The Cancer MDT - Oncology lecture notes PDF

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Oncology lecture notes...

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The Cancer MDT: Routes to a cancer diagnosis: -

Screen detection Two week wait GP referral Other outpatient Inpatient elective Emergency presentation Death certificate only Unknown

A cancer MDT: group of healthcare professionals with expertise in a specific cancer, who meet regularly to discuss the care of individual patients. Each tumour site has its own MDT with core members (radiologists, pathologists, site specific surgeons, specialist physicians, medical oncologists, clinical oncologists, cancer nurse specialists, MDT co-ordinators). It is responsible for:   

Confirming a cancer diagnosis Recommending a treatment plan Developing individual treatment pathways for patients

Tertiary centres – diagnose and treat all types of tumours, using all drugs and therapy Requires knowledge of:  

Type of cancer – primary site, histology and grade, biological subtype Extent of disease

Requires understanding of patient:    

Fitness of treatment Co-morbidities Wishes and priorities Quality of life

Uncertainty in cancer care: key issue for cancer patients. Doctors will be able to describe the evidence base for the management strategy they recommend but will generally not be able to predict the outcome for an individual patient.

Improving cancer outcomes: -

Developing better treatments Catch cancer at an earlier stage Stop people from developing cancer

Lifestyle changes: stop smoking, reduce UV light exposure, diet, weight and physical activity, preventing infections that cause cancer (vaccinations, antibiotic eradication and fresh drinking water)

Improving early detection:  -

UK cancer screening programmes Breast cancer screening: women aged 50-70, 3 yearly mammogram Bowel cancer screening: 60-74, 2 yearly faecal immunochemical test Cervical cancer screening: women aged 25-64, 3 yearly cervical smear

Benefits: helps spot cancer at an early stage when treatment is more likely to be successful, cervical screening can identify changes before cancer develops. Risks: missed cancers, false positives, over diagnosis, anxiety/worry, harms associated with test procedures  Early detection by doctors: recognition of ‘red flag’ symptoms, encouraging patients to return with persistent and progressive symptoms, 2 week wait referrals  Earlier presentation by patients: low awareness of symptoms of cancer, reluctance to waste GP’s time

Improving treatments for cancer: Precision oncology: an innovative approach to cancer treatment that ensures treatment is specifically designed and targeted to a patient’s unique form of cancer: identifying which tumours should respond to targeted anti-cancer therapies – expression/overexpression, abnormal proteins, targeting altered DNA sequences of tumours Germline genome: heritable, implications for family. PARP inhibitors are a targeted therapy for patients with BRCA1 and BRCA2 Somatic genome: not heritable, no implications for family, can change as cancer progresses Clinical trials are vital for improving all aspects of cancer care...