Oncology (briefly)
Dr. Jamie Barfield
Overview
Glossary of terms
Principles of treatment
Chemotherapy
Radiotherapy
Common side effects
Summary
Glossary
Medical oncology
Chemotherapy, hormones and surgery
Clinical oncology
Chemotherapy, hormones, surgery and radiotherapy
Glossary
Radical
Curative intent
Palliative
Treatment where cure is not possible
Adjuvant
Treatment given after surgery
Glossary
Neoadjuvant
Treatment given prior to surgery
Concomitant
Treatment given at the same time
Chemotherapy
Aims to inhibit growth of cancerous cells more than healthy
cells
Can be given orally, IV, intrathecal, topically or
intratumour
Given in cycles - the cycle length depends on the agent used
First chemotherapy developed from mustard gas in the first world
war. They noticed soldiers exposed to mustard gas became
cytopenic.
Chemotherapy
Alkylating agentsAlkylate DNA and crosslink it. When trying to copy
DNA cell will enter apoptosiseg. cisplatin,
cyclophosphamideAntimetabolitesNucleoside analogues. Can only
become incorporated during S phase.eg. methotrexate,
capecitabineAntimicrotubuleVinca alkaloids prevent microtubule
formation, taxanes prevent disassemblyeg. vincristine and
paclitaxelTopoisomerase inhibitorsPrevent uncoiling of DNA so can
not replicate or transcribe.eg. etoposide, doxorubicin
Chemotherapy
Monoclonal antibodies
VEGF inhibitor (bevacizumab/Avastin)
Radiotherapy
Usually uses high energy photons but can also use protons
Main mechanism of action is free radical generation causing DNA
damage
Radiotherapy
Dose is a number of Gray over a number of treatments of
fractions
eg. 20Gy 5#
Gray is the absorbed dose
Sievert is the effective dose
1 Gray is the absorption of 1 joule of ionising radiation per
kilogram of matter
Radiotherapy
Background radiation per year in UK2.2 mSvBackground radiation per
year in USA6.24 mSvChest Xray0.02 mSvCT chest, abdo & pelvis10
mSvAdjuvant radiotherapy for eg. breast cancer60 Sv
Radiotherapy
Fractioning
Splits the dose over a number of days
Allows healthy tissue to recover
Gives opportunity for different cell cycle phases to be
targeted
Radiotherapy
External beam
Image guided
Intensity modulated
Stereotactic
Brachytherapy
Image of child is Gordon Isaacs, first person treated with
external beam radiotherapy in 1957
Side effects of both regimes
Nausea and vomiting
Lethargy and fatigue
Mucositis
Diarrhoea
Secondary malignancy
Chemotherapy side effects
Hair loss
Loss of appetite
Lack of concentration
Loss of libido or sexual function
Radiotherapy side effects
Erythema
Dysphagia
Pain
Serious side effects
Neutropenic sepsis
Uncontrolled vomiting or diarrhoea
Death
Neutropenic sepsis is neutrophils
