The document discusses oncology and cancer biology. It defines neoplasia as uncontrolled proliferation of transformed cells. The primary goals of surgical and radiation therapy for cancer are local and regional control, while systemic therapy aims for systemic control to prevent distant recurrence. The most common cancers worldwide are lung cancer in men and breast cancer in women. Cancer diagnosis involves methods like biopsy to obtain a definitive diagnosis. Staging systems like TNM are used to determine cancer progression. A multidisciplinary approach utilizing surgery, radiation, chemotherapy, targeted therapy and other modalities can improve survival rates compared to surgery alone.
Principles of medical_oncology dr. varunVarun Goel
- The document discusses several key principles of medical oncology including that cancer treatment is multidisciplinary, early stage cancers are more curable than late stage, and the best treatment is often found in clinical trials.
- It describes the basic tenets of chemotherapy including that it can be used for induction treatment of advanced cancers or as adjuvant treatment after local therapy to treat high risk of recurrence. The intent of chemotherapy can be curative or palliative.
- Several models of tumor growth and response to chemotherapy are explained including the Skipper-Wilcox model, concepts of combination chemotherapy, and the Goldie-Coldman model regarding emergence of drug resistance with increased tumor size.
Management of Testicular Cancers document provides an overview of testicular cancer including:
- Epidemiology showing highest rates in Western countries and increasing worldwide incidence. India has a low incidence of 0.5 cases per 100,000 men.
- Risk factors include cryptorchidism, family history, and genetic conditions. Germ cell tumors are the most common type.
- Staging uses AJCC TNM system and International Germ Cell Consensus Classification for metastatic disease.
- For stage I seminoma, surveillance is an option but adjuvant radiotherapy to para-aortic region is still commonly used with dog leg fields showing similar outcomes to para-aortic fields alone and reducing toxicity
This document discusses recent updates in lung cancer. It begins by noting that lung cancer is the leading cause of cancer death in the US and is often diagnosed at an advanced stage. Screening with low-dose CT scans can detect lung cancer earlier and has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. The National Lung Screening Trial established low-dose CT screening as an effective screening method for those at high risk. Biomarker testing is important to identify driver mutations and guide targeted therapy options, though barriers like tissue availability and turnaround time exist. Osimertinib has demonstrated superior progression-free survival compared to earlier EGFR TKIs for patients with EGFR-mut
1) Breast cancer is a major global health problem, with most cases occurring in developing countries. Ghanaian studies show that patients often present with advanced-stage disease and experience poor outcomes.
2) Early breast cancer is defined as stage 0, 1, or 2 based on tumor size and lymph node involvement. Treatment involves surgery such as breast-conserving therapy or mastectomy, followed by radiation and/or systemic therapies based on tumor biomarkers.
3) Ductal carcinoma in situ (DCIS) is a non-invasive proliferation of malignant cells within breast ducts. Diagnosis is often from mammography screening, and management involves surgery such as lumpectomy plus radiation therapy based on prognostic factors.
This document discusses carcinoma of unknown primary (CUP). Key points:
- CUP is defined as metastatic cancer where the primary site cannot be identified after evaluation. It accounts for 2-5% of cancers and has a median survival of 6-9 months.
- The cancer is often aggressive and may have disseminated before the primary is detectable. Major histologies are adenocarcinoma (60-90%) and squamous cell carcinoma (5%).
- Favorable subsets with better prognosis include peritoneal carcinomatosis resembling ovarian cancer, isolated axillary adenopathy resembling breast cancer, and poorly differentiated neuroendocrine tumors.
- Treatment involves systemic chemotherapy. Selection of regimen depends on
Principles of medical_oncology dr. varunVarun Goel
- The document discusses several key principles of medical oncology including that cancer treatment is multidisciplinary, early stage cancers are more curable than late stage, and the best treatment is often found in clinical trials.
- It describes the basic tenets of chemotherapy including that it can be used for induction treatment of advanced cancers or as adjuvant treatment after local therapy to treat high risk of recurrence. The intent of chemotherapy can be curative or palliative.
- Several models of tumor growth and response to chemotherapy are explained including the Skipper-Wilcox model, concepts of combination chemotherapy, and the Goldie-Coldman model regarding emergence of drug resistance with increased tumor size.
Management of Testicular Cancers document provides an overview of testicular cancer including:
- Epidemiology showing highest rates in Western countries and increasing worldwide incidence. India has a low incidence of 0.5 cases per 100,000 men.
- Risk factors include cryptorchidism, family history, and genetic conditions. Germ cell tumors are the most common type.
- Staging uses AJCC TNM system and International Germ Cell Consensus Classification for metastatic disease.
- For stage I seminoma, surveillance is an option but adjuvant radiotherapy to para-aortic region is still commonly used with dog leg fields showing similar outcomes to para-aortic fields alone and reducing toxicity
This document discusses recent updates in lung cancer. It begins by noting that lung cancer is the leading cause of cancer death in the US and is often diagnosed at an advanced stage. Screening with low-dose CT scans can detect lung cancer earlier and has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. The National Lung Screening Trial established low-dose CT screening as an effective screening method for those at high risk. Biomarker testing is important to identify driver mutations and guide targeted therapy options, though barriers like tissue availability and turnaround time exist. Osimertinib has demonstrated superior progression-free survival compared to earlier EGFR TKIs for patients with EGFR-mut
1) Breast cancer is a major global health problem, with most cases occurring in developing countries. Ghanaian studies show that patients often present with advanced-stage disease and experience poor outcomes.
2) Early breast cancer is defined as stage 0, 1, or 2 based on tumor size and lymph node involvement. Treatment involves surgery such as breast-conserving therapy or mastectomy, followed by radiation and/or systemic therapies based on tumor biomarkers.
3) Ductal carcinoma in situ (DCIS) is a non-invasive proliferation of malignant cells within breast ducts. Diagnosis is often from mammography screening, and management involves surgery such as lumpectomy plus radiation therapy based on prognostic factors.
This document discusses carcinoma of unknown primary (CUP). Key points:
- CUP is defined as metastatic cancer where the primary site cannot be identified after evaluation. It accounts for 2-5% of cancers and has a median survival of 6-9 months.
- The cancer is often aggressive and may have disseminated before the primary is detectable. Major histologies are adenocarcinoma (60-90%) and squamous cell carcinoma (5%).
- Favorable subsets with better prognosis include peritoneal carcinomatosis resembling ovarian cancer, isolated axillary adenopathy resembling breast cancer, and poorly differentiated neuroendocrine tumors.
- Treatment involves systemic chemotherapy. Selection of regimen depends on
Oncology and surgical practice are becoming more integrated, as surgeons are often responsible for initially diagnosing and managing solid tumors. A thorough understanding of cancer epidemiology, etiology, staging, and natural history is required to determine the optimal surgical therapy for each patient. Tumor cells acquire several characteristics before becoming fully malignant, including establishing independence from normal growth controls, achieving immortality and angiogenesis, and developing the abilities to invade other tissues and disseminate throughout the body. Both genetic and environmental factors contribute to cancer development in complex ways. A combination of inherited predispositions and exposures to carcinogenic chemicals, viruses, radiation, and other external factors drive the transformation of normal cells into malignant tumors.
- Oligometastatic disease refers to a limited number of metastases that may be amenable to local treatment.
- Stereotactic body radiation therapy (SBRT) for lung oligometastases from various primary cancers can achieve high rates of local control with minimal toxicity.
- Patient selection is important, with longer disease-free interval, fewer metastatic sites, and controlled primary tumor associated with improved outcomes after aggressive local therapy of oligometastases.
- Ongoing clinical trials are investigating SBRT for synchronous and metachronous oligometastatic disease to define optimal patient populations and treatment approaches.
1) Targeted kinase inhibitors such as sorafenib show promise in treating radioactive iodine refractory thyroid cancer, with sorafenib demonstrating a partial response rate of 36% and clinical benefit in 82% of patients in one study.
2) Management of radioactive iodine refractory thyroid cancer involves local therapies when possible and enrollment in clinical trials of small molecule tyrosine kinase inhibitors like sorafenib, which target pathways important in thyroid cancer signaling and growth.
3) Guidelines recommend targeted kinase inhibitors as first-line treatment for radioactive iodine refractory thyroid cancer based on their improved efficacy over chemotherapy and ability to potentially prolong progression-free and overall survival.
1) Around 60-70% of breast cancer patients have estrogen receptor positive tumors, making them candidates for hormonal therapy which has been shown to improve survival rates.
2) Tamoxifen is the standard adjuvant hormonal therapy and has been shown to reduce breast cancer recurrence rates by 24-43% and mortality by 14-23% depending on duration of therapy.
3) Aromatase inhibitors like letrozole and anastrazole are also used as adjuvant therapy and have been shown in trials to further reduce recurrence rates compared to tamoxifen alone.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
This document summarizes hormonal treatment for breast cancer, including the history and mechanisms of various endocrine therapies. It discusses the timeline of developments in hormonal therapies from the late 19th century to present, covering areas like surgical oophorectomy, tamoxifen, aromatase inhibitors, and more. Key findings and mechanisms of different therapies like tamoxifen, aromatase inhibitors, and fulvestrant are summarized. The optimal use and duration of adjuvant tamoxifen therapy is discussed based on various clinical trials. The relationship between tamoxifen benefit and estrogen/progesterone receptor status is also covered.
Management of Early Breast Cancer (by Dr. Akhil Kapoor)Akhil Kapoor
Comprehensive discussion on Management of Early Breast Cancer along with NCCN guidelines.
Slides prepared by Dr. Akhil Kapoor
(Resident, Department of Radiation Oncology,
Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan, India
The document discusses lung cancer, which is the leading cause of cancer death worldwide. It estimates that there are 1 million new lung cancer cases each year. Smoking is the primary risk factor, causing 78-90% of lung cancer cases. The document provides statistics on lung cancer incidence and mortality rates around the world. It also discusses risk factors, types of lung cancer, symptoms, functions of the lungs, and paraneoplastic syndromes that can occur in lung cancer patients.
This document provides information on thyroid cancer and the thyroid gland. It discusses the anatomy of the thyroid gland and its blood supply. It describes the different types of thyroid cancer such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hurthle cell carcinoma. It covers the pathology, risk factors, diagnostic process, treatment options, and prognosis for each cancer type. The main treatment approaches discussed are surgery, radioactive iodine therapy, and TSH suppression.
Locally advanced breast cancer is stage III breast cancer characterized by large primary tumors with involved lymph nodes. Key points:
- Suspensory ligaments can become invaded, leading to skin dimpling. Lymph nodes are divided into groups for staging.
- Axillary nodes are the primary drainage site and are divided into levels based on relation to pectoralis minor muscle.
- Internal mammary nodes also commonly involved with medial/central/lower tumors.
- Locally advanced breast cancer is usually treated with neoadjuvant chemotherapy to downstage the tumor, followed by surgery and radiation. Molecular subtyping aids treatment planning.
This document discusses targeted therapy for breast cancer. It begins by providing background on declining mortality rates for breast cancer over time. It then discusses how cancers develop multiple alterations that allow uncontrolled growth and outlines six essential alterations in cell physiology that contribute to malignancy. The document discusses molecular alterations that occur in breast cancer progression. It defines targeted therapy as drugs that target uniquely disrupted pathways in cancer cells. The document outlines several targeted therapies for breast cancer including hormonal therapies like tamoxifen, aromatase inhibitors, and fulvestrant. It discusses clinical trials demonstrating the benefits of these therapies. It also discusses therapies that target the HER2 receptor like trastuzumab and lapatinib. In summary, the document provides an overview of targeted
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Target Audience: Oncology fellows and Oncologists
Carcinoma of unknown primary is a challenging scenario often encountered in Oncology practice. This slide presentation discusses favorable and unfavorable presentations of CUP and it's management
1) Total neoadjuvant therapy (TNT) involves chemotherapy before and after chemoradiotherapy for locally advanced rectal cancer, aiming to increase downstaging and improve outcomes.
2) A review found TNT achieved a 22% pathological complete response rate compared to 13% for chemoradiotherapy alone, with possibly improved survival.
3) However, most evidence comes from observational studies. Two randomized controlled trials found TNT reduced distant metastases and improved disease-free survival compared to chemoradiotherapy alone.
This document summarizes systemic therapy options for malignant melanoma, including cytotoxics, immunotherapy, targeted therapies, and their outcomes. Key points discussed are: (1) Immunotherapy with checkpoint inhibitors like ipilimumab and pembrolizumab have significantly improved response rates and survival compared to traditional chemotherapies; (2) Combining BRAF and MEK inhibitors has become an important targeted therapy approach as it improves outcomes over BRAF inhibitors alone by delaying resistance; (3) Emerging evidence suggests combining immunotherapy and targeted therapies may provide further benefit.
This document discusses the management of carcinoma of the vulva. It covers topics such as anatomy, epidemiology, etiology, pathology, presentation, investigations, prognosis, treatment for early and late stage disease including surgery, lymph node dissection, radiotherapy, brachytherapy, chemotherapy, follow up, and melanoma and Paget's disease of the vulva. Key points discussed include that treatment is recommended for all women with vulvar HSIL, wide local excision should be performed if cancer is suspected, and HSIL can also be treated with other local methods. Lymph node involvement is an important prognostic factor, and sentinel lymph node biopsy is used to detect lymph node metastases. Radiotherapy may be used as pre-
This document summarizes a clinical seminar on the management of breast cancer. It provides statistics on breast cancer incidence and risk factors such as genetic predisposition, hormone exposure, radiation exposure, and age. It discusses screening guidelines, staging workup, pathological assessment of biopsies, intrinsic subtypes, and treatment options including surgery, radiation, chemotherapy, endocrine therapy, targeted therapy, and management of ductal carcinoma in situ. Treatment is tailored based on tumor subtype, size, lymph node involvement, and menopausal status, with the goal of reducing the risk of recurrence after primary treatment.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
1. The document discusses the principles of oncology, including the biological nature of cancer, major causative factors, methods of prevention and treatment.
2. Cancer management requires a multidisciplinary approach including surgery, radiation, chemotherapy, hormonal therapy, palliative care and screening. Treatment goals depend on cancer stage and include cure, prolonging survival, or palliation.
3. The hallmarks of cancer include autonomy, resistance to apoptosis, limitless replicative potential, and evading immune destruction. Both genetic and environmental factors can cause cancer through various mechanisms.
This document provides an overview of benign and malignant breast pathology, including:
1. It outlines the differences between symptomatic and screen-detected breast disease, and describes various types of benign breast disease like cysts, duct ectasia, and fibroadenomas.
2. It discusses risk factors for breast malignancy and the process of non-operative diagnosis using triple assessment and multidisciplinary review meetings.
3. The document covers types of breast cancer treatment and classifications like in situ versus invasive carcinoma, and explains prognostic indicators in invasive carcinoma like tumor grade and lymph node status.
Oncology and surgical practice are becoming more integrated, as surgeons are often responsible for initially diagnosing and managing solid tumors. A thorough understanding of cancer epidemiology, etiology, staging, and natural history is required to determine the optimal surgical therapy for each patient. Tumor cells acquire several characteristics before becoming fully malignant, including establishing independence from normal growth controls, achieving immortality and angiogenesis, and developing the abilities to invade other tissues and disseminate throughout the body. Both genetic and environmental factors contribute to cancer development in complex ways. A combination of inherited predispositions and exposures to carcinogenic chemicals, viruses, radiation, and other external factors drive the transformation of normal cells into malignant tumors.
- Oligometastatic disease refers to a limited number of metastases that may be amenable to local treatment.
- Stereotactic body radiation therapy (SBRT) for lung oligometastases from various primary cancers can achieve high rates of local control with minimal toxicity.
- Patient selection is important, with longer disease-free interval, fewer metastatic sites, and controlled primary tumor associated with improved outcomes after aggressive local therapy of oligometastases.
- Ongoing clinical trials are investigating SBRT for synchronous and metachronous oligometastatic disease to define optimal patient populations and treatment approaches.
1) Targeted kinase inhibitors such as sorafenib show promise in treating radioactive iodine refractory thyroid cancer, with sorafenib demonstrating a partial response rate of 36% and clinical benefit in 82% of patients in one study.
2) Management of radioactive iodine refractory thyroid cancer involves local therapies when possible and enrollment in clinical trials of small molecule tyrosine kinase inhibitors like sorafenib, which target pathways important in thyroid cancer signaling and growth.
3) Guidelines recommend targeted kinase inhibitors as first-line treatment for radioactive iodine refractory thyroid cancer based on their improved efficacy over chemotherapy and ability to potentially prolong progression-free and overall survival.
1) Around 60-70% of breast cancer patients have estrogen receptor positive tumors, making them candidates for hormonal therapy which has been shown to improve survival rates.
2) Tamoxifen is the standard adjuvant hormonal therapy and has been shown to reduce breast cancer recurrence rates by 24-43% and mortality by 14-23% depending on duration of therapy.
3) Aromatase inhibitors like letrozole and anastrazole are also used as adjuvant therapy and have been shown in trials to further reduce recurrence rates compared to tamoxifen alone.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
This document summarizes hormonal treatment for breast cancer, including the history and mechanisms of various endocrine therapies. It discusses the timeline of developments in hormonal therapies from the late 19th century to present, covering areas like surgical oophorectomy, tamoxifen, aromatase inhibitors, and more. Key findings and mechanisms of different therapies like tamoxifen, aromatase inhibitors, and fulvestrant are summarized. The optimal use and duration of adjuvant tamoxifen therapy is discussed based on various clinical trials. The relationship between tamoxifen benefit and estrogen/progesterone receptor status is also covered.
Management of Early Breast Cancer (by Dr. Akhil Kapoor)Akhil Kapoor
Comprehensive discussion on Management of Early Breast Cancer along with NCCN guidelines.
Slides prepared by Dr. Akhil Kapoor
(Resident, Department of Radiation Oncology,
Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan, India
The document discusses lung cancer, which is the leading cause of cancer death worldwide. It estimates that there are 1 million new lung cancer cases each year. Smoking is the primary risk factor, causing 78-90% of lung cancer cases. The document provides statistics on lung cancer incidence and mortality rates around the world. It also discusses risk factors, types of lung cancer, symptoms, functions of the lungs, and paraneoplastic syndromes that can occur in lung cancer patients.
This document provides information on thyroid cancer and the thyroid gland. It discusses the anatomy of the thyroid gland and its blood supply. It describes the different types of thyroid cancer such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hurthle cell carcinoma. It covers the pathology, risk factors, diagnostic process, treatment options, and prognosis for each cancer type. The main treatment approaches discussed are surgery, radioactive iodine therapy, and TSH suppression.
Locally advanced breast cancer is stage III breast cancer characterized by large primary tumors with involved lymph nodes. Key points:
- Suspensory ligaments can become invaded, leading to skin dimpling. Lymph nodes are divided into groups for staging.
- Axillary nodes are the primary drainage site and are divided into levels based on relation to pectoralis minor muscle.
- Internal mammary nodes also commonly involved with medial/central/lower tumors.
- Locally advanced breast cancer is usually treated with neoadjuvant chemotherapy to downstage the tumor, followed by surgery and radiation. Molecular subtyping aids treatment planning.
This document discusses targeted therapy for breast cancer. It begins by providing background on declining mortality rates for breast cancer over time. It then discusses how cancers develop multiple alterations that allow uncontrolled growth and outlines six essential alterations in cell physiology that contribute to malignancy. The document discusses molecular alterations that occur in breast cancer progression. It defines targeted therapy as drugs that target uniquely disrupted pathways in cancer cells. The document outlines several targeted therapies for breast cancer including hormonal therapies like tamoxifen, aromatase inhibitors, and fulvestrant. It discusses clinical trials demonstrating the benefits of these therapies. It also discusses therapies that target the HER2 receptor like trastuzumab and lapatinib. In summary, the document provides an overview of targeted
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Target Audience: Oncology fellows and Oncologists
Carcinoma of unknown primary is a challenging scenario often encountered in Oncology practice. This slide presentation discusses favorable and unfavorable presentations of CUP and it's management
1) Total neoadjuvant therapy (TNT) involves chemotherapy before and after chemoradiotherapy for locally advanced rectal cancer, aiming to increase downstaging and improve outcomes.
2) A review found TNT achieved a 22% pathological complete response rate compared to 13% for chemoradiotherapy alone, with possibly improved survival.
3) However, most evidence comes from observational studies. Two randomized controlled trials found TNT reduced distant metastases and improved disease-free survival compared to chemoradiotherapy alone.
This document summarizes systemic therapy options for malignant melanoma, including cytotoxics, immunotherapy, targeted therapies, and their outcomes. Key points discussed are: (1) Immunotherapy with checkpoint inhibitors like ipilimumab and pembrolizumab have significantly improved response rates and survival compared to traditional chemotherapies; (2) Combining BRAF and MEK inhibitors has become an important targeted therapy approach as it improves outcomes over BRAF inhibitors alone by delaying resistance; (3) Emerging evidence suggests combining immunotherapy and targeted therapies may provide further benefit.
This document discusses the management of carcinoma of the vulva. It covers topics such as anatomy, epidemiology, etiology, pathology, presentation, investigations, prognosis, treatment for early and late stage disease including surgery, lymph node dissection, radiotherapy, brachytherapy, chemotherapy, follow up, and melanoma and Paget's disease of the vulva. Key points discussed include that treatment is recommended for all women with vulvar HSIL, wide local excision should be performed if cancer is suspected, and HSIL can also be treated with other local methods. Lymph node involvement is an important prognostic factor, and sentinel lymph node biopsy is used to detect lymph node metastases. Radiotherapy may be used as pre-
This document summarizes a clinical seminar on the management of breast cancer. It provides statistics on breast cancer incidence and risk factors such as genetic predisposition, hormone exposure, radiation exposure, and age. It discusses screening guidelines, staging workup, pathological assessment of biopsies, intrinsic subtypes, and treatment options including surgery, radiation, chemotherapy, endocrine therapy, targeted therapy, and management of ductal carcinoma in situ. Treatment is tailored based on tumor subtype, size, lymph node involvement, and menopausal status, with the goal of reducing the risk of recurrence after primary treatment.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
1. The document discusses the principles of oncology, including the biological nature of cancer, major causative factors, methods of prevention and treatment.
2. Cancer management requires a multidisciplinary approach including surgery, radiation, chemotherapy, hormonal therapy, palliative care and screening. Treatment goals depend on cancer stage and include cure, prolonging survival, or palliation.
3. The hallmarks of cancer include autonomy, resistance to apoptosis, limitless replicative potential, and evading immune destruction. Both genetic and environmental factors can cause cancer through various mechanisms.
This document provides an overview of benign and malignant breast pathology, including:
1. It outlines the differences between symptomatic and screen-detected breast disease, and describes various types of benign breast disease like cysts, duct ectasia, and fibroadenomas.
2. It discusses risk factors for breast malignancy and the process of non-operative diagnosis using triple assessment and multidisciplinary review meetings.
3. The document covers types of breast cancer treatment and classifications like in situ versus invasive carcinoma, and explains prognostic indicators in invasive carcinoma like tumor grade and lymph node status.
This document provides information on oncology nursing objectives and cancer pathophysiology. It defines key terms like neoplasia, tumors, and cancer. It describes the biological process of oncogenesis and carcinogenesis. It discusses cancer cell proliferation patterns and etiology factors like viruses, chemicals, genetics, diet, and hormones. It also covers cancer detection, diagnosis, staging, grading, and primary treatment methods including surgery, radiation therapy, and chemotherapy.
Here are some additional common side effects of chemotherapy:
- Mucositis (inflammation and ulcers in the mouth and gastrointestinal tract)
- Dermatologic effects like rashes, dry skin, nail changes
- Hepatotoxicity and kidney toxicity with some agents
- Cardiotoxicity with agents like doxorubicin
- Secondary cancers and myelodysplasia due to mutagenic effects
- Infertility issues depending on the agents used
It's important for nurses to thoroughly assess for and manage side effects during chemotherapy treatment.
- Cancer treatment is multidisciplinary, involving oncology care, clinical trials, and diagnosis through tissue examination. Early stage cancers are more curable than late stages.
- Oncology aims to provide lifelong care while minimizing harm through careful consideration of treatment intent (curative vs palliative), dose optimization, and multimodal approaches including surgery, chemotherapy, and targeted therapies.
- Surgical management of cancer involves diagnosis, staging, removal of the primary tumor and metastases when possible with curative intent or palliation, considering individual patient factors. Reconstruction aims to improve function and quality of life post-treatment.
Breast cancer is a malignancy originating from breast tissue. This chapter
distinguishes between early stages, which are potentially curable, and
metastatic breast cancer (MBC), which is usually incurable.
This document provides an overview of colorectal cancer. It discusses that colon and rectal cancers are separate but share a similar path of carcinogenesis. Colon cancer is more common and preventable/curable. 90% of cases occur after age 50. Screening has reduced mortality by nearly 50% in the US. Staging determines prognosis and treatment. Common diagnostic tests include colonoscopy, biopsy, and imaging. Surgery is the primary treatment while radiation poses toxicity risks.
This document summarizes information about breast carcinoma, including:
- Pakistan has the highest rate of breast cancer in Asia, with approximately 90,000 new cases diagnosed annually.
- Common risk factors include age, family history, obesity, lack of breastfeeding, and environmental toxins.
- Screening is recommended annually with mammography after age 40. Diagnosis involves biopsy of suspicious lumps.
- Treatment options include surgery, chemotherapy, radiation therapy, hormone therapy, and reconstruction as needed.
Cancer has existed for millions of years in various forms. The key causes of cancer include environmental/behavioral factors like tobacco, alcohol, viruses, radiation, and chemicals. Cancer arises through mutations in cells over time. Screening aims to detect cancer early through safe, inexpensive tests to improve treatment outcomes. The main treatment modalities are surgery, radiotherapy, chemotherapy, and combinations of these. The goals of treatment depend on cancer type and stage, and may be curative or palliative to improve quality of life. Dental practitioners can help prevent cancer through education and may detect early signs during examinations.
Stage III colon cancer denotes lymph node involvement. Standard treatment options include surgery for wide resection and anastomosis as well as adjuvant chemotherapy. Patients with one to three involved nodes have a significantly better survival rate than those with four or more involved nodes. Stage IV colon cancer denotes metastatic disease. Treatment may include surgical resection of primary lesions or metastases in selected cases, palliative radiation or chemotherapy, and clinical trials of new drugs or therapies. Survival rates vary significantly depending on stage, from 92% for stage I to 11% for stage IV colon cancer.
This document provides an overview of cancer biology and management. It discusses the epidemiology of cancer, noting that over 1.6 million new cancer diagnoses occur annually in the US. The most common causes of cancer death are lung, prostate, breast and colorectal cancers. It also describes the hallmarks of cancer at the cellular level, including uncontrolled growth, evasion of cell death, limitless replicative potential and metastasis. The diagnosis and staging of cancer is covered, as well as tumor markers, and surgical and chemotherapy approaches to management.
ca uterus cancer in uterus, common female problemSasiSoman3
Endometrial cancer arises from the lining of the uterus. The major risk factors include increased estrogen exposure unopposed by progesterone, obesity, and hereditary nonpolyposis colorectal cancer. Symptoms include abnormal uterine bleeding, especially in postmenopausal women. Diagnosis is made by endometrial biopsy, which is recommended for women with risk factors or abnormal bleeding. Most cases are diagnosed early and treated with hysterectomy and radiation, resulting in high survival rates.
This document provides an overview of the management of breast cancer. It discusses the epidemiology, relevant anatomy, etiopathogenesis, pathology, clinical features, differential diagnosis, staging, treatment options including surgery, chemotherapy, radiotherapy and hormonal therapy. It also covers special cases, complications, follow up, prognosis and prevention of breast cancer. The management involves a multidisciplinary approach with the goal of cure for early disease and palliation for late or metastatic disease.
This document discusses the management of locally advanced breast cancer (LABC). Key points:
1. LABC includes stages IIIA, IIIB, IIIC breast cancer with large tumors (>5cm), chest wall involvement, skin ulcers, or fixed lymph nodes. Inflammatory breast cancer is an aggressive subtype of LABC.
2. Diagnosis involves history, physical exam, imaging like mammography and MRI, and biopsy. Staging workup includes labs, imaging of chest, abdomen, pelvis and bone.
3. Treatment involves neoadjuvant chemotherapy to downstage the cancer and allow for surgery. Surgery may include mastectomy or breast conservation. Postoperative radiation and endocrine therapy
Hepatocellular carcinoma is a primary malignancy of the liver that is now the third leading cause of cancer deaths worldwide. Chronic hepatitis B or C infection and cirrhosis are major risk factors. Treatment options include surgical resection, liver transplantation, radiofrequency ablation, transarterial chemoembolization, and systemic therapies, with resection and transplantation offering the best outcomes for eligible patients with early-stage disease. However, hepatocellular carcinoma commonly recurs within 2 years despite treatment.
CARCINOMA OF THE BREAST for mbbs 600L studentsIgbashio
This document summarizes information about carcinoma of the breast, including:
- It is the most common malignancy affecting women worldwide, with risk factors including age, family history, reproductive factors, and lifestyle.
- Types include ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma.
- Signs and symptoms include painless breast lumps, nipple discharge or retraction, and potential metastases.
- Staging uses TNM and Manchester systems and involves investigations like biopsy, imaging and blood tests.
- Treatment involves surgery, radiation, chemotherapy, hormonal therapy and other targeted approaches.
This document discusses oncologic disorders and breast cancer. It provides details on carcinogenesis, cancer development and progression, breast cancer risk factors and presentation, diagnosis, staging, prognostic factors, and treatment approaches for early, locally advanced, and metastatic breast cancer. Treatment involves surgery, radiation, chemotherapy, endocrine therapy, targeted therapies, and palliation depending on the cancer stage and characteristics. The goal is cure for early-stage cancer and disease control for advanced or metastatic cancer through prolonging survival and improving quality of life.
Cancer chemotherapy and treatment involves several methods. Chemotherapy uses drugs to prevent or treat cancer by killing cancer cells. Common chemotherapies include fluorouracil, capecitabine, and cytarabine which are pyrimidine analogues that interfere with DNA synthesis in cancer cells. These drugs have similar mechanisms of action but different routes of administration and toxicity profiles. Combination chemotherapy uses multiple agents to increase effectiveness while reducing resistance. Careful dosing and administration is needed due to the narrow therapeutic index of chemotherapy drugs.
2021 World Cancer Day Campaign
World Cancer Day aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease.
#IAmAndIWill
Similar to Oncology: basic science for general surgical residents (20)
Chronic venous disease (CVD) refers to abnormalities of the venous system that are long-lasting in nature and may cause signs or symptoms. CVD ranges from varicose veins to more advanced chronic venous insufficiency. Risk factors include age, female sex, obesity, prolonged standing, family history, and parity. The venous system consists of superficial veins like the great saphenous vein and deep veins like the femoral vein. Pathophysiology involves valve incompetence and reflux in the superficial system and obstruction or reflux in the deep system. Clinical presentation varies but includes heaviness, aching, cramps, and skin changes classified from C1 to C6. Investigation involves duplex ultrasound scanning and treatment options range from compression
1. Abdominal vascular injuries can be lethal due to hemorrhage. Management may include non-operative, endovascular, or operative approaches.
2. Blunt injuries often cause retroperitoneal hematomas in four zones, while penetrating injuries usually require opening the hematoma.
3. Most arterial injuries can be repaired, while venous injuries can often be ligated if extensive, with monitoring for sequelae.
The document discusses trauma to the pancreas. It begins with an overview of pancreatic anatomy and mechanisms of injury. It then describes the clinical presentation and methods for diagnosis of pancreatic trauma, including CT, MRCP, and ERCP. The document outlines a proposed revised grading system for pancreatic injuries from Grade I to V. It concludes with a discussion of management strategies depending on the grade of injury, including expectant management, surgery such as distal pancreatectomy or pancreaticoduodenectomy, and complications.
1) Duodenal trauma can present during laparotomy or be detected on CT scans. Isolated duodenal hematomas may be managed non-operatively with NG tube and TPN.
2) Operative procedures for duodenal trauma include duodenal repair and ancillary procedures like periduodenal drainage and feeding jejunostomy.
3) Complications include duodenal fistula and increased morbidity with major vascular injury, pancreatic injury, or injury-operation delay over 24 hours. Overall mortality is usually due to major vascular injury and ranges from 5-30%.
Breast cancer is a disease where breast cells grow out of control, and is one of the leading causes of cancer death in women. Screening methods include mammography and ultrasound to check for abnormalities. The diagnosis involves a history, physical exam, imaging tests, and pathology to determine the stage. Treatment depends on the stage and includes surgery such as mastectomy or lumpectomy, radiation therapy, and systemic therapies like chemotherapy, hormone therapy, or targeted drugs.
This document provides information about the anatomy of the scalp and skull, including the layers of the scalp and the structures underneath. It also references sources that describe the brain's ventricular system and how to interpret CT scans of the brain, noting some types of injuries that may appear such as epidural hematoma, subdural hemorrhage, subarachnoid hemorrhage, cerebral contusions, and intracerebral hemorrhages.
Cervical spine trauma can cause serious injuries to the vertebrae and spinal cord. A general surgeon provides an overview of cervical spine anatomy and classifications of injuries. Key points include that the cervical spine is made up of 7 vertebrae and has significant lordosis. Injuries are evaluated based on clinical exam, imaging, and stability classifications. Common injuries discussed are craniovertebral junction injuries, axis fractures, and subaxial cervical injuries. Initial management focuses on immobilization and identification of neurological deficits, while treatment depends on the injury and stability. Complications include spinal cord injury, which can impact respiratory and cardiovascular function.
1. The document outlines the steps for the primary and secondary survey in the initial assessment of a trauma patient. It includes assessing the airway, breathing, circulation, disability, and exposure (ABCDE) and describes adjuncts like monitoring, imaging, catheter placement, investigations and treatments.
2. The primary survey involves a rapid assessment of life threats and stabilization, including airway management, breathing and ventilation, hemorrhage control, neurological assessment, and environmental control.
3. After initial stabilization, the secondary survey involves a full head-to-toe examination, gathering a medical history, considering transfer, and continued monitoring of the patient.
This document discusses common findings on CT brain scans related to various head injuries, including extradural hematoma (EDH), subdural hematoma (SDH), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and brain contusions. It provides details on the visual appearance and timing of injuries, such as EDH appearing lens shaped in the acute phase, SDH potentially associated with bridging veins tears, and chronic SDH displaying septations.
This document outlines damage control surgery techniques for trauma patients. Damage control surgery aims to control hemorrhage and contamination through limited operations, followed by intensive care resuscitation and reoperation. Specific techniques are described for the thorax, vasculature, liver, pancreas, spleen, and hollow viscera. Temporary abdominal closure is commonly used to prevent abdominal compartment syndrome before planned reoperation and definitive repair. Complications of open abdomen like fluid/protein loss and intestinal fistula require careful management.
This document provides an overview of pelvic fractures, including:
1. Classification systems for pelvic fractures including the Tile and Young-Burgess systems.
2. Diagnosis involves a history of traumatic injury and physical exam to check for signs of bleeding from the pelvis. Imaging of the pelvis is also used.
3. Management focuses on reducing pelvic volume to control bleeding through techniques such as pelvic binding, preperitoneal pelvic packing, external fixation, and angiographic embolization.
This document provides an overview of common gastric problems for interns, including approaches to epigastric pain, alarm features in dyspeptic patients, and gastrointestinal evaluation of iron deficiency anemia. It discusses peptic ulcer disease, including causes, complications like bleeding and perforation, and treatment options. Evaluation of epigastric pain involves ruling out life-threatening conditions before considering treatments for conditions like gastritis. Endoscopy is recommended for dyspeptic patients with alarm features or risk factors for malignancy.
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of hospital death. VTE results from an interaction between venous stasis, hypercoagulability, and endothelial injury. Risk factors include advanced age, immobilization, surgery, trauma, cancer, and genetic or acquired thrombophilias. DVT presents with leg pain, swelling, and discoloration while PE causes shortness of breath, chest pain, and potentially cardiovascular collapse. Diagnosis involves D-dimer testing, ultrasound for DVT, and CT pulmonary angiography for PE. Treatment includes anticoagulation with heparin, low
This randomized controlled trial compared two spontaneous breathing trial (SBT) strategies: a 2-hour T-piece trial versus a 30-minute trial with pressure support ventilation (PSV) of 8 cmH2O. The Kaplan-Meier curves showed a significantly higher rate of successful extubation, defined as being free of invasive ventilation for 72 hours, in the PSV group compared to the T-piece group. Reasons for reintubation were not significantly different between groups. While the T-piece SBT was less well tolerated, the PSV SBT of 30 minutes was sufficient to assess breathing ability without increasing post-extubation respiratory failure rates.
1) Variceal bleeding occurs in patients with cirrhosis and portal hypertension when enlarged veins in the esophagus or stomach (varices) rupture.
2) Management of variceal bleeding involves stabilizing the patient, performing endoscopy within 12 hours to identify varices, and administering vasoactive drugs to control bleeding along with antibiotics to prevent infection. Endoscopic variceal ligation or sclerotherapy can help stop active bleeding from varices.
3) For non-variceal upper GI bleeding, endoscopic treatment with adrenaline, coagulation, or clips is usually attempted first. Surgery may be needed for uncontrolled or recurrent bleeding after failed endoscopic attempts.
This document discusses guidelines for treating head and cervical spine trauma. The key points are:
1) The primary goals for head trauma are to prevent secondary brain injury through oxygenation and prompt transfer to a trauma center, with CT scans not delaying transfer.
2) Cervical spine injury must be considered in multiple trauma patients and immobilized to prevent neurological worsening. Indications for immobilization include altered mental status, spinal symptoms, or concerning mechanism of injury.
3) Imaging of the cervical spine depends on clinical decision tools, with CT preferred if available from occiput to T1; if CT is unavailable, plain films from these regions including swimmer's and odontiod views may be obtained initially.
This document provides information on various skin, soft tissue, and hand infections including severity classifications. It describes conditions like abscesses, folliculitis, furuncles, carbuncles, erysipelas, cellulitis, and necrotizing fasciitis. For necrotizing fasciitis, it emphasizes the need for aggressive and rapid treatment including emergent debridement and antibiotics to prevent high mortality rates. It also covers specific hand infections like paronychia, felon, pyogenic flexor tenosynovitis, and bursal infections.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
3. • Neoplasia (new growth): uncontrolled
proliferation of transformed cells
• The surgeon often is responsible for the initial
diagnosis and management of solid tumor
4. • Primary surgical therapy refers to en bloc resection of
tumor with adequate margins of normal tissues and
regional lymph nodes
• Adjuvant therapy refers to radiation and systemic
therapies, including chemotherapy, immunotherapy,
hormonal therapy, and biologic therapy
• The primary goal of surgical and radiation therapy is
local and regional control and for systemic therapy is
systemic control by treatment of distant foci of
subclinical disease to prevent distant recurrence
6. Most common cancer worldwide
• In men
1. Lung
2. Prostate
3. Colorectal
4. Stomach
5. liver
• In women
1. Breast
2. Colorectal
3. Cervix
4. Lung
5. stomach
11. • Six essential that dictate malignant growth:
– Self-sufficiency of growth signal
– Insensitivity to growth inhibitory signal
– Evasion of apoptosis
– Potential for limitless replication
– Angiogenesis
– Invasion and metastasis
Hallmarks of Cancer
12. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 280
13. • Oncogenes: proto-oncogene mutation
• Proto-oncogenes: help cells grow. Cells will grow
out of control when mutate and lead to cancer
• Tumor-suppressor genes: normal genes that slow
down cell division, when don't work properly,
cells can grow out of control, which can lead to
cancer
14. Genes Associated with Hereditary Cancer Risk
• Tumor development at a much younger age than
usual
• Presence of bilateral disease
• Presence of multiple primary malignancy
• Presentation of a cancer in the less affect sex
• Clustering of the same cancer type in relatives
• Occurrence of cancer in association with other
conditions such as mental retardation or
pathognomonic skin lesions
17. Physical Carcinogens
• Helicobacter pylori: gastric cancer
• Opisthorchis viverrini: cholangiocarcinoma
• Asbestos and silica: lung and mesothelial
cancer
24. Cancer Diagnosis
• Definitive diagnosis of solid tumor is obtained
by biopsy
– Mucosal lesion: by endoscope
– Palpable lesion: excise or punch biopsy
– Non-palpable: ultrasound or CT-guided
– Always orientate the tissue
– Do not contaminate to reduce local recurrence
25. • Fine-Needle Aspiration (FNA)
– Easy and safe
– Only cytology, no information on tissue
architecture
– Fix specimen in 95% alcohol
– Example: thyroid, breast, lymph node
Cancer Diagnosis
26. • Core-needle biopsy
– Safe
– Best with under ultrasound-guided
– Histologic finding
– Disadvantage: sampling error
Cancer Diagnosis
27. • Incisional biopsy
– Large lesion
– Outside
• Excisional biopsy
– Small lesion
– Curative intent with negative tissue margin
Cancer Diagnosis
28. Cancer Staging
• The most widely accepted systems are
American Joint Committee on Cancer (AJCC)
and the International Union Against Cancer
(UICC)
• TNM: tumor, node, metastasis
• Staging system may include prognostic factors
such as tumor size, location, extent, grade, and
dissemination to regional lymph nodes or
distant sites
29. • Patients considered to be high risk for distant
metastasis usually undergo preoperative
staging work-up
– A set of imaging of preferential metastatis
– CXR, U/S upper abdomen, bone scan to rule out
lung, liver, bone metastasis
– Or CT abdomen
Cancer Staging
30. Tumor Markers
• Prognostic marker: molecular marker that
predict disease-free survival
• Predictive marker: predicting response to
certain therapies
– ER, HER2 in breast cancer
31. • Allow early diagnosis
• Limitations:
– Tumor markers levels can be elevated in benign
conditions
– Many are low sensitivities and specificities
– Not specific for certain type of cancer
Tumor Markers
32. • Prostate-Specific Antigen (PSA)
– Elevated in both BPH and prostate cancer
– Normal is below 4 ng/mL
– Use for prostate cancer screening becomes
controversial due to over diagnosis and over
treatment
Tumor Markers
33. • Carcinoembryonic Antigen (CEA)
– Detected in primary colorectal, breast, lung,
ovarian, prostate, liver, pancreatic cancer
– In benign condition: diverticulitis, peptic ulcer,
bronchitis, liver abscess, alcoholic cirrhosis
– “smoker”
– Pre-op elevation of CEA in CRC = poor prognosis
Tumor Markers
34. • Alpha-Fetoprotein (AFP)
– Produced by developing fetus
– Eleveated in HCC and germ cell tumor of ovary
and testicle
– Also in cirrhosis, hepatic necrosis, acute hepatitis,
ataxia, pregnancy
– Sensitivity for detecting HCC is 60%: enough for
screening
Tumor Markers
35. European Association for the Study of the Liver. EASL-EORTC Clinical Practice
Guidelines: Management of hepatocellular carcinoma. Journal of Hepatology 2012
vol.56:908-43.
36. • Cancer Antigen 19-9 (CA19-9)
– Mostly used in cholangiocarcinoma despite low
sensitivity (40-70%) and specificity (50-80%)
with positive predictive value of 16-40%
– Insufficient to screen or monitor colon and
pancreatic cancer
Tumor Markers
37. Multidisciplinary Approach to Cancer
• Surgery is an effective therapy for most solid
tumor
• But patients who die from cancer usually die
from metastatic disease
• To improve survival rates, systemic and
radiation therapy are the key
38. Surgical Management of
Primary Tumor
• The goal is to achieve oncologic cure
• Inoperable disease: primary tumor is not
resectable with negative margin
• Determine the operability by imaging before
surgery: thin-section CT scan
• Appropriate margin depends on type of cancer
39. Surgical Management of
Regional Lymph Node
• Most oncologic operations have been designed
to remove both primary tumor and draining
lymphatic en bloc
• A formal lymphadenectomy is likely to
minimize the risk of regional recurrence
• In breast, colon, and lung cancer, removal
large number of lymph node improves overall
survival rates
40. • Patients with nodal metastases may be offered
adjuvant therapy
• In clinically negative regional LN, lymphatic
mapping technology and sentinel node biopsy
have the role
Surgical Management of
Regional Lymph Node
41. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 305.
42. • The first node to receive drainage from the
tumor site is termed the sentinel node
• Most likely contained metastases
• The practice is designed to avoid morbidity
from lymph node dissection
• Standard of care in breast cancer and
melanoma
Surgical Management of
Regional Lymph Node
43. Surgical Management of
Distant Metastasis
• Depends on number and sites, cancer types,
rate of growth, previous treatment and
response, patient’s age, physical condition, and
desire
• Usually not curable with surgery
• Cure in selected cases with isolated metastases
to the liver, lung, brain
44. • Goal is to resect with negative margin
• In patients with unresectable liver metastases
due to location near intrahepatic blood vessel,
multifocal, or inadequate LFT, alternative
choice is tumor ablation with cryotherapy or
radiofrequency ablation
Surgical Management of
Distant Metastasis
45. Chemotherapy
• Primary modality for patient with distant
metastasis
• Adjuvant therapy: chemotherapy administered
to patients with high risk to distant recurrence
but no evidence
– Goal is to eradicate micrometastatic disease
46. • Principles: destroys cells by first-order kinetics
= a constant percentage of cells is killed, not a
constant number of cells
– 1 kg to 1 g to 1 mg rather being eliminate totally
Chemotherapy
47. • Combination therapy: providing greater
efficacy than single therapy by mechanisms
– Maximum cell kill
– Broader range of coverage of resistant cell lines
– Delays the emergence of drug-resistant cell-lines
Chemotherapy
48.
49. • Toxicity: normal tissue with a high growth
fraction are sensitive to chemotherapeutic
effects:
– Bone marrow
– Oral and intestinal mucosa
– Hair follicles
– Testes and ovaries
Chemotherapy
50. Hormonal Therapy
• Most notably breast and prostate cancer
• Tissue growth under hormonal control
• Examples:
– Surgical ablation: salpingo-oophorectomy
– Androgens: danazol
– Antiandrogens: abiraterone, casodex
– glucocorticoids
– gonadotropin inhibitors
52. Targeted Therapy
• Directed at the processes involved in tumor
growth
• Major groups: growth factor receptor
inhibitors, inhibitors of intracellular signal
transduction, cell-cycle inhibitors, apoptosis-
based therapies, and antiangiogenic compound
• Examples: imatinib, trastuzumab,
bevacizumab, lapatinib
53. Immunotherapy
• The aim is to induce or potentiate inherent
antitumor immunity that can destroy cancer
cells
• Example: ipilimumab (cytotoxic T lymphocyte
antigen 4: CTLA-4) on phase 3 study
54. Gene Therapy
• Variety of strategy
• Enhancement of immune responses to cancer
cells
• Replacement of mutated or deleted tumor-
suppressor gene
55. Radiation Therapy
• Results in DNA damage
• The goal of adjuvant radiotherapy is to
decrease local regional recurrence rate
• For inoperable tumor: to make it operable (but
increase risk of wound healing problem)
• For palliation: to reduce symptom
56. • Fractionation = delivery of radiation in divided
doses
• Planning: Conventional Fractionation
– 1.8 – 2 Gy/day
– 5 days each week
– For 3 – 7 weeks
Radiation Therapy
57. • Mainly use in
– Cervial cancer
– Prostate cancer
– Lung cancer
– Esophageal cancer
Radiation Therapy
60. Response criteria: target lesion
• Complete Response (CR)
– Disappearance all target lesion
– Any pathological LN have reduction < 10mm
• Partial Response (PR)
– At least 30% decrease in sum of diameters of
target lesions
61. • Progressive Disease (PD)
– At least 20% progression
– New lesion
• Stable Disease (SD)
Response criteria: target lesion
62. • Target lesion: maximum 5 measurable lesions
(maximum of 2 lesions per organ)
• Non-target lesion: all other lesion including
pathological LN
• Baseline sum diameter: diameter of target
lesions that calculated as baseline
63. • Measurable lesion:
– 10 mm by CT
– 10 mm by clinical exam
– 20 mm by CXR
– For malignant LN, 15 mm will be measurable
• Non-measurable lesion
– All other lesion including small lesion
– Pathological LN at least 10 mm < 15 mm
64. References
Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015.
Townsend CM et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical
Practice. 19th ed. Philadelphia: Elsevier Saunders, 2012.
European Association for the Study of the Liver. EASL-EORTC Clinical Practice Guidelines:
Management of hepatocellular carcinoma. Journal of Hepatology 2012 vol.56:908-43.
Khan SA et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut
2012; 61:1657-69.
Eisenhauer EA et al. New response evaluation criteria in solid tumours: Revised RECIST
guideline (version 1.1). European Journal of Cancer 45 (2009) 228-47.
www.cancer.org
http://www.nci.go.th/th/index1.html