APPROACH TO THE

MAGNITUDE OF THE PATIENT TREATMENT SUPPORTIVE

! RISK FACTORS: ! DIAGNOSIS ! CURATIVE ! PAIN

" Age (2/3 of cases >65 y.o) " History and Physical Exam ! PALLIATIVE " CAUSES
# 0-49 y.o. - 1:29 M, 1:19 W " Invasive tissue biopsy ! MANAGEMENT OF TREATMENT # TUMOR (70%)
# 50-59 y.o. - 1:15 M, 1:17 W " FNAB (thyroid nodule) COMPLICATIONS # SURGICAL (20%)
# 60-69 y.o. - 1:6 M, 1:10 W " Molecular diagnostic information " RESIST CRITERIA # UNRELATED
" Smoker # Cell surface markers # Complete response TO CANCER OR
" Alcohol consumption # Intracellular proteins • Disappearance of all evidence of TREATMENT
" Obesity ! DEFINING THE EXTENT OF # Partial response (10%)
" Physical inactivity DISEASE AND PROGNOSIS • >50% reduction in the sum of the " RELIEF
" Low fruit and vegetable " Clinical staging products of the perpendicular # PHARMACOLO
consumption # Physical exam diameter of all measurable lesions GIC
" Unsafe sex # Radiographs [PD] INTERVENTION
" Air pollution # Isotopic scans • 30% decrease in the sum s of the (85%)
" Indoor smoke # CT scans longest diameters of lesion[L] # ANTITUMOR
" Contaminated injections " Pathologic staging # Progressive response THERAPY (12%)
! EPIDEMIOLOGY # Information during surgery • >25% increase PD ! NAUSEA
" INCIDENCE • Intraoperative palpation • 20% increase L " ACUTE EMISIS
# MALE • Resection of regional LN # Stable disease # Within 24 hours of
• Prostate (19%) and/or adjacent to the • Does not meet any criteria treatment
• Lung (14%) tumor " TUMOR MARKERS # Due to stimulation
• Colorectal (9%) • Inspection # Table 65-6 of vomiting center
• Bladder (7%) • Biopsy ! LONG TERM FOLLOW UP " DELAYED EMISIS
# FEMALE # Histologic examination " TRADTIONAL FOLLOW UP # 1-7 hours after
• Breast (30%) " Tumor burden # Timing treatment
• Lung (12%) # Physiologic reserve • Monthly (6-12months) # Related to bowel
• Colorectal (8%) • Patient Age • Every other month (1 year) inflammation
• Thyroid (6%) • Karnofsky performance • Every 3 months ( 1 year) " ANTICIPATORY
" DEATH status (table 65-4) • Every 6 months ( 1 year) EMISIS
# MALE ! <70 (poor prognosis) • Anually # Before
• Lung (27%) • Eastern Cooperative # Test administration of
• Colorectal (9%) Oncology Group (ECOG) • Imaging chemotherapy
• Prostate (8%) (table 65-5) • Biopsy (persistent abnormality) # Response to visual
• Pancreas (7%) ! >3 (poor prognosis) " NEW GUIDELINES and olfactory
# FEMALE # Less frequent, History and PE stimuli of previous
• Lung (25%) chemotherapy
• Breast (14%) ! EFFUSIONS
" Secondary to Lung Ca,
• Colerectal (9%)
Breast Ca,
• Pancreas (7%)