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Medicine 5th year, 2nd lecture/part two (Dr. Abdulla Sharief)
 

Medicine 5th year, 2nd lecture/part two (Dr. Abdulla Sharief)

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The lecture has been given on Apr. 28th, 2011 by Dr. Abdulla Sharief.

The lecture has been given on Apr. 28th, 2011 by Dr. Abdulla Sharief.

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    Medicine 5th year, 2nd lecture/part two (Dr. Abdulla Sharief) Medicine 5th year, 2nd lecture/part two (Dr. Abdulla Sharief) Presentation Transcript

    • GENERAL MANAGEMENT PRINCIPLES Dr.Abdulla Sherif.
    • GOALS OF NON - SURGICAL TREATMENT
      • Curative
      • Choriocarcinoma
      • Teratoma
      • Seminoma
      • High - grade lymphoma
      • Cervical cancer
      • Head and neck cancer
    • GOALS OF NON - SURGICAL TREATMENT
      • Radical, occasionally curative
      • Small - cell lung cancer
      • Stage III ovarian cancer
    • GOALS OF NON - SURGICAL TREATMENT
      • Adjuvant (with surgery)
      • Breast cancer
      • Stage I-II ovarian cancer
      • Colorectal cancer
      • Osteogenic sarcoma
    • GOALS OF NON - SURGICAL TREATMENT
      • Palliative
      • Metastatic breast cancer
      • Stage IV varian cancer
      • Advanced gastrointestinal ancers
      • Metastatic sarcoma
      • Metastatic prostate cancer
      • Advanced lung cancer
    • General principles of management:
      • Patients must be informed of the diagnosis and the stage and prognosis for the disease, to allow an informed discussion about treatment options .
      • The initial consultation must be unhurried and empathetic so that the patient's history, fears and concerns can be fully ascertained .
      • The doctor needs to establish good communication and a rapport with the patient .
      • Patients' responses to the diagnosis of cancer vary from shock to denial, anxiety, depression or inappropriate fatalism .
      • Oncologists have to remain sensitive to patients' needs and fears, yet still be able to discuss the appropriateness of starting and stopping treatment .
    • General principles of management:
      • The future cannot be foreseen with certainty, so discussions with patients and relatives must take account of the variability in outcome and response to treatment, but in a way that does not undermine their confidence .
      • It is not helpful to give patients '6 months to live', or to describe a treatment as having been 'successful' when residual disease may be present .
      • Integral to treatment planning is a decision about the aims of therapy & these should be clear to the doctor, to the patient and to the patient's family .
    • Cancer treatments:
      • Can be divided into :
      • Curative treatment
      • Palliative treatment - given to alleviate symptoms, with an emphasis on quality rather than quantity of life
      • However, sometimes the best way of achieving symptomatic control is to reduce the amount of cancer with systemic anti - cancer treatment .
      • Adjuvant treatments - given after primary therapy such as surgery, when there is no known residual disease but a defined risk of recurrence which can be reduced by another treatment For example, radiotherapy, chemotherapy and hormonal therapy each incrementally reduce the risk of recurrent breast cancer .
    • Cancer treatments:
      • Many treatments for cancer are associated with significant morbidity and sometimes mortality.
      • It is therefore of paramount importance to the patient and clinician to define the goal of a treatment strategy at the outset, accepting that this may need to be revised in the light of subsequent assessment.
      • If the goal of therapy is cure then clearly a greater degree of toxicity will be acceptable than if it is palliative.
    • Cancer treatments:
      • TREATMENT PLANNING:
      • Increasingly, multiple treatments are being used to obtain optimal results, particularly where the aim of treatment is cure.
      • Usually, a strategy is designed by a multidisciplinary team which includes representatives from all the specialties that may be involved in the management of the patient (e.g. medical and clinical oncologists and specialist surgeons).
    • Cancer treatments:
      • ASSESSMENT OF RESPONSE For treatments
      • where there is measurable disease (such as the primary cancer or metastatic disease), it is important to formally assess response, usually at defined times such as after radiotherapy or a certain number of courses of chemotherapy.
      • Where possible, marker lesions such as clinically measurable lymph nodes or radiologically imageable lung or liver metastases should be assessed, and response defined as either complete or partial, static or progressive disease.
      • If the primary cancer has been excised and the treatment is adjuvant, this is not possible, so a course of therapy is defined and completed, as long as toxicity is acceptable.
      • With palliative therapy, assessment of response is more subjective and may focus on an improvement in general well-being, pain control or performance status.
      • Whether objectively or subjectively, it is important to assess response to therapy accurately, so that ineffective treatment is stopped as soon as possible.
    • Cancer treatments:
      • SANCTUARY SITES
      • Systemic therapies have poor penetration of the brain and testes, as a consequence of which potentially radical drug treatment can fail.
      • For leukaemias this poses a major problem and requires additional therapy.
      • In solid tumour oncology, limited small-cell lung carcinoma has a subsequent high incidence of symptomatic and life-threatening brain metastases, which can be reduced by additional therapy with prophylactic cranial irradiation (PCI).
      • Patients with breast cancer that over-expresses the Her-2 oncogene also have a high risk of developing brain metastases (up to one-third of patients with metastatic disease)
      • benefit of PCI in small-cell lung cancer is leading to studies to determine whether a similar approach might be justified in this aggressive subtype of breast cancer.