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ô rgery
ô Radiation therapy
m ¬-ystemic treatment:
ô ñhemotherapy
ô Hormonal therapy
ô Biotherapy
m 6- pportive care
m 4-Non-conventional therapy
m rgery was the first modality sed s ccessf lly in
the treatment of cancer.
m It is the only c rative therapy for many common
solid t mors.
m The most important determinant of a s ccessf l
s rgical therapy are the absence of distant
metastases and no local infiltration.
m îicroscopic invasion of s rro nding normal
tiss e will necessitate m ltiple frozen section.
m Resection or sampling of regional lymph node is
s ally indicated.
m rgery may be sed for palliation in patients for
whom c re is not possible.
m Has significant role in cancer prevention.
ô 3.g familial polyposis coli.
m atients with conditions that predispose them to
certain cancers or with genetic traits
Associated with cancer can have normal life span
with prophylactic s rgery.
-colectomy .
-oophorectomy.
-thyroidectomy.
-removal of premalignant skin lesion .
m Radiation therapy: is a local modality sed in the
treatment of cancer .
m ccess depend in the difference in the radio
sensitivity between the t mor and normal tiss e.
m It involves the administration of ionizing radiation
in the form of x-ray or gamma rays to the t mor
site.
m îethod of delivery: 3xternal beam(teletherapy).
Internal beam therapy(Brachytherapy).
m Radiation therapy is planned and performed by a
team of n rses, dosimetrists,physician and
radiation oncologist.
m A co rse of radiation therapy is preceded by a
sim lation session in which low-energy beam are
sed to prod ce radiograghic images that indicate
the exact beam location.
m Radiation therapy is s ally delivered in
fractionated doses s ch as 180 to 600 cGy per
day,five times a week for a total co rse of 5-8
weeks.
m Radiation therapy with c rative intent is the main
treatment in limited stage Hodgkin¶s
disease,some NHL,limited stage ca
prostate,gynecologic t mors&ñN t mor .
m Also can se in palliative &emergency setting.
m There is two types of toxicity ,ac te and long
term toxicity.
m ystemic symptoms s ch as Fatig e,local skin
reaction,GI toxicity,oropharyngeal
m cositis&xerostomia.myelos ppression.
m Long-term seq elae:may occ r many months or
years after radiation therapy.
m Radiation therapy is known to be
m tagenic,carcinogenic,and teratogen,and
having increased risk of developing both
secondary le kemia and solid t mor.
m For decades have been sed systemically to
treat malignant disorders.
m They are administer by specialists in n clear
medicine or radiation oncologist.
m Radioactive iodine:in the from of 161I is effective
therapy for well differentiated thyroid ca
m tronti m-89. Is sed for the treatment of body
metastasis.it is an alkaline earth element in the
same family as calci m
m ystemic chemotherapy is the main treatment
available for disseminated malignant diseases.
m rogress in chemotherapy res lted in c re for
several t mors.
m ñhemotherapy s ally req ire m ltiple cycles.
m ñytotoxic agent can be ro ghly categorized based
on their activity in relation to the cell cycle.
m £hat is the difference between phase specific &
phase non specific?«..
m hase non-specific:
ô The dr gs generally have a linear dose-
response c rve(w the dr g administration ,the
w the fraction of cell killed). eg:
ñyclophosphamide,ñisplatin
m hase specific:
ô Above a certain dosage level,f rther increase
in dr g doesn¶t res lt in more cell killing.b t
yo can play with d ration of inf sion. eg:
îethotrexate,Vincristine
m Alkylating agents: ñyclophosphamide
m Antimetabolites: îethotrexate
m Antit mor antibiotic: Actinomycin D
m lant alkaloids: Vincristine
m Other agents: Hydroxy rea
m Hormonal agent: Tamoxifen
m 3very chemotherape tic will have some
deleterio s side effect on normal tiss e .
m 3.G; îyelos ppression,na sea&vomiting,
tomatitis,and alopecia are the most freq ently
observed side effects.
m ñ (complete remission)is the
disappearance of all detectable malignant disease.
m
:is decrease by more than 50% in
the s m of the prod cts of the perpendic lar
diameters of all meas rable lesions.
m
:no increase in size of any lesion nor
the appearance of any new lesions.
m
:means an increase by at least
¬5% in the s m of the prod cts of the perpendic lar
diameters of meas rable lesion or the appearance
of new lesions.
m îany hormonal antit mor agents are f nctional agonist
or antagonist of the steroid hormone family.
m Adrenocorticoids:
m Antiandrogen: Fl tamide
m 3strogen: 3thinyl estradiol
m Antiestrogen: Tamoxifen
m rogestins: îedroxyprogesterone acetate
m Gonadotropin-releasing hormone agonists: B serelin
m omatostatin analog es: Octreotide
m Are freq ently sed in combination regimen for
the treatment of lymphocytic le kemia and
lymphoma.
m They f nction by binding to gl cocorticoid-
specific receptors present in lymphoid cells and
initiate programmed cell death
m They most commonly sed agent are
prednisone,methylprednisone,dexamethosone.
m Fl tamide :
3ffectively blocks the binding of androgen to its
receptor in the periphral tiss e .
It is sed in the treatment of disseminated prostate
ca
m Imm notherapy:
ô Interle kins
ô îonoclonal Antibodies
ô Interferons