Targeted Therapy for Advanced Cancer Patients with Poor Performance Status

Neither is simply better in every case. MRI is the more definitive test to rule out cancer, but mammography, a form of X-ray, can miss a tumour hidden in fattier breast tissue, which is common in women under 30 to 35. In younger women, ultrasound or MRI is preferred; mammography becomes more effective after around 35 to 40, once fibrous tissue outweighs fat. MRI is more accurate but costlier and more involved for the patient, which is why mammography is offered first, with a PET-CT or a CT of the chest, abdomen and pelvis used for staging.

Immunotherapy is highly effective and carries far fewer side effects than standard chemotherapy. In cancers with a large initial tumour burden, such as lung cancer, it is usually combined with chemotherapy at first, since immunotherapy alone takes time to bring a heavy disease burden under control. Once the disease responds, treatment continues on immunotherapy alone to maintain that response.

Any scrotal swelling should first be evaluated with ultrasound, which will show a testicular mass or enlargement, but there is no test that gives a confirmed diagnosis before surgery, that only comes after radical orchiectomy. Of 100 patients presenting with a testicular swelling, roughly 80 to 90 percent will have cancer and about 10 percent tuberculosis, so for the large majority a biopsy is avoided, since it risks spreading the cancer, in favour of going directly to orchiectomy. Tumour markers such as AFP and beta-hCG, elevated in seminoma and yolk-sac tumours, can support the ultrasound finding, but the standard recommendation regardless of marker levels is orchiectomy rather than biopsy.

PSA is not specific for prostate cancer at all, no tumour marker is specific for any single cancer. An elevated PSA in a patient with a prostatic mass could reflect BPH or cancer, and can rise even after a digital rectal exam or ejaculation. Very high values, such as over 100, are more suggestive of cancer, so if PSA is extremely elevated yet the biopsy shows only BPH, the biopsy may simply have missed the cancerous core, which does happen. In such suspicious cases, a gallium-68 PSMA PET scan, highly specific for prostate cancer, can help confirm or rule out malignancy before treating for BPH alone.

Core needle biopsy is sufficient for breast cancer, and there is no need for excisional biopsy in most cases. For a small tumour such as a fibroadenoma, excisional biopsy is an option, but core needle biopsy is equally effective, and if the mass proves benign, surgery can be avoided altogether.

Often yes. Because most targeted drugs are oral tablets without chemotherapy's classic side effects, they can be tolerated by patients whose performance status would rule out standard chemotherapy, though the specific drug still needs to be individually assessed.

Chemotherapy in a very poor clinical state can do more harm than good, since it acts on rapidly dividing healthy cells as well as the cancer.

She went from bedridden with severe headache and vomiting to a complete resolution of her brain metastases, and remains well three years later.