tumour 3 .pdf

Treatment 1. Prophylaxis Eradication of precancerous lesions e.g familial polyposis total proctocoloectomy Mastectomy Treatment 2. Multidisciplinary approach  1. Early ( loco-regional ,curable ,operable) cancer No evidence of distal spread Curable is possible Treatment is...

Treatment 1. Prophylaxis Eradication of precancerous lesions e.g familial polyposis total proctocoloectomy Mastectomy Treatment 2. Multidisciplinary approach  1. Early ( loco-regional ,curable ,operable) cancer No evidence of distal spread Curable is possible Treatment is radical Treatment is essential by loco-regional modalities. i.e surgery , radiotherapy or both Adjuvant treatment of systemic modalities. i.e chemotherapy in cases of possibility of systemic distant metastasis The larger the number of involved lymph nodes the higher the possibility of microscopic metastasis 2. Late (systemic ,incurable , inoperable ) cancer palliative treatment Distant metastasis Cure is impossible Treatment is palliative Systemic treatment by chemotherapy , hormones Surgery or radiotherapy may be needed as palliative for local symptoms Pain is reliefed by analgesics , neurosurgical operations that interrupt pain pathway  1. Surgery Removal of primary tumor by radical surgery with wide safety margin to ensure removal of microscopic extension Lymph nodes treatment is variable In GIT best removed with the tumor In the Neck removed if involved In Breast , axillary clearance or irradiated Lymph nodes with the tumor is removed (in block dissection) During surgery avoid spillage of the malignant cells  Advantages Quick , effective large numbers of curies The one method that ensure that tumor is fully excised by histopathological examination of the specimen Disadvantages Produce functional and cosmetic disabilities Can not applied in advanced tumors  2. Radiotherapy May replace surgery or given in addition to it In lymphoma replace surgery , Cancer breast: addition to surgery Powerful x-rays , gamma rays , electrons or heavy particles Direct to tumours : from outside the body teletherapy Placing radioactive pellets or needles at cancer site brachytherapy Advantages Treatment cancer without effect patient’s ability to function Can destroy microscopic extension Is a safer option for older patients , unfit for surgery Do not require hospitalization Disadvantages Some tumours are less sensitive (adeno carcinoma ) May associated with skin burns , enteritis Slower ( 5 to 8 weeks ) Not suitable of metastatic cases ( can not irradiate the whole body ) 3. Chemotherapy Indicated with surgery when micro metastasis are expected In early stage cancers used as secondary systemic treatment In late stage cancers used as primary local treatment Prevent the cancer cells from multiplying by interfering with their ability to replicate DNA Advantages Travel through the circulation , can reach malignant cells any where in the body Many tumours can be cured ( lymphomas , testicular tumours , leukemia) May be given trans-arterial catheters to decrease systemic effects Neoadjuvant ( chemotherapy before surgery) to downstage the tumour  Disadvantages Often kill many healthy cells and thus bring on serious side effects Tendency to damage to the rabidly growing cells of the bone marrow ( anemia , leukopenia , thrombocytopenia ) Diarrhea , nausea , vomiting , hear loss 4.Hormone therapy -hormone blocking -hormone supplement -Effect the rate at which tumour cells grow and multiply e.g: Anti-estrogens in Ca. breast Androgen blocked in Ca. prostate Throxin to suppress TSH in papillary Ca. Prognosis Because we are never sure that all microscopic disease has been eradicated , prognosis is expressed in terms of 5 and 10 years cure rate  Factors affecting prognosis of malignant neoplasm I. Tumor Stage TNM:  Tumor size(T): worse prognosis in larger tumors because it disseminate early to the regional LN.  Lymph node(N): (most important and accurate prognostic factor)  Involved or not: if involved more worse prognosis.  Number: more number associated with more worse prognosis.  Discrete or matted: discrete better prognosis than matted.  Distant metastasis (M): presence of distant metastasis worsens the prognosis. Grade: well differentiated (better prognosis) undifferentiated (most bad prognosis) Site: example: dorsum of the tongue more bad prognosis than sides of the tongue Type: the prognosis of sarcoma is more bad than carcinoma II. Management Early detection and proper treatment. III. Patient: (more worse prognosis in the following conditions) Age (according to the tumor)  Cancer thyroid better prognosis in young age.  Cancer breast worse prognosis in young age. chronic debilitating diseases as DM, renal failure, cancers Immunosuppressive drugs as steroid and chemotherapy Malnutrition. Delay in management of cancer Delay in presentation Delay in suspicious Delay in diagnosis Delay in treatment Leads to difficult in treatment and bad results Thank you