Cancer Lecture Notes PDF

Clinical Sciences: Medical and Neurological conditions Cancer Tony Wong Assistant Professor of Practice, PolyU Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pai...

Clinical Sciences: Medical and Neurological conditions Cancer Tony Wong Assistant Professor of Practice, PolyU Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care What is “Cancer” ? A cancer, is thought to develop from a cell in which the normal mechanisms for control of growth and proliferation are altered. Current evidence supports the concept of carcinogenesis as a multistage process that is genetically regulated How are normal and cancer growth different? Normal Growth (day-to-day) Dead cells shed from outer surface Epidermis Cell migration Dividing cells in basal layer Dermis How are Normal and Cancer Cell division different? Normal cell division Cell Suicide or Apoptosis Cell damage no repair Cancer cell division First Second Third Fourth or mutation mutation mutation later mutation Uncontrolled growth How are normal and cancer growth different? Normal growth proliferation are altered Cancer cells grow into surrounding tissues Invasion Cancer cells grow into surrounding tissues [Invasive] and blood vessels Cancer cells grow into blood vessels Metastasis Cancer cellsprimary area -> other systems reinvade Cancer and grow cells are at new location transported by the circulatory system to distant sites Pathology of cancer Tumors may arise from any of four basic tissue types Epithelial tissue Connective tissue (Muscle, bone, and cartilage) Lymphoid tissue Nerve tissue The first step in this process is initiation, which requires exposure of normal cells to carcinogenic substances. Substances that may act as carcinogens or initiators include chemical, physical, and biologic agents Two major classes of genes are involved in carcinogenesis: oncogenes and tumor suppressor genes Tumor characteristics Invade and destroy the surrounding tissue. The cells are genetically unstable Loss of normal cell architecture results in cells that are atypical of their origin. Lose the ability to perform their usual functions. -> lost the function of the organ Metastasize, and consequently, recurrences are common after removal or destruction of the primary tumor. Carcinogens An agent, mixture or exposure that can increase the age specific incidence of human cancer Known carcinogenic factors Tobacco smoking Passive smoking Chronic infection Alcohol drinking Hormones Imbalanced Diet, obesity and physical inactivity Ionizing radiation even UV light from the Sun will increase risk of skin cancer Occupation exposures e.g. hairstylists, mine workers Genetic susceptibility Carcinogenic Agent WHO International Agency for Research on Cancer (IARC) May affect some animals Tobacco smoking - Group 1 in IARC Causes 13 different cancers Lung, oral cavity, nasal cavity and nasal sinuses, pharynx, larynx, esophagus, stomach, pancreas, liver, urinary bladder, kidney, uterine cervix and myeloid leukemia Largest increase in tobacco related cancers in China and other Asian countries Passive smoking causes lung cancer and non neoplastic diseases, such as coronary heart disease, chronic respiratory symptoms, and adverse effects on fetal growth Nearly half of never smokers are exposed to tobacco smoke at home, at work and in bars and restaurants. About 10-15% of lung cancers in never smokers are attributed to passive smoking Third hand smoking? E cigarette?  Electronic Cigarette ? All e cigarettes contain harmful substances. There is limited research on their long term health risks, as they have only been readily available in the U.S. since 2006. Because of the risks, the U.S. Food and Drug Administration (FDA) took initial steps towards regulating these products in 2016. As of September 2019, there have been more than 800 cases of a severe lung disease, including 12 deaths, in the United States. All the affected patients reported previous use of vaping devices, but there is no confirmed link with a specific vaping device or e liquid. In 2019, an outbreak of severe vaping associated lung illness affected users throughout the US. Similar cases of vaping associated lung illness were reported in the UK and Japan before the outbreak occurred. 2,506 hospitalized cases have been reported to the Centers for Disease Control and Prevention (CDC) from all 50 54 deaths have been as of December 17, 2019. American Society of Clinical Oncology (ASCO), 2019 HK Council on Smoking & Health (COSH), 2018 Chronic infections Approximately 15 to 20% of cancers worldwide have been attributed to infectious agents. Examples of specific infectious agents and cancers (Group 1 in IARC) Hepatitis B related to liver cancer (55% of the world’s liver cancer is caused by infection with Hep B virus) Epstein Barr virus lymphomas H. pylori related to gastric cancer (CA stomach) Human papillomavirus (HPV type 16,18, 31, 33, 45, 52 & 58) related to cervical cancer (female) & cancer of the mouth and throat, penis, or anus (male) Chronic infection and cancers Most common: Ca stomach -> HPV -> Hep B  Alcohol drinking Alcohol drinking is one of the most important known causes of human cancer Established casual association between alcohol drinking and cancers of Oesophageal cancer digestive system S Colorectal Liver Breast Oral cavity Pharynx Larynx Hormones Imbalance/too much Reproductive factors and endogenous hormones late age at menopause increases the risk of breast cancer hormone replacement therapy increases the risk of breast cancer (estrogen therapy) estrogen progestogen oral contraceptive reduces the risk of ovarian cancer (WHO IARC Monographs Group I Carcinogenic Risk) Imbalanced diet, obesity & physical inactivity Processed meat is classified in Group 1 of carcinogenic agents by IARC Chinese salted fish is classified in Group 1 Red meat is classified in Group 2a Overweight and obesity > Increase the risk of cancer, especially colorectal and stomach Intakes of fruit and vegetables & Physical activity > Reduce the risk of cancer Ionizing radiation Group 1 in IARC in all kind of ionizing radiation Different sources of radiation Fukushima nuclear disaster Natural (from space, materials) Solar radiation (UV) Industrial Nuclear power plant Medical X ray, various sites Occupational Exposures  Aetiology of Cancer Group Definition (Summary) Carcinogenic to humans Risks and Causes of cancer 1.Tobacco smoking (including second-hand smoking) NOT fully understood yet >> 2. Alcoholic beverages 3. Aflatoxin further investigation 4. Helicobacter pylori What’re KNOWN 5. Hepatitis B virus 6. Hepatitis C virus heredity factors 1 7. Human Immunodeficiency Virus Age (Sufficient evidence) 8. Human Papillomavirus types 16, 18, 31,33,35,39 etc. 9. Epstein-Barr Virus Exposure to carcinogens (see 10. Ultraviolet radiation Table – Classification 11. Benzene, according to International 12. Salted fish (Chinese style) Agency for Research on 13. Radon 14. Some metals like Cadmium, Radium, Beryllium Cancer (IARC) under World 15. Soot Health Organization (WHO)) 2A Probably* carcinogenic to humans Some lifestyle factors, e.g. (Limited evidence) 2B stress, less vegetable, less (Limited evidence) Possibly* carcinogenic to humans physical activity, … etc. 3 Not classifiable as to its carcinogenicity to humans (Inadequate evidence) * The terms probably carcinogenic and possibly carcinogenic have no quantitative significance and are used simply as descriptors of different levels of evidence of human carcinogenicity, with probably carcinogenic signifying a higher level of evidence than possibly carcinogenic. Genetic susceptibility Accounting for 5-10% of the cancer BRCA1, BRCA2 with Ca Breast APC with Colorectal cancer May have a higher chance compared to the ones who don't have the gene  Angelina Jolie’s story; after mastectomy The recently married actress wrote that she was recently told by doctors that "a number of inflammatory markers" were elevated, which, taken together, could point to early cancer. She carries the BRCA1 gene, which brings an estimated 87% risk of breast cancer and a 50% risk of ovarian cancer, and her family has a history of cancer, as her mum had breast cancer and died of ovarian cancer. After she received the call, Angelina Joliehttps://www.glamourmagazine.co.uk/person/angelina-jolie said: "I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn't live to see my children grow up and to meet my grandchildren. "I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarising, and it is peaceful." Angelina then had a PET/CT scan, which was clear, and the tumour test came back negative, but she still opted to remove her ovaries and tubes. "In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer," she wrote. "My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother's ovarian cancer was diagnosed when she was 49. I'm 39." The Hollywood star believes that not every woman with the BRCA gene should rush for surgery, but for her personally, it was the right thing to do. She wrote: "It is not possible to remove all risk, and the fact is I remain prone to cancer. I will look for natural ways to strengthen my immune system. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, 'Mom died of ovarian cancer'". Angelina continued: "Regardless of the hormone replacements I'm taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared." SOURCE: THE NEW YORK TIMES, 2015 Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care Terminology in Cancer Neoplasia (Greek for ‘new growth’) is the abnormal and uncontrolled proliferation of cells in a tissue or organ Most neoplasms proliferate to form distinct masses, i.e., tumors CA (Cancer) e.g. CA Colon, CA Lung What are some different kinds of cancer? Related to the blood Mostly attack organs Leukemias Carcinomas Bloodstream Directly related to lymph system Lung Lymphomas Breast (women) Lymph nodes Related to fat, bone and muscles Colon Sarcomas Bladder Prostate (men) Fat Bone Muscle What are some different kinds of cancer? Cancer Prefixes Point to Location Prefix Meaning adeno- gland chondro- cartilage erythro- red blood cell hemangio- blood vessels hepato- liver lipo- fat lympho- lymphocyte melano- pigment cell myelo- bone marrow myo- muscle osteo- bone Classifications: Benign & Malignant Benign Inconspicuous lesion that generally remains confined to its tissue of origin When the lesion is detected at an early stage, it may be completely resected and may NOT cause the patient’s death Malignant show a great degree of anaplasia, i.e., reversion of cells to an immature or less differentiated form have the properties of invading neighboring structures have an ability to spread through the lymphatic system and bloodstream to OTHER organs  What is the difference between a benign tumor and a malignant tumor? Benign (not cancer) tumor Malignant (cancer) cells invade cells grow only locally and neighboring tissues, enter blood cannot spread by invasion or vessels, and metastasize to metastasis different sites Time Cancer metastasis Metastasis results from the spread of tumor cells from their original location to OTHER organ sites; metastatic disease is the main cause of death from cancer The organ distribution of metastases depends upon the type and location of the primary tumor and the route of dissemination of metastatic cells. Metastasis development Metastasis may develop from a small number of “Cancer stem cells” Can self renew and generate daughter cells Evolve into different cell shapes and properties upon interactions with their environments Why are malignant tumors dangerous? Brain Melanoma cells travel through bloodstream Liver Melanoma (initial tumor)  Classification: TNM staging T: Tumor the original (primary) N: Nodes. It tells whether the cancer has spread to the nearby lymph nodes M: metastasis. It tells whether the cancer has spread to distant parts of the body Definition Scale T aspects of the original (primary) tumor, TX: tumor can’t be measured. such as its size, how deeply it has grown T0: no evidence of a primary tumor (it cannot be found). into the organ it started in, and whether Tis: the cancer cells are only growing in the most superficial layer of tissue, without growing into it has grown into nearby tissues deeper tissues. This may also be called in situ cancer or pre-cancer. T1, T2, T3, and T4 : the tumor size and/or amount of spread into nearby structures. The higher the T number, the larger the tumor and/or the more it has grown into nearby tissues. N whether the cancer has spread into NX: nearby lymph nodes cannot be evaluated. nearby lymph nodes N0: nearby lymph nodes do not contain cancer. N1, N2, and N3: the size, location, and/or the number of nearby lymph nodes affected by cancer. The higher the N number, the greater the cancer spread to nearby lymph nodes. M whether the cancer has spread M0: no distant cancer spread was found. (metastasized) to distant parts of body) M1: the cancer has spread to distant organs or tissues (distant metastases were found). National Cancer Institute TNM Staging The cancer has spread to distant organs or tissues The higher the N number, the greater the cancer spread to nearby lymph nodes T number, the larger the tumor and/or the more it has grown into nearby tissues. Staging by Roman Numeral System Stage What it means Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer. Stage 1, Stage 2, Cancer is present. The higher the number, the larger the cancer tumor and the & Stage 3 more it has spread into nearby tissues. Stage 4 The cancer has spread to distant parts of the body. Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care Global statistics Global statistics (2) Huge number of incidents but not the main cause of death Both the number of incidents and death rates are high bcz patients discovered at stage 4 (terminal illness) Cancer statistics in Hong Kong https://www3.ha.org.hk/cancereg/default.asp Local statistic by Gender 2020 Male: 1. Lung closely related to smoking Female: 1. Breast 2. Colorectum mostly related to oral, diet 2. Colorectum 3.Prostate ageing 3. Lung Mortality in 2020 - Both Sexes Rank Site No. Rel. Freq. 1 Lung 3,910 26.4% 2 Colorectum 2,287 15.4% 3 Liver 1,530 10.3% 4 Pancreas 813 5.5% 5 Breast 756 5.1% 6 Stomach 613 4.1% 7 Prostate 484 3.3% 8 Non-Hodgkin lymphoma 397 2.7% 9 Leukaemia 365 2.5% 10 Oesophagus 318 2.1% All Sites (Include other sites not listed above) 14,805 100.0% Mortality rate in Hong Kong 2020 Male Female Rank Site No. Rel. Freq. Rank Site No. Rel. Freq. 1 Lung 2,526 29.3% 1 Lung 1,384 22.4% 2 Colorectum 1,315 15.2% 2 Colorectum 972 15.8% 3 Liver 1,123 13.0% 3 Breast 751 12.2% Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care How to make diagnosis of Cancer ? Blood test: Complete Blood Count (CBC – WBC, blood platelet), Carcinoembryonic antigen (CEA), Prostate-specific antigen (PSA) X-ray observe lung mass or tumour from other organs Ultrasound – abdomen, liver, kidney Computerized Tomography (CT) Distortion or enlargement of an organ Change in density and the extent of infiltration of primary tumors Magnetic resonance imagery (MRI) Spinal cord, brain and sarcoma and evidence of bone metastases PET Scan (Positron Emission Tomography) Surgery Procedure – Aspiration cytology, needle biopsy and CT guided fine needle biopsy Biopsies reveal the type of tumor, the level of differentiation and the degree of invasion Extract some of the mass using needle -> observe from the microscope -> compare the shape and form with the normal cells Chest X ray with Ca Lung CT & PET scan A positron emission tomography (PET) scan is an imaging test that can help reveal the metabolic or biochemical function of your tissues and organs. The PET scan uses a radioactive drug (tracer) to show both normal and abnormal metabolic activity. The diagram showed the Ca Lung with metastasis MRI scan of spinal cord tumor Non-traumatic spinal cord injury(NTSCI) A heterogeneous group of conditions regarding: Underlying pathologies Degeneration of the vertebral column – resulting in cord compression (e.g. degenerative cervical myelopathy) Metastatic disease, – resulting in cord compression (spinal tumour) Vascular aetiologies (spinal AVM) Inflammation (transverse myelitis) Some may have multiple possible causes, e.g. some patients can have both traumatic and nontraumatic factors contributing to their spinal damage. For example, a patient with cervical myelopathy that results in a fall can sustain a central cord syndrome. Neurological level Tetraplegia versus Paraplegia Completeness of spinal cord damage Complete versus incomplete Pattern of onset of spinal cord damage. acute onset over seconds, minutes, or hours, a subacute onset over days, or a chronic onset over weeks or longer. Please refer to RS2480 Dr Sam Chan SCI note for supplementary information NTSCI – A Possible Definition Can be defined as … the occurrence of a neurological deficit involving the spinal cord parenchyma, cauda equina, or conus medullaris that did not result from an external cause Biopsy needle test for Ca Breast Biopsy needle set What does a pathologist look for when he/she examines biopsy tissue with a microscope? Compare with normal cells regarding the size, pattern, boundaries Normal Hyperplasia Mild Carcinoma in dysplasia situ (severe dysplasia) Cancer (invasive) What does a pathologist look for examining biopsy tissue? Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care Cancer Treatment Radiotherapy Chemotherapy Surgery Bone marrow transplant Psycho-oncology therapy Rehabilitation Early intervention Most patients at stage 4 would die bcz most organs are damaged Early identification, early intervention The cancer cells strive to adapt and fight off the defense systems of the organism and progressively adopt an aggressive and invasive behavior Metastatic cancer cells have become so good at adapting themselves to new conditions that they resist many attempts at killing them , including cytotoxic drugs (chemotherapy) or radiation treatments most cancers are best treated at an early stage, at a time when cancer cells still have limited adaptive capacity and are thus unable to bypass the effects of treatment Once metastasized, not easy to locate all the cancerous cells. Radiotherapy over 50% of all patients who develop cancer will require radiotherapy at some time during their illness Uses high doses radiation to damage DNA (inc normal cells) Usually in combination with other therapy such as chemotherapy and surgery Apply before surgery to minimize the size of tumor Apply after surgery to kill the remaining cancer cells Modern radiotherapy Linear accelerators Beams are smaller Beam shapes can be varied Beam energies can be varied for different degrees of dose penetration CT guided 3D planning -> increases accuracy towards the tumour Radiation therapy for Breast Cancer Chemotherapy Medical oncology Cure cancer by slowing the growth of cancer or prevent relapsed of the cancer can be used to ease symptoms These drugs are often administered in combination, using multiple mechanisms to kill cancer cell Chemotherapy has significantly improved survival of cancer The cytotoxic drugs associated with a range of side effects System therapy usual chemotherapy Kill cells, especially on rapidly dividing cells, including normal and cancerous cells Targeted therapy target at specific cancer type Act on specific molecular targets that are associated with cancer Have different targets Cytostatic (block tumor cell proliferation) Mark side-effect: Hair loss, oral ulceration, diarrhea, vomit, nausea, neutropenia, -> resistance Surgery For cancer diagnosis and staging (biopsy) Obtain a tissue sample for diagnosis and determining the stage Cancer screening and prevention For direct cancer treatment Tumor removal esp in stage 1 can palpate & X metastasis Direct resection and removal of visible tumors remove part of the tumor to make the system works better For preventive treatment Treatment of precancerous lesions or removal of normal organs which are of an elevated risk of developing cancers (prophylactic resection of the colon and rectum) Surgery (cont’d) Emergencies Save the life, relieve pain, prevent organ failure Rehabilitation E.g., cosmetic surgery for breast reconstruction Palliative care Improve quality of life, e.g., epidural for pain management; wound or ulcer care Bone Marrow Transplant used in Leukemia and Lymphoma Autologous transplants: patients receive their own stem cells (hematopoietic stem cells) Syngeneic transplants: patients receive stem cells from their identical twin Allogeneic transplants: patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient also may be used. X in HK Psycho-oncology therapy Over 50% of cancer patients have been reported with psychological distress – Anxiety, depression May X success + residual problems Therapy for patient and family members Education, counselling (crisis oriented or psychodynamic) Cognitive (cognitive reframing, problem solving) therapy or mind body techniques (relaxation, hypnosis, meditation) Group interventions (expressive existential, cognitive behavioral, psycho- educational) Couple or family interventions improve depression, quality of life, and adherence to cancer treatments to promote survival Rehabilitation in Oncology To regain physical, social and psychological and work related functionality Interdisciplinary and comprehensive approach Physical therapy Occupational therapy Pain management Exercise, diet counselling, smoking cessation education Psychological counselling/psychotherapy Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care Signs & Symptoms of Cancer May NOT with significant signs and symptoms at the early stage Cancer can affect multiple organs that causing almost ANY sign or symptom Where there is any sign or symptom, it may the primary tumor site General signs and symptoms: Unknown weight loss If have SSx, may have alrdy invaded different body parts Fever with unknown cause -> affects the bone -> pain & fatigue Fatigue Ca liver has no sensation -> metaphasis to spine -> severe pain Pain without any injury A lump/mass observed/palpated A wound not be healed (ulcer development) A wart/mole that change in shape, size, color or any abnormal bleeding/secretion Cancer patients’ symptom burden Weight Nausea Confusion Pain Fatigue Appetite Loss Vomiting Anxiety SOB Agitation -> affect oral intake -> severe weight loss  Cancer Pain Direct tumor invasion of tissue or neural structures (75%) After effects of cancer therapy (20%) Unrelated to cancer (10%) Most patients have more than one type of pain at various times during active cancer treatment, in survivorship, with advanced disease, at end-of-life Moderate to severe pain (numerical rating scale score ≥5) was reported (38%) of all patients. Arieke H.J et al., 2016  Pain -> affects daily function e.g. reluctant to move + develop anxiety stress depression -> poor sleep -> higher risk of fall + Adverse effect of Pain cognitive function -> QOL ↑HR, ↑BP, ↑RR , sweating, agitation, ↓mobility Anxiety / Stress / Depression Sleep disorders, drowsiness, fatigue Impaired ambulation, falls, ↓ mobility/activity Cognitive dysfunction, agitation, restlessness ↓Socialization Patient/family perceptions of patient suffering Polypharmacy, ↑nursing time ↑Healthcare costs, ↓Productivity ↓QOL Therapeutic approaches to Cancer pain Pharmacotherapy Opioids / Nonopioids / Adjuvant co analgesics Anesthesiologic /Surgical block the pain sensation/nerve Psychological Treatment pain acceptance or level may be related to mood and coping strategies Rehabilitation Program Live with the pain Lifestyle redesign Cancer Fatigue management “An unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment, despite adequate rest, that interferes with usual functioning” Generalized weakness resulting in inability to initiate certain activities Easy fatigue and reduced capacity to maintain performance Mental fatigue resulting in impaired concentration, loss of memory, and emotional lability (NCCN: National Comprehensive Cancer Network) A1 and at least five out of A2-A11 have been present for most days in at least two consecutive weeks in the past month (ICD-10) A A1 Significant fatigue diminished energy or increased need to rest disproportionate to any recent change in activity level A2 generalized weakness , limb heaviness A3 diminished concentration or attention A4 Decreased motivation or interest to engage in usual activities A5 Insomnia or hypersomnia A6 Experience of sleep as un refreshing or non restorative A7 Perceived need to struggle to overcome inactivity A8 Marked emotional reactivity (such as sadness, frustration, irritability) to feeling fatigued A9 Difficulty completing daily tasks attributed to feeling fatigued A10 Perceived problem with short term memory A11 Post exertional malaise lasting several hours B: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C: Evidence from history, physical examination, or laboratory findings that symptoms are a consequence of cancer or cancer treatment more self-awareness of managing their own problems D: Symptoms are not primarily a consequence of co morbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium Symptomatic treatment of fatigue Established drugs corticosteroids, megestrol acetate Investigational drugs Thalidomide, methylphenidate, modafinil, melatonin, fish oil, l-carnitine, Counseling Physical therapy Regular low-intensity exercises Occupational therapy - Lifestyle redesign Lecture Outline Etiology of Cancer Terminology and Classifications Cancer Statistics Cancer Diagnosis Cancer Treatment Cancer Pain and Fatigue Palliative Care X cancers can be cured Palliative care Looking after people with incurable illnesses , relieving their suffering and supporting them through difficult times Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual Its about living as well as dying, not to lengthen or shorten life but to let the time remaining, be days, or months, or years, can be as peaceful and fruitful as possible https://www.who.int/health-topics/palliative-care Palliative care – Who should provide PC? about living as well as dying Every health professional should be able to provide care and support to people with cancer and their families Have a working understanding of symptom control, psychosocial care and how to optimize a person’s function Specialized supportive and palliative care services Direct effects of the cancer Short and long term effects of the treatment Co-morbid illnesses that can be affected by the systemic challenge to the body of cancer Psychological effects of a cancer diagnosis identical with death Different stages of services in Hong Kong Palliative Care 舒緩 improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment Hospice Care 寧養 focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs End of Life Care 善終 requires a range of decisions, including questions of palliative care, patients' right to self determination (of treatment, life), medical experimentation. In addition, end of life treatments are subject to considerations of patient autonomy. Local resources and references  Useful web source  Some of the training material are based on Local I. Hong Kong Cancer Registry https://www3.ha.org.hk/cancereg/ II. Hong Kong Anti-cancer Society https://www.hkacs.org.hk/en/ III. Centre for Health Protection https://www.chp.gov.hk/en/healthtopics/content/25/102972.html IV. Hong Kong Cancer Fund https://www.cancer-fund.org/blog/ V. Cancer Online Resource Hub https://www.cancer.gov.hk/en/about_us/menu_index.html VI. HKSH Cancer Centre (Island East) https://www.hksh-emc.com/en/our-services/hksh-cancer-centre.php VII. Hong Kong Integrated Oncology Center https://www.hkioc.com.hk/ International I. American Cancer Society https://www.cancer.org/