I. Cancer Prevention:

1. lifestyle & intake modifications to down-throttle adverse stimuli:
   1. no cigarette smoking
   2. no tobacco snuff or dip
   3. no sunburns

II. Cancer Neoadjuvant treatment:

This involves maneuvers and treatments begun prior to the definitive treatment regimen. 

1. breast cancer:

   • discontinue all estrogenic medications or herbs

   • chemotherapeutic assault on a larger (= to, > than 3 cm. and/or aggressive) tumor prior to surgery

2. rectal cancer:

   • presurgical radiation

III. Cancer Treating for cure:

1. lifestyle & intake modifications to down-throttle adverse stimuli:
   1. no cigarette smoking
   2. no tobacco snuff or dip
   3. no sunburns
2. prophylactic/adjuvant therapy:
   1. breast radiation after lumpectomy thought to have completely removed d-CIS
3. antigrowth:
   1. suppress (or remove source of) stimulating hormones (breast & prostate cancer):
      1. Tamoxifen
   2. cancel the oncogene: Herceptin (against HER-2); we must IHC test the tumor for gene-product over-expression and/or use the FISH technique (controlled against CE17) to see if the HER-2 gene is amplified in a ratio greater than 2.0
   3. Gleevec (anti-C-kit ?) against GIST and CML
   4. epidermal growth factor (EGF) receptor binders: block the stimulation of the tyrosinase cell-proliferation cascade
4. cell death cycle: neoplastic cells often refuse to die
   1. Genasense: one protein involved in regulating cell death is Bcl-2 & when Bcl-2 is overexpressed, cell death is hindered; and Genasense is an antisense molecule designed to block Bcl-2 gene overexpression in such as CLL, melanoma, multiple myeloma, and non-small-cell lung cancer.
5. immune mediated or immuno-WBC booster:
   1. goad WBCs or antibodies to attack malignant cells:
      1. Rituxan: Rituxan® (Rituximab), indicated for the treatment of patients with relapsed or refractory low-grade or follicular, CD20 positive, B-cell non-Hodgkin's lymphoma: medicinal anti-CD20 attaches to malignant (and benign) CD20 positive lymphoma cells or lymphoid cells...we need to IHC test the tumor to make sure that it has CD20 protein on it. Rituxan is the first monoclonal antibody licensed for the treatment of cancer in the United States 
      2. Bexxar: (Tositumomab plus I¹³¹) for CD20 positive non-Hodgkin lymphoma that relapsed after Rituxan.
      3. Campath: Campath (alemtuzumab), indicated for refractory CLL, works by binding to the CD52 antigen that is present on the surface of the malignant (B-CLL) lymphocytes. After binding, the drug induces antibody-dependent lysis. This causes the removal of malignant lymphocytes from the blood, bone marrow, and other affected organs.
      4. GVAX:
      5. Virulizin:
   2. vaccines:
   3. "injure" tumor cells so that more sensitive to chemo &/or XRT:
      1. IMC-C225 (C225; Erbitux): is an experimental biological treatment that strikes molecular targets -- called EGF receptors -- on cancerous tumors. This appears to weaken the cancer cells' defenses against chemotherapy and radiation therapy. Licensed and manufactured by ImClone Systems, Inc., IMC-C225 is being studied in clinical trials at M. D. Anderson and elsewhere. According to ImClone, current trials involve patients with cancers of the colon, pancreas, breast and head and neck. Planned clinical trials will involve patients with renal cell, esophageal, ovarian and lung cancers.
   4. instillation of organisms: BCG intravessicular instillation for urinary bladder cancer (TCC)
6. radiation:
   1. zone/region
      1. superficial beam: BCC skin cancers
      2. intralumenal brachytherapy: rectal, tracheobronchial, and esophageal
      3. intra-organal "seeds": prostate & breast
      4. external beam
      5. intracavitary
   2. target the malignant cells:
      1. Bexxar: radioactive I¹³¹isotope tagged to  monoclonal CD20 antibody specific for the target cells; pretreatment loading dose of non-radioactive CD20 to block/bind sites on benign CD20 positive cells & leaves the open sites on CD20-richer lymphoma cells for Bexxar binding (therefore, we ought to give a quantitative adjective in our IHC reports on lymphomas). I¹³¹isotope affects about a 0.5 mm. radius
7. anti-angiogenesis:
   1. Neovastat
   2. semaxanib
8. surgery:
9. heat/cold ablation:
10. cytotoxic chemotherapy:
    1. topical: 5FU on superficial squamous lesions (PMKs).

IV. Palliative Methods:

V. Benign Disease:

1. Actimmune (interferon gamma-1b): blocks multiplication of fibroblasts (scar-forming cells) by inhibiting the production & action of the scar-forming molecule, TGF-beta (used in osteopetrosis, idiopathic pulmonary fibrosis).