- 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.

1. Principles of
Medical Oncology

2. BASIC TENETS
• Cancer Treatment is multidisciplinary
• The suspicion of cancer is based on clinical acumen
• Diagnosis is based on examination of tissue
samples

3. BASIC TENETS
• Oncology care is for life
• Early stage cancers are more curable than late
stage
• Best treatment is often found in clinical trials

4. CLINICAL features
• Cancer, like Syphilis,
is the "Great Masquerader“ must be
considered in every suspect case
• No symptom should be attributable to
cancer without persuasive evidence
eg: Pulmonary insufficiency
Meningoencephilits
Unexplained pain

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. Proving the diagnosis
• Cytology - from stomach, cervix, bronchus
• Biochemical markers
βhCG, Alfa fetoproteins, CA19-9, CA125
• Histological proof
• To evidence Always aim to have
histological diagnosis

7. Laws of Therapeutics-Loeb
• If what you are doing, is doing good, keep
doing it.
• If what you are doing, is not doing good,
stop doing it.
• If you do not know what to do, do nothing.
• Never make the treatment worse than the
disease.

8. • Hippocratic admonition
"Primum non nocere“(first do no harm)
• Curative and subcurative oncology is toxic
• Attempts to abrogate toxicity by reducing
dose will result in a failed regimen

9. Curative chemotherapy
• High dose chemotherapy
• Certainty of severe toxicity

10. Palliative chemotherapy
• Palliative chemotherapy is given without curative intent,
but simply to decrease tumor load and increase life
expectancy. For these regimens, a better toxicity profile
is generally expected.
• Minimising potential toxicity is the goal
• Try not to compromise on quality of life
• Dose reduction to avoid toxicity is permissible

11. Adjuvant Chemotherapy
• Adjuvant chemotherapy is used to treat patients
known to be at high risk of recurrence after
initial local therapy (surgery, radiation) has
removed all evidence of disease
• In addition to surgery/radiotherapy
• Goal – to eradicate micrometastases
• Reduce local and systemic recurrence
• Improve overall survival

12. Proven role of adjuvant CT
❑ Breast
❑ Ovary
❑ Cervix
❑ Colon
❑ Gastric

13. Neo-adjuvant
• Neoadjuvant therapy is given after a histological
diagnosis has been established, but before
definitive surgical/radiation therapy.
• Localised cancer
• Local therapies are less than completely
effective

14. Neo-adjuvant therapy
Rationale
• Immediate exposure of local and possible
distant disease to effective chemotherapy,
avoiding the delay introduced by surgery
• Immediate in vivo assessment of chemotherapy
responsiveness of the primary tumor, and
therefore, of possible nodal or distant
micrometastatic disease

15. Neo-adjuvant therapy
• Reduce the size of primary tumor
• Better chance of complete resection
• Preservation of organ function
●
Laryngeal cancer
●
Anal cancer
●
Osteosarcoma
●
Bladder cancer

16. Proven role of Neo-adjuvant
therapy
❑ Anal cancer
❑ Bladder cancer
❑ Breast cancer
❑ Cervical cancer
❑ Head and neck cancer
❑ Lung cancer
❑ Ovarian cancer

17. Surgical Management OF Cancer

18. Intent of Therapy
●
CURATIVE
●
PALLIATIVE

19. Cancers CURABLE with
Chemotherapy
❑ Choriocarcinoma
❑ ALL of childhood
❑ Hodgkin's disease
❑ Burkitt's lymphoma
❑ APML
❑ Large Follicular cell lymphoma
❑ Hairy cell leukemia
❑ Embryonal cell carcinoma of testis

20. SUBCURABLE Cancers
●
Wilm's tumor
●
Osteosarcoma
●
Ewing's sarcoma
●
Embryonal rhabdomyosarcoma
●
Small cell carcinoma of lung

21. Basic Principles
CHEMOTHERAPY
1. Primary Induction treatment- for advanced
disease or for cancers for which there are no other
effective treatment approaches
2. Adjuvant treatment
Adjuvant chemotherapy is used to treat patients known
to be at high risk of recurrence after initial local therapy
(surgery, radiation) has removed all evidence of
disease

22. Staging Of Cancer
Since 1959 all solid tumors are staged under
the Universally accepted TNM System.
T = Tumor Size(TIS T0, T1,T2,T3,T4, TX.)
N = Lymph Node Status (Nx N0, N1,N2,)
M = Metastatic Spread status.

23. The Role of Surgery in the
management of cancer
Surgery now encompasses all areas of
cancer care…
1.Prevention.
2.Diagnosis.
3.Staging.
4.Treatment.
5.Palliation.

24. Principles of Surgery – Cancer
For most solid tumours, surgery remains the definitive
treatment and the only realistic hope of cure. Role of surgery
in cancer treatment include –
•Diagnosis & staging
•Removal of primary disease
•Removal of metastatic disease
•Palliation

25. Surgery in Cancer
• Diagnosis & Staging
> Lap Ultrasound & Biopsy
> Sampling Lymph nodes
• Removal of primary disease
> Removal of primary tumour + lymph node
• Removal of metastatic disease
> Liver metastases - Resection
> Lung metastases – Pulmonary resection
• Palliation
> By pass procedures

26. Prophylactic Surgery
Undescended Testis (Cryptorchidism)
Can cause Testicular Cancer
Treatment is = Orchiopexy/ Orchidectomy

27. Prophylactic Surgery
2.Multiple Polyposis coli :
Can cause Colonic cancer..
Treated with Prophylactic Proctocolectomy

28. Prophylactic Surgery
3. Familial Colonic cancer :
Treated with Prophylactic Colectomy

29. Prophylactic Surgery
4.Ulcerative Colitis = Colonic Cancer
Treated with prophylactic Colectomy.

30. Prophylactic Surgery
Strong history of Familial Breast cancer &
Familial History of Ovarian Cancer.
? Prophylactic Mastectomy.
? Prophylactic Oophorectomy.

31. Various Methods of biopsy….
1. Aspiration Biopsy (FNAC)
2. Needle Biopsy ( Tissue Core biopsy)
3. Incisional Biopsy.
4. Excisional Biopsy.
Role Of Surgery in Diagnosis Of
Cancer.

37. Role Of Surgery in Cancer
treatment.
Definitive surgical treatment for Primary cancer.
Surgery to reduce the bulk of primary or residual
disease.
Surgical resection of Metastatic disease with curative
intent.
Surgery for the treatment of Oncologic emergencies.
Surgery for palliation.
Surgery for Reconstruction & Rehabilitation.

38. Definitive surgical treatment of
Primary Cancer…..
Surgery in primary resections is dictated by…
1.Stage of the Cancer.
2.Mechanism & knowledge of local spread.
3. Morbidity & mortality of the procedure.
4.General condition of the patient.
5. Risk of Anesthesia.

39. Surgical Management of Oncologic
Emergencies.
Emergency /life threatening situations do arise in cancer
patients.
These situations usually include…
1. Exsanguinating Blood loss.
2. Hollow organ perforations.
3. Acute abscesses.
4. Surgical decompression of central nervous system.
5. Bowel / urinary obstruction.
6. Biliary obstruction with jaundice.
7. Asphyxiation due to tracheal obstruction.

40. Reconstructive & Rehabilitative
Surgery.
Many Radical Cancer surgeries cause massive
tissue losses, resulting in dysfunction & bad
cosmesis.
This applies particularly to Head & Neck
cancers, Breast Cancer, Cancer of Testis,
Bone cancers.
Latest advances in Plastic surgery, Bio
Prosthesis has radically improved this scene.

41. Reconstructive & Rehabilitative
Surgery.
Many Radical Cancer surgeries cause massive
tissue losses, resulting in dysfunction & bad
cosmesis.
This applies particularly to Head & Neck
cancers, Breast Cancer, Cancer of Testis,
Bone cancers.
Latest advances in Plastic surgery, Bio
Prosthesis has radically improved this scene.

42. What lies in Future ?
Increasing application of Laparoscopic Surgery ,
Video assisted surgery.
Increasing use of Lasers, Harmonic scalpels,
Automatic stapling devices.
Use of Robotic Surgery.
Use of Nano Surgical techniques.
Use of Super high voltage Gamma Knives
(Cyber knife)

45. Методы лечения костных
опухолей
Эндопротезирование: искусственный сустав (полусустав),
полимерометаллический эндопротез

46. Методы лечения костных
опухолей
Аллопластика,
полимерометаллическое
эндопротезирование

47. Остеогенная саркома (пример лечения)
Остеогенная саркома наружного мыщелка бедренной кости

48. Остеогенная саркома (пример лечения)
Остеогенная саркома наружного мыщелка бедренной кости

49. Остеогенная саркома (лечение)
Эндопротезирование: тотальное (слева)
и однополюсное

50. Остеогенная саркома (лечение)
Ротаторная пластика

51. Остеогенная саркома (лечение)
Ротаторная пластика

52. Остеогенная саркома ( исход лечения)
Исход лечения после ампутации

53. ISJP named after prof. M. Sitenko

54. ISJP named after prof. M. Sitenko

55. ISJP named after prof. M. Sitenko

56. ISJP named after prof. M. Sitenko

58. THANK you for attention