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Last update: Lydie Procházková (01.10.2008)
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Last update: Lydie Procházková (30.09.2008)
The aim of the subject:
Learning about clinical symptoms of cancerous diseases, gaining differential diagnostics ability, determination of algorithm of staging check-up and determination of the extent of the disease and probable prognosis according to the symptoms. Further aim is to teach students complex therapy of oncogenous diseases. |
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Last update: Lydie Procházková (30.09.2008)
Literature:
De Vita V., Hellman S., Rosenberg S.A. et al. Cancer. Principles and Practice of Oncology. Lippincott, 7. edition, Philadelphia 2005 Perez C. A., Brady L. W., Halperin E. C., et al. Principles and Practice of Radiation Oncology. Lippincott , 4. edition, Philadelphia 2004 TNM Classification of Malignant tumours. Wiley-Liss, New York 2002 CD with part of texts "course Tumours " (3.LF UK)
www.nccn.org www.cancernetwork.com
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Last update: Lydie Procházková (30.09.2008)
Methods of instruction : seminars, practical session
Conditions for getting credit: Final test The test consists of 20 multiple-choice questions each with 4 possibilities out of which only one is correct. At minimum 15 correct answers, i.e. 75% is necessary for passing the test. Presence at practical sessions ? at least 50%. Presence at seminaries is facultative. |
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Last update: Lydie Procházková (30.09.2008)
Syllabus of the subject ?Cancer 2008
The aim of the subject: Learning about clinical symptoms of cancerous diseases, gaining differential diagnostics ability, determination of algorithm of staging check-up and determination of the extent of the disease and probable prognosis according to the symptoms. Further aim is to teach students complex therapy of oncogenous diseases.
Introduction: In the large majority of cases, the treatment of malignant tumours is complex and highly specialized. It can be guided only by a specialist-oncologist. The training of medical students in the subject ?Cancer? is not aimed at making such specialists, only teaching of basic knowledge and practice of oncology, strictly relevant for other areas in medicine. The teaching will be based on pathophysiological, pathological and clinical features of a particular malignant diseases. Logical approach to the relevant investigations and treatment strategy will be required. One of the main problems in oncology is a late diagnosis of a malignancy, causing delay in instituting an appropriate treatment. It will be repeatedly stressed that tumours must not be forgotten in the differential analysis of most symptoms. The teaching should go along following baselines: Terminology and nomenclature of malignant diseases Symptomatology of malignancies Rational indication of addinitional investigation procedures including the assessment of their results Principles of treatment modalities in oncology Indication, timing and sequence of treatment modalities in a particular malignant disease Explaining the necessity of a complex treatment Basic follow-up guidelines Possible side-efects of oncology therapy, their early diagnosis and treatment Ways and possibilities of cancer prevetion In view of the introduced concept of study in the 3rd Medical Faculty, there is a substantial overlap between oncology and other medical specialities.
Clinical importance: Malignant diseases are the second cause of death in the Czech population. At present, approximately one in three persons will be diagnosed having a malignant tumor and every fifth one will die of it.
Definitions of malignant and benign tumours (characteristics)
Epidemiology: Risk assessment and methods of risk defitition Incidence and prevalence Most common malignancies (acc. To age and sex)
Principles of treatment of malignant tumours: Radical therapy Palliation Symptomatic treatment Sequencing and timing Neoadjuvant, basic, adjuvant Induction, maintenance, consolidation, salvage Concomitan, sequential
Treatment modalities: Surgrery Oncologic surgery is part of training in general surgery.
Radiotherapy Basic definition Types of ionizing radiation and examples of clinical use Absorption of ionizing radiation in the matter. Possibilities how to influence the dose distribution Mechanism of action in malignant and healthy tissues Teleradiotherapy vs brachytherapy Radiotherapy planning Definition of the target volume Basic radiobiology Kinetics of cell killing by ionizing radiation Differences between healthy and malignant cell and possibilities of its positive exploration. Total dose, dose per fraction. Overall treatment time Hyperfractionation, hypofractionation, acceleration of radiotherapy Dose rate and its influence on therapeutic index Acute, chronic and late radiation toxicity Integration of radiotherapy into a complex oncological treatment Basic of radiobiology
Chemotherapy Basic definition. Kinetics of oncogenous progression and respond to the effect of cytostatics. Cytostatistics groups according to mechanism of effect and chemical structure. Principles of combining cytostatics. Modes of administration, dosage, chemotherapy intensity. Timing. Resistance to cytostatics. Acute, chronic and late toxicity of chemotherapy. Integration of chemotherapy into complete oncological treatment.
Hormonal therapy Mechanisms of effectiveness, examples of hormonally dependent tumours.
Immunotherapy and biological treatment Principles of antitumour immunotherapy and biological treatment.
Supportive treatment Pain. Causes and types of oncological pain. Pain degree determination. Pain treatment. Infection in oncological patients. Most frequent causes of infection. Prevention and treatment. Nutrition of oncological patients, metabolic disorders, causes and treatment. Psychological support.
Special oncology
Brain tumors The subject also includes ?Nervous system disorders? and ?Mental changes?
Head and neck tumours Incidence Anatomy, histopathology - Epidermoid carcinoma, Malignant lymphoma, , Adenocarcinoma, Adenoid cystic carcinoma, Mucoepidermoid carcinoma Grouping according to anatomy (oral cavity, naso- , oro- and hypopharynx, larynx, nasal cavity and sinuses, salivary glands, ear) Diagnosis and diferential diagnosis History Physical examination- incl. endoscopy (direct and indirect laryngoskopy, epipharyngoscopy, rhinoskopy) Additional investigations - CT, MRI, ultrasonography of the neck Biopsy. Indication and types Clinical picture Treatment ? surgery, radiotherapy, radiochemotherapy, combination of radiotherapy and surgery and/or chemotherapy with regard to organ and function saving procedures Pain in the neck, dysphagia and odynophagia, bleeding, voice change, neck lymphadenopathy. Symptoms according to the localisation of primary lesion Risk factors: Smoking, Alcohol abuse. Prevention. Results and prognosis, scheme of follow-up
Tumours of the mediastinum Also part of subjects ?Dyspnoe and pain on the chest? and ?Abdominal symptomatology - dysphagia, nausea, vomiting, regurgitation..? Anatomy of the mediastinum, topography Symptomatology Dysphagia, odynophagia, loss of weight, pain on the chest, recurrent pneumonia Special problematics (e.g. thymoma - myasthenia gravis, aplastic anemia, hypogamaglobulinemia, collagenosis) Basic groups Carcinoma of the oesophagus Thymoma Neurogenic tumours Germinal tumours Lymphomas (Tumours of the thyroid gland- if thyroid localised in the mediastinum) Ethiology Histopathology of mediastinal tumours Adenocarcinoma and epidermoid carcinoma, malignant lymphomay, adenoma, thymoma, neurogenic tumours, germinal tumours Diagnosis and differential diagnosis History, Physical examination Additional investigations - chest X-ray, MRI, CT of the mediastinum, esophagoscopy, mediastinoscopy, liver sonography Differential diagnosis of enlarged mediastinum Treatment Indication of radical and palliative treatment- in general. Surgery. Basic surgical procedures in oesophageal carcinoma. Radiotherapy- indication of radical and adjuvant radiotherapy. Brachytherapy and teletherapy. Indication of chemotherapy. Results and prognosis
Lung carcinoma, mesothelioma Definition and clinics- also part of the subject ?Dyspnea and pain on the chest? Lung anatomy, physiology of gas exchange, interpretation of lung function tests Etiology and patophysiology Histopathology Benign lung tumours Small-cell and non-small-cell lung carcinoma Mesothelioma General and chest symptoms Loss of weight, cough, dyspnea, pain on the chest, hemoptysis, stridor, superior vena cava syndrome, dysphagia, Horner´s syndrome, Pancoast syndrome Extrathoracic symptomatology caused by metastases Paraneoplastic symptoms Also part of the subject ?Endocrine and metabolic disorders? Diagnosis and differential diagnosis History, Physical examination Additional investigations - chest X-Ray, CT, bronchoscopy, mediastinoscopy and thoracoscopy, biopsy Differential diagnossis of pleural effusion Treatment Indication and basic thoracosurgical approaches. Radiotherapy (indication, techniques). Chemotherapy (indication, basic drugs and combinations) Indication of ?prophylactic? cranial irradiation in small-cell lung carcinoma. Results and prognosis Prevenion Tobacco abuse. Mesothelioma as a result of occupational hazard
Gastrointestinal tumours Basic grouping Carcinoma of the stomach Tumours of the liver and subhepatic region, carcinoma of the pancreas and biliary ducts Tumours of the small intestine Colorectal carcinoma Anal cancer Anatomy of the organs of the abdomen, portal system Lymphatic drainage of particular abdominal organs Definition and clinics- also part of the subject ?Pain in the abdomen? Pain, loss of appetite, loss of weight, cachexy Nausea, vomiting, disorders of the passage up to the acute ileus Changes in the stools habits, changes of the stools colour and consistency Obstructive icterus, hematemesis, melaena, hypochromic anemia, fatigue, enlargement of the abdomen, bleeding Symptoms due to hormone overproduction (carcinoid, islet-cell tumours of the pancreas) Risk factors, genetic Patology of GIT tumours - adenocarcinoma, malignant lymphoma, carcinoid. Islet-cell tumours of the pancreas. Diagnosis and differential diagnosis History, Physical examination incl. per rectum examination Additional investigations: X-Ray of the stomach (double contrast method), gastroscopy, ultrasonography and CT of the abdomen, ERCP, i.v. urography, cystoscopy, colonoscopy, rectoscopy, irrigography Importance of tumour markers in the diagnostics and follow-up of GIT carcinoma Treatment Surgery of the stomach, intestine, lymphadenectomy Chemotherapy- basic indication Radiotherapy- basic indication Biological treatment Possibilities of screening and prevention of colorectal carcinoma Prognosis Carcinoma of the anus Clinical picture Anatomy of the anus and anal region, lymphatic drainage Risk factors Diagnosis History, Physical examination Additional investigations- CT, bipedal lymphography, lung X-ray Treatment Radiotherapy. Radio-chemotherapy. Surgery. Indication of particular tretment modalities, especially from the point of an organ and function preservation Results and prognosis
Breast cancer Incidence, risk factors Genetic Non-familial, especially relationship to estrogens Anatomy of the breast Histopathology Non-invasive and invasive carcinoma, basic subgroups Special category- Paget´s disease, phyllodes tumour ?Inflammatory? breast carcinoma Characteristics and natural course of the disease Diagnosis and differential diagnosis History, Physical examination. Technics of the breast and lymphatic areas examination. Additional investigations- basic risk features in mammography, ultrasonography. Biopsy Additional staging examinations (Chest X-Ray, bone scintigraphy, liver sonography, tumour markers) Treatment Surgery. Indication of mastectomy and breast conserving surgery. Radiotherapy. Basic indications- basic, adjuvant, salvage, palliative. Brachytherapy. Possible treatment complications. Chemotherapy. Neoadjuvant, adjuvant, palliative. High-dose chemotherapy. Hormonal treatment, biological treatment Follow-up Results and prognosis Screening Recommended procedures in standard and high-risk population
Malignant lymphoma and leukemia- peripheral lyphadenopathy, anemie Definition and clinics- also part of the subject ?Fever? and ?Bleeding? Anatomy and patophysiology. Anatomy of the lymphatic system, hematopoesis and its disorders Histopathology. Histopatologic classification of lymphoma and leukemia Diagnosis and differential diagnosis History (fatigue, fewer, sweating, itching, bleeding...) Physical examination Additional investigations- interpretation of the blood count, bone marrow and trephine, staging investigations. Emphasis on the rational approach Characteristic and natural course of particular types of leukemia and lymphoma. Appropriate choice and sequence of treatment modalities Treatment Cytostatic chemotherapy- induction, consolidation and maintenance chemotherapy, prophylaxis of the CNS invovement. Place of the high-dose chemotherapy with peripheral progenitor cells or bone marrow transplant Indication of radiotherapy Toxicity of chemo- and radiotherapy including late effects Results and prognosis According to leukemia or lymphoma type
Urogenital tract tumours except testicular carcinoma (tumours of the kidney, ureter, urinary bladder, urethra and prostate) Anatomy of the urogenital tract Definition and clinical picture. Hematuria and dysuria- part of the subject ?Bleeding? Etiology and patophysiology. Risk factors Histopathology Adenocarcinoma of the kidney, urinary bladder and prostate. Transitional cell carcinoma, epidermoid carcinoma. Wilms´ tumour and sarcomas- see ?Childhood tumours? Diagnosis and differential diagnosis History and physical examination Examination per rectum, bimanual examination under anaesthesia Additional investigations- IVU, CT of the abdomen, ultrasonography, cystoscopy and endoscopic biopsy, tumour markers (PSA), transrectal endosonography Characteristic and natural course of the disease. Influence on the treatment strategy Treatment Surgery- radical nephrectomy, radical cystectomy, radical prostatectomy. Indication and basic procedure. Palliative nephrectomy. Transuretral resection of the prostate Radiotherapy. Basic indication and technique. Acute and chronic treatment toxicity. Chemotherapy. Basic indication, choice of drugs. Hormonal manipulation. Mehanism of action. Basic indications and contraindications. Imunotherapy. Indications and treatment toxicity Results and prognosis Follow-up. Racional indication of procedures
Tumours of the testis Clinical picture- also part of the subject ?Reproduction and developmental disorders? Anatomy and embryology Lymphatic drainage Development of the sperm, hormonal production Etiology and patophysiology, risk factors Histopathology Germinal tumours (seminomas and non-seminomas) Gonadal tumours Other Diagnosis and differential diagnosis History, Physical examination Additional investigations - ultrasonography, staging procedures (CT of the pelvis and retroperitoneum, bipedal lymphography, CT of the mediastinum, chest X-Ray), tumour markers Differential diagnostis of testicular tumours Treatment Surgery: High transinguinal orchiectomy as diagnostic and therapeutic procedure Retroperitoneal lymphadenectomy Radiotherapy. Basic indication and technique. Chemotherapy. Indication and drugs Unsolved issues of adjuvant treatment Results and prognosis Follow-up. Importance of tumour markers
Gynecologic tumours - carcinoma of the uterus, uterine cervix, carcinoma of the ovary and Fallopian tube, carcinoma of the vagina and vulva Clinical picture- bleeding in the menopause, post-coital bleeding, vaginal discharge- also part of the subject?Bleeding? Other symptoms ? fatigue, enlargement of the abdomen, symptoms due to hormone overproduction (steroid hormones in endocrine active ovarian tumours) Ethiology and patophysiology Risk factors, Estrogens, HPV, HIV Anatomy of the female pelvis Histopathology - carcinoma and gonadal and germinal tumours of the ovary, adenocarcinoma, sarkoma of uterine corpus, epidermoid carcinoma and adenocarcinoma of the uterine cervix Precanceroses Diagnosis and differential diagnosis History, Physical examination Additional investigations- colposcopy, cytology, fractionated curretage of the uterus, hysteroscopy, ultrasonography, Lung X-ray, cystoscopy and rectoscopy, renal ultrasonography, CT of retroperitoneum and pelvis, i.v. urography, bipedal lymphography, MR of the pelvis Treatment Surgery. Indication and procedures Radiotherapy (teletherapy and brachytherapy). Rational of the combination. Acute and chronic side-effects. Role of chemotherapy Results and prognosis Sex education Hormonal manipulation Screening
Bone and soft tissue sarcoma Also part of the subject?Disorders of the locomotive system?
Skin cancer Clinical picture- also part of the subject ?Skin changes? Anatomy of the skin Etiology a patophysiology Risk factors Genetic, Non-familial Exposition to the ionizing and non-ionizing radiation, Chemical cancerogens Malignant transformation of a pigmented nevus Histopathology Precanceroses Melanoblastoma Spinocellular carcinoma and basalioma Skin lymphoma Diagnosis and differential diagnosis History, Physical examination Treatment Surgery. Basic principles of radical treatment of melanoma and non-melanoma Radiotherapy Adjuvant treatment of melanoma Imunotherapy, Chemotherapy Results and prognosis
Endocrinologically active tumours The subject also includes ?Endocrine and metabolic diseases?. Tumours of the eye and orbit Clinical picture- also part of the subject ?Sensory disorders?
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