Cancer Care Other Flashcards
Imaging
TMN Staging: How is T determined?
• Tx: primary tumour cannot be assessed
• T0: no evidence of primary tumour
• Tis: carcinoma in situ
• T1: site/tumour specific, generally small
• T2: site/tumour specific
• T3: site/tumour specific, generally large
• T4: site/tumour specific but usually refers to direct extension
into adjacent organs/tissues
TMN Staging: How is N determined?
- Nx: nodes cannot be assessed
- N0: no evidence of nodal involvement
- N1: site/tumour specific
- N2: site/tumour specific
- N3: site/tumour specific
TMN Staging: How is M determined?
- Mx: presence of metastases cannot be assessed
- M0: no evidence of metastases
- M1: distant metastases present
How is nodes evaluated on imaging as suspicious?
Malignant characteristics:
- indistinct borders
- heterogenous
- round shape
Size
- >9mm always suspicious
- size: larger-more likely malignant
- shape: round, L/T <2
- heterogeneous echotexture
- loss of central fatty hilum/thinning of the hilum
- eccentric versus concentric thickening of the cortex
- presence of microcalcifications
- necrosis: cystic/coagulative
- Ill-defined capsular margins: invasion
What are the disadvantages of clinical trial?
The clinical trial may require more time than a non-clinical trial treatment such as more visits to the clinical trial site, more treatments, hospital stays, etc. There may be unpleasant, serious or life threatening side effects to experimental treatments
What is a phase 1 study in a clinical trial?
• The aim of phase I studies is to explore drug toxicity
• May involve about 12 to 20 patients who are treated with the
drug under investigation at escalating doses.
• This may be achieved either through dose escalation in the same individuals or by increasing doses between patient cohorts, for instance by using a Fibonacci approach
• Early and late phase 1 studies
• First in human studies/ healthy volunteers
Six rights most relevent to palliative medicine
- right to life
- right to be free from inhuman or degrading treatment
- right to liberty
- right to private life and family life home and correspondence
- right to freedom of thought, consioenxe and religion
- right to enjoy all these human rights without discrimination
explain the concept of double effect as it applies to medicine
Double effect
– Permits the relief of suffering even when this may lead to a premature death
In case law this has been understood in the context of suffering physical pain
explain the concept of acts and ommissions as it applies to medicine
- Where an action and a failure to act (or stopping something) that lead to the same outcome
- That it makes an ethical difference whether an agent intervenes to bring about a result, or omits to act in circumstances in which it is foreseen that as a result of the omission the same result occurs
What is the law around giving fluids and nutrition to patients at end of life?
- If clinically assisted nutrition or hydration is necessary to keep a patient alive, the duty of care will normally require the doctor to provide it, if a patient with capacity wishes to receive it.16
- Clinically assisted nutrition or hydration may be withheld or withdrawn if the patient does not wish to receive it; or if the patient is dying and the care goals change to palliative care and relief of suffering; or if the patient lacks capacity to decide and it is considered that providing clinically assisted nutrition or hydration would not be in their best interest
How can you decide when treatment his futile at EOL?
Physiological futility
Quantitative futility Qualitative futility
Treatment that cannot achieve its physiological aim
Treatment that has <1% chance of succeeding
Treatment that cannot achieve an acceptable quality of life treatment that merely preserves unconsciousness or fails to relieve total dependence on intensive medical care
An intervention that will not change the fact that the patient will die in the near future
The patient has an underlying condition that will not be affected by the intervention and which will lead to death within weeks to months
What is the difference between active and passive euthanasia?
- Active euthanasia –Deliberately doing something to someone to cause them to die, by a HCP or other . ( to a patient with observed and irreversible suffering )
- Passive euthanasia –When someone dies because medical professionals don’t do something necessary to keep a patient alive , or by stopping something that is keeping patient alive
What is the current position of the UK on euthanasia?
• Withdrawal of life-support is permissible
• Withdrawal of feed and fluids administered by tube is
permissible (Bland 1993)
• Withdrawal and failure to start are morally indistinguishable
• Any action with intent to end life is illegal
• Illegal for doctors to assist a suicide
• CPS guidance 2010
Public health lecture:
What percentage of cancers are preventable?
50%
safe sex screening diet sun exposure physical activity limit alcohol control weight reduce tobacco use
Wilson Jungner criteria for screening programmes
Condition
• The condition sought should be an important health problem
• The natural history of the condition, including development from latent
to declared disease, should be adequately understood
• There should be a recognizable latent or early symptomatic stage
Test
• There should be a suitable test or examination
• The test should be acceptable to the population
Treatment
• There should be an accepted treatment for patients with recognized disease
• Facilities for diagnosis and treatment should be available
Programme
• There should be an agreed policy on whom to treat as patients.
• The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
• Case-finding should be a continuing process and not a “once and for all” project.
