Badheeb najran cancer unit 2013

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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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  • Badheeb najran cancer unit 2013

    1. 1. Towards Multidisciplinary Cancer Care at KKH- Najran Ahmed Badheeb , MD. Professor Of Oncology & internal medicine King Khalid Hospital- Najran
    2. 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. 3. Cancer in Saudi Arabia : 2004
    4. 4. Cancer in Saudi Arabia : by sex
    5. 5. Cancer in Saudi Arabia : by age
    6. 6. Cancer in Saudi Arabia : by ASR
    7. 7. In Najran: General
    8. 8. Males::In Najran
    9. 9. In Najran: females
    10. 10. There is an urgent need for Cancer registry • Saudi Cancer Registry (population based). • Hospital based registry
    11. 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. 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. 13. Phases of the development • Phase (I): Medical & surgical oncology (?). • Phase(II): Nuclear medicine • Phase (III): addition of radiation oncology service.
    14. 14. Phase : 1
    15. 15. Chemotherapy Preparation room
    16. 16. Chemotherapy infusion room
    17. 17. Chemotherapy infusion room
    18. 18. VAD team
    19. 19. Safe handling of chemotherapy
    20. 20. Social support
    21. 21. Your diagnosis is cancer !!
    22. 22. Psychological support
    23. 23. Nutritional support
    24. 24. Palliative care & pain management
    25. 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. 26. Cancer research unit • Epidemiologists • Bio- statistician
    27. 27. Early detection clinic
    28. 28. Early detection clinic
    29. 29. Procedure Room
    30. 30. KHH lab upgrade
    31. 31. immunohistochemistry
    32. 32. Flowcytometry
    33. 33. Cytogenetics
    34. 34. Phase II
    35. 35. Phase II Bone Scan Patient A Multiple bone metastase s
    36. 36. Phase: III
    37. 37. Phase: III
    38. 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. 39. Function To approve the best evidence based multidisciplinary diagnostic & therapeutic approach for tumor cases.
    40. 40. Multidisciplinary Tumor Board Surgical, medical & radiation oncologists, radiologists, pathologists, nuclear medicine, and coordinator nurses , social worker & psychologist specialists
    41. 41. Saudi cancer Guidelines NCCN • Modified from • Written by the most expert oncologists in the country in each branch.
    42. 42. What is the NCCN? An Alliance of 21 Academic Cancer Centers in USA
    43. 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. 44. Examples from Breast Cancer Guideline
    45. 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. 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. 47. What is the best for the patient? Neoadjuvant ? Adjuvant ? •M astectomy vs. lumpectomy •Lymph node dissection vs. sentinel lymph node biopsy
    48. 48. Sentinel Lymph Node Biopsy 2. Track the lymphatic drainage of the
    49. 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. 50. Thank you

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