• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology
 

BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology

on

  • 640 views

 

Statistics

Views

Total Views
640
Views on SlideShare
632
Embed Views
8

Actions

Likes
0
Downloads
0
Comments
0

1 Embed 8

http://www.eso.net 8

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology Presentation Transcript

    • Janez Žgajnar Institute of Oncology Ljubljana
    •  
    •  
    •  
    •  
    •  
    •  
      • Institute of Oncology Ljubljana
      • Basics of surgical oncology
      • Screen detected breast cancer and multidisciplinary approach
    • Institute of Oncology Ljubljana
      • Founded in 1938
      • Today major comprehensive cancer centre in Slovenia
      • The professional work is based on a high-quality multidisciplinary approach to diagnosis and treatment.
      • The Institute is the central national institution
        • that partially performs, and at a national level, directs the programs of comprehensive cancer care in the fields of prevention, early detection, treatment and rehabilitation.
      • Education and research
      • National cancer registry (www.slora.si)
    •  
      • >3000 major surgery procedures
      • 6000 patients RT
      • ~5000 patients cytotoxic systemic treatment introduced
      • 950 employees (~140 physicians)
    • Multidisciplinary work and the IO
      • 14 different MD meetings weekly at the OI
      • Collaboration in MD meetings in other institutions in Slovenia
      • Teleconference MD meeting introduced this year
    • AIM of the IO as a leading oncology center in the state
      • To improve all aspects of the oncology in Slovenia
      • To enable equal access to high quality diagnostics and treatment for all citizens
      • NATIONAL CANCER PLAN
    • Basics of Surgical Oncology
    • Surgical oncologist
      • “ Surgeons who devote most of their time to the study and treatment of malignant neoplastic disease”
      • Pollock R and Morton D, Cancer Medicine 2003
    • Profound knowledge needed
      • Pathology of the disease
      • Diagnostic procedures
      • Multimodality treatments
        • Systemic treatment
        • Radiotherapy
        • Specific surgical procedures
      • Surgical oncology is more a
      • COGNITIVE ( how and when)
      • than
      • TECHNICAL ( how)
      • surgical specialty
    •  
    • Sentinel node biopsy limfoscintigraphy
    • Sentinel node biopsy surgery
    • Some facts about surgery in cancer treatment
      • Surgery is the oldest modality of cancer treatment
      • When used as a single modality it cures more patients that other modalities
      • It is the most effective treatment of the local disease and the regional lymph nodes
    • Development of cancer surgery
      • Originally only conservative
        • Removal of the gross lesion
      • Extensive surgery with curative intent
        • Mutilating procedures
      • Conservative- with multimodality treatment
    • Surgical components of cancer management (1)
      • Prevention
        • Prophylactic surgery
      • Biopsy and the diagnosis of the tumor
        • Needle biopsy
          • Fine needle, core biopsy
        • Incisional biopsy
        • Excisional biopsy
    • Surgical components of cancer management (2)
      • Staging
      • Preoperative preparation
      • Cancer surgery
    • Types of cancer surgery (1)
      • Wide local resection with removal of a wide margin of healthy tissue
        • Excision of a “ pseudocapsule ” (a zone of a compressed normal tissue interspersed with neoplastic cells)
    •  
    • Types of cancer surgery (2)
      • “ En block” resections to encompass gross and microscopic disease in adjacent anatomical locations
        • i.e. regional lymph nodes with all lymphatic channels
    •  
    •  
    •  
    •  
    • Tearing the rectosacral ligament
    • Pelvic nerves and dissection plane Righ hypograstric n. Left hypograstric n. R.J. Heald (modified)
    • Correct and incorrect plane of dissection Correct plane Incorrect plane
    • Good TME specimen
    • Indications for surgery
      • Primary local or loco-regional treatment
      • Treatment of the locoregional relapse
      • Treatment of the distant metastases
      • Palliative treatment
    •  
    •  
    •  
    •  
    • Case report of a screen detected breast cancer
    • Why this choice?
      • Mammographic screening is an example of a highly complex approach which illustrates the multidisciplinary in oncology in order to achieve measurable results
      • Opportunistic screening is the opposite example A lot of work – no result
    • Breast cancer in Slovenia by stage and period Register raka za Slovenijo
    • 24.848 15.192 14.623 6.252 16.098 Σ = 64.683 8.688 32.103 9.122 42.005 16.056 I. II. III. Target population (50- 69): 255.624 Average cumulative incidence rate 1998 – 2002 4,68-5,37 5,38-6,06 6,06-6,74 6,75-7,42 7,43-8,11 5.954 Σ = 91.655 Σ = 99.286
    • SIEMENS - NOVATION HOLOGIC - SELENIA Mobile units
    • Screening workflow and timing P T T T P P S Č S S Č Č P P P Double reading CONSENSUS Invitation to further assessment ASSESSMENT PREOPERATIVE MDC MEETING The patient is informed 15%-20% 5%-7% 1%-2%
    • Multidisciplinary meetings (1)
      • Breast tumor board
        • Multimodal therapy discussed Surgeon, radiotherapist, medical oncologist, pathologist
      • Nonpalpable lesions
        • From screening after needle biopsies
        • After surgery of the nonpalpable lesions Surgeon, pathologist, radiologist
      • Breast reconstruction meeting Surgeon, reconstructive surgeon
    • Mammography screening MD meetings
      • Consensus conference
      • MDC preoperative meeting Surgeon, pathologist, radiologist
      • MDC postoperative meeting
    •  
    • Screen detected breast cancer (1)
      • 51 year old women, invited for mammography screening
      • M y cro c alcifications revealed in upper outer quadrant of the right breast
    •  
    • CONSENSUS conference
      • Two groups of M y crocalc: 18mm and 22 mm
      • BIRAD 4b
      • RECOMMENDATION: Vacuum assisted core biopsy recommended
    • High grade DCIS
    • High grade DCIS
    • Preoperative conference (radiologist, pathologist, surgeon, nurse)
      • Bifocal, large area, high grade DCIS RECOMMENDATION: mastectomy and sentinel node biopsy +/- reconstruction
    • Reconstruction MD meeting (surgical oncologist, plastic surgeon)
      • RECOMMENDATION: immediate autologous free flap (DIEP) reconstruction
    • Free flaps : DIEP msTRAM SIEA continues to dominate as the workhorse for (autologous tissue) breast reconstruction.
    •  
    •  
      • Invasive ductal cancer and DCIS
      • IDC 13 mm, G2,
      • ER 100%, PR 70%,
      • HER 2 not yet available
      • sentinel node metastasis 7mm
    • Postoperative conference (radiologist, pathologist, surgeon, nurse)
      • RECOMMENDATION: completion axillary node dissection
    • Final histopathology result
      • Invasive ductal cancer and DCIS
      • IDC 13 mm, G2,
      • ER 100%, PR 70%,
      • HER 2 negative
      • MIB 10-15%
      • Axillary lymph node status 1/24
    • Breast cancer tumor board
      • Documentation submitted
    • conclusion
      • No conclusions until Sunday