ONCOLOGY

Patient Management
ONCOLOGY
Patient management
Cancer patient management: Solid tumors

Clinical findings

Biopsy Cancer diagnosis CT scans

Staging/Grading

Therapeutic intention

Therapeutic decision
ONCOLOGY
Patient management
Tumor markers:
Examples

Prostate Breast
cancer Pancreatic
cancer cancer
PSA CA 15-3
EAP CA 19-9

Ovarian
cancer
CA 125

Testicular
cancer
AFP, β hCG 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.
ONCOLOGY
Patient management
TNM classification

Tumor

Nodes

Metastasis
ONCOLOGY
Patient management
Tumor extent/staging

Tumor extent/staging

Metastatic disease Localized disease

= limited stage

Resectable Nonresectable
Extent tumor tumor

Operable Inoperable
patient patient
Chemotherapy
Radiotherapy
Surgery
Immunotherapy Surgery Radiation therapy
Hormonal therapy + Radiation therapy Chemotherapy
Palliative care and/or Hormonal therapy
+ Chemotherapy
+ Hormonal-immunotherapy Immunotherapy
ONCOLOGY
Patient management
Classification: Leukemias

 Morphology and cytochemistry

(ie, lineage)

 Maturational stage

 Genotype

Scheinberg DA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;2293-2321.
Deisseroth AB, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;2321-2343.
ONCOLOGY
Patient management
Staging: Lymphomas

 Number of nodal sites involved

 Presence of disease above or
below diaphragm
 Presence or absence of systemic
symptoms
 Presence or absence of
extranodal disease

Shipp AA, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997:2165-2220.
ONCOLOGY
Patient management
Performance status scales
Correspondence between ECOG and Karnofsky scales

ECOG KARNOFSKY
Grade Criteria (simplified) % Functional 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 60
50
3 In bed >50% of time 40 Unable to care for self; requires
equivalent of institutional or hospital
30 care; disease may be progressing rapidly
4 100% bedridden 20
10
5 Dead 0 Dead
ONCOLOGY
Patient management
Surgery in cancer
 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

Rosenberg SA. Cancer: Principles & Practice of Oncology, 5th ed. 1997;295-306.
ONCOLOGY
Patient management
Radiation therapy

 Teletherapy (eg, orthovoltage, supervoltage,

intraoperative radiotherapy, stereotaxic
radiosurgery)
 Brachytherapy (eg, internal radiation therapy,
interstitial radiation therapy, intracavitary
radiation, intraluminal radiation therapy)

Hellman S. Cancer: Principles & Practice of Oncology, 5th ed. 1997;307-332.

ONCOLOGY
Patient management
Systemic therapies

 Chemotherapy
– Cytotoxic agent
– Hormonal therapy

 Biologic therapy

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

Thank you