follow up for gu malignancies l.
Download
Skip this Video
Download Presentation
Follow-up for GU Malignancies

Loading in 2 Seconds...

play fullscreen
1 / 23

Follow-up for GU Malignancies - PowerPoint PPT Presentation


  • 122 Views
  • Uploaded on

Follow-up for GU Malignancies. David Kim Radiation Oncologist BCCA - Southern Interior. Follow-up of GU Malignancies. Objectives rationale, aim, and details of general follow-up general BCCA guidelines and position follow-up of specific GU sites low risk seminoma

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Follow-up for GU Malignancies' - robbin


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
follow up for gu malignancies

Follow-up for GU Malignancies

David Kim

Radiation Oncologist

BCCA - Southern Interior

follow up of gu malignancies
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate
follow up of gu malignancies3
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate
follow up of gu malignancies4
Follow-up of GU Malignancies

Definition

  • “an action that serves to increase the effectiveness of a previous one”
follow up of gu malignancies5
Follow-up of GU Malignancies

Rationale for follow-up:

  • early detection of recurrent or metachronous disease leads to more effective salvage
  • provide reassurance for patients
  • allows for improved ancillary patient support
  • improves data collection for research
follow up of gu malignancies6
Follow-up of GU Malignancies

Aims of follow-up:

  • manage individual patient (where early detection and intervention would improve patient outcome)
  • permit a review of current cancer management policy
follow up of gu malignancies7
Follow-up of GU Malignancies

Type and frequency of follow-up is determined by:

  • type and extent of disease ~ likelihood of recurrence (location, frequency and “curability”)
  • likelihood and severity of treatment complications
  • utility of investigative tools (early detection of abnormalities that results in improved outcomes)
  • viable/appropriate method of intervention
  • individual patient needs
follow up of gu malignancies8
Follow-up of GU Malignancies

Location of follow-up:

  • follow-up is often managed at a cancer center
  • follow-up may be managed by a family doctor or a local specialist if:
    • investigative tools and interpretation of results are available
    • long distances complicate follow-up visits
follow up of gu malignancies9
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate
follow up of gu malignancies10
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate
follow up of gu malignancies11
Follow-up of GU Malignancies

General guidelines from the BCCA GU tumor group website:

  • Following the completion of treatment, all patients need to be monitored for potential recurrence of cancer and complications of therapy. This is needed both for management of the individual patient (where early detection would improve outcome), and to permit periodic review and improvement of current treatment policy.
  • Often it is felt appropriate to share follow up with the family doctor (and/or the urologist), in which case it is important for the patient to be clear who is responsible for certain aspects of the disease, e.g., symptom control by the family doctor, with advice from the BC Cancer Agency at the doctor's request.
  • Notification is requested in the event of any of the following:
    • recurrence at the primary site (particularly in patients with clinically localized disease treated with surgery and/or radiotherapy)
    • metastasis at regional or distant sites
    • complications of therapy especially if acute requiring hospitalization, or chronic and symptomatic
    • death with primary cause and whether cancer or treatment contributed
  • The event, date, and evidence where appropriate should be sent to the Agency chart where it will come to the attention of the oncologist, and will be available for periodic review by the tumour group. This information is requested annually for patients no longer followed at the BCCA.
follow up of gu malignancies12
Follow-up of GU Malignancies

General follow-up guidelines from the GU tumor group:

  • cancer recurrence and treatment complication monitoring
  • management of the individual patient
  • review and improve current treatment policy.
  • responsibility for various aspects of follow-up
  • notification is requested for:
    • recurrence, metastasis, treatment complications, death
  • information is requested annually
follow up of gu malignancies13
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate
follow up of gu malignancies testis
Follow-up of GU Malignancies - Testis

germ cell tumors

non-germ cell tumors

non seminoma

seminoma

N0 (surveillance)

N0 (post-radiation)

N1-2

N3, or post-relapse

follow up of gu malignancies testis15
Follow-up of GU Malignancies - Testis

germ cell tumors

non-germ cell tumors

non seminoma

seminoma

N0 (surveillance)

N0 (post-radiation)

N1-2

N3, or post-relapse

follow up of gu malignancies kidney
Follow-up of GU Malignancies - Kidney
  • regular follow up for post-surgical patients
  • follow-up is through the urologist and/or the family doctor
  • asymptomatic recurrence usually incurable, but a solitary metastasis may be treated definitively.
follow up of gu malignancies bladder
Follow-up of GU Malignancies - Bladder
  • Superficial Bladder Cancer
  • subsequent resections, institution of intravesical chemotherapy or consideration of radical cystectomy may be indicated
follow up of gu malignancies bladder18
Follow-up of GU Malignancies - Bladder
  • Muscle-Invasive Disease
  • follow up for local recurrence following radical irradiation is essential since salvage cystectomy may have curative potential
  • all post-cystectomy patients, unless on clinical trials, should be followed by the family physician and urologist
follow up of gu malignancies prostate
Follow-up of GU Malignancies - Prostate
  • The main goal of follow-up is the early detection of recurrence in those situations where the early institution of salvage therapy can cure or prolong life. Local recurrence after radical prostatectomy may be an example. In contrast, most patients who have received primary radical radiation therapy may only be managed with palliative intent in the event of recurrence, and the value of routine follow-up is questionable.
follow up of gu malignancies prostate20
Follow-up of GU Malignancies - Prostate

Watchful waiting

  • distinguish progressive from indolent cancer
    • PSA velocity
  • focus on symptoms
    • urinary incontinence, obstructive symptoms
    • erectile dysfunction
    • bone pain
  • imaging only if clinically warranted
  • institution of definitive therapy
  • other medical care should be maintained
follow up of gu malignancies prostate21
Follow-up of GU Malignancies - Prostate
  • Surgery
    • regular PSA testing
    • early PSA nadir
    • treatment complications
    • salvage RT
    • salvage hormone therapy

Post definitive therapy

  • Radiation Therapy
    • regular PSA testing
    • late PSA nadir
    • treatment complications
    • salvage hormone therapy
follow up of gu malignancies prostate22
Follow-up of GU Malignancies - Prostate

Metastatic disease

  • PSA testing at the physician’s discretion
  • focus on symptoms
  • imaging for specific symptoms where treatment is anticipated
  • more frequent follow-up if systemic therapy is refused?
  • management of hormone refractory disease
follow up of gu malignancies23
Follow-up of GU Malignancies

Objectives

  • rationale, aim, and details of general follow-up
  • general BCCA guidelines and position
  • follow-up of specific GU sites
    • low risk seminoma
    • other sites (bladder, kidney, other testicular tumors, urethra, penis, renal pelvis and ureter)
    • prostate