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6-05-08Notes - Lecture#20 Thursday Annoucements-1 Your...

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Lecture #20, Thursday 6/5/08 - 1 - Annoucements: Your FINAL is on TUESDAY, JUNE 10 TH in THE SAME LECTURE HALL. Check the syllabus for REGRADE information. CANCER TREATMENTS Traditional Therapies 1. Surgery – resection (cutting out) of tumor masses - Primary, non-metastatic tumors (if possible) are the ideal, but not necessary. 2. Chemotherapy – drug treatments - Historically cytotoxic, but hopefully targeted in the near future. o Ideal target – highly expressed and employed for survival by cancer cells. 3. Radiation Therapy – med-high dose of radiation targeted to tumor sites. - Induces localized DNA damage to tumor cells, killing them. Surgery - Taking out: primary tumor mass + as much surrounding tissue as possible without harming the patient’s quality of life. - Has been done for centuries – painful and unpleasant without anesthesia (as you can imagine.) - 1809: 1 st modern surgery – Utah: o Ephraim McDowell (physician) removed a 22 lb. ovarian tumor from Mrs. Jane Crawford (patient) without anesthesia or antiseptics , and she survived 30 years after that. Innovations (that have benefited surgical oncology) 1. 1846: Warren at Massachusetts General Hospital – used ether (as an anesthetic) - Ether Dome: big domed amphitheatre used for surgery. It allowed surgeons to operate without fear of also falling asleep during surgery because the ether vapors would rise up away from the operating table. 2. Lister – earliest proponent of antisepsis and hand washing by doctors. - He found it increased patient survival; other doctors were against the idea at the time. Likelihood of survival without surgery - Inversely correlated with increased disease – the more sick the patient, the less likely to they are to survive surgery and/or general anesthesia. o 1/10 5 (1 in 10,000) people in the general population, don’t survive general anesthesia. o 1/15 (1 in 15) will die as a result of general anesthesia use if severely ill (i.e. have significant tumor burdens).
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Lecture #20, Thursday 6/5/08 - 2 - They are weakened by the tumor and its treatments (radiation and chemo), so surviving surgery is tough. Surgery is used for: (in decreasing order of usefulness) 1. Treatment of primary tumor. 2. Removal of any residual tumor mass after chemotherapy – process called “debunking”. 3. Removing mets (can be a useful tool). 4. Treating oncological emergencies. - Used to treat patients with significant tumor burdens and/or mets that can’t be treated with radiation or chemotherapy (that is, it wouldn’t be of benefit), but have other complications as a result of the tumor and/or mets (i.e. an intestinal blockage). o Without surgery, these patients might not survive a day. - Not curative. 5. People with pain associated with tumor burdens. - In this case, surgery is used to severe nerves to relieve the pain.
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