ΔΙΑΓΝΩΣΤΙΚΗ ΚΑΙ ΘΕΡΑΠΕΥΤΙΚΗ ΠΡΟΣΕΓΓΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ

Παρουσίαση με θέμα: "ΔΙΑΓΝΩΣΤΙΚΗ ΚΑΙ ΘΕΡΑΠΕΥΤΙΚΗ ΠΡΟΣΕΓΓΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ"— Μεταγράφημα παρουσίασης:

1 ΔΙΑΓΝΩΣΤΙΚΗ ΚΑΙ ΘΕΡΑΠΕΥΤΙΚΗ ΠΡΟΣΕΓΓΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ
ΔΙΑΓΝΩΣΤΙΚΗ ΚΑΙ ΘΕΡΑΠΕΥΤΙΚΗ ΠΡΟΣΕΓΓΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ

2 USA 2015

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5 TUMOR GROWTH 10 12 10 9 number of cancer cells diagnostic threshold
(1cm) time undetectable cancer detectable cancer limit of clinical detection host death

6 ΣΥΜΠΤΩΜΑΤΑ ΑΠΟ ΤΟΝ ΚΑΡΚΙΝΟ
ΣΥΜΠΤΩΜΑΤΑ ΑΠΟ ΤΟΝ ΚΑΡΚΙΝΟ Τοπική δράση σε ιστούς & όργανα Παρανεοπλασματικές εκδηλώσεις

7 Θεραπευτική Αντιμετώπιση
Διάγνωση Σταδιοποίηση Θεραπευτική Αντιμετώπιση

8 ΚΑΡΚΙΝΟΣ : ΜΕΘΟΔΟΙ ΔΙΑΓΝΩΣΗΣ & ΣΤΑΔΙΟΠΟΙΗΣΗΣ
ΚΑΡΚΙΝΟΣ : ΜΕΘΟΔΟΙ ΔΙΑΓΝΩΣΗΣ & ΣΤΑΔΙΟΠΟΙΗΣΗΣ Ιστορικό Φυσική εξέταση Απεικονιστικές μέθοδοι Ενδοσκοπήσεις ( κυτταρολογική – βιοψία ) Ανοικτή βιοψία, FNA, Pap – test Εργαστηριακές εξετάσεις

9 BREAST CANCER/LOCAL MANIFESTATIONS Signs and symptoms at presentation
Palpable mass Thickening Pain Mass or pain in the axilla Nipple discharge Nipple retraction Edema or erythema of the skin

10 BREAST CANCER Breast inspection
Skin dimpling

11 BREAST CANCER Breast palpation

12 BREAST CANCER Regional nodes assessment

13 BREAST CANCER Spread to lymph nodes
Supraclavicular Subclavicular Distal (upper) axillary Central (middle) Proximal (lower) Mediastinal Internal mammary Interpectoral (Rotter’s)

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16 BREAST CANCER Fine-needle aspiration biopsy
Out In Suction End Suction Back and Forth

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18 BREAST CANCER/DISTANT MANIFESTATIONS
BREAST CANCER/DISTANT MANIFESTATIONS Signs and symptoms at presentation Brain Pulmonary Bone Lymph nodes Skin Liver Kidney

19 TNM CLASSIFICATION Tumor Nodes Metastasis Good Bad Prognosis

20 BREAST CANCER Stage IV disease
Any T any N M1 M1 = Distant metastasis (including metastases to ipsilateral supraclavicular, cervical, or contralateral internal mammary lymph nodes)

21 BREAST CANCER Distal spread
Brain + Skin + Lung + + + Pleura + + + Liver + + Adrenals + + Bone

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24 BREAST CANCER Survival by stage
Percent surviving 100 80 60 40 20 Stage 0 Stage I Stage IIA Stage IIB Stage IIIA Stage IIIB Stage IV Years after diagnosis

25 BREAST CANCER Survival according to the number of positive nodes
1 2-3 4-5 6-10 11-15 16-20 21 or more Percent Surviving 100 40 20 80 60 Years after diagnosis Adapted from Wilson RE et al, 1994

26 PRIMARY BREAST CANCER Good prognostic factors
Patient’s age: older than 50 years Axillary nodes: not involved Size of tumor: small (< 1 cm) Local extension of tumor: absent Histologic examination: well-differentiated tumor (grade I) Cytologic study: little atypia of nuclei (grade I) Estrogen Progesterone Oncogene amplification: absent receptors: positive (ER + and PR +)

27 PRIMARY BREAST CANCER Poor prognostic factors
Patient’s age: 35–40 years Axillary nodes: involved Size of tumor: large (>5 cm) Local extension of tumor: present Histologic examination: anaplastic tumor (grade III) Cytologic study: severe atypia of nuclei (grade III) Estrogen Progesterone HER2 Oncogene amplification: present receptors: negative (ER – and PR – )

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30 LUNG CANCER Signs and symptoms at diagnosis
FREQUENCY (%) 75 50 40 40 40 40 35 35 35 30 25 25 15 15 15 15 COUGH DYSPNEA CHEST PAIN HEMOPTYSIS PNEUMONITIS WEIGHT LOSS GENERALIZED ANOREXIA FEVER ANEMIA WEAKNESS

31 LUNG CANCER Paraneoplastic syndromes
SMALL CELL LARGE CELL SQUAMOUS ADENOCARCINOMA +++ ++ Inappropriate ADH secretion Ectopic ACTH production Gynecomastia Eaton-Lambert Hypercalcemia (nonmetastatic) Hypertrophic osteoarthropathy Thrombocytosis Hypercoagulable stage +++ ++ + +++ ++ +++ ++

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37 LUNG CANCER Incidence of major histologic types
33% 25% 25% 16% 1% EPIDERMOID CARCINOMA ADENOCARCINOMA LARGE-CELL CARCINOMA SMALL-CELL CARCINOMA OTHERS (Bronchoalveolar mixed)

38 LUNG CANCER HISTOLOGIC TYPES Smokers vs nonsmokers
68 SQUAMOUS CELL ADENOCARCINOMA LARGE CELL SMALL CELL BRONCHOALVEOLAR 56 38 35 27 23 23 22 21 17 13 11 10 9 10 6 5 3 2 1 SMOKER (%) NONSMOKER (%) SMOKER (%) NONSMOKER (%) MALE FEMALE Adapted from Rosenow and Carr

39 LUNG CANCER Local and distal spread
Brain Draining lymph nodes Liver Adrenals Bone

40 NON–SMALL CELL LUNG CANCER Split by stages
37% 28% 15% 10% 10% T1 N0 T1 N1 T2 N0 T2 N1 IIIA Resectable IIIA Partially Resectable IIIB Unresectable Adapted from a lung cancer group survey

41 COLON Anatomic segments and vascular supply
Transverse colon Splenic flexure Hepatic flexure Mid. colic a. Inf. mes. v. Sup. mes a. and v. R. colic a. Inf. mes. a. L colic a. Ascending colon Descending colon Ileocolic a. Aorta small intestine Sup hemorrhoidal a. and v. Sigmoid a. Cecum Sigmoid colon RIGHT LEFT Rectum Internal pudenda a. Middle hemorrhoidal a. Inferior hemorrhoidal a.

42 COLORECTAL CANCER Pretreatment evaluation
HISTORY — Including familial history of CRC/polyps/other cancers PHYSICAL EXAMINATION — Digital examination of the rectum — Hepatomegaly/ascites/lymphadenopathies — In women: breast/ovarian abnormalities LABORATORY DATA — Blood count, CEA, liver chemistry GASTROINTESTINAL EXAMINATION — Full colonoscopy IMAGING — Chest X-ray — Abdominal ultrasound for colon cancer — Abdominal pelvic CT scan for rectal cancer — Other CT scans as appropriate (metastases) --- MRI, … etc if needed …

43 RECTAL CANCER Sigmoidoscopy
All rights reserved Dr Ligoury, CNRI.

44 COLORECTAL CANCER Symptomatology and evolution
1) EARLY STAGES 3) LATE STAGE RIGHT-SIDE COLON Vague abdominal aching Anemia (iron loss by chronic microscopic bleeding) Weakness Weight loss Change in bowel movements Rectal fullness Urgency Bleeding Tenesmus Pelvic pain (later stage) No symptoms Abdominal pain Flatulence Minor changes in bowel movements Rectal bleeding Anemia Constipation or diarrhea Abdominal pain (colicky pain) Obstructive symptoms (nausea/vomiting) 2) LATE STAGE LEFT-SIDE COLON 4) LATE STAGE RECTUM

45 COLORECTAL CANCER Symptoms and their frequency
65% Pain Compared frequency of clinical symptoma- tology of colon cancer (from 180 cancers) 40% 36% Changes in bowel movements 78% 25.5% Weakness Anemia Bleeding Abdominal mass Occlusion 7% 11% 0.8% 7% 88% 6.5% Right-side colon cancer Left-side colon cancer 0% 1.6% 7% Adapted from Metman EH, Bertrand J, Bouleau PH. Rev Prat. 1979; 29(13):

46 COLORECTAL CANCER TNM classification, definition of T (primary tumor)
Tis T1 T2 T3 T4 Extension to an adjacent organ Mucosa Muscularis mucosae Submucosa Muscularis propria Subserosa Serosa

47 COLORECTAL CANCER Usual prognostic factors
Prognostic factor Bad prognosis Stage TNM III-IV Age <40 years Performance status WHO >2 Symptoms + Duration of symptoms <6 months Obstruction/perforation + Location of primary tumor Rectum/rectosigmoid Histopathology Mucinous (colloid) and signet-ring adenocarcinomas LDH CEA/Other biomarkers >5 ng/mL Ploidy Aneuploidy

48 COLORECTAL CANCER 5-year postsurgery follow-up guidelines
Procedure/Test Frequency Comment History/examination Every 3-4 mo for 2y and then every 6 mo for 3y Colonoscopy Preoperatively or mo postoperatively, then every mo Chest X-ray Every 6 mo CEA Every 2-4 mo for 2y then every 6 mo for 2y Liver (US) Same Liver chemistries CT scans (chest, abdo, pelvic) Other scans (liver, spleen, bone) Detects one third of recurrences Every 3 years after free of polyps } As indicated by findings on history, examination, or elevated CEA levels CEA, serum carcinoembryonic antigen; CT, computed tomography; US, ultrasound

49 COLORECTAL CANCER Sites and frequency of distant metastases
Liver 38-60% Abdominal lymph nodes 39% Lung 38% Peritoneum 28% Ovary 18% Adrenal glands 14% Pleura 11% Brain 8% Bone 10% Adapted from: Kemeny N, Seiter K. Colon and rectal carcinoma. In: Handbook of chemotherapy in clinical oncology. SCI ed.1993:

50 ΟΓΚΟΛΟΓΙΚΟΣ ΑΣΘΕΝΗΣ Θα πρέπει να χορηγηθεί θεραπεία ή όχι ; εάν ναι
ΟΓΚΟΛΟΓΙΚΟΣ ΑΣΘΕΝΗΣ Θα πρέπει να χορηγηθεί θεραπεία ή όχι ; εάν ναι Τι θεραπεία πρέπει να χορηγηθεί ; και Ποιος είναι ο θεραπευτικός στόχος ; - ριζική εκρίζωση της νόσου - συμπληρωματική μετά την εγχείρηση - ανακουφιστική Πότε ; Χρονική διάρκεια ;

51 ΘΕΡΑΠΕΙΑ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ
ΘΕΡΑΠΕΙΑ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ Εγχείρηση Χημειοθεραπεία Ορμονοθεραπεία Ακτινοθεραπεία Βιολογικές θεραπείες

52 ΑΣΘΕΝΕΙΣ ΜΕ ΚΑΡΚΙΝΟ : ΣΧΕΔΙΑΣΜΟΣ ΘΕΡΑΠΕΥΤΙΚΗΣ ΠΡΟΣΕΓΓΙΣΗΣ
ΑΣΘΕΝΕΙΣ ΜΕ ΚΑΡΚΙΝΟ : ΣΧΕΔΙΑΣΜΟΣ ΘΕΡΑΠΕΥΤΙΚΗΣ ΠΡΟΣΕΓΓΙΣΗΣ Επιλογή & αξιολόγηση θεραπευτικών παραγόντων Συνδυασμός ή Μονοθεραπεία ; Χορήγηση των ανώτερων δυνατών δόσεων στο συντομότερο χρονικό διάστημα Αξιολόγηση δραστικότητας έγκαιρα ...