In the first part of this series, I discussed a few features that may be described on a cancer pathology report.  Here, I will delve into other aspects that may be discussed at an appointment with an Oncologist.

Doctor Discussing With Patient In Clinic

Gene-based tests:

  • Some gene-based tests may be run on a cancer, to help determine risk that it may recur after surgery. Examples include Oncotype DX ® and MammaPrint®.  Such information is useful in deciding on adjuvant therapies. Such tests do not necessarily apply to all cancers, and even when used (such as in breast and colon cancer), may not apply to all cases. When they do apply, they can provide information that may help an individual and their oncologist determine whether they might benefit from certain adjuvant therapies after surgery.
  • Some other gene-based tests may be used to predict what sort of chemotherapy might possibly work against the cancer. Whether such tests may be useful or not, depends on the situation.  Most commonly, tests in this category are considered in the setting of stage IV cancer.
  • Some gene-based tests are used to determine overall risk of developing cancers.  Examples include testing for mutations in BRCA1 and BRCA2.  An oncologist may recommend that an individual meet with a Genetic counselor to consider having such tests run.

Forms of anti-cancer medication treatments:

  • Chemotherapy.  This is the oldest form of medication used against cancer. These medications typically cause direct cancer cell death. They may be more likely to cause certain generalized side effects because their action is often based on features also seen in healthy cells. For example, a chemotherapy drug called cisplatin acts by cross-linking DNA to cause cell death. Even normal cells have DNA so the bone marrow for example, may be affected causing lowered blood cell production.   Blood cell count typically recovers once the chemotherapy drug has washed out of the system, although uncommonly, there may be long-term permanent effects.
  • Anti-hormone medications.  These block effects of hormones.  For example, anti-estrogens may reduce estrogen production by the body, or may prevent estrogens from acting where they usually do.  Drugs in this category are most commonly used to treat breast cancer.  Testosterone blocking treatments may also be used in prostate cancer for example.
  • Targeted therapies.  These belong to a fast growing category of anti-cancer treatments.   Such medications go after a particular feature on cancer cells and so may be less likely to cause some generalized side effects that may be seen with conventional chemotherapy. Nonetheless, even targeted therapies may be associated with some unique side effects requiring close follow up when being taken.
  • Immunotherapy.  These target a part of the immune system to encourage attack on cancer cells. There are some very effective drugs in this category, such as pembrolizumab, nivolumab, etc, that can be used in a growing number of cancers.