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PRINCIPLES OF CANCER MANAGEMENT

PRINCIPLES OF CANCER MANAGEMENT. Treatment. surgery. -. Radiotherapy. Chemotherapy. Hormonal Therapy. (single or multimodality ). Surgical Oncologist.

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PRINCIPLES OF CANCER MANAGEMENT

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  1. PRINCIPLES OF CANCER MANAGEMENT

  2. Treatment surgery - Radiotherapy Chemotherapy Hormonal Therapy (single or multimodality)

  3. Surgical Oncologist • “A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. • ”Society of Surgical OncologyTraining Program Guidelines, 2004

  4. PRINCIPLES OF CANCER MANAGEMENT SURGICAL ONCOLOGY

  5. surgical Mangement of cancer Prevention Diagnosis Treatment of primarytumor . Resection of metastasis 0 . - Management of oncological emergencies Surgery for palliation . - Surgery for residual diseaseSurgery for reconstruction Cytoreduction Regional chemotherapy

  6. Surgery for Cancer Prevention

  7. Role of Surgery in primary Cancer Prevention Pre-cancerous lesions • Leukoplakia of the tongue • Thyroid gland in MENS II • Colon in FAP • Colon in HNPCC •Breast in BRCA mutations•

  8. Leukoplakia of the tongue

  9. Colon in FAP

  10. ClinicalDiagnosis History&Physical Examination depends on involoved system-late symtoms&sighns Investigation for fitness and staging Histological Diagnosis

  11. ROLES FOR SURGERY - DIAGNOSIS OF CANCER

  12. Histological Diagnosis Needle Aspiration Trucut Biopsy Incisional biopsy Excisional Biopsy

  13. Biopsy Surgeon’s responsibilities: •Selection of appropriate biopsy method and site •Responsible that the tissue reach the pathologist timely and properly . •Communicate the results to the patient, family, other physicians •Provide initial prognosis and information on follow-up care

  14. surgical Mangement of cancer Objectives cure palliation . [single or part of multimodality]

  15. The wide excision of primary melanomas in the skin that can be cured locally by surgery alone in about 90% of cases. The resection of colon cancers with a 5-cm margin from the tumor results in anastomotic recurrences in less than 5% of cases

  16. The magnitude of surgical resection is modified in the treatment of adjuvantmany cancers by the use of treatment modalities

  17. local resection e.g. BCC e.g. breast ca wide local radical local excision e.g. compartment en block excision

  18. Principles of surgical resection of tumor •Adequate margin of resection •Prevention of tumor spillage •Minimal manipulation •Reconstruction

  19. Surgery for palliation Colostomy Gastrostomy Amputation

  20. Surgery for reconstruction and rehabilitation

  21. Surgery for Residual Disease After Neoadjuvent chemotherapy After radiotherapy After inadequate surgery

  22. Cytoreductive surgery Ovarian cancer Burkitt's lymphoma

  23. The resection of pulmonary metastases in patients with soft tissue and bony sarcomas can cure as many as 30% of patients pulmonary metastases in patients with soft tissue and bony sarcomas can cure as many as 30% of patients pulmonary metastases in patients with soft tissue and bony sarcomas can cure as many as 30% of patients Surgery for MetastaticDisease metastases to: -lung -brain -liver can be controlled by surgical resection -

  24. Metastasectomy This is done when: •The primary tumor is controlled or can be controlled •Metastasis is single or multiple •Evidence that metastasectomy is associated clinical benefits •Tumor doubling time is sufficiently long •No significant co-morbid factor

  25. Metastasectomy • Complete resection of distant metastases improves five-year overall survival rates • 40% for colorectal cancer with resection of liver metastases • 30% for sarcoma with resection of lung metastases • 16% for breast cancer with resection of brain metastases

  26. Perforation of the gastrointestinal tract after effective treatment for lymphoma SURGERY FOR ONCOLOGIC EMERGENCIES Hemorrhage Abscesses Perforation

  27. cancer invading the central nervous system represents another surgical emergency that can lead to preservation of function. gastrointestinalPerforation of the tract after effective treatment for lymphoma

  28. central nervouscancer invading the system represents another surgical emergency that can lead to preservation of function.

  29. Regional Chemotherapy

  30. Staging of cancer Staging is the clinical or pathological assessment of the extent of cancer spread

  31. 12/20/2019

  32. straging Clinical staging is a preoperative assessment It is based on clinical, radiological and operative information Used to determine treatment offered to the patient

  33. tt Pathological staging is a postoperative assessment

  34. Objectives -Provides useful prognostic information -Allows decisions to be made regarding adjuvant therapy -Allows comparison of treatment outcomes between different centers

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