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Medical Oncology

Medical Oncology. BASIC PRINCIPLES OF ONCOLOGICAL DIAGNOSIS. Anamnesis Familial history (genetic predisposition) Evaluation of risk factors Evaluation of physical status Laboratory Radiological assessment Invasive methods - histological evaluation Staging (TNM).

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Medical Oncology

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  1. Medical Oncology

  2. BASIC PRINCIPLES OF ONCOLOGICAL DIAGNOSIS • Anamnesis • Familial history (genetic predisposition) • Evaluation of risk factors • Evaluation of physical status • Laboratory • Radiological assessment • Invasive methods - histological evaluation • Staging (TNM)

  3. Clinical Oncology: STATISTICAL BASICS • 20% of all Austrians die of cancer. • There are about 35.000 newly diagnosed cancers in Austria/Year. • Men have a high frequency of prostatic cancer (20.5%), lung cancer (16%) and colon carcinoma (14.7%). • Women have a high frequency of breast cancer (25.5%) and colon carcinoma (14.2%). • The most frequent tumour is colorectal cancer. • Lung cancer has the highest mortality (24.1% of all male cancer cases).

  4. Symptoms of malignant diseases • Systemic Symptoms: • loss of appetite • loss of weight • fatigue • fever • night sweat • Intractable, worsening cough • Hemoptysis, Hemoptoe • Dyspnea, Hoarseness • Palpable tumour mass • Rectal (fecal) bleeding • Oedema of the face and neck

  5. Laboratory parameters suggestive of malignancy Blood count + differential (Anaemia? leucocytes? platelets?) Blood chemistry (Transaminases, Bilirubin, alkal. Phosphatase, Laktatdehydrogenase, Calcium, Sodium, Potassium, Iron) Erythrocyte sedimentation rate Electrophoresis

  6. Tumourmarkers • Tumourmarkers are: • not sensitive for early detection (with the potential exception of PSA, beta-HCG, AFP) • not specific. • Accordingly, they should not be regarded as tools for early detection of cancer or tumour search. • However, they might be helpful for assessment of response to therapy and follow up.

  7. Tumourmarkers CEA, CA15.3, CA12.5, CA 19.9, MCA TPS beta-HCG AFP PSA Beta-2-Microglobulin

  8. Tumourmarkers in the follow up of various cancers HISTOLOGY / LOCALISATIONMARKER ADENOCACRCINOMA CEA BREAST CANCER CA 15.3 GASTROINTESTINAL CARCINOMAS CA 19.9 OVARIAN CANCER CA 12.5 HEPATOCELLULAR CARCINOMA, TESTICULAR CANCER AFP SQUAMOUS CELL CARCINOMA SCC NEUROENDOCRINE CARCINOMA NSE PROSTATE CANCER PSA GERM CELL CARCINOMA (z.B. SEMINOMA) b-HCG

  9. TUMOURMARKERS LABORATORY PARAMTERS…. SYMPTOMS.... .... ARE ONLY INDIRECT CLUES FOR CANCER. THE ONLY CLINICALLY RELEVANT PROOF IS HISTOLOGICAL VERIFICATION.

  10. Clinical staging of carcinomas Conventional radiology Sonography Computed tomography (CT) Magnetic resonance imaging (MRI) Bone scan (Positron emission tomography - PET)

  11. CARCINOMA DIAGNOSIS Remember Treatment must not be given in the absence of a clear-cut histological diagnosis.

  12. Therapeutic options • Surgery • Radiation • Medical Oncology

  13. Medical Oncology • NEOADJUVANT THERAPY • ADJUVANT THERAPY • THERAPY OF METASTATIC DISEASE

  14. NEOADJUVANT THERAPY OF CANCER Administration before surgery in order to • decrease tumor bulk/size • Modification of tumour biology • estimate the effectiveness of given therapy

  15. GOAL OF THERAPY IN METASTATIC DISEASE • Maintain organ function • Palliation of symptoms • Prolongation of survival

  16. Medical Oncology Remember The effectivity of a certain therapy for a certain tumour can not be translated into other tumours.

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