 'big change' in the body over 2-3 months
• Screening


  A process of identifying apparently healthy people who may be at increased risk of a disease or condition
• Screening does not reduce the risk of developing cancer, but for some cancers it may help with early detection and hence improve the therapeutic outcome and increase survival
• Screening should be distinguished from diagnosis
• Screening programmes factors


  • How effectively the tests distinguish between individuals with cancer and those without
  • To what extent any diagnosed malignancy causes clinical problems
  • To what extent the screening test puts the individual at risk
  • What the beneficial and harmful effects of the treatment are on the patient's quality of life
• Diagnostic tests


  • Blood tests
  • Scans
• Scan types


  • X-ray
  • Ultrasound
  • Endoscopic Ultrasound Scan (EUS)
  • Positron Emission Tomography (PET)
  • Magnetic Resonance Imaging (MRI)
  • Computer Tomography (CT)
• Scan characteristics


  • X-ray uses x-radiation, Ultrasound uses sound waves
  • EUS uses a tube-like instrument called an endoscope with an ultrasound scanner attached
  • PET shows up changes in tissues that use glucose as their main source of energy
  • MRI uses magnets to create an image of the tissues of the body
  • CT uses a number of x-rays to make a 3D image of an affected area
• Staging helps to classify solid tumours
• Principles of cancer treatment

  • Success of treatment depends on the stage at which the cancer is diagnosed & determines the type of treatment offered to the patient
• Treatment aims


  • Destroy the tumour
  • Reduce the tumour in size to improve quality of life for the patient
• Treatment options


  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Hormonal therapy
  • Transplant
• Surgery

  If you cut the tumour out then your body is free of the cancer (in theory)
• Radiotherapy


  Uses ionising radiation to damage cancer cells, with normal cells repairing themselves faster than cancer cells
• Chemotherapy


  Cytotoxic chemotherapy works by killing cells, with actively dividing cells being most affected
• Chemotherapy administration routes


  • Intravenous (IV)
  • Oral
  • Intrathecal (IT)
  • Bladder - intravesical
  • Intrapleural
• Extravasation


  The leakage (or accidental infiltration) of drugs outside of the vein and into surrounding tissues
• Consequences of extravasation


  • Stop chemotherapy/infusion
  • Hospitalisation / more hospital visits
  • Psychological consequences
  • Possible infections
  • Loss of income
  • Lawsuit
  • Impact on family
  • Impact on professionals
• Common antidotes used for extravasation

  • Heat or cold packs
  • Steroids
  • Dimethyl sulphoxide (DMSO)
  • Hyaluronidase
  • Sodium triosulphate
  • Dexrazoxane (Savene)
• Targeted therapy


  Blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumour growth
• Immunotherapy


  Uses the body's immune system to fight the abnormal cancer cells, boosting the immune system
• Immunotherapy side effects


  • Very different from chemo, radio and surgery
  • Many agents are taken orally and may be perceived as 'safer' than parenteral chemotherapy
  • May cause hypertension or cardiac complications, rather than neutropenia or bone marrow suppression or nausea and vomiting
  • One common side-effect from tyrosine kinase inhibitors is skin toxicity
• Hormonal therapy


  Involves the manipulation of the endocrine system by administering medicines that inhibit the production or activity of certain hormones
• Transplant


  Stem cell transplantation involves eliminating a patient's haematopoietic and immune system by chemotherapy and or radiotherapy and replacing it with stem cells either from another individual or with a previous harvested portion of the patient's own haematopoietic stem cells
• Research, more targeted therapies, and genomics/gene therapies are the future in cancer treatment
• Risk factors for non-small cell lung cancer (NSCLC)

  • Current tobacco smokers are 15 times more likely to die from lung cancer than life-long non-smokers
  • Risk is associated with both duration and consumption
  • Smoking cessation is beneficial even in patients who have smoked for many years
  • Exposure to other known carcinogens (e.g. asbestos) have been associated with lung cancers
  • Radon, a naturally occurring gas, is thought to be the 2nd biggest cause of lung cancer
  • Family history
• Treatment options for NSCLC

  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Targeted therapies (Tyrosine Kinase inhibitors, Immunotherapy)
• Staging and treatment options for NSCLC

  • Stage 0-I: Curative surgery via lobectomy
  • Stage II-III: Surgery and Chemotherapy combined with radiotherapy (chemoradiotherapy)
  • Stage IV: Palliative chemotherapy, or targeted treatment if eligible
• Chemotherapy regimen for NSCLC

  • Cisplatin plus vinorelbine (every 21 days)
  • Cisplatin 130mg/m2 IV on day 1
  • Vinorelbine 30mg/m2 (max 60mg) IV on days 1 and 8
• Adverse effects of Cisplatin/Vinorelbine regimen

  • Bone marrow suppression
  • Nausea and vomiting
  • Nephrotoxicity
  • Peripheral neuropathy
• Oral targeted therapies for NSCLC

  Erlotinib is an example of a tyrosine kinase inhibitor (TKI), which is an option for locally advanced or metastatic NSCLC if the cancer cells have a mutation in the gene which codes for Epidermal Growth Factor Receptor Tyrosine Kinase (EGFR-TK), which applies to <18% of patients with NSCLC
• TKI adverse effects

  • Skin toxicity (75%)
• Cisplatin plus vinorelbine


  Chemotherapy regimen for NSCLC (every 21 days)
• Chemotherapy can improve symptoms, but survival benefit in advanced cancer is modest (30-40% response rate, median survival 10 – 12.6 months)