4th Jan stuff

Thursday, January 4, 2018 3:21 PM

PDT:
• Highest sensitivity is fluorescence followed by white light and autofluorescence, but
autofluorescence has the best specificity
• PPIX is used for autofluorescence, more in tumour due to decreased ferrochelatase activity but
reduced specificty due to autofluorescence from other tissues

Imaging
• CT: barium meal or iodine as contrast agent, quite cheap, and reproducible, 3D and good contrast,
and can be used with pacemakers or any metal implants
• Cons: misdiagnosis!! And more xrays so can't have too many per year
• MRI: hard to difficult moving things like lungs, contrast agent: DCE
• Gadolinium - T1 enhancer, enhances the signal, go from dark to bright
• Perfusion imaging: arterial spin labelling, tag water molecules and make them paramagnetic so
when they come into the field they make things darker
• Right: high signal on perfusion imaging and low signal on necrosis (diffusion imaging) because less
diffusion
•
• Ultrasound: only for liver metastases
• SPECT: gamma rays everywhere but they use detectors to block them off and get ray from one
angle so they can then make an image
• Spect more common
Poor resolution compared to PET but it's more widely avaiable because longer tracers
Iodine

• And with some tracers, I and Lu they are beta emitters too so you can get therapy at the same
time
• PAI: infrared that gets into tissue, thermoexpansion which leads to ultrasound wave, limited depth
of penetration but high resolution

Anti-angiogenesis:
• Bevacizumab: adverse effects helping to inform which patients to give it to, so e.g wound healing
is a complication so you wouldn't give it to patients that had surgery
• Diarrhea - fast growing cells, tyrosine kinase
Nausea, stomatitis, hypertension because targetting vessels, hand-foot syndrome (udderly smooth
lol), and decline in ejection fraction so patients with risk factors for angina
• VEGF pathway in immunosupression too
• Cabozantib: everyone had a side effect! Hypothyroidism that may not getting better
• Bevacizumab and sunitinib also used as insurance policy now after tumour resection
• Ooh pericytes protect normal vessels from vascular disrupting

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• Ooh pericytes protect normal vessels from vascular disrupting
• Combrestatin A4PL: binds tubulin and disrupts and disrupts VE cadherin and b-catenin and makes
the enothelial cells of the vessel break apart; spare tumour rim and were also getting toxicity to
wherever there are lots of blood vessels, e.g sensory ataxia and bowel and cardiac ischemia

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