Clinical Content Update -Cancer

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Clinical Content Update Cancer John Horton,
M.B., Ch.B. October, 2004
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Clinical Content Update-Cancer-

• Reasons
• 1. Important cause of mortality and
• morbidity
• 2. Will remain important during the
• next 10 years.
• 3. Medical care is effective in
• reducing mortality and morbidity.

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Significant Causes of Cancerincidence and
Mortality in Central Asia

• 1. Lung and upper respiratory passages
• 2. Colorectal
• 3. Breast
• 4. Cervix
• 5. Others

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Information/experiences needed for students to
address problems in oncology

• Knowledge of etiologic factors (including
  genetic) and progression of cancer from
  pre-cancerous lesions through metastasis
• Identification of persons at high risk for cancer
• Promotion of healthy lifestyles to minimize
  cancer risk
• Organization/implementation of effective cancer
  screening

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Information (continued)

• 5. Knowledge of presenting symptoms and signs of
  cancer
• 6. Referral techniques and resources for
  diagnosis and treatment of established cancer
• 7. Cancer treatment methods
• 8. Recognition and management of symptoms, i.e.,
  pain, nausea, constipation
• 9. Capability of providing/assisting with
  terminal care.

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Approaches/techniques to consider in addressing
objectives in Oncology

• 1. Link basic science closely with clinical
  examples.
• 2. Do not attempt to cover all types of
  cancer. Use only the most common ones in Central
  Asia,
• 3. Identify the key issues regarding 3 or 4
  types of cancer chosen to illustrate the basic
  science and clinical approaches used.

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Possible tumor-types to serve as examples

• 1. Lung
• 2. Breast
• 3. Cervix
• 4. ?

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Summary of interventions known to impact most on
various cancer types

• Intervention Lung Breast Cervix
• Prevention ?
• Early detection/ ? ?
  
• Screening
• Treatment ? ?

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Describe and demonstrate diagnostic methods for
cancer

• Biopsy
• Needle aspiration
• Imaging
• Limitations of clinical-only diagnosis

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Describe and demonstrate cancer treatment
techniques

• Surgery
• Radiation therapy
• Systematic therapy-chemotherapy
• -hormone therapy
• -targeted therapy
• Support-medical
• -psychological
• Note Importance of multimodal approach

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Examples of linkages between basic science and
clinical education

• a. Primary prevention-
• Carcinogenic sequence and progression with
  smoking prevention and cessation
• b. Early detection/screening-
• i) Etiology (papilloma/cervix) with cytology
  screening programs for cervix cancer
• ii) Biases and limitations of screening programs
  with breast cancer
• c. Clinical presentation and progression-
• i) Use any/all to illustrate typical symptoms of
  initial tumor eg. regional and distant
  (metastatic) spread
• ii) Emphasize pathology/genetics/molecular
  oncology.

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Issues to emphasize

• 1. Design the objectives/competencies to
  address the future needs of the country.
• 2. Link basic science with clinical education
  and experience in the key tumor types.
• 3. Emphasize primary and secondary prevention,
  presenting symptoms/findings, and symptom
  control.
• 4. Evaluate the competencies.