ROJoson PEP Talk: Cancer Management - FundaGen - Part 1

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Cancer

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Cancer
October 30, 2021
1400H - 1500H
Via Zoom

3. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Cancer
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

4. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

5. From October 23,
2021 onwards, I have
started tackling
Health Disorder and
Health Issue Courses.
This may take 3 years
or longer.

6. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Cancer
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
Cancer, which is part
of the Cancer
Course.

7. Definitions of Terms in Title:
Fundamentals – the basic principles; the
foundation; the basis
Generalities – majority; not all; not
detailed; not specific
Medical Management of Cancer –
diagnosis and treatment of cancer by
physicians
Fundamentals
and
Generalities
in Medical
Management
of Cancer

8. Contents:
• Screening for cancer
• Symptoms that will lead to suspected presence
of cancer
• Clinical diagnosis of cancer
• Paraclinical diagnostic procedures for cancer
• Treatment for cancer
• Surveillance of cancer
• Prognosis of cancer
• Palliative and hospice care for cancer patients
Fundamentals
and
Generalities
in Medical
Management
of Cancer
PART 1
PART 2

9. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer

10. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Screening for cancer means looking for a
cancer that may be present in apparently
healthy and asymptomatic persons.

11. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Screening for cancer
means looking for a
cancer that may be
present in
apparently healthy
and asymptomatic
persons.
General Screening Methods
• Risk-assessment interview or
evaluation
• Risk-assessment interview and physical
examination
• Risk-assessment interview and physical
examination with use of instrumental
or laboratory diagnostic procedures

12. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
If POSITIVE for
higher risk, proceed
to symptom-sign
evaluation (physical
examination) and if
indicated, do
instrumental or
laboratory
diagnostic
procedures.
General Screening Methods
• Risk-assessment interview or
evaluation
Looking for higher risk for cancer in a
particular patient / person
• Family history of cancer
• Risky lifestyle and behavior (tobacco
use; unsafe sex; sharing needles;
excessive sun exposure; etc.)

13. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
If NEGATIVE for
higher risk, MAY
STOP HERE or
proceed to
symptom-sign
evaluation
(interview and
physical
examination) to
complete the basic
essentials of
screening.
General Screening Methods
• Risk-assessment interview or
evaluation
Looking for higher risk for cancer in a
particular patient / person
• Family history of cancer
• Risky lifestyle and behavior (tobacco
use; unsafe sex; sharing needles;
excessive sun exposure; etc.)

14. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
If POSITIVE for
higher risk and with
SUSPECTED
PRESENCE of cancer
based on symptoms
and signs, proceed
to instrumental or
laboratory
diagnostic
procedures as
indicated.
General Screening Methods
• Risk-assessment interview and physical
examination
This constitutes the basic essentials of
screening.

15. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
If NEGATIVE for
higher risk and with
NO SUSPECTED
PRESENCE of cancer
based on symptoms
and signs, MAY STOP
HERE.
General Screening Methods
• Risk-assessment interview and physical
examination
These constitute the basic essentials of
screening.

16. Screening for cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
In this era of
commercialism in
medicine and health
care,
BEWARE of a lot of
hospitals and
laboratory clinics
peddling screening
packages for cancer.
Don’t be swayed
easily by the
marketing and
discount offers.
General Screening Methods
• Risk-assessment interview and physical
examination with use of instrumental
or laboratory diagnostic procedures
• DO instrumental or laboratory
diagnostic procedures only if POSITIVE
FOR HIGHER RISK FOR CANCER or / and
IF WITH SUSPECTED PRESENCE OF
CANCER BASED ON SYMPTOMS AND
SIGNS.

17. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer

18. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
There are more than 200 types of cancers.
200 types of cancers is not equated to 200
set of symptoms that have to be
memorized for purpose of early diagnosis.
Let’s simplify things for
• efficient early diagnosis.
• PATIENT EMPOWERMENT purpose.

19. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Cancers are first classified into solid and
liquid cancers. Then, the organs or tissues
of origin.
Let’s use these classifications to make a
simple-to-remember list of symptoms that
will lead to suspected presence of cancer.
Let’s call these symptoms - ALERT
SYMPTOMS or SYMPTOM-CUES.
First know the ALERT
SYMPTOMS or
SYMPTOM-CUES for
blood cancers (liquid
cancers) and then
non-blood cancers
(solid cancers).

20. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Liquid cancers (blood cancers such as
leukemias)
ALERT SYMPTOMS (blood-disorder
symptom-cues):
• Unusual easy bruising
• Unusual bleeding tendency
• Red spots on the skin
Liquid cancers
– ALERT
SYMPTOMS
The ALERT
SYMPTOMS or
SYMPTOM-CUES for
BLOOD cancers are
those associated
with BLOOD disorder
causing symptoms.

21. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Solid cancers (presenting with mass/es in
various organs and tissues)
ALERT SYMPTOMS: (general symptom-cues
in any organs and tissues)
• Palpable and/or visible mass/es or
bukol in superficial organs and tissues
Solid cancers
– ALERT
SYMPTOMS
The ALERT
SYMPTOMS OR
SYMPTOM-CUES for
SOLID cancers are
those associated
with a MASS disorder
causing symptoms.

22. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Solid cancers (presenting with mass/es in
various organs and tissues)
ALERT SYMPTOMS: (general symptom-cues
in any organs and tissues)
• Symptoms that may be caused by a
mass-effect in internal and deep organs
and tissues (headache; cough;
hoarseness; difficulty in swallowing;
change in bowel habit; etc.)
Solid cancers
– ALERT
SYMPTOMS
The ALERT
SYMPTOMS OR
SYMPTOM-CUES for
SOLID cancers are
those associated
with a MASS disorder
causing symptoms.

23. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Solid cancers (presenting with mass/es in
various organs and tissues)
ALERT SYMPTOMS: (general symptom-cues
in any organs and tissues)
• Symptoms that may be caused by an
unusual negative event in the mass
such as pain, bleeding and discharge
(e.g. headache; vomiting of blood; coughing of
blood; passage of blood per anus; unusual
vaginal discharge; etc.)
Solid cancers
– ALERT
SYMPTOMS
The ALERT
SYMPTOMS OR
SYMPTOM-CUES for
SOLID cancers are
those associated
with a MASS disorder
causing symptoms.

24. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Warning Signals for Cancers
1.Change in bowel or bladder habits
2.A sore that does not heal
3.Unusual bleeding or discharge
4.Thickening or lump in the breast or elsewhere
5.Indigestion or difficulty in swallowing
6.Obvious change in a wart or mole
7.Nagging cough or hoarseness
In the Internet, one
commonly sees these
“Warning Signals of
Cancers.”
I don’t know who
originally created
this. Most likely in
the USA.
The warning signals
started with 7. Some
centers now give as
many as 17 signals
and more.

25. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Warning signals for Cancers
1. Abnormal periods or pelvic pain
2. Changes in bathroom habits
3. Bloating
4. Breast changes
5. Chronic coughing
6. Chronic headache
7. Difficulty swallowing
8. Excessive bruising
9. Frequent fevers or infections
10. Oral changes
11. Skin changes
12. Pain that lasts
13. Persistent fatigue
14. Postmenopausal
bleeding
15. Stomach pain or
nausea
16. Unexplained
weight loss
17. Unusual lumps
University of California San Francisco - UCSF, 2020
In the Internet, one
commonly sees these
“Warning Signals of
Cancers.”
I don’t know who
originally created
this. Most likely in
the USA.
The warning signals
started with 7. Some
centers now give as
many as 17 signals
and more.

26. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Warning Signals for Cancers
1.Change in bowel or bladder habits
2.A sore that does not heal
3.Unusual bleeding or discharge
4.Thickening or lump in the breast or elsewhere
5.Indigestion or difficulty in swallowing
6.Obvious change in a wart or mole
7.Nagging cough or hoarseness
These 7 Warning
Signals of Cancers is a
simplified infographic
focusing on the more
common cancers in
the community and
their common alert
symptoms.

27. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Warning Signals for Cancers
1.Change in bowel or bladder habits
2.A sore that does not heal
3.Unusual bleeding or discharge
4.Thickening or lump in the breast or elsewhere
5.Indigestion or difficulty in swallowing
6.Obvious change in a wart or mole
7.Nagging cough or hoarseness
• Bowel or bladder
cancers
• Skin cancers
• Any cancer in
hollow organs
• Mass or bukol
anywhere
• Esophagus and
stomach cancers
• Melanomas
• Lung, laryngeal
and thyroid
cancers
Symptom-cues

28. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Warning signals for Cancers
1. Abnormal periods or pelvic pain
2. Changes in bathroom habits
3. Bloating
4. Breast changes
5. Chronic coughing
6. Chronic headache
7. Difficulty swallowing
8. Excessive bruising
9. Frequent fevers or infections
10. Oral changes
11. Skin changes
12. Pain that lasts
13. Persistent fatigue
14. Postmenopausal
bleeding
15. Stomach pain or
nausea
16. Unexplained
weight loss
17. Unusual lumps
UCSF, 2020
This UCSF list of 17
Warning Signals of
Cancers is more
comprehensive and
specific but still
cannot be said to be
complete.
Challenge: how to
remember them.

29. Symptoms that will lead to suspected
presence of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
May use
• 7 Warning Signals of Cancer
• More than 7 Warning Signals of Cancer
• ROJoson Alert Symptoms – Symptom-
Cues for Cancer using 2-step algorithm
(cues for liquid – blood cancers and
cues for solid cancers) and then for the
latter, look for symptom-cues for mass,
mass-effect and mass-event.
Liquid cancers – ALERT
SYMPTOMS
Solid cancers – ALERT
SYMPTOMS
• Palpable and/or visible
mass/es in superficial
organs and tissues
• Symptoms that may be
caused by a mass-
effect in internal and
deep organs and
tissues
• Symptoms that may be
caused by a negative
event in the mass such
as pain, bleeding and
discharge

30. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer

31. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Before I go further into the
discussion on clinical diagnosis of
cancer, which is the first thing
that a physician does in medical
management, let me say,
I utilize this framework of patient
management process which I
have discussed before and which
is applicable to all kinds of
patients and all kinds of medical
concerns, whether cancer or not.

32. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Clinical diagnosis means a conclusion or
decision made by a physician after
examining a patient and after evaluation
of the data on symptoms and signs.
Symptoms are what are felt and observed
by the patient or a person on the body.
Signs are findings of a physician after
physical examination of a patient.

33. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Procedures in clinical diagnosis of cancer:
Patient has symptoms.
• Physician evaluates the symptoms to see if
these are alert signals or symptoms-cues for
cancer or not.
• Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.

34. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Processes used in clinical diagnosis of
cancer:
• Pattern recognition
• Prevalence

35. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Processes used in clinical diagnosis of
cancer:
• Pattern recognition process means realization
that the patient’s presentation conforms to a
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.

36. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Blood cancers exemplified by leukemias
Symptoms and signs are non-specific and are variable with
the following as common symptoms and signs (with the
underlined ones as particular cues)
•Easy bleeding or bruising
•Recurrent nosebleeds
•Tiny red spots in your skin (petechiae)
•Frequent or severe infections
•Fever or chills
•Persistent fatigue, weakness
•Losing weight without trying
•Swollen lymph nodes, enlarged liver or spleen
•Excessive sweating, especially at night
•Bone pain or tenderness
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
Leukemia
suspect

37. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Breast Mass
30 years old and above
Palpable breast mass
Solid
Fixed (not movable)
With armpit lymph node
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
Breast cancer
suspect
Breast cancer
probable
Breast cancer
most probable

38. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Breast Mass
Any age
Palpable breast mass
Cystic (containing fluid)
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
NOT breast
cancer suspect
BENIGN
Macrocyst
Hormonal change

39. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Breast Mass
Any age
Palpable breast mass
With redness, tenderness and possible pus
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
NOT breast
cancer suspect
BENIGN
Infection
Abscess

40. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Thyroid Mass
Any age, any sex
Palpable thyroid mass
Feel solid and hard
With neck lymph node
With hoarseness of voice
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
Thyroid cancer
suspect
Thyroid cancer
probable
Thyroid cancer
most probable

41. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Thyroid Mass
Any age, any sex
Palpable thyroid mass
Cystic (containing fluid)
Example of
symptom- and sign-
cues and use of
pattern recognition
and prevalence in
the clinical diagnosis
of cancers
NOT thyroid
cancer suspect
BENIGN
Colloid cyst

42. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Remember the definition of cancer when
evaluating a mass.
Cancer is a medical
disease when some of
the body’s cells grow
uncontrollably with a
potential
to invade the adjacent
body tissues or organs
and
to spread to distant
tissues or organs.

43. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Suspect cancer in a mass with cues of
invasion of adjacent tissues – ILL-DEFINED
BORDER and FIXATION.
Cancer is a medical
disease when some of
the body’s cells grow
uncontrollably with a
potential
to invade the adjacent
body tissues or organs
and
to spread to distant
tissues or organs.

44. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Suspect cancer in a mass with cues of
spread to distant tissues or organs.
Cancer is a medical
disease when some of
the body’s cells grow
uncontrollably with a
potential
to invade the adjacent
body tissues or organs
and
to spread to distant
tissues or organs.

45. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Procedures in clinical diagnosis of cancer:
Patient has symptoms.
• Physician evaluates the symptoms to see if
these are alert signals or symptoms-cues for
cancer or not.
• Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.

46. Clinical diagnosis of cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
At end of the clinical examination,
physician makes a clinical diagnosis:
Possible conclusion or decision:
• Not cancer
• Cancer suspect
• Cancer probable
• Cancer most probable
The next thing for
the physician to
decide is whether to
do a paraclinical
diagnostic
procedure or not –
instrumental or
laboratory
diagnostic
procedure

47. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer

48. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
The foremost indication for a paraclinical
diagnostic procedure can be stated this
way:
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.

49. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
- degree of certainty on the primary
clinical diagnosis and
- comparison of the treatment plans for
the primary and secondary clinical
diagnoses.
As a rule, there is no need
for a paraclinical
diagnostic procedure if:
• you are quite
certain of your
primary clinical
diagnosis.
• treatment plans for
primary and
secondary
diagnoses are the
same.

50. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
If there is a need for a
paraclinical diagnostic
procedure, the
physician uses the B-
R-C-A processes.
B – stands for benefit;
R – risk; C – cost; A –
Availability.
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3

51. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
The physician gives or
lists the various
options of paraclinical
diagnostic procedures
and then gives data
on the BRCA.
With the data given,
the patient is asked
what s/he prefers.
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3

52. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Issues
• Using the fad, the popular one without
comparative analysis (benefit, risk, cost and
availability) of other options (usually with no
considerations for cost-effectiveness and
patient preference)
• Shotgun approach ordering every possible test
just to catch a diagnosis
• Ordering tests not needed for diagnosis of
cancer
There are several
issues to discuss in
the selection of
paraclinical diagnostic
procedures to be done
for suspected cancer.
There are a lot of
confusion, not to say
errors, happening.
NOT recommended

53. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Other issues
• Primary and secondary indications
• Direct vs indirect investigations of the
suspected cancer
There are several
issues to discuss in
the selection of
paraclinical diagnostic
procedures to be done
for suspected cancer.
There are a lot of
confusion, not to say
errors, happening.

54. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Primary indications for a paraclinical diagnostic
procedure for cancer:
- Not quite certain of the clinical diagnosis of
cancer (at the moment, just a suspect or
probable)
- Need to be very very certain in the diagnosis of
cancer because an extensive complex
treatment procedure is being planned
Primary indications
refer to the direct
information needed
on the tumor or alert
symptom itself where
cancer is being
suspected.
PRIMARY
PARACLINICAL
DIAGNOSTIC
PROCEDURES
FIRST priority – must be accomplished first!

55. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Secondary indications for a paraclinical diagnostic
procedure for cancer:
- Need to know before treatment
- the extent of the cancer
- other info, such as the specific cancer type
and prognostic exams
Secondary indications
refer to the other
information needed in
the planning of
treatment if there is
cancer.
SECONDARY
PARACLINICAL
DIAGNOSTIC
PROCEDURES
SECOND priority – if needed to be done,
should be after the primary indications.

56. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Direct vs indirect investigations of the suspected
cancer
- Direct means done on the suspected primary
cancer lesion itself such as biopsy of the lesion.
- Indirect means done outside the suspected
primary cancer lesion such that if positive for
cancer will infer cancer on the primary lesion.
Both approaches can
be done as dictated by
the situation.
However, as much as
possible do the direct
approach first.
Do the second
approach only if the
direct approach is not
feasible or difficult.

57. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Blood cancer suspect
Examples of
physicians’ ordering
for paraclinical
diagnostic procedures
Shotgun approach
• Complete blood
count
• Blood cell
examination
• Bone marrow
biopsy
• Imaging such as CT
scans and MRIs
Targeted sequential approach
• Complete blood count
if indicated
• Blood cell examination
if indicated
• Bone marrow biopsy
if indicated
• Imaging such as CT scans
and MRIs
Recommended

58. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Breast cancer suspect with a palpable mass
Examples of
physicians’ ordering
for paraclinical
diagnostic procedures
Shotgun approach
• Ultrasound breast
• Mammography
• CT Scan
• Tumor Markers
• Bone Scan
• Ultrasound
abdomen
• PET scan
Targeted and sequential
with prioritization
approach
• Breast mass
examination (eg biopsy
+/- ultrasound
if indicated
• Extent of cancer tests
Recommended

59. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Cancer suspect needing a paraclinical diagnostic
procedure
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available

60. Paraclinical diagnostic procedures for
cancer
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Breast cancer suspect with a palpable mass
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures
Procedures Benefit (goal –
to be more
definite on the
diagnosis)
Risk Cost Availability
Biopsy Direct info (4+
diagnostic
yield)
Pain PPP
Ultrasound Indirect (2+) No pain P
Mammogra
phy
Indirect (1+) Pain +
Radiation
PP
CT scan Indirect (3+) No pain +
Radiation
PPPP
√
√
√
√

61. Fundamentals
and
Generalities
in Medical
Management
of Cancer
Summary
Take Away
Contents:
• Screening for cancer
• Symptoms that will lead to suspected presence
of cancer
• Clinical diagnosis of cancer
• Paraclinical diagnostic procedures for cancer
• Treatment for cancer
• Surveillance of cancer
• Prognosis of cancer
• Palliative and hospice care for cancer patients
PART 1
PART 2

62. Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
cancer.
Fundamentals
and
Generalities
in Medical
Management
of Cancer
Take Away in
relation to
Patient
Empowerment
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management.

63. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Cancer