Oncology Klinika úrazové chirurgie / Dept. of Traumatology FN Brno-Bohunice C:\Users\Martin\Desktop\obr. orthobull\cclls.jpg nmedical discipline doing research on cancer and caring for oncologic patients, providing prevention, diagnostics, complex treatment and care. n Population morbidity and mortality nCardiovascular diseases 51 % nCancer disease 26 % nInfectious diseases 6,8 % nExternal causes ( injuries, suicides, poisoning) 5,9 % nRespiratory disorders 5,6 % nGastrointestinal disorders 4,5 % n C:\Users\Martin\Desktop\obr. orthobull\jine\dušení, tonutí, el proud\525602626.png C:\Users\Martin\Desktop\obr. orthobull\jine\dušení, tonutí, el proud\1200px-Leading_cause_of_death_world.png n Cancer /tumour disease – genetic disorder, disease of DNA, n n Genetic changes can proceed to unregulated atypical cells n nTumour transformation – can affect whatever somatic cell capable of cell division n nMore 100 tumours n nTumour / Neoplasia – abnormal tissue, mass of abnormal cells with abnormal growth and proliferation nCancer – system disease caused by uncontrolled growth and spread of abnormal cells Cancerogenesis nProcess of formation of mutations that make changes of genetic information - Gene mutations nGene – section of DNA designated for proteins, inc. proteins having control over cell cycle n1 gene - 2 alleles n n n n n n Slide show: How genetic disorders are inherited - Mayo Clinic C:\Users\Martin\Desktop\obr. orthobull\onk\11-newtechnolog.jpg nImportant genes of DNA nProto-oncogene nAnti-oncogenes/ tumour suppressor genes n nmalignant tumour disease requires several significant mutations n ( minimally 4-6 ) n nProto-oncogene – commonly presenting structural gene which product – protein take control of cell cycle and cell division n(coding growth factor/receptor, transcription factors) n n nOncogene – mutated proto-oncogene – with increased activity presenting permanent mitotic activity, causing ig. overproduction of growth factors, growth factor receptors, …. nImplementation of virus into oncogene n nMutations are activating nDominant mutation – mutation of one allele suffice to bring on manifestation of mutation n C:\Users\Martin\Downloads\k prezentacim\1200px-Oncogenes_illustration.jpg C:\Users\Martin\Desktop\obr. orthobull\onk\proto onco domin.png n The Arts, Sciences and Medicine: CANCER of UNKNOWN PRIMARY C:\Users\Martin\Desktop\obr. orthobull\onk\mutations.jpg C:\Users\Martin\Desktop\obr. orthobull\onk\proto-oncogene mutation.jpg nTumour suppressor genes – have negative control of cell cycle n n Obstruct cell division when presented DNA mistakes nFixing damaged DNA nLoss of tumour suppressor genes - uncontrolled division of cells with damaged DNA n nMutations are recessive - inactivating - manifestation of mutation needs damage of both two alleles n n C:\Users\Martin\Desktop\obr. orthobull\onk\recessive.gif n C:\Users\Martin\Downloads\k prezentacim\image052.jpg C:\Users\Martin\Desktop\obr. orthobull\600px-Rb1mutace.png Cancerogenous factors - mutagens n Physical factors nGama, X-ray, neutron radiation nUV radiation nThermal radiation n nRadiation – direct hit to DNA chain - chain breaks n indirect effect – formation of ion´s, radicals nBasis oxidation, breakage of phosphodiester binding n n nChronic mechanical irritation n 12: Direct and indirect actions of radiation. The structure of DNA is... | Download Scientific Diagram n Chemical factors nAromatic and polycyclic hydrocarbons nHeavy metals nAromatic amines nNitrogenous substances nHormones n nIndirect effect – oxidative stress – ion´s, radicals nDirect effect to DNA - in replication phase – incorporation of bases analogues nout of replication – alkylation, desamination, hydroxylation of bases n n n nMainly in places of direct contact of substances with mucosa n nCigarette smoke – mouth, windpipes, lungs, kidneys , bladder n nitrites, nitrates, fat - large intestine, kidneys, bladder n n n n Biological factors nVirus infections n Hepatitis B, C virus – hepatocellular carcinoma n Epstein Barr virus - Burkitt lymphoma n HPV - cervix and rectal carcinoma nChronic infection nChronic inflammation n nBiological mutagens - less common n n n n n n n n C:\Users\Martin\Desktop\obr. orthobull\the-formation-of-a-tumor-oncogene-virus-8.png Oncogenesis / Cancerogenesis n nMultiple step process C:\Users\Martin\Desktop\obr. orthobull\3-s2.0-B9780128147191000288-f28-12-9780128147191.jpg nTumorous tissue – have different qualities from healthy tissue n nMorphological difference - tissue and cellular abnormalities n nFunctional difference – mainly nonfunctional, newly gained/lost function ( hormone production) n nBiological difference - increased ability to proliferate (shorter cell cycles, increased number of replications) n Tumour morphology nTumour differentiation – how much are tumour cells similar to normal specialized cells of tissue from which tumour originate n nDedifferentiation – appearance of primitive nonspecific and non-specialized cells – means increasing aggressiveness n n n n n Tumour morphology nDysplasia – still non-tumorous increased cell proliferation, cells have loss of uniformity and architectonics, cells disarrangement, increased mitotic activity, loss of cell stratification – ig. cells with mitotic activity out of basal layer n C:\Users\Martin\Desktop\obr. orthobull\dysplasia.jpg C:\Users\Martin\Desktop\obr. orthobull\CDR761240-750.jpg nTumour abnormalities nMorphological differences of tumorous tissue n nLoss of layered or glandular arrangement, loss of intercellular cohesion, disappearing of extracellular matrix at mesenchymal tumours n n Cellular abnormalities nNucleus - enlargement, increased nuclear coloration, nuclear polymorphism, multiple nucleus nCytoplasmic changes - cellular size changes – mainly enlargement, shape differences, loss of specialized functions or apparatus, increased coloration n n n n n n n n n Grading (tumors) - Wikipedia C:\Users\Martin\Desktop\obr. orthobull\onk\Characteristics of Cancer Cells.png Tumour´s transformation nChanged ability of functional differentiation nIncreased ability of proliferation nDecrease of apoptosis nIncreased telomerase activity – prolongation of cell life even cell immortality nChanged cell intercellular activity with surrounding cells and extracellular matrix - loss of cohesion with other cells, loss of adhesion to extracellular matrix, loss of contact inhibition - tumour invasiveness n C:\Users\Martin\Desktop\obr. orthobull\h979.jpg nTumour (true) x Pseudo tumour (false) n nPseudo tumours represents lump / bulging of tissue – origin and microscopic view is different from tumours n nCysts, pseudo cysts, inflammatory pseudo-tumours, piling up of anorganic substances - salts nHypertrophy, hyperplasia, hyperregneration n n n Recurrent giant cell tumor of the phalanx: A rare occurrence Agrawal AC - J Orthop Traumatol Rehabil C:\Users\Kubenstein\Desktop\Image-075.png nHypertrophy – increase in volume of cells ( mainly microfibrils) - muscle training, myocardial muscle due to high blood pressure n nHyperplasia – increase in number as reaction to stimulation of tissue region - chronic mechanical / inflammatory irritation, subside when stimulation disappear nDue to hormonal stimulation – benign prostatic hyperplasia, thyroid gland n n C:\Users\Martin\Desktop\obr. orthobull\onk\Response+to+Stress+Hyperplasia+Normal+Cells+Atrophy+Metaplasia.jpg Biological character of tumours nDetermined by genetic (enzymatic) equipment how acts in host organism nBenign tumours (relative harmless) - slow in growth, clearly bordered – clearly visible boundary between normal and tumorous cells nBenign tumour cells are similar to normal differentiated cells, low in number of nuclear atypicalities, nCommon fibrous sheath n n don´t have metastasis, expansive growth – enlarging compact mass having local pressure effect on surrounding tissues, nThe mass in moveable against the bottom nMalignant tumours (harmful) – have rapid growth, don´t have fibrous sheath, poorly unclear boundaries, don´t move against the bottom, nThe cells are substantially immature, irregular in shape and undifferentiated, have a lot of nuclear atypicalities nInvasive growth – spread to surrounding tissues due to release of enzymes decomposing collagen and proteoglycans n nProduce distant metastasis and have systemic effect n C:\Users\Martin\Desktop\obr. orthobull\ibenign x malignant.png n Site of origin nMesenchymal nEpithelial nNeuroectodermal ngerminal n n Histogenetic origin provides name of tumour n nBenign - suffix - oma / ademoma, lipoma, fibroma, osteoma / nMalignant - adjectove - sarcoma, carcinoma, blastoma / adenocarcinom, neuroblastoma, fibrosarcoma/ Tumour spreading nContinuous spreading - tumour mass expand superficially along anatomically defined structures – fascias, perineural / intraneural spreading, along vessels and grow through surrounding tissue n nDistant spreading – metastasis formation – release of tumorous cells from primary focus into distant perceptive tissues n nHaematogenous – tumour grow into the vessels and spreading through venous blood – mainly liver, lungs, brain, kidney, suprarenal gland bones nLymphogenous – grow into lymphatic vessels and into lymph nodes and later in to the blood n n nImplantation spreading – in cavities (abdominal, thoracic, intestine) n n solitary metastasis – only 1 metastasis in body n nGeneralize tumour spreading – primary tumour focus and > 3 metastasis n Complications of tumours n Benign nLocal nCompression of surrounding structures – compression of ureter, intestine, nerves nObstruction of hollow organ – ileus, cyst, jaundice, hydrocephalus nNecrosis – secondary infection n nGeneral - production endocrine active hormones n n Malignant tumour complications nLocal nCompression of surrounding structures nDestruction of normal invaded tissue – pathological fractures, reduced haematopoiesis nSurface ulceration – bleeding ( occult blood loss) nEroded blood vessels – massive bleeding nPerforation of hollow organs nfistula formation nNecrosis – secondary infection n nGeneral – hormonal activity, cytokine activity n n n Classification of tumour disease nTyping - determine histological origin of tumour tissue n nGrading - assess grade of differentiation of tumour cells grade I – IV n nG1 – high grade of differentiation, low malignancy nG2 – moderate grade of differentiation, moderate malignancy nG3 – low grade of differentiation, high malignancy nG4 – undifferentiated , very high malignancy n nStaging – define the extend of general body´s affection – TNM classification Precancerous / premalignant condition nDysplasia - morphological abnormal cells associated with increased risk of cancer disease n nHyperplasia – of hormonally dependent tissue – endometrium, prostate nDysplasia nMetaplasia - transformation of one type of epithelial cell into different epithelial cell n I.g. – Barrett oesophagus - commonly lined oesophagus with squamous cells due to chronic irritation of gastric reflux in lower part, the mucosa transforms into columnar intestinal-like cells n Bronchial metaplasia due to smoking – ciliated columnar cells transforms into squamous cells nLevel of dysplastic changes - grades I – III. nLow grade (I) x high grade (II-III) V3.1 2018 fgt_ jimc_j25 Anal Dysplasia and Anal Cancer n C:\Users\Martin\Desktop\obr. orthobull\onk\Response+to+Stress+Hyperplasia+Normal+Cells+Atrophy+Metaplasia.jpg C:\Users\Martin\Desktop\obr. orthobull\adaptation-30-sept2013-24-638.jpg C:\Users\Martin\Desktop\obr. orthobull\2bb64dac13f5cc1d1c9f5fec258ab5ca513fcdb2.png Cancer effects nPatient are put in danger of fatality by dissemination, not by the primary tumour n nDestruction of tissue and organ, loss of function nObstruction of hollow organs – stop of passage nParaneoplastic syndrome – abnormal hormone /cytokines production – paraneoplastic syndrome – Cushing sy, Hypercalcemia, nCancer cachexia – rapid loss of fat, muscles, fatigue nImmunodeficiency nHypercoagulation nCancer cachexia C:\Users\Martin\Desktop\obr. orthobull\Mechanisms-involved-in-cancer-cachexia-Tumour-derived-catabolic-factors-such-as.png Management of Cancer Cachexia: ASCO Guideline A Switch from White to Brown Fat Increases Energy Expenditure in Cancer-Associated Cachexia: Cell Metabolism Per-Olof Hasselgren | Research Development of tumour disease nPrecancerosis - long-lasting process of cancer formation of pathologically changed tissue n nPreclinical stadium - there is evidence of malignant transformation of cells, small in size, no difficulties for host, long-lasting process, difficult to find n nClinical manifestation – progressively faster growth, emerging typical signs and symptoms, usually months. C:\Users\Martin\Desktop\obr. orthobull\onk\slide_12.jpg Diagnostic process nEarly diagnosis of malignant tumours has the most effective results of treatment outcome with low recurrence rate n nMajority of patients come with typical signs of locally advanced disease n n General signs nWeight loss nFever nLoss of apatite nFatigue nParaneoplastic syndrome n n n Local signs – related to organ affection n nLump of tumour mass in soft tissues nHollow organ obstruction/ perforation nOrgan function disorder nOrgan/ structure compression nBleeding npain n n WHO warning signs n nChange of stereotype of bowl movement /urination nUnusual bleeding / discharge nNo healing wound nLump in breast / soft tissues nLoss of appetite, loss of weight, dysfagia nLong lasting cough and hoarseness nChange in birthmark / nevus n Story Slam Red Flag [01/19/20] 8 Warning Signs Of Cancer You Should Never Ignore nClinical examination – visual inspection, palpation, auscultation n n„symptom“ examination n n nObtaining tissue biopsy – biopsy, FNAB, true-cut, cytology n nHistopatological examination n - Benign/malignant n - Type n - Grade n n C:\Users\Martin\Desktop\obr. orthobull\tyd-aspiration-biops_fig2.jpg C:\Users\Martin\Desktop\obr. orthobull\images.jpg C:\Users\Martin\Desktop\obr. orthobull\tru cut.jpg C:\Users\Martin\Desktop\obr. orthobull\300px-LungCACXR.PNG Bowel Colorectal Cancer and Polyps | Brisbane, Australia nStaging – assessment of extend of cancer disease n nLocal extend nSystemic extend n nChest X-ray, abdominal sono nChest, Abdominal CT + contrast, MRI nBone scan, PET- CT / PET MRI n nTNM classifying n nAssessment of patient´s general status, organ functions, comorbidities n n C:\Users\Martin\Desktop\obr. orthobull\300px-LungCACXR.PNG C:\Users\Martin\Desktop\obr. orthobull\pet mri.jpg C:\Users\Martin\Desktop\obr. orthobull\lung ca ct.jpg Anatomy of Liver Mets Oncomarkers nChemical substances released from tumour / host tissues as response to tumours n nIn normal conditions are not presented or in minimal concentrations, benign condition n low sensitivity and specificity nScreening and diagnostics : PSA, AFP n nMonitoring of treatment response n nCEA, CA19-9, CA125, PSA, nTNM staging system – internationally used for almost all tumours. Assess anatomic extend - size of tumour, number of lymph nodes, presence of metastases n C:\Users\Martin\Desktop\obr. orthobull\26a7722616f7c3c977ecf721ebd39915.jpg C:\Users\Martin\Desktop\obr. orthobull\TNM-084c4763-71fa-44c8-9e9f-f6e028c3ff96.png ncTNM - clinical - before therapy – clinical examination, imagining examinations, biopsy. n npTNM – postoperative/pathological/ - after assessment of resected organ and surrounding tissue n n nStage of disease n C:\Users\Martin\Downloads\k prezentacim\747px-Cancer_stages.png Colon Cancer Symptoms, Survival Rate, Treatment & Stages nR –classification n presentation of tumour at resection margin n n R0 – no tumour n R1 – microscopic rest n R2 - macroscopic rest n C:\Users\Martin\Desktop\obr. orthobull\BCO_Pathology_Pg12_A_Image_tcm8-334308.jpg Performance status n assessment of cancer patient´s general well-being and physical activities of daily living – estimation of therapeutic options – organism functional reserves to withstand aggressive oncologic treatment n nPS 0 – normal activity nPS 3 – more than 50% daytime in bed nPS 5 – completely bedridden, no selfcare n nKarnofsky index Pin on Fibro n C:\Users\Martin\Desktop\obr. orthobull\performance-status-img.jpg nMmultidisciplinary oncologic board n nSpecialists of different clinical speciality - radiology, clinical oncology, surgeons, pathologists, radiation therapist n n presented case report, time axes, symptoms, comorbidities, performance status. There is considered stage of cancer disease - anatomical extend of disease and histological type and aggressivity of tumour with regard to therapeutic modalities nThere is define therapeutic plan with agreement of majority of specialists n Therapeutic modalities n Locoregionale nOncologic surgery nRadiation oncology n n Systemic nChemotherapy nHormonal therapy nTargeted „biological“ treatment nImmune therapy n Goals of therapy nCurative – „healing“ from cancer n nExtending life expectancy n nExtending time without severe difficulties n nSymptoms relief nCurative th – radical surgical, RT, CHT treatment – removing all affected cancerous tissue n nPalliative th – active treatment being aimed at extending life expectancy /CHT, RT/, slow down spreading n nPalliative th – active treatment being aimed at relief of symptoms /CHT, RT, surgery/, improve quality of life n nPalliative – symptomatic and supportive therapy n no influence on progressive cancer disease , relief difficulties n nIncreasement of treatment effectiveness specific combination of treatment modalities n nNeoadjuvant th – initial CHT/RT to reduce tumour mass and tumour extend before planned surgical treatment, RT. n nAdjuvant th (CHT)– after surgical treatment (RT) to eliminate residual micrometastasis ( positive resection margins, positive lymph nodes dissection) n Oncologic surgery nMost important curative modality of solid tumours – removing tumour mass nCurative effectiveness at localized disease n nresection of primary tumour nresection of affected - draining regional lymph nodes nmetastasis resection n n nManagement of complications – perforation, obstruction, bleeding, symptoms removal nTaking of histological samples nRadical (safe) resection of tumour focus into healthy tissue – resection margins /R0/ /2cm edge of healthy tissue/ n n C:\Users\Martin\Desktop\obr. orthobull\Complex-resection-margins-The-illustration-depicts-a-distal-colectomy-specimen-with-a.png C:\Users\Martin\Desktop\obr. orthobull\resec.jpg C:\Users\Martin\Desktop\obr. orthobull\220px-Edges_and_margins_in_intestinal_tumor.png n n n n n n n C:\Users\Martin\Desktop\obr. orthobull\resection.jpg C:\Users\Martin\Desktop\obr. orthobull\lung-cancer-treatments.jpg nLymphadenectomy – resection of potentially affected regional lymphatic nodes nEn block resection - avoid violation of tumour capsule, don´t cut adhesions, resects tumour with surrounding tissue or part of organ if possible nVein ligation first n nMultivisceral extended radical resection – radical resection of tumour and solitary metastasis n nPer operative cryobiopsy – assessment of resection margins /R0 x R1/, assessment of lymphatic nodes – extension of resection / lymphadenectomy n n Lymphadenctomy nStandard procedure – primary tumour resection + regional lymph nodes. Preventive measure eradication of potential contained micro metastasis nspecial histological examination - immunohistochmistry, PCR – can prove micro metastasis 2mm n selective – therapeutic – dissection of tumour affected lymph nodes , prevention of locoregional relapse n n Usually in solid tumour dissection of I. level of lymph nodes n §Sentinel lymph node - patent blue dye, / radionuclide , most common breast cancer, melanoma, §examination of sentinel lymph node decide about extend of lympadenectomy C:\Users\Martin\Desktop\obr. orthobull\sentinel 1.jpg C:\Users\Martin\Desktop\obr. orthobull\sentinel 2.gif C:\Users\Martin\Desktop\obr. orthobull\Picture%20005.jpg C:\Users\Martin\Desktop\obr. orthobull\SocialThumb.00003453-201307000-00004.F1-4.jpeg nMetastasis surgical therapy n nBiological convenient type of tumour, limited number of meta nPrimary tumour is possible to remove nThere are no unremovable metastasis n nColorectal – liver nKidney - bone n n n C:\Users\Martin\Desktop\obr. orthobull\RFA.jpg Palliative surgical therapy nIn case of impossible radical resection of tumour or metastasis nImprove quality of life, prevent complications, treating complications n n bypass procedures, ostomies - in case of bowel obstruction, nTreatment of bowel perforation, stop of bleeding, dilatation and stenting of stenosis, ninsertion of CVC, enteral catheter n n Visceral Surgery: Treatment Options in Palliative Care C:\Users\Martin\Desktop\obr. orthobull\1-s2.0-S1096288314000151-gr2.jpg nPalliative tumour resection – R1, R2 – lower complication rate, symptomatic effect, better response to chemoradiotherapy n nCytoreduction/ debulking - reduction of tumour mass - before chemotherapy radiation therapy/ nDecompression procedures - spinal cord nPain release n C:\Users\Martin\Desktop\obr. orthobull\pasted image 243x208.jpg C:\Users\Martin\Desktop\obr. orthobull\800wm.jpg n C:\Users\Martin\Desktop\obr. orthobull\abdominal-paracentesis-2-638.jpg C:\Users\Martin\Desktop\obr. orthobull\X2604-S-22.png C:\Users\Martin\Desktop\obr. orthobull\F1.large.jpg C:\Users\Martin\Desktop\obr. orthobull\picc.jpg nReconstructive phase of surgical therapy - improve quality of living in patients with long-term prognosis nReconstruction of soft tissues defects, after breast resection nRestoration of bowel continuity, reservoir function n nPreventive surgical procedures - genetic predisposition n FAP – colectomy n MEN II - thyreoidectomy C:\Users\Martin\Desktop\obr. orthobull\ZAR710a35_6cb5bb56ac2746c1ae9053aa770d6174_0.jpg C:\Users\Martin\Desktop\obr. orthobull\microsurgicalreconstruction.jpg Radiation therapy /RT/ nSome types of tumours are radiosensitive - focused dose of ionizing electromagnetic radiation can destroy cancer cells nlocoregional effect /tumour + regional lymph nodes/ n nDifferentiated tumours of thyroid gland, Prostate, n epidermal skin tumours, tumours of head and neck, breast n n/X-Ray, Gamma/ – cellular death, n gamma radiation - exponential kinetics nProton therapy - particular radiation n higher energy, the most of energy release in tumour mass, n n n n n n n n n n n nImportant critical structures reduce extend of use of RT n nAdjuvant RT prevents locoregional relapse after surgical resection /breast cancer, head and neck cancer nPalliative RT – bone metastasis n nSide effects of RT n n n Acute Chronic n Postiradiation dermatitis Fibrosis n Mucositis Neurodegeneration n radiation ulcers n C:\Users\Martin\Desktop\obr. orthobull\210-mucositis-stomatitis-Sonis-Cancer-2010-116-1-mucositis.JPG n C:\Users\Martin\Desktop\obr. orthobull\Woman_prepared_for_radation_therapy.jpg C:\Users\Martin\Desktop\obr. orthobull\450px-Gamma_Knife_Graphic.jpg C:\Users\Martin\Desktop\obr. orthobull\radiation-in-oral-cancers-51-638.jpg C:\Users\Martin\Desktop\obr. orthobull\mucosa.jpg Chemotherapy nMedication which is effective against process of cell division, - gene toxicity, the fastest dividing the most affected nUsually used in combination of more drugs to take advantage of different mechanisms of effect to have stronger anti-tumor effect n nCurative therapy – chemosensitive haematological tumours nCurative / palliative therapy - metastatic extend of disease – n systemic effect – penetrate into all tissues, general effect nAffecting all rapidly dividing cells - malignant cells, n Bone marrow, hair follicles, mucosa, germinal cells n nRequires cyclic administration n n n C:\Users\Martin\Desktop\obr. orthobull\chemo.jpg nAlkylation agents nAntitumor antibiotics nAntimetabolites nPlant alkaloids n n n nChemotherapy side effects n nAcute - Nausea, vomiting nSubacute - Alopecia, mucositis, hematotoxicity nChronic - Infertility, neuropathy, cardiovascular disorders, n secondary tumours n n n n n n n Effect of chemotherapy drugs on cell cycle. | Download Scientific Diagram Hormonal therapy nHormonally active tumours – use hormones as GF nBlocking hormone = blocking of proliferation n n Breast, Prostate, Ovarium, Thyroid gland cancer n nOrgan removal nBlock of receptor – antiestrogene - Tamoxifen nBlock of hormone synthesis nPituitary gland blocking n n n n C:\Users\Martin\Desktop\obr. orthobull\breast-cancer-hormone-therapy-32-638.jpg Targeted biological therapy nNon gene toxicity nTargeted against specific signal pathways of GF or pathways of controlling molecules inside tumour cells nBlocking these pathways stop proliferation of tumour cells, don´t destroy tumour cells n n have no side effects related to overall stop of proliferation and cell deaths nCombination of targeted therapy + chemotherapy/ RT n n n nDifferent spectrum of side effects – hypertension, rashes, hypothyroidism, positive correlation between effect and side effect nUsually have not curative effect n nImatinib /Gleevec/ – CML nBevacizumab /Avastin/ angiogenesis inhibitor nTrastuzumab /Herceprin/ - breast cancer n n C:\Users\Martin\Desktop\obr. orthobull\biological therapy.png nMonoclonal Ab – against receptors on surface n large molecules – iv administration, can´t get in brain nComplex of binding Ab +receptor cell can by lysate by complement lymphocytes nFlu like side effect symptoms – fever, chills, muscle joint pain, anaphylaxis n n n„small molecules“ – get in cell, block signal pathway inside, p.o. intake, cam get in brain nNo immune effect nSide effect skin and GI symptoms n Immune therapy nBring about or stimulate nonspecific – innate and specific immune response against tumour cells n nIL -2 – renal carcinoma, interferone alfa nBone marrow transplant nAnti-tumour vaccination (preventive, therapeutic) - HPV n nRisk of induction of autoimmune response n n n n n n Supporting therapy nRelieve patient from difficulties from tumour symptoms or oncologic treatment n n pain killers nAntiemetic nLeukocyte growing factors nBlood transfusion, Epo nAnti depressants nEnteral / parenteral nutrition nMedication to improve nutrition nAntibiotics n psychotherapeutic support n n n Epidemiology nMandatory announcement of detection of new cancer disease to Oncological register n nMortality rate – parameter of deaths on tumours per 100 000 and year nIncidence rate - number of newly diagnosed tumours on 100 000 and year n n n n5year survival rate – since treatment, n Prevention nPrimary prevention –– keeps disease from occurring, exclusion of inner and outer risk factors n e.g. healthy diet, non-smoking policy, environment, vaccination - HPV n nSecondary prevention – diagnostics of early cancer disease, before locally advanced, better therapeutic options. n Active screening of malignant diseases and precancerosis and their treatment. n nTertiary prevention – regular oncologic follow ups after the end of therapy for cancer disease – burst out of relapse – regular re-staging n n n n Preventive screening nregular preventive GP examinations nInpatient exam - breast, digital rectal exam. nWidespread screening measures n nPreventive check up q 2 y GP nProstate M >50 yo q 2 y nPreventive gynaecologic check up F > 18 yo q1y nMammography F > 45 yo q 2 y nOccult stool blood >50 yo q 2 y nEndoscopic bowl exam > 55 yo q 10 y nPer rectum exam >55 yo q 10 y n n n n n n n Most common malignity n nM: lung cancer, prostate cancer, colorectal cancer, renal cancer n nF: breast cancer, lung cancer, colorectal cancer, ovarian, cervical cancer, n n