ROJoson PEP Talk: Cancer Surveillance after Definitive Treatment

1. February 10, 2024
1400H - 1500H
Via Zoom
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.

2. February 10, 2024
1400H - 1500H
Via Zoom
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
There will be group pictures
at start and end of PEP TALK –
show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

5. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.

9. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer depending on
our enthusiasm,
discipline and
perseverance.

10. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
My PEP TALK today is
entitled:
CANCER
SURVEILLANCE AFTER
DEFINITIVE
TREATMENT

11. Contents
• What is cancer surveillance after definitive
treatment?
• How is cancer surveillance after definitive
treatment being done?
• Why is cancer surveillance after definitive
treatment a must do and how long?
• What are approaches and guides in cancer
surveillance after definitive treatment?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and other
professionals.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

12. What is cancer surveillance after definitive
treatment?
Surveillance – close watch, close observation,
close monitoring (generic sense)
Surveillance in medicine – close watch,
observation and monitoring of any event related
to MEDICINE.
Cancer surveillance – close watch, observation
and monitoring of any event related to CANCER.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

13. What is cancer surveillance after definitive
treatment?
Cancer surveillance on a patient – close watch,
observation, close monitoring in a cancer patient
DURING treatment and AFTER treatment for the
following:
• response to treatment
• Behavior / course without active cancer
treatment procedure
• remission
• recurrence
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

14. What is cancer surveillance after definitive
treatment?
Cancer surveillance on a cancer patient – usually
used in the context of close and continuous
watch, observation and monitoring for recurrence
after a definitive cancer treatment.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

15. What is cancer surveillance after definitive
treatment?
CANCER DEFINITIVE TREATMENT - primary
treatment chosen to provide high chance for cure
or with the intent to cure, specifically done in
which all clinically evident cancers are completely
resolved, annihilated, or removed.
Treatment not done for complete resolution of all
clinically evident cancers is NOT cancer definitive
treatment. It is usually called CANCER
PALLIATIVE TREATMENT.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
The phrase “Cancer
Surveillance” is
usually used in the
setting of a cancer
definitive treatment
and not in cancer
palliative treatment.

16. What is cancer surveillance after definitive
treatment?
CANCER SURVEILLANCE after DEFINITIVE
TREATMENT
= close watch, observation and monitoring for
CANCER RECURRENCE AFTER DEFINITIVE
TREATMENT.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

17. Why is cancer surveillance after definitive treatment a must do and how
long?
There is always a possibility of CANCER RECURRENCE even after a
definitive treatment.
NO doctor will guarantee CURE – that the cancer will not recur.
The cancer can occur at anytime and as long as the patient is alive.
The objective of cancer surveillance is to catch a cancer recurrence early
enough, if it recurs, and to remedy it as soon as possible and if still,
possible (best effort).
Thus, cancer surveillance after definitive treatment is a must do and it is
a life-time affair.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

18. How is cancer surveillance after definitive
treatment being done?
This can be done with close (continuous and
regular) watch, observation, and monitoring of:
1. Symptoms of patients (what they felt and
observed)
2. Signs from physical exams of physicians,
particularly cancer specialists
3. Laboratory diagnostic tests or procedures
Question: All 3? Just 1 and 2? Just 3? Just 2? etc.
------------------APPROACHES
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.

19. What are approaches and guides in cancer
surveillance after definitive treatment?
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

20. What are approaches and guides in cancer
surveillance after definitive treatment?
1. Symptoms of patients (what they felt and
observed)
2. Signs from physical exams of physicians,
particularly cancer specialists
3. Laboratory diagnostic tests or procedures
• Minimalist approach – No. 1 and No. 2 first and
then do No. 3 only as indicated
• Maximalist approach – No.1, No. 2, and No. 3
all at once in one sitting.
• Ritualistic approach – No. 3 only
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.

21. What are approaches and guides in cancer
surveillance after definitive treatment?
1. Symptoms of patients (what they felt and
observed)
2. Signs from physical exams of physicians,
particularly cancer specialists
3. Laboratory diagnostic tests or procedures
• Minimalist approach – No. 1 and No. 2 first and
then do No. 3 only as indicated
• Maximalist approach – No.1, No. 2, and No. 3
all at once in one sitting.
• Ritualistic approach – No. 3 only
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
ROJoson’s TPORs:
Minimalist approach – No. 1 and
No. 2 and then do No. 3 only as
indicated.

22. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
1st MUST DO:
1. To emphasize to laypeople and patients on
using SYMPTOMS (what they felt and
observed) as the first step in the cancer
surveillance and to not rely solely on
physician’s examination and diagnostic tests.
2. To educate patients on what ALERT
SYMPTOMS OF RECURRENCE for their
particular cancer to watch, observe and
monitor.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.

23. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
1st MUST DO:
1. To emphasize to laypeople and patients on
using SYMPTOMS (what they felt and
observed) as the first step in the cancer
surveillance and to not rely solely on
physician’s examination and diagnostic tests.
2. To educate patients on what ALERT
SYMPTOMS OF RECURRENCE for their
particular cancer to watch, observe and
monitor.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Example in breast cancer patients, feel and observe for
the following common ALERT SYMPTOMS of
RECURRENCE:
• A mass on the operated side / site of the breast or
on the other breast – possible recurrence
• Protracted HEADACHE – possible recurrence or
spread to BRAIN
• Protracted COUGH – possible recurrence or spread
to LUNG
• Protracted BONE PAIN – possible recurrence or
spread to BONE
• Protracted ABDOMINAL PAIN, RIGH UPPER SIDE /
JAUNDICE – possible recurrence or spread to LIVER

24. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
1st MUST DO:
1. To emphasize to laypeople and patients on
using SYMPTOMS (what they felt and
observed) as the first step in the cancer
surveillance and to not rely solely on
physician’s examination and diagnostic tests.
2. To educate patients on what ALERT
SYMPTOMS OF RECURRENCE for their
particular cancer to watch, observe and
monitor.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Example in thyroid cancer patients, feel and
observe for the following common ALERT
SYMPTOMS of RECURRENCE:
• A mass on the operated side / site or on
other parts of the neck – possible
recurrence
• Protracted COUGH – possible recurrence or
spread to LUNG
• Protracted BONE PAIN – possible
recurrence or spread to BONE
• Protracted HEADACHE – possible
recurrence or spread to BRAIN

25. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
1st MUST DO:
1. To emphasize to laypeople and patients on
using SYMPTOMS (what they felt and
observed) as the first step in the cancer
surveillance and to not rely solely on
physician’s examination and diagnostic tests.
2. To educate patients on what ALERT
SYMPTOMS OF RECURRENCE for their
particular cancer to watch, observe and
monitor.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Example in abdominal cancer patients, feel
and observe for the following common ALERT
SYMPTOMS of RECURRENCE:
• Protracted pain on the abdomen – possible
recurrence
• A mass on the operated side / site or on
other parts of the abdomen – possible
recurrence
• Protracted COUGH – possible recurrence or
spread to LUNG

26. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
1st MUST DO:
1. To emphasize to laypeople and patients on
using SYMPTOMS (what they felt and
observed) as the first step in the cancer
surveillance and to not rely solely on
physician’s examination and diagnostic tests.
2. To educate patients on what ALERT
SYMPTOMS OF RECURRENCE for their
particular cancer to watch, observe and
monitor.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
A lot of cancer patients are not doing
this self-monitoring regularly
(monthly at least, and for life) and
have not been taught by physicians.

27. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.

28. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
In the check-up, the cancer patients should tell
the cancer specialist of any symptoms felt and
observed that may be suspicious for cancer
recurrence. IF NONE, SAY NONE.

29. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
In the check-up, the minimum examination to
be done by the cancer specialist is a physical
examination or clinical examination (just based
on interview and sign data). Laboratory
diagnostic tests are done only when indicated.

30. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
A lot of cancer patients are not doing
these regular check-ups with their
cancer specialists at planned
intervals.
Planned intervals – to be recommended by the
cancer specialists – based on the degree of risk of
recurrence of a particular cancer at time of
definitive treatment and after so many years in
remission. The higher the risk – the more frequent
the check-ups. The longer the years in remission –
the less frequent the check-ups. However, still
lifetime check-ups as cancer can always recur.

31. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
Example in breast cancer patients, minimum
physician’s physical exam for assessment and
evaluation for possible recurrence include
inspection and palpation of the following
areas:
• Both breasts (or chest area/s where the
total mastectomy was done)
• Both armpits
• Both neck especially above the collarbone
• Right upper abdomen (to palpate the liver
for possible mass recurrence)

32. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
Example in breast cancer patients, planned
intervals for check-up after definitive
treatment may have the following guidelines:
• Stage III more frequent than Stage I and II
breast cancers.
• 1st year – every 2-3 months after the wounds
have healed
• 2nd to 5th years – every 6 months
• > 5 years – every 12 months
• >10 years – every 24 months

33. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
Example in thyroid cancer patients, minimum
physician’s physical exam for assessment and
evaluation for possible recurrence include
inspection and palpation of the following
areas:
• Central neck where the thyroid gland is
located
• Lateral neck for possible lymph node
recurrence

34. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
2nd MUST DO:
• To see and consult a physician (specially a
cancer specialist) for regular assessment and
evaluation (check-up) at planned intervals (as
recommended by the cancer specialist).
• Similar to the recommendation to see a dentist
at planned intervals (every 6 or 12 months) for
dental check and oral health maintenance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
Example in thyroid cancer patients, planned
intervals for check-up after definitive
treatment may have the following guidelines:
• More frequent in more advanced stage of
thyroid cancer – more frequent in those
with lymph node metastasis
• 1st year – every 2-3 months after the wounds
have healed
• 2nd to 5th years – every 6 months
• > 5 years – every 12 months
• >10 years – every 24 months

35. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Battery of
Laboratory Tests
for Cancer - Meaning
Multiple tests being
ordered or done to
check for cancer with
the intent to be
comprehensive and
to apply the law of
elimination in the
interpretation

36. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Battery of
Laboratory Tests
for Cancer - Meaning
Multiple tests being
ordered or done to
check for cancer with
the intent to be
comprehensive and
to apply the law of
elimination in the
interpretation
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.

37. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.
Example in breast cancer patients, a battery of tests
would usually include the following ordered by the
physicians:
• CT scan of the chest (at times chest xray) – to check
recurrence or spread to the lungs
• CT scan of the brain to check recurrence or spread to
brain
• Bone scan – to check recurrence or spread to bone
• Ultrasound of the abdomen (at times CT scan) – to
check recurrence or spread to the liver.
• Blood chemistry to check recurrence or spread to liver
• Others

38. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.
Example in breast cancer patients, a selective approach
on laboratory diagnostic tests is usually done this way:
• On clinical / physical examination, because of
protracted headache, a recurrence or spread to the
brain is suspected. Selective test would include a CT
scan of the brain.
• IN THIS SCENARIO, the battery test is not needed if
there is NO NEED to determine the extent of
recurrence in other parts of the body (as there are no
symptoms elsewhere) and management will be the
same regardless of findings in other tests.

39. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.
Example in breast cancer patients, a selective approach
on laboratory diagnostic test is usually done this way:
• On clinical / physical examination, because of
protracted cough, a recurrence or spread to the lung is
suspected. Selective tests would include a chest xray
initially and then CT scan of the chest as indicated.
• IN THIS SCENARIO, the battery test is not needed if
there is NO NEED to determine the extent of
recurrence in other parts of the body (as there are no
symptoms elsewhere) and management will be the
same regardless of findings in other tests.

40. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.
Example in thyroid cancer patients, a battery of
tests would usually include the following ordered
by the physicians:
• Ultrasound of the thyroid and neck at times CT
scan of the neck
• Thyroglobulin
• Total body scan
• Thyroid function tests (FT4, FT3, TSH)
• Others

41. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson’s TPORs:
3rd MUST DO: (THING TO DO AFTER PHYSICAL
AND CLINICAL EXAMINATION BY PHYSICIAN)
Do laboratory diagnostic tests only when
indicated after the physical and clinical
examination (selective only, not battery of tests).
ONLY when there is a suspicious for a recurrence
and the physician needs to be more definite in
the diagnosis.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
A lot of cancer patients and a lot of
physicians are not doing this selective
approach in diagnostic testing.
They are being ritualistic and
maximalist.
Example in thyroid cancer patients, a selective approach
on laboratory diagnostic tests is usually done this way:
• On clinical / physical examination, because of a
palpable nodule on the thyroid bed, a local recurrence
is suspected. Selective tests would include an
ultrasound of the thyroid and neck.
• IN THIS SCENARIO, the battery test is not needed if
there is NO NEED to determine the extent of
recurrence in other parts of the body as there are no
symptoms elsewhere) and management will be the
same regardless of findings in other tests.

42. What are approaches and guides in cancer surveillance after definitive
treatment?
ROJoson’s TPORs:
There are clinical studies that compare the use of battery of tests vs
selective test approaches in breast cancer surveillance.
Results of this trial support the view that a protocol of frequent
laboratory tests and roentgenography after primary treatment for
breast cancer does not improve survival or influence health-related
quality of life. Routine use of these tests should be
discouraged.(JAMA. 1994;271:1587-1592)
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

43. What are approaches and guides in cancer surveillance after definitive
treatment?
ROJoson’s TPORs:
There are clinical studies that compare the use of battery of tests vs
selective test approaches in breast cancer surveillance.
Conclusions. —Periodic chest roentgenography and bone scan allow
earlier detection of distant metastases, but anticipated diagnosis
appears to be the only effect of intensive follow-up, and no impact on
prognosis is evident after 5 years. Periodic intensive follow-up with
chest roentgenography and bone scan should not be recommended as
a routine policy.(JAMA. 1994;271:1593-1597)
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

44. What are approaches and guides in cancer surveillance after definitive
treatment?
ROJoson’s TPORs:
There are clinical studies that compare the use of battery of tests vs
selective test approaches in cancer surveillance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

45. What are approaches and guides in cancer surveillance after definitive
treatment?
ROJoson’s TPORs:
There are clinical studies that compare the use of battery of tests vs
selective test approaches in cancer surveillance.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
BIG EXPENSE
LESS EXPENSE

46. What are approaches and guides in cancer
surveillance after definitive treatment?
1. Symptoms of patients (what they felt and
observed)
2. Signs from physical exams of physicians,
particularly cancer specialists
3. Laboratory diagnostic tests or procedures
• Minimalist approach – No. 1 and No. 2 first and
then do No. 3 only as indicated
• Maximalist approach – No.1, No. 2, and No. 3
all at once in one sitting.
• Ritualistic approach – No. 3 only
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
ROJoson’s TPORs:
Minimalist approach – No. 1 and
No. 2 and then do No. 3 only as
indicated.

47. What are approaches and guides in cancer
surveillance after definitive treatment?
1. Symptoms of patients (what they felt and
observed)
2. Signs from physical exams of physicians,
particularly cancer specialists
3. Laboratory diagnostic tests or procedures
• Minimalist approach – No. 1 and No. 2 first and
then do No. 3 only as indicated
• Maximalist approach – No.1, No. 2, and No. 3
all at once in one sitting.
• Ritualistic approach – No. 3 only
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.
ROJoson’s TPORs:
Minimalist approach:
symptom-sign based surveillance
and selective diagnostic tests as
indicated

48. What are approaches and guides in cancer
surveillance after definitive treatment?
ROJoson TPORs
1. Symptoms of patients (what they felt and
observed) (regular, monthly at least, for lfe)
2. Signs from physical exams of physicians,
particularly cancer specialists (regular at
planned intervals for life)
3. Laboratory diagnostic tests or procedures (as
indicated – selective / not battery of tests)
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
CANCER
SURVEILLANCE after
DEFINITIVE
TREATMENT
= close watch,
observation and
monitoring for
CANCER
RECURRENCE AFTER
DEFINITIVE
TREATMENT.

49. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Summary
Take Away
Contents
• What is cancer surveillance after definitive
treatment?
• How is cancer surveillance after definitive
treatment being done?
• Why is cancer surveillance after definitive
treatment a must do and how long?
• What are approaches and guides in cancer
surveillance after definitive treatment?

50. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on CANCER SURVEILLANCE AFTER
DEFINITIVE TREATMENT.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
management of CANCER SURVEILLANCE
AFTER DEFINITIVE TREATMENT as part of
your health management.
CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT

51. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
This ends my PEP
TALK today on:
CANCER
SURVEILLANCE AFTER
DEFINITIVE
TREATMENT

52. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

53. Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

54. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

55. CANCER
SURVEILLANCE
AFTER
DEFINITIVE
TREATMENT
Empowerment
objective - for laypeople
to have an essential
understanding on
CANCER SURVEILLANCE
AFTER DEFINITIVE
TREATMENT as part of
their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!