ONCOLOGYONCOLOGYPatient ManagementPatient Management

ONCOLOGYONCOLOGYPatient managementPatient managementCancer patient management: Solid tumorsCancer patient management: Solid tumors

Therapeutic decisionTherapeutic decision

Clinical findingsClinical findings

Cancer diagnosisCancer diagnosis

Therapeutic intentionTherapeutic intention

BiopsyBiopsy CT scansCT scans

Staging/GradingStaging/Grading

ONCOLOGYONCOLOGYPatient managementPatient managementTumor markers: Tumor markers: ExamplesExamples

ProstateProstatecancercancer

PSAPSAEAPEAP

TesticularTesticularcancercancer

AFP, AFP, hCGhCG

PancreaticPancreaticcancercancer

CA 19-9CA 19-9

BreastBreastcancercancer

CA 15-3CA 15-3

OvarianOvariancancercancer

CA 125CA 125

Tretter C. Current Cancer Therapeutics. 1998;224-237.Rosenbaum EH. Everyone’s Guide to Cancer Therapy, 3rd ed. 1997;616-622.

Haskell CM. Cancer Treatment, 4th ed. 1995;322-337.Berek JS. Cancer Treatment, 4th ed. 1995;628-634.

ONCOLOGYONCOLOGYPatient managementPatient managementTNM classificationTNM classification

TTumorumor

NNodesodes

MMetastasisetastasis

ONCOLOGYONCOLOGYPatient managementPatient managementTumor extent/stagingTumor extent/staging

Localized diseaseLocalized disease= limited stage= limited stage

ChemotherapyRadiotherapy

SurgeryImmunotherapy

Hormonal therapyPalliative care

Tumor extent/stagingTumor extent/staging

Metastatic diseaseMetastatic disease

ExtentExtentResectableResectable

tumortumorNonresectableNonresectable

tumortumor

OperableOperablepatientpatient

InoperableInoperablepatientpatient

Surgery+ Radiation therapy+ Chemotherapy+ Hormonal-immunotherapy

Radiation therapyChemotherapyHormonal therapyImmunotherapy

and/or

Classification: LeukemiasClassification: Leukemias

ONCOLOGYONCOLOGYPatient managementPatient management

Morphology and cytochemistry (ie, lineage)

Maturational stage

Genotype

Scheinberg DA, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;2404-2447.

Staging: LymphomasStaging: Lymphomas

Shipp AA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997:2165-2220.

ONCOLOGYONCOLOGYPatient managementPatient management

Number of nodal sites involved

Presence of disease above or below diaphragm

Presence or absence of systemic symptoms

Presence or absence of extranodal disease

ONCOLOGYONCOLOGYPatient managementPatient managementPerformance status scalesPerformance status scales

Correspondence between ECOG and Karnofsky scales

GradeGrade Criteria (simplified)Criteria (simplified) %% Functional statusFunctional status

0 Normal activity 100 Able to carry on normal activity;no special care is needed

90

1 Symptoms but ambulatory 80

70 Unable to work; able to live at home;cares for most personal needs;a varying amount of assistance is needed

2 In bed <50% of time 6050

3 In bed >50% of time 40 Unable to care for self; requiresequivalent of institutional or hospital

30 care; disease may be progressing rapidly

4 100% bedridden 2010

5 Dead 0 Dead

ECOGECOG KARNOFSKYKARNOFSKY

Surgery in cancerSurgery in cancer

Rosenberg SA. Cancer: Principles & Practice of Oncology, 6th ed. 2001;253-264.

ONCOLOGYONCOLOGYPatient managementPatient management

Tissue acquisition for histologic disease

Primary treatment modality in localized disease (alone or in combination with other treatment modalities)

Reduction of tumor bulk

Resection with intent to cure

Treatment of oncologic emergencies

Reconstruction or rehabilitation

Palliation of tumor-related symptoms

Prophylactic use in high-risk patients

ONCOLOGYONCOLOGYPatient managementPatient management

Teletherapy (eg, orthovoltage, supervoltage, intraoperative radiotherapy, stereotaxic radiosurgery)

Brachytherapy (eg, internal radiation therapy, interstitial radiation therapy, intracavitary radiation, intraluminal radiation therapy)

Radiation therapyRadiation therapy

Hellman S. Cancer: Principles & Practice of Oncology, 6th ed. 2001;265-288.

ONCOLOGYONCOLOGYPatient managementPatient management

Chemotherapy– Cytotoxic agent– Hormonal therapy

Biologic therapy

Systemic therapiesSystemic therapies

Haskell CM. Cancer Treatment. 4th ed. 1995;31-56.