PEPITO, RICA ALYSSA M.

UNIVERSITY OF CEBU SCHOOL OF MEDICINE Source: Harrison’s Principles of Internal Medicine 20 th Edition

Approach to Cancer Patients (Ch. 65)

ASSESS
EXTENT AND TREATMENT SUPPORTIVE
EPIDEMIOLOGY DIAGNOSIS RESPONSE TO FOLLOW-UP
PROGNOSIS PLAN CARE
TREATMENT

STAGING Periodic repeat survival for 5 years

AGE - most significant INVASIVE TISSUE PHYSIOLOGIC MULTIDISCIPLINARY
- evaluation of imaging and if normal without recurrence is
risk factor BIOPSY RESPONSE APPROACH
disease extent >> repeat biopsy tantamount to cure CREDO FOR
(after thorough - second major ONCOLOGY:
History and Physical determinant of
cure sometimes,
Examination) treatment outcome
If disease persists to extend life often,
INCIDENCE – Prostate Address disease disappearance of all and
CLINICAL STAGING TNM System Other staging systems = new salvage
and breast CA most complications evidence of disease
– physical exam, treatment plan to comfort always
common in men and
women respectively imaging (radiographs SURROGATE
Histology, grade, and scans) MARKERS OF POOR
invasiveness, cell primary tumor lesion PROGNOSIS Partial response >50%
Medical, radiation,
surface markers, (T1–4, where a higher Dukes classification – reduction (sum of
definitive surgical
molecular markers number indicates a colorectal CA perpendicular routine practice to
(neoadjuvant) PAIN = 10-division
PATHOLOGIC tumor of larger size) diameters of all follow-up monthly for
visual analogue scale -
STAGING – lesions) OR 30% 6–12 months, then
CANCER DEATHS – Patient’s age pharmacologic
information from decrease (longest every other month for
Lung CA is the most intervention,
surgical procedures International diameters) a year, every 3
common cause in IF WITHOUT antitumor therapy
(inspection, resection, Nodal involvement Federation of months for a year,
both men and women APPARENT PRIMARY Psychosocial support
biopsy) (N0-N1) Gynecologists and every 4 months for a
SITE - define based on Obstetricians (FIGO) year, every 6 months
age, sex, involvement, classification - Karnofsky for a year, and then
histology, tumor gynecologic cancers performance status Progressive disease - annually Anti-emetics,
markers, patient (<70) appearance of any thoracentesis for
history Metastatic disease new lesion OR >25% symptomatic
7 MODIFIABLE RISK (M0-M1) increase effusions (chest tube
FACTORS: smoking, Ann Arbor (perpendicular drainage if recurrent),
alcohol, obesity, classification - Eastern Cooperative diameters) OR 20% psychosocial support,
inactivity, low fruit Hodgkin’s disease Oncology Group increase (longest stress reduction
and vegetable (ECOG) performance diameters)
consumption, unsafe status (>=3)
sex, air pollution,
indoor smoke and
contaminated Stable disease - tumor
injections shrinkage or growth
does not meet any
criteria