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m 1-Local therapy:

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

m Hematopoietic growth factors.


m Dses materials made by the body or in a
laboratory to boost patients¶ nat ral defenses
against cancer (also called biologic therapy)

m îonoclonal antibodies (rit ximab)

m Radiolabeled antibodies (ibrit momab [Zevalin]


and tosit momab [Bexxar] and iodine I-161)
m Interferon (dr g that helps strengthen the imm ne
system) occasionally sed, alone or with
chemotherapy
m Interle kin-¬, or IL-¬, has been fo nd to be
effective in some people with melanoma,
lymphoma, or with renal (kidney) cancer
m Hematopoietic Growth Factors are a gro p of
s bstances with the ability to s pport
hematopoietic (blood cell) colony formation in
vitro. This gro p of s bstances incl des
erythropoietin, interle kin-6 and colony-stim lating
factors (ñ Fs).
m HGFs are sed to promote bone marrow
proliferation in aplastic anemia, following cytotoxic
chemotherapy, or following a bone marrow
transplant.
m pportive ñare in cancer is the prevention and
management of the adverse effects of cancer and
its treatment. This incl des management of
physical and psychological symptoms and side
effects across the contin m of the cancer
experience from diagnosis thro gh anticancer
treatment to post-treatment care. 3nhancing
rehabilitation, secondary cancer prevention,
s rvivorship and end of life care are integral to
pportive ñare.
m alleviates symptoms and complications of cancer
m red ces or prevents toxicities of treatment
m s pports comm nication with patients abo t their
disease and prognosis
m allows patients to tolerate and benefit from active
therapy more easily
m eases emotional b rden of patients and care
givers
m helps cancer s rvivors with psychological and
social problems
m · tarves´ the t mor by disr pting its blood s pply

m This therapy is given along with chemotherapy

m Bevaciz mab (Avastin) was approved by the D. .


Food and Dr g Administration (FDA) in ¬004 for
the treatment of stage IV colorectal cancer