COMMUNAL TUMOUR BOARD IN THE HEART OF AFRICA
Aug 07, 2015
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- 1. The Lagos Musculoskeletal Oncology Network [LAMON]: A communal tumour board in a resource constrained environment
- 2. Background Globally, multidisciplinary management has been the most effective care for patients with cancer. Previously, formal multidisciplinary team for management of musculoskeletal tumours was non existent in Lagos [probably in Nigeria as a whole] Hence the need for a team of specialists from various hospitals in Lagos to integrate patient care. Further collaboration with specialists outside Lagos...........
- 3. Objectives To achieve integrated care pathways for patients with musculoskeletal tumours[MST] in Lagos. Adherence as much as possible to agreed local and national guide lines in the management of MSTs. Avail every team member the opportunities for educational/professional development especially through the inclusion of trainees. LAMON may eventually translate into a national network
- 4. Network Associates Pathology: 6 consultants Radiation Oncology: 2 consultants Radiology: 5 consultants Plastic Surgery: 2 consultants Surgical Oncology: 2 consultant Orthopaedic Surgery: 9 consultants Networking extended to specialists as required i.e. Pharmacists, Social workers, Physio and occupational therapists, Specialist nurses
- 5. MDT meeting structure Monthly clinical meeting to discuss patient care. Regular meeting scheduled for 2nd Monday of every month Agenda structured into radiology discussion, Histopathology discussion + AOB. Decisions about surgery, chemotherapy, radiotherapy and timing of modalities, planned at the meetings.
- 6. 0 2 4 6 8 10 12 14 16 So far: 117 cases reviewed 81 cases with histological Diagnoses
- 7. The book! a product of the network
- 8. CHALLENGES High cost of available reconstruction prosthesis High cost of chemotherapy Unavailability of any bone bank in the West African sub-region to for reconstruction options. Unavailability of robust health insurance in Nigeria for most patients undergoing cancer treatment. Inadequate advocacy network to influence decision makers
- 9. NOTABLE CASES
- 10. A.A: X-rays of a 9 yr old boy with polyostotic fibrous dysplasia in the upper and lower limbs. Offered conservative treatment after deliberations.
- 11. A.A : bone scan revealing polyostotic fibrous dysplasia
- 12. O.F : 56 yr old female presenting with recurrent aneurysmal bone cyst left femur. Had resection as a staged procedure, awaiting endoprosthetic total femoral replacement as a second stage procedure. MRI scan Post up X-ray Resected tumour
- 13. E.A : 10 year old girl with huge osteosarcoma right femur. Late presentation on account of traditional bone setters precluded limb salvage. Unfortunately required emergency amputation and chemotherapy Picture of amputated stump Preoperative X-ray
- 14. G.O: 8 yr old girl with fracture through a proximal femur fibrous dysplasia. Post curettage and fibular cortical grafting. Preoperative X- ray Post operative X- ray
- 15. P.E: 42 yr old gentleman with metastatic cancer. Had fracture treatment and chemotherapy. Preoperative X- rays CT scan chest
- 16. AU: recurrent fibromatoses left shoulder. Had excision plus flap cover in conjunction with plastic surgeons. Presently undergoing adjuvant chemotherapy Intraoperative photograph Pre operative radiograph
- 17. V.H : 31 yr old lady with recurrent giant cell tumour left femur. Had resection plus distal femoral endoprosthetic reconstruction. Post operative photograph Preoperative photograph
- 18. V.H: intraoperative photograph, pre and post op X-rays
- 19. M.M: young lady with huge schwanoma in the buttock. Had resection of the mass with adequate margins. Preoperative photograph CT scan buttock Intraoperative photograph
- 20. colores variados.networking works!
- 21. Conclusion LAMON (Lagos musculoskeletal oncology network ) is an initiative borne out the dearth of resources for cancer care in the Lagos metropolis The network has so far contributed to the care of over a hundred patients within the first year of inception. Communal tumour boards like LAMON need social and corporate support as model multidisciplinary cancer management team for developing countries.
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