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Basic Treatment of Oncologic Surgery

Department of Surgery
Medical Faculty of Hasanuddin University
2012
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
 Treatment Planning depend on :
- Histopathologic type of cancer
- Stage ( Early stage or late stage )
- Operable or Inoperable
- Curative or Palliative treatment
- Patients Performance Status
 The aim of cancer treatment :
- Curative
- Paliative

 Treatment possibilities in oncology include


- Operative / surgery
- Chemotherapy
- Radiotherapy
- Hormonal Therapy
Treatment Classification
 Main Treatment
- Surgical Oncology
- Radiation Oncology
- Medical oncology
- Hormonal Therapy

 Adjuvant Therapy:
- Adjuvant Surgery / Operative
- Adjuvant Chemotherapy
- Adjuvant Radiotherapy
- Adjuvant Hormonal Therapy
Operative / surgery
 The mainstay of cancer treatment is surgery

 Type of Surgery in Oncology :


- Diagnostic Surgery
- Defenitive Surgery
- Preventive / prophylactic surgery
- Debulking
- Metastasectomy
- Restorative ( reconstructive ) surgery
- Supportive surgery
- Palliative Surgery
- Oncologic Emergency Surgery
Type of Surgery

 Diagnostic Surgery
This type of surgery is used to get a tissue sample for
histopathologic examination

 Defenitive Surgery
Defenitive surgery or Curative Surgery is done when a tumor
appears to be confined to one area and it is likely that all of the
tumor can be removed.
 Preventive / prophylactic surgery
This type of surgery is done to remove body tissue that is likely
to become malignant even though there are no sign of cancer at
the time of surgery.

 Debulking Surgery
Also called Cytoreductive Surgery, this type of surgery is done to
remove some but not all of the tumor
 Metastasectomy
This type of surgery is done to remove the metastasis
tumor far from the primary tumor site

 Restorative ( reconstructive ) surgery


This type of surgery is used to change the way a person
looks after major cancer surgery or to restore the function
of an organ or body part after surgery
 Supportive surgery
This type of surgery is used to help with other types of
treatment

 Palliative Surgery
This type of surgery is used to treat complication of
advanced cancer or to correct a problem that is causing
discomfort or disability
 Oncologic Emergency Surgery
This type of surgery is done for life saving
- Bleeding
- Tracheal Obstruction

 Open Exploration Surgery


- Laparotomy
- Thoracotomy
Chemotherapy

 Chemotherapy may be used with :


- Curative Intent ( only 10% of Cancer )
- Palliative Intent

 Chemotherapy can be given as :


- Primary Treatment
- Adjuvant Chemotherapy
 prolonged survival
- Neoadjuvant Chemotherapy
 to reduce the size of tumor
Classification of Chemotherapy
ALKYLATING ANTI- MITOTIC
ANTIBIOTICS OTHERS
AGENTS METABOLITES INHIBITORS

BUSULFAN CYTOSINE ETOPOSIDE BLEOMYCIN L-ASPARAGINASE

CARMUSTINE ARABINOSIDE TENIPOSIDE DACTINOMYCIN HYDROXYUREA

CHLORAMBUCIL FLOXURIDINE VINBLASTINE DAUNORUBICIN PROCARBAZINE

CISPLATIN FLUOROURACIL VINCRISTINE DOXORUBICIN

CYCLOPHOSPHAMIDE MERCAPTOPURINE VINDESINE MITOMYCIN-C

IFOSFAMIDE METHOTREXATE TAXOIDS MITOXANTRONE

MELPHALAN PLICAMYCIN
Antibiotics
Antimetabolites

S
(2-6h)
G2
(2-32h) Vinca alkaloids

M Mitotic inhibitors
(0.5-2h)

Taxoids

Alkylating agents

G1
(2-h)

G0
 Regimen of Chemotherapy :
- Monotherapy
- Combination therapy

ACTIVITY SAFETY
Different mechanisms of action Compatible side effects
Different mechanisms of resistance
SIDE EFFECTS OF CHEMOTHERAPY
Alopecia
Mucositis

Pulmonary fibrosis
Nausea/vomiting
Cardiotoxicity
Diarrhea
Cystitis Local reaction

Sterility Renal failure


Myalgia
Myelosuppression
Neuropathy
Phlebitis
Radiotherapy
 Radiotherapy is the therapeutic use of ionizing radiation in
treatment of patient with cancer

 There are 2 kind of Radiotherapy :


- External Beam Radiotherapy
- Interstitial and Intracavitary Brachy therapy

Radiotherapy :
- Curative
- Paliative
Hormonal Therapy
 Steroid hormone are required for the growth and function of :
- Breast, endometrium and prostat

 Cancer that arise in these tissue also depend on steroid hormone

 Steroid Hormone can act as :


- Cancer Risk Factors
- Cancer Preventatives
 Hormonal Therapy :
- Steroid Hormone Deprivation
- Steroid Hormone Antagonist
Hormonal Therapy :
 Steroid Hormone Deprivation :
- Ovarian Ablation
- Orchidectomy
- GnRH
- Progestins
- Aminogluthemide
- Estrogen
- Androgens

 Steroid Hormone Antagonist :


- Tamoxifen
- Flutamide
Response of therapy
 Complete Response
- Clinical
- Histopathologic
 Partial Response
 Minimal Change
 No Change
 Progressive
Reconstruction and rehabilitation
Step 6 : Follow-up / Rehabilitation & Reconstruction

Thank You
 4 objectives in rehabilitation of patients with cancer:
- Psychosocial support
- Optimization of physical functioning
- Vocational counseling
- Optimization of social functioning
Thank You