Download ONCOLOGY Patient management

ONCOLOGY
Patient Management
ONCOLOGY
Patient management
Cancer patient management: Solid tumors
Clinical findings
Biopsy
Cancer diagnosis
Staging/Grading
Therapeutic intention
Therapeutic decision
CT scans
ONCOLOGY
Patient management
Tumor markers:
Examples
Prostate
cancer
PSA
EAP
Pancreatic
cancer
CA 19-9
Breast
cancer
CA 15-3
Ovarian
cancer
CA 125
Testicular
cancer
AFP, hCG
Tretter C. Current Cancer Therapeutics. 1998;224-237.
Rosenbaum EH. Everyone’s 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.
ONCOLOGY
Patient management
TNM classification
Tumor
Nodes
Metastasis
ONCOLOGY
Patient management
Tumor extent/staging
Tumor extent/staging
Metastatic disease
Extent
Chemotherapy
Radiotherapy
Surgery
Immunotherapy
Hormonal therapy
Palliative care
Localized disease
= limited stage
Resectable
tumor
Operable
patient
Surgery
+ Radiation therapy
+ Chemotherapy
+ Hormonal-immunotherapy
Nonresectable
tumor
Inoperable
patient
Radiation therapy
Chemotherapy
and/or
Hormonal therapy
Immunotherapy
ONCOLOGY
Patient management
Classification: Leukemias

Morphology and cytochemistry
(ie, lineage)

Maturational stage

Genotype
Scheinberg DA, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;2404-2447.
ONCOLOGY
Patient management
Staging: Lymphomas

Number of nodal sites involved

Presence of disease above or
below diaphragm

Presence or absence of systemic
symptoms

Presence or absence of
extranodal disease
Shipp AA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997:2165-2220.
ONCOLOGY
Patient management
Performance status scales
Correspondence between ECOG and Karnofsky scales
ECOG
Grade
0
Criteria (simplified)
Normal activity
KARNOFSKY
%
100
90
1
Symptoms but ambulatory
2
In bed <50% of time
60
50
3
In bed >50% of time
40
30
100% bedridden
5
Dead
Able to carry on normal activity;
no special care is needed
80
70
4
Functional status
Unable to work; able to live at home;
cares for most personal needs;
a varying amount of assistance is needed
Unable to care for self; requires
equivalent of institutional or hospital
care; disease may be progressing rapidly
20
10
0
Dead
ONCOLOGY
Patient management
Surgery in cancer

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
Rosenberg SA. Cancer: Principles & Practice of Oncology, 6th ed. 2001;253-264.
ONCOLOGY
Patient management
Radiation therapy

Teletherapy (eg, orthovoltage, supervoltage,
intraoperative radiotherapy, stereotaxic
radiosurgery)

Brachytherapy (eg, internal radiation therapy,
interstitial radiation therapy, intracavitary
radiation, intraluminal radiation therapy)
Hellman S. Cancer: Principles & Practice of Oncology, 6th ed. 2001;265-288.
ONCOLOGY
Patient management
Systemic therapies

Chemotherapy
– Cytotoxic agent
– Hormonal therapy

Biologic therapy
Haskell CM. Cancer Treatment. 4th ed. 1995;31-56.