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Patient Management

Patient Management. Clinical findings. Biopsy. Cancer diagnosis. CT scans. Staging/Grading. Therapeutic intention. Therapeutic decision. Patient Management Cancer patient management: Solid tumors. Patient Management Tumor markers: Examples.

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Patient Management

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  1. Patient Management

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

  3. Patient ManagementTumor markers: Examples 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. Patient ManagementTNM classification

  5. Tumor extent/staging Metastatic disease Localized disease = limited stage Resectable tumor Nonresectable tumor Extent Inoperable patient Operable patient Chemotherapy Radiotherapy Surgery Immunotherapy Hormonal therapy Palliative care Radiation therapy Chemotherapy Hormonal therapy Immunotherapy Surgery + Radiation therapy + Chemotherapy + Hormonal-immunotherapy and/or Patient ManagementTumor extent/staging

  6. 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 Patient ManagementPerformance status scales Correspondence between ECOG and Karnofsky scales

  7. Surgery in cancer management Tissue acquisition for histologic assessment Primary treatment modality for 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

  8. Patient ManagementRadiotherapy Teletherapy (eg, orthovoltage, supervoltage, intraoperative radiotherapy, stereotactic radiosurgery) Brachytherapy (eg, internal radiation therapy, interstitial radiation therapy, intracavitary radiation, intraluminal radiation)

  9. Patient ManagementSystemic therapies • Chemotherapy • Cytotoxic agents • Hormonal therapy • Biologic therapy

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