Basic Management,KOMPAC 2015

Basic Principles of Cancers Management Widiana, I.K.Division of Surgical Oncology, Department of Surgery Faculty of Medicine University of Udayana / Sanglah Teaching Hospital Denpasar Bali2014

INTRODUCTION

Incidence

THE PHYLOSOPHIC THINKING: For the time being, the best chance of cure of most solid tumors remains resection. The surgeon is the primary care doctor for the patients with solid malignant tumor and coordinated their care. (Surgeon as a leader in Multidiscipline approach) Recently, the standard procedure of malignant tumor treatment depend on Genomic profiling

The surgeon as a prognostic factor of solid tumors.

Copeland III, EM. Surgical Oncology: A Specialty in Evolution, Ann Surg Oncol 1999;6:424-432

THE FACTS ABOUT SURGERIES IN TREATING SOLID CANCERS (CURE RATES) :Surgery is the key to survival of solid cancer patients (62%).Radiation therapy is responsible for 25% cure rate.Chemotherapy is responsible for 4% cure rate.Combination of those three modalities will increase cure rate for another 9% ( total of 71% cure rate).Surgery is still the most important modality in curing solid cancers(Kroon, et al., 2001)

THE FACTS ABOUT SURGERIES IN TREATINGSOLID CANCERS :Adjuvant chemotherapy, especially for Breast & Colo- Rectal cancers has become important in the last decade. The Role of Surgery in treating solid cancers has increased a great deal, although very often it is ignored.

Surgical Oncology is even now playing more important role in curing solid cancers, because of more effective screening and detection programs are available. In which, loco-regional treatment is probably the best instant curative treatment.

BASIC MANAGEMENTS OF CANCERS1. DIAGNOSIS- Clinical- Imaging- Histopathology2. STAGING3. PERFORMANCE STATUS4. PLANNING THERAPY Genomic Profiling5. IMPLEMENTATION THERAPY6. FOLLOW-UP

Clinical diagnosisDefinitive diagnosis

ParotisTyroid1. DIAGNOSISClinical

Tang Lip Breast

IMAGING ONCOLOGY

Mammography

Imaging : CT, MRI, PET Scan

THE PROGRESS OF SURGICAL ONCOLOGY HISTOPATHOLOGY 1. Biopsy : FNAB, Core biopsy, Open biopsy, Imaging guided biopsy2. Pathology/molecular pathology: HE, IHC, PCR, FISH, CISH3. Sentinel Node biopsy (Melanoma, Breast, HN, GI tract).

The Surgeons Need to KnowFinal Pathologic DiagnosisHistologic Type / subtype of TumorAbsence or presence (and depth) of invasion into adjacent or distant structuresStatus of surgical marginsLymph node statusCancer Cells BehaviorImmune ResponsePredictive and prognostic factors

(Hawes, et al., 2009)

COMPONENTS OF THE SURGICAL PATHOLOGY REPORTS1. Patients Identification and Pertinent Demographics2. Primary or Secondary Submitting Physicians3. Final Pathologic Diagnosis4. Comments, Synoptic Report, or Microscopic Description5. Clinical Data and Surgical Specimens Submitted6. Intra operative Consultations7. Gross Specimens Label Identifiers and gross Dissection Description8. Medicolegal Disclaimers9. Special Stains or Studies Performed10. All responsible Pathologists(Hawes, et al., 2009)

Surgeons PathologistsPartnershipCommunication, Adaptation & CommitmentPATIENTS

SAFETY

The Surgical Pathology ReportThe final report is a critical medicolegaldocument to define :The underlying disease processDisseminates prognostic and therapeutic information Not only for clinicians but also for patients and familiesThe role of it is, Has evolved significantly from diagnostician to consultant because of added responsibilities of developing, performing, and interpreting new technologies to obtain prognostic and therapeutic data taken from tissue specimens. (Hawes, et al., 2009)

HistopathologyFine Needle Aspiration Biopsy

Core Needle Biopsy

Incisional biopsyIts a wrong approach

Excisional Biopsy

Sentinel Node Biopsy

2. STAGING

-TNM SYSTEM (UICC/AJCC)-Tumor primary- Lymph node- Metastasis

3. Performance Status Karnofsky Scale.100% - Normal, no complaints, no evidence of disease.90% - Able to carry on normal activity; minor signs or symptoms of disease.80% - Normal activity with effort; some signs or symptoms of disease.70% - Cares for self; unable to carry on normal activity or to do active work.60% - Requires occasional assistance, is mostly able to care for himself.50% - Requires considerable assistance an frequent medical care.40% - Disabled, requires special care assistance.30% - Severely disabled, hospitalization indicated; death on imminent20% - Very sick, hospitalization necessary; active supportive treatment necessary.10% - Moribund, fatal processes progressing rapidly.0% - Death. ECOG , WHO Scale

4. Planning therapy and Implementation

Stage I,II Surgery ( adjuvant)Stage III NAC Surgery adjuvantStage IV palliative Quality of Life (QoL) Stage III NAC (3 cycles) Response Surgery No response radiation or chemotherapy second line response Surgery (Especially Breast and Colo-Rectal cancer) (PERABOI, 2011)

DFS & OS

SUMMARYSurgery is the key to survival of solid cancer patients Combination of those modalities (Surgery, radiation, chemotherapy and biotherapy) therapy will increase cure rate.Surgery is still the most important modality in curing solid cancersGood planning is a good outcome

Enjoy..SUKSMA

****************************