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Oncology for Geriatricians: Best of Five Questions

Who looks after cancer patients . Radiologist. Palliative Care. General Practitioner. Allied Professionals. 12 Best of five questions. Note down the answer to each questionWe will discuss each answer at the endTime for questions. 1. A 78 year old man, presented with a 4 week history of lethargy, breathlessnessand severe abdominal pain. He was previously independent but now requires help to wash and dress. He has no past medical history. Non-smoker.On examination he is unwell, has bilateral32259

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Oncology for Geriatricians: Best of Five Questions

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    1. Oncology for Geriatricians: Best of Five Questions Robert Metcalf Medical Oncology Registrar Christie Hospital

    2. Who looks after cancer patients

    3. 12 Best of five questions Note down the answer to each question We will discuss each answer at the end Time for questions

    16. Answers and discussion

    19. Cancer of unknown primary Third commonest presentation in those over 70 Represents 15% of referrals to oncology

    24. Confirming the diagnosis Exclude malignancies that are potentially curable Lymphoma, germ cell Only perform investigations that will change management Common tumour markers have a limited role in the diagnosis and prognosis

    25. Metastases to lymph nodes can be cured Axillary Cervical Inguinal Mediastinal/ retroperitoneal/ elsewhere Breast ENT Anal Germ cell/ lymphoma

    29. 5 year survival for colorectal cancer patients (diagnosed 1996-2002) by stage at diagnosis, England

    30. A Medical Oncologist’s Concept of Cancer

    31. (Neo-)Adjuvant therapy - Curative

    34. National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) November 2008 National audit of deaths within 30 days of systemic anti-cancer therapy 42% of patients admitted under general medicine Care judged as ‘good’ in 35% of deaths ‘Room for improvement’ in 49%

    41. Prostate Cancer Stats >30,000 new cases per year UK Approx 10,000 deaths per year Autopsy studies suggest 70% of men aged >80 have histological evidence of cancer of the prostate Most commonly adenocarcinoma

    42. Gleason’s pattern Small uniform glands More stroma between glands Distinctly infiltrative margins Irregular masses of neoplastic glands Only occasional gland formation

    43. Risk assessment Gleason: Score 1 to 5 for the most common pattern and second most common pattern eg 4+3 Score <6 low risk Score 6 - 7 int risk Score >7 high risk PSA <10 low risk PSA 10-20 int risk PSA >20 high risk T1-2a low risk T2b-2c int risk T3-4 high risk

    46. Brachytherapy

    47. Treatment for localised prostate cancer Radical prostatectomy (40% PSA failure) Radical radiotherapy (50% PSA failure) External beam or brachytherapy Androgen deprivation – non-curative Watchful waiting followed by the above

    48. Treatment for metastatic prostate cancer Growth is androgen dependant Number of hormone treatment options Surgical castration Medical castration, LHRH agonist eg goserelin Androgen blockade, eg bicalutamide Median duration of response 18 – 24 months Hormone refractory disease Combine castration with androgen blocker Median survival with hormone refractory disease 12 months Radiotherapy and radioactive strontium Some efficacy from mitoxanthrone and docetaxel

    51. Acute leukaemia as late effect Retrospective analysis of c. 65000 patients with breast cancer (USA) 10000 chemotherapy v 55000 no chemotherapy Age 66 to 104 Median follow up 54.8 months 10 year risk of AML 1.8% in chemo group 1.2% in no chemo group

    56. Summary: If I was asked to set the questions… Common cancers Breast, Colon, Prostate (+ possibly include lung) Hot issues in oncology Managing acute toxicities Late effects of chemotherapy (cancer survivors) Streamlining diagnostic pathway for unknown primary

    57. Thank you Any questions

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