How can immunotherapy be used to treat metastatic breast cancer? Ian Krop, MD, PhD, discusses the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 and hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
What is biomarker?
What is the purpose of biomarker
Processes of biomarker development?
Types of Biomarkers
What is biomarker testing for cancer treatment?
Uses of Biomarkers in Cancer Medicine
Uses of Biomarkers in Cancer Drug Discovery
How can immunotherapy be used to treat metastatic breast cancer? Ian Krop, MD, PhD, discusses the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 and hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
What is biomarker?
What is the purpose of biomarker
Processes of biomarker development?
Types of Biomarkers
What is biomarker testing for cancer treatment?
Uses of Biomarkers in Cancer Medicine
Uses of Biomarkers in Cancer Drug Discovery
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Audio and slides for this presentation are available on YouTube: http://youtu.be/e_KVYJX2GTs
Have you ever wondered about your genetic predisposition to cancer? How cancer evolves in families? Or how cancer cells differ from normal cells in your body? Join Judy Garber, MD, MPH, director of the Center for Cancer Genetics and Prevention at Dana-Farber Cancer Institute, as she explores the basics of cancer genetics, DNA mutations, genetic screening, management, and more.
Audio and slides for this presentation are also available on YouTube: http://youtu.be/ukXhuy5cXrE
Huma Q. Rana, MD, a cancer geneticist with Dana-Farber Cancer Institute, explains the cancer risk associated with BRCA1 and BRCA2 gene mutations. This presentation was originally given on July 23, 2013 as part of the "What Every Woman Should Know" event put on by Dana-Farber's Susan F. Smith Center for Women's Cancers.
Breast cancer & biomarkers, their types, novelty of breast cancer biomarkers. Detailed study of her2, p53, BRCA1, BRCA2, DPD, 21-Gene signature, 70-Gene signature, cd106, vcam1, nlr, bFGF, mammaglobin, ER, PR, CEA. Pthological samples for biomarkers test, Ranges of various biomarkers, breast cancer diagnosis, prognosis, occurance, selection of breast caner treatment like targeted therapy.
Biomarkers have a diversified role in diagnosis, prognostication and risk stratification. This presentation aims to compile the basic information and new literature on various biomarkers pertaining to cancer care.
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Audio and slides for this presentation are available on YouTube: http://youtu.be/e_KVYJX2GTs
Have you ever wondered about your genetic predisposition to cancer? How cancer evolves in families? Or how cancer cells differ from normal cells in your body? Join Judy Garber, MD, MPH, director of the Center for Cancer Genetics and Prevention at Dana-Farber Cancer Institute, as she explores the basics of cancer genetics, DNA mutations, genetic screening, management, and more.
Audio and slides for this presentation are also available on YouTube: http://youtu.be/ukXhuy5cXrE
Huma Q. Rana, MD, a cancer geneticist with Dana-Farber Cancer Institute, explains the cancer risk associated with BRCA1 and BRCA2 gene mutations. This presentation was originally given on July 23, 2013 as part of the "What Every Woman Should Know" event put on by Dana-Farber's Susan F. Smith Center for Women's Cancers.
Breast cancer & biomarkers, their types, novelty of breast cancer biomarkers. Detailed study of her2, p53, BRCA1, BRCA2, DPD, 21-Gene signature, 70-Gene signature, cd106, vcam1, nlr, bFGF, mammaglobin, ER, PR, CEA. Pthological samples for biomarkers test, Ranges of various biomarkers, breast cancer diagnosis, prognosis, occurance, selection of breast caner treatment like targeted therapy.
Biomarkers have a diversified role in diagnosis, prognostication and risk stratification. This presentation aims to compile the basic information and new literature on various biomarkers pertaining to cancer care.
Oncology Nursing:-An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can be defined as meeting the various needs of oncology patients during the time of their disease including appropriate screenings and other preventive practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon the end of life.
What is oncology?
Oncology is the branch of medicine that researches, identifies, and treats cancer. A physician who works in the field of oncology is an oncologist.
Oncologists must first diagnose cancer, which is usually carried out via biopsy, endoscopy, X-ray, CT scanning, MRI, PET scanning, ultrasound, or other radiological methods. Nuclear medicine can also be used to diagnose cancer, as can blood tests or tumor markers. Oncology is often linked with hematology, which is the branch of medicine that deals with blood and blood-related disorders.
Treatment
Once a diagnosis is made, the oncologist discusses the disease stage with the patient. Staging will dictate the treatment of cancer. Chemotherapy — which is defined as the destruction of cancer cells — may be used, as well as radiation therapy. Surgery is used to remove tumors. Hormone therapy is used to treat certain types of cancers, and monoclonal antibody treatments are gaining popularity. Research into cancer vaccines and immunotherapies is ongoing. Palliative care in oncology treats pain and other symptoms of cancer.
Treatment team
Cancer is often treated in a team effort, with at least two or three types of oncologists, including medical, surgical, or radiation. The oncology treatment team may also include a pathologist, a diagnostic radiologist, or an oncology nurse. In the event of a new or a difficult-to-treat case of cancer, the oncology care team may consult a tumor board, made up of various medical experts from all relevant disciplines. The tumor board reviews the case and recommends the best course of cancer treatment for the patient.
Oncology nurse
The oncology nurse has many roles, from helping with cancer screening, detection, and prevention, to the intensive care focus of bone marrow transplantation. Work settings for oncology nurses also vary and include acute care hospitals, ambulatory care clinics, private offices, radiation therapy facilities, and home care agencies. Oncology nurses work with adult and pediatric patients with cancer.
Pediatric Oncology
Pediatric oncology is a medical specialty that focuses on cancer care for children.
The National Cancer Institute estimates that 10,270 new cases of cancer will be diagnosed in children in 2017. Of these, 1,190 children will die from the disease.
Pediatric oncology is an important medical field that treats all pediatric cancer types, including acute lymphocytic leukemia,
Week 6 DiscussionQuestion ARisk management is a matter of id.docxcockekeshia
Week 6 Discussion
Question A
Risk management is a matter of identifying the situations that could cause your project to fail. Common risks include loss of staff, decreased funding, decision point approvals not completed in a timely manner, and content not being available. Brainstorm three or four other risks that you have seen in your professional experience. If you are having trouble identifying projects, brainstorm with your classmates or contact your instructor.Once you have 3-4 risks, identify at least two ways to prevent each and two ways to resolve them, if they happen in spite of your preventions. Post your ideas.
Question B
How does the Work Breakdown Structure (WBS) help to minimize risks? How often should a risk analysis be conducted? Why are risks often overlooked?
1-Today I am going to talk to you about prostate cancer. The purpose of my presentation is to discuss the role of diagnostic imaging in prostate cancer patient. I will start my presentation by introducing the condition of the pathology, then I will mention the general symptoms, investigation staging and treatment of the condition. Then I will focus on the patient case study pathway. Finally, I will summarise my presentation and I will give you time for questions after the presentation.
2- Prostate cancer is a fatal disease that affects millions of men worldwide every year. Its clinical behavior ranges from low grade tumours that never develop to aggressive tumours those growths into metastases disease (Johnson et al, 2014). The cause of the disease has not been found, but several related risk factors have been known, such as genetics, age and diet. Prostate cancer is the highest prevalent non-skin malignant tumors diagnosis in male patients in the UK, accounting 24% of entirely new cancers. The main prospect of developing prostate cancer is related to advancing age, that has been seen diagnoses occurring in men over the age of 65 and is rare in those 40 years of age (Stephens et al, 2008)
3- prostate gland is a walnut' sized structure which located between the penis and the bladder and surrounds the urethra, just lies posteriorly to rectum. It has functional relation with urinary and reproductive systems and its main role is to produce the liquid part of semen. Prostate gland divided into three distinctive anatomic zonal components: the central zone, transitional zone and the peripheral zone which compromises 70% by volume (Tempany & Franco, 2012).
4- The preponderance of prostate cancers is adenocarcinomas that initially derived from the outer or peripheral zone of the prostate gland. In early stage, prostate cancer hardly shows symptoms and is mostly diagnosed by fortunate PSA test, but overtime patient may present to clinic with lower urinary tract symptoms such as: trouble starting urine, pain during urination, increased urgent of urination, poor stream, erection trouble so on (Wijesinha & Fridenberg, 2007)
5- The initial tests for diagnosing prostate cancer a.
Understanding Cancer: How Genetics Plays a Rolekinsleyaniston
Genetic testing looks at your DNA to identify changes that cause or may put you at risk for certain diseases or disorders. The results from genetic tests provide information that may help you and your doctor recognize and manage these health conditions. Visit: https://www.genomesmart.com/geno-blog/understanding-cancer--how-genetics-plays-a-role
Cancer Symptoms And Prognosis Stages Early Detection.pptxDr.Kanury Rao
Cancer is one of the most frequent diseases in which cells are damaged and malignant. The rapid growth of technology is giving people living with cancer new hope. Dr. Kanury Rao and his colleagues are at the forefront of this transition and are committed to developing improved cancer therapies and cures.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. What is Cancer?
“Cancer is a name given to a collection
of related diseases, where some of the
body’s cells begin to divide without
stopping and spread into surrounding
tissue.”
www.cancer.gov
3. What Causes Cancer?
Cancer is a genetic disease—that is, it is caused by changes to genes that
control the way our cells function, especially how they grow and divide.
Genetic changes that cause cancer can be inherited from our parents(germ
line). They can also arise during a person’s lifetime as a result of errors
that occur as cells divide or because of damage to DNA caused by certain
environmental exposures (somatic mutations).
Each person’s cancer has a unique combination of genetic changes. As
the cancer continues to grow, additional changes will occur.
4. ‘Driver’ Mutations
Each cancer is characterized by
numerous somatic mutations, of which
only a subset contributes to the
tumor’s progression.
Scientists want to be able to
distinguish these “driver”
mutations from the
preponderance of neutral
“passenger” mutations that
characterize each cancer,
5. Genetic Drivers of Cancer
The genetic changes that contribute to cancer tend to
affect three main types of genes:
Proto-oncogenes are involved in normal cell growth and division. When
these genes are altered they may become cancer-causing genes (or
oncogenes), allowing cells to grow and survive when they should not.
Tumor suppressor genes are also involved in controlling cell growth and
division. Cells with certain alterations in tumor suppressor genes may divide
in an uncontrolled manner.
DNA repair genes are involved in fixing damaged DNA. Cells with mutations
in these genes tend to develop additional mutations in other genes.
Together, these mutations may cause the cells to become cancerous.
6. Understanding Cancer
Type: there are more than 100 types of cancer. The cancer is usually
named after the site where it starts and are called carcinoma. There are
unusual types like sarcoma, leukemia, myeloma or lymphoma. The biopsy
or pathology report will describe the type of cancer and often include
multiple other important factors that can effect the prognosis (or outcome).
Stage: how far the cancer has spread. There are generally 4 stages of each
type of cancer and currently the AJCC (American Joint Committee on
Cancer) 7th edition staging system is used which came out in 2010. The
pathology report, the findings from surgery (if done) and imaging studies
(e.g. CT scans, MRI scans, PET scans) are all used to try to determine an
accurate stage.
7. Path Report
The diagnosis of cancer usually starts with a biopsy of the
tumor (histology) or cancer mass (if possible) or collection
of cells (cytology) from the patient. Important things to look
for on a pathology report:
1. Type of cancer (where did it start and is it a specific subtype)
2. Invasive or not
3. Size and depth of invasion
4. Other structures invaded (like lymph nodes or nearby structures)
5. Grade or measure of how mutated or fast growing the cancer is
6. Margins (has it been completely removed)
7. Other specific risk or prognostic factors (hormone receptors, vascular
or perineural invasion, proliferation score, ulceration and many other
important site specific factors)
8. Genetic profile (e.g. BRACA, ALK, HER2, luminal, Oncotype DX,
EGFR, etc. including NGS or next generation sequencing)
9. Genetic Profile
MammaPrint will determine
whether adding chemotherapy
(CT) to endocrine therapy (ET)
will improved the cure rate
10. Genetic Profile
Prosigna will classify breast
cancer into a molecular category
that will have much different risks
of recurrence
11. Using Adjuvant Online to Calculate
the Benefit from taking
Chemotherapy based on genetic
recurrence risk score
Low risk
High risk
12. Understanding Cancer
Stage: how far the cancer has spread. There are
generally 4 stages of each type of cancer and
currently the AJCC (American Joint Committee
on Cancer) 7th edition staging system is used
which came out in 2010.
The pathology report, the findings from surgery
(if done) and imaging studies (e.g. CT scans,
MRI scans, PET scans) are all used to try to
determine an accurate stage.
13. Understanding The Stage
AJCC 7th Ed Staging System is based
on the TNM System
T: stand for tumor and cancer be based on size or depth of
invasion and commonly goes from T0 to T4
N: stands for lymph node spread based on the number of
nodes, size of nodes or location of nodes and is usually from N0
to N3
M: stands for evidence of distant metastases and is usually M0
or M1
Stage: generally combines all 3 of these (and sometime other
factors as well) to group patients into stage categories generally
from 0 to 4 but can include sub stages like IVa , IVb or IVc
14. For breast cancer, the size and number of nodes combine to determine
the stage
15. For colon cancer, the depth of invasion is critical to determine the stage
16. Understanding The Stage
Why is the stage
important?
Because it guides
treatment strategies and
predicts outcome and
19. Treatments
1.No treatment (either unnecessary, won’t
work anyway, it’s not worth it to
the patient)
2.Surgery
3.Radiation
4.Chemotherapy
1.Conventional chemotherapy
2.Hormone Therapy
3.Immunotherapy
4.Targeted Therapy/ Precision
Medicine
20. Surgery : local treatment, may be disfiguring but if
the tumor can be removed it is quite successful
Radiation: regional treatment, may have less side
effects then surgery, successful if the cancer is radio-
sensitive
Chemotherapy: widespread, treats the whole body,
may have significant side effects, success depends
completely on whether the cancer is sensitive to the
available drugs
Basic Treatments
21. Combined Modality Therapy in the
Treatment of Pediatric
Rhabdomyosarcoma
Treatment 5 Year Survival
Surgery 10 – 20%
Surgery plus PostOp Radiation 40 – 50%
Surgery, Rad. then Chemotherapy 80 – 90%
22. Precision Therapy
Precision or targeted therapies work by exploiting the molecular
underpinnings of cancer. The precision of cancer treatments
has become more sophisticated with each passing year.
Therapies that attack multiple genetic drivers of cancer in
combination or harness the body’s own immune system to
attack tumor cells have improved outcomes for patients with
difficult-to-treat cancers.
Of all the newly FDA-approved cancer therapies approved in
2015, 12 (62.5%) are classified as precision therapies.
24. Best Treatment
How do patients know if they are receiving the
best, current available therapy?
25. Treatment decisions should be made by the patient and
family in consultation with a multi disciplinary panel of
cancer specialists c/w current NCCN guidelines. These
can be accessed free online at NCCN.org or the patient
site at www.nccn.org/patients
26. Treatment decisions should be
made by the patient and family in
consultation with a multi
disciplinary panel of cancer
specialists c/w current NCCN
Should be a
Team
Approach
29. Prognosis
Note that there are many factors that effect
the odds and length of survival
1.The type and location of the cancer
2.The stage and site of spread
3.The cancer grade or speed of growth
4.Other specific traits of the cancer cell
5.The patient’s own health,
age and performance score
6.The response to treatment
30. 0 – Asymptomatic (Fully active, able to carry on all pre-disease activities
without restriction)
1 – Symptomatic but completely ambulatory (Restricted in physically
strenuous activity but ambulatory and able to carry out work of a light or
sedentary nature. For example, light housework, office work)
2 – Symptomatic, <50% in bed during the day (Ambulatory and capable
of all self care but unable to carry out any work activities. Up and about
more than 50% of waking hours)
3 – Symptomatic, >50% in bed, but not bedbound (Capable of only
limited self-care, confined to bed or chair 50% or more of waking hours)
4 – Bedbound (Completely disabled. Cannot carry on any self-care.
Totally confined to bed or chair)
5 – Death
ECOG Performance Score
31. JOP September 2014 vol. 10no. 5 e335-
e341
Survival in Patients with Advanced
Cancer Based on Performance Score
32. If the patient has a good response to
treatment then survival will be prolonged
34. Impact of Response to Chemotherapy on
Breast Cancer Patients by Cancer Type
Luminal- A Type Cancers Triple Negative
Definition and Impact of Pathologic Complete Response on Prognosis After Neoadjuvant
Chemotherapy in Various Intrinsic Breast Cancer Subtypes
JCO May 20, 2012 vol. 30 no. 15 1796-1804
35. Recommended Web Sites from
Doctor Miller
The best site would be the NCCN / esp. the patient
site: www.nccn.org or www.nccn.org/patients
The next best would be from the NCI (National
Cancer Institute) or CancerNet at www.cancer.gov
the NCI booklets are very good at
www.cancer.gov/publications/patient-education
CancerNet from ASCO (American Society of Clinical
Oncology) is very good at www.cancer.net
American Cancer Society at www.cancer.org is
good
Finally Doctor Miller’s site at
www.aboutcancer.com has a large amount of
information and a medical video channel