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ONCOLOGYONCOLOGY
Patient ManagementPatient Management
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ONCOLOGYONCOLOGYPatient managementPatient management
Cancer patient management: Solid tumorsCancer patient management: Solid tumors
Therapeutic decisionTherapeutic decision
Clinical findingsClinical findings
Cancer diagnosisCancer diagnosis
Therapeutic intentionTherapeutic intention
BiopsyBiopsy CT scansCT scans
Staging/GradingStaging/Grading
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ONCOLOGYONCOLOGYPatient managementPatient management
Tumor markers:Tumor markers:ExamplesExamples
ProstateProstatecancercancer
PSAPSA
EAPEAP
TesticularTesticularcancercancer
AFP,AFP, hCGhCG
PancreaticPancreaticcancercancer
CA 19-9CA 19-9
BreastBreastcancercancer
CA 15-3CA 15-3
OvarianOvariancancercancer
CA 125CA 125
Tretter C. Current Cancer Therapeutics. 1998;224-237.
Rosenbaum EH. Everyones Guide to Cancer Therapy, 3rd ed. 1997;616-622.Haskell CM. Cancer Treatment, 4th ed. 1995;322-337.
Berek JS. Cancer Treatment, 4th ed. 1995;628-634.
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ONCOLOGYONCOLOGYPatient managementPatient management
TNM classificationTNM classification
TTumorumor
NNodesodes
MMetastasisetastasis
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ONCOLOGYONCOLOGYPatient managementPatient management
Tumor extent/stagingTumor extent/staging
Localized diseaseLocalized disease
= limited stage= limited stage
Chemotherapy
Radiotherapy
Surgery
Immunotherapy
Hormonal therapy
Palliative care
Tumor extent/stagingTumor extent/staging
Metastatic diseaseMetastatic disease
ExtentExtentResectableResectable
tumortumorNonresectableNonresectable
tumortumor
OperableOperablepatientpatient InoperableInoperablepatientpatient
Surgery
+ Radiation therapy
+ Chemotherapy
+ Hormonal-immunotherapy
Radiation therapy
Chemotherapy
Hormonal therapy
Immunotherapy
and/or
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Classification: LeukemiasClassification: Leukemias
ONCOLOGYONCOLOGYPatient managementPatient management
Morphology and cytochemistry(ie, lineage)
Maturational stage
Genotype
Scheinberg DA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;2293-2321.
Deisseroth AB, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;2321-2343.
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Staging: LymphomasStaging: Lymphomas
Shipp AA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997:2165-2220.
ONCOLOGYONCOLOGYPatient managementPatient management
Number of nodal sites involved
Presence of disease above orbelow diaphragm
Presence or absence of systemic
symptoms
Presence or absence ofextranodal disease
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ONCOLOGYONCOLOGYPatient managementPatient management
Performance status scalesPerformance status scales
Correspondence between ECOG and Karnofsky scales
GradeGrade Criteria (simplified)Criteria (simplified) %% Functional statusFunctional status
0 Normal activity 100 Able to carry on normal activity;no special care is needed
90
1 Symptoms but ambulatory 80
70 Unable to work; able to live at home;
cares for most personal needs;a varying amount of assistance is needed
2 In bed 50% of time 40 Unable to care for self; requires
equivalent of institutional or hospital
30 care; disease may be progressing rapidly
4 100% bedridden 20
10
5 Dead 0 Dead
ECOGECOG KARNOFSKYKARNOFSKY
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Surgery in cancerSurgery in cancer
Rosenberg SA. Cancer: Principles & Practice of Oncology, 5th ed. 1997;295-306.
ONCOLOGYONCOLOGYPatient managementPatient management
Tissue acquisition for histologic disease
Primary treatment modality in localized disease
(alone or in combination with other treatment modalities)
Reduction of tumor bulk
Resection with intent to cure
Treatment of oncologic emergencies
Reconstruction or rehabilitation
Palliation of tumor-related symptoms
Prophylactic use in high-risk patients
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ONCOLOGYONCOLOGYPatient managementPatient management
Teletherapy (eg, orthovoltage, supervoltage,
intraoperative radiotherapy, stereotaxicradiosurgery)
Brachytherapy (eg, internal radiation therapy,
interstitial radiation therapy, intracavitary
radiation, intraluminal radiation therapy)
Radiation therapyRadiation therapy
Hellman S. Cancer: Principles & Practice of Oncology, 5th ed. 1997;307-332.
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ONCOLOGYONCOLOGYPatient managementPatient management
Chemotherapy
Cytotoxic agent
Hormonal therapy
Biologic therapy
Systemic therapiesSystemic therapies
Haskell CM. Cancer Treatment. 4th ed. 1995;31-56.
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Thank you
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