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a daganat-terápia alapjai. Diagnosis Histopathology Tumor markers Cell surface markers (CD20, CD34…) Genetic markers (BRCA-1,Philadelphia chromosome) Tumor markers in the blood α-FP (testis, HCC), β-HCG (testis, trophoblastic neoplasia PSA CEA (colorectal, breast, lung),
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a daganat-terápia alapjai • Diagnosis • Histopathology • Tumor markers • Cell surface markers (CD20, CD34…) • Genetic markers (BRCA-1,Philadelphia chromosome) • Tumor markers in the blood • α-FP (testis, HCC), • β-HCG (testis, trophoblastic neoplasia • PSA • CEA (colorectal, breast, lung), • CEA125(ovary), • CA199(pancreas), • thyroglobulin (thyroid) • Lactic dehydrogenase, LDH .
a daganat-terápia alapjai • Staging • TMN staging: (for solid tumors) • T: tumor size • N: node involvement • M: metastases • Ex: T2N1M0
a daganat-terápia alapjai • Modalities of Treatment • Surgery • Radiation • Chemotherapy
a daganat-terápia alapjai • Immunotherapy (melanoma, Bladder cancer, renal cell carcinoma) • BCG Vsaccine (local regional bladder cancer) • Monoclonal antibody • Trastuzumab • rituximab • Hormonal therapy (breast cancer, prostate cancer) • Drugs inducing differentiation • all-tans retinoic acid (ATRA) • Hematopoietic stem cell transplantation
a daganat-terápia alapjai • Criteria for Response • Cure: patient is entirely free of disease and has the same life expectancy. • Complete response (CR): complete disappearance of all cancer and no evidence of new disease for at least 1 month. • Partial response (PR) : 50% or greater decrease in the tumor size or other disease markers, and no evidence or any new disease for at least 1 month. • Stable disease: tumor size neither grows nor shrinks significantly. • Progression of disease: 25% increase in the tumor size or the development of and new lesions while receiving treatment.
a daganat-terápia alapjai • Management of treatment-related toxicity • Infections • Hematological reactions • Nausea and vomiting • Oral complications • Pulmonary complications • Cardiac toxicities • Gonadal dysfunction • Second cancers • Neurotoxicity • Nephrotoxicity • Hepatotoxiity
Paraneoplastic syndrome • Chronic adrenocortical insufficiency • Adrenal, lymphoma • Dermatomyositis and polymyositis • Lung, stomach, ovary • Hypercalcemia: • Lung, breast, prostate • DIC : Acute promyelocytic leukemia • SIADH: Lung, esp. SCLC • Thrombophlebitis: • lung, breast, ovary, Prostate
Summary • Cancer is not a single disease entity. • Cancer biology is the most important aspect in treating or preventing cancers • Chemotherapy pharmacy service or oncology pharmacy service • Know the general concepts of cancers, focus on the drug-related problems.