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Badheeb najran cancer unit 2013

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A brief summary on the upcoming cancer centre in Najtan City , Saudi Arabia Kingdom

A brief summary on the upcoming cancer centre in Najtan City , Saudi Arabia Kingdom

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  • Proposed 4th step – looking at quality of life, changing opioid delivery, looking at invasive treatments
  • There is evidence for the involvement of EGFR in the progression of CRC. Expression is stronger in tumor than normal mucosa [1] and strongest in tumor regions of deepest invasion [2,3]. EGFR expression correlates with the ability of CRC cells to produce hepatic metastases [4], and EGFR expression was shown to be higher in tumors of more advanced stage [5,6].
    Mayer et al showed that pts with EGFR-expressing tumors (>50% of tumors stained) had a shorter median survival than those with non EGFR-expressing tumors (8.7 vs 34.0 mths, p<0.02) [7]. EGFR expression on liver metastases was shown to be a predictor of disease-free survival after partial liver resection [8].
    EGFR is expressed in 25–77% of CRC [1,9].
    EGFR is expressed in 72–86% of MCRC [2,10–12].
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Transcript

  • 1. Towards Multidisciplinary Cancer Care at KKH- Najran Ahmed Badheeb , MD. Professor Of Oncology & internal medicine King Khalid Hospital- Najran
  • 2. Objectives • • • • Cancer : the size of the problem in Najran Cancer unit : the goals. The Tumor Board at KKH: functions & guidelines The importance of multidisciplinary approach.
  • 3. Cancer in Saudi Arabia : 2004
  • 4. Cancer in Saudi Arabia : by sex
  • 5. Cancer in Saudi Arabia : by age
  • 6. Cancer in Saudi Arabia : by ASR
  • 7. In Najran: General
  • 8. Males::In Najran
  • 9. In Najran: females
  • 10. There is an urgent need for Cancer registry • Saudi Cancer Registry (population based). • Hospital based registry
  • 11. Objectives • Cancer : the size of the problem in Najran • Cancer unit : the goals. • The Tumor Board at KKH: functions & guidelines • The importance of multidisciplinary approach.
  • 12. Goals of the oncology Service: • A comprehensive evidence based cancer (including the psycho-social care). • To be a nucleus for the upcoming cancer center. • Training Centre for the doctors, medical students, nurses ,pharmacists, social workers, etc. • Cancer registry service (both hospital based & population based). • Cancer research .
  • 13. Phases of the development • Phase (I): Medical & surgical oncology (?). • Phase(II): Nuclear medicine • Phase (III): addition of radiation oncology service.
  • 14. Phase : 1
  • 15. Chemotherapy Preparation room
  • 16. Chemotherapy infusion room
  • 17. Chemotherapy infusion room
  • 18. VAD team
  • 19. Safe handling of chemotherapy
  • 20. Social support
  • 21. Your diagnosis is cancer !!
  • 22. Psychological support
  • 23. Nutritional support
  • 24. Palliative care & pain management
  • 25. Modified WHO Analgesic Ladder Quality of Life Invasive treatments Proposed 4 th Step Opioid Delivery Pain persisting or increasing Step 3 Opioid for moderate to severe pain ± Nonopioid ± Adjuvant Pain persisting or increasing The WHO Ladder Step 2 Opioid for mild to moderate pain ± Nonopioid ± Adjuvant Pain persisting or increasing Step 1 ± Nonopioid ± Adjuvant Pain Deer, et al., 1999
  • 26. Cancer research unit • Epidemiologists • Bio- statistician
  • 27. Early detection clinic
  • 28. Early detection clinic
  • 29. Procedure Room
  • 30. KHH lab upgrade
  • 31. immunohistochemistry
  • 32. Flowcytometry
  • 33. Cytogenetics
  • 34. Phase II
  • 35. Phase II Bone Scan Patient A Multiple bone metastase s
  • 36. Phase: III
  • 37. Phase: III
  • 38. Objectives • Cancer : the size of the problem in Najran • Cancer unit : the goals. • The Tumor Board at KKH: functions & guidelines • The importance of multidisciplinary approach.
  • 39. Function To approve the best evidence based multidisciplinary diagnostic & therapeutic approach for tumor cases.
  • 40. Multidisciplinary Tumor Board Surgical, medical & radiation oncologists, radiologists, pathologists, nuclear medicine, and coordinator nurses , social worker & psychologist specialists
  • 41. Saudi cancer Guidelines NCCN • Modified from • Written by the most expert oncologists in the country in each branch.
  • 42. What is the NCCN? An Alliance of 21 Academic Cancer Centers in USA
  • 43. NCCN Levels of Evidence • Category 1: Based upon high-level evidence and uniform NCCN consensus that intervention is appropriate • Category 2A: Based on lower-level evidence and uniform NCCN consensus that it constitutes appropriate care • Category 2B: Based upon lower-level evidence and NCCN consensus that it constitutes appropriate care • Category 3: Any level of evidence but major NCCN disagreement that the recommendation is appropriate.
  • 44. Examples from Breast Cancer Guideline
  • 45. Objectives • • • • Cancer : the size of the problem in Najran Cancer unit : the goals. The Tumor Board at KKH: functions & guidelines The importance of multidisciplinary approach.
  • 46. Fundamental questions When is surgery enough? Should we use chemotherapy? difficult to reverse practice Which treatment should we use? toxicity-many 'equal' therapies efficacy dosage
  • 47. What is the best for the patient? Neoadjuvant ? Adjuvant ? •M astectomy vs. lumpectomy •Lymph node dissection vs. sentinel lymph node biopsy
  • 48. Sentinel Lymph Node Biopsy 2. Track the lymphatic drainage of the
  • 49. Personalized Oncology Ligand Ligand EGFr dimer Signal Adapters and Enzymes Grb-2 Shc SOS Grb-2 P13K MAPK = mitogen-activated protein kinase PTEN P13k = phosphatidylinositol 3-kinase SOS Ras Raf Akt MEK 1/2 Signal mTOR Transcription Factors FKHR GSK-3 Cascade BAD MAPK p27 Jun Cyclin D-1 FOS Myc
  • 50. Thank you