1. ONCOLOGY Patient Management

2. ONCOLOGY Patient management Cancer patient management: Solid tumors Therapeutic decision Clinical findings Cancer diagnosis Therapeutic intention Biopsy CT scans Staging/Grading

3. ONCOLOGY Patient management Tumor markers: Examples ProstatecancerPSAEAP Testicularcancer AFP,  hCG Pancreaticcancer CA 19-9 Breastcancer CA 15-3 Ovariancancer CA 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.

4. ONCOLOGY Patient management TNM classification T umor N odes M etastasis

5. ONCOLOGY Patient management Tumor extent/staging Localized disease = limited stage Chemotherapy Radiotherapy Surgery Immunotherapy Hormonal therapy Palliative care Tumor extent/staging Metastatic disease Extent ResectabletumorNonresectabletumor Operablepatient Inoperablepatient Surgery + Radiation therapy + Chemotherapy + Hormonal-immunotherapy Radiation therapy Chemotherapy Hormonal therapy Immunotherapy and/or

6. Classification: Leukemias ONCOLOGY Patient management Morphology and cytochemistry (ie, lineage) Maturational stage Genotype Scheinberg DA, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;2404-2447.

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

8. ONCOLOGY Patient management Performance status scales Correspondence between ECOG and Karnofsky scales GradeCriteria (simplified)%Functional status 0Normal activity100Able to carry on normal activity; no special care is needed 90 1Symptoms but ambulatory80 70Unable to work; able to live at home; cares for most personal needs; a varying amount of assistance is needed 2In bed <50% of time60 50 3In bed >50% of time40Unable to care for self; requires equivalent of institutional or hospital 30care; disease may be progressing rapidly 4100% bedridden20 10 5Dead0Dead ECOGKARNOFSKY

9. Surgery in cancer Rosenberg SA. Cancer: Principles & Practice of Oncology, 6th ed. 2001;253-264. ONCOLOGY Patient 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

10. ONCOLOGY Patient management Teletherapy (eg, orthovoltage, supervoltage, intraoperative radiotherapy, stereotaxic radiosurgery) Brachytherapy (eg, internal radiation therapy, interstitial radiation therapy, intracavitary radiation, intraluminal radiation therapy) Radiation therapy Hellman S. Cancer: Principles & Practice of Oncology, 6th ed. 2001;265-288.

11. ONCOLOGY Patient management Chemotherapy –Cytotoxic agent –Hormonal therapy Biologic therapy Systemic therapies Haskell CM. Cancer Treatment. 4th ed. 1995;31-56.