ONCOLOGY Patient Management


Patient management
Cancer patient management: Solid tumors
Clinical findings


Cancer diagnosis

CT scans


Therapeutic intention

Therapeutic decision

Tumor markers: Examples
Prostate cancer

Patient management

Pancreatic cancer
CA 19-9

Breast cancer
CA 15-3

Ovarian cancer
CA 125

Testicular cancer
AFP, β 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.

TNM classification

Patient management

Tumor Nodes Metastasis

Tumor extent/staging

Patient management
Tumor extent/staging
Metastatic disease Localized disease = limited stage Resectable tumor Operable patient Nonresectable tumor Inoperable patient


Chemotherapy Radiotherapy Surgery Immunotherapy Hormonal therapy Palliative care

Surgery + Radiation therapy + Chemotherapy + Hormonal-immunotherapy

Radiation therapy Chemotherapy and/or Hormonal therapy Immunotherapy


Patient management
Classification: Leukemias

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.

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.


Patient management
Performance status scales
Correspondence between ECOG and Karnofsky scales
ECOG Grade

100 90

Criteria (simplified)
Normal activity

Functional status
Able to carry on normal activity; no special care is needed


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 3

In bed <50% of time In bed >50% of time

60 50 40 30 Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly

4 5

100% bedridden Dead

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, 5th ed. 1997;295-306.

     

Radiation therapy

Patient management

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, 5th ed. 1997;307-332.

Systemic therapies

Patient management

Chemotherapy – Cytotoxic agent – Hormonal therapy Biologic therapy

Haskell CM. Cancer Treatment. 4th ed. 1995;31-56.

Thank you