This document discusses the establishment of a multidisciplinary cancer care unit at King Khalid Hospital in Najran, Saudi Arabia. It aims to provide comprehensive cancer treatment using evidence-based guidelines. The cancer unit has several goals, including becoming a training center and establishing a cancer registry. It has developed phases to expand its services from medical and surgical oncology initially to include nuclear medicine and radiation oncology. A multidisciplinary tumor board follows guidelines to determine the best diagnostic and treatment approaches for patients. The importance of a multidisciplinary approach is emphasized to determine personalized treatment plans tailored to each patient.
2. Objectives
•
•
•
•
Cancer : the size of the problem in Najran
Cancer unit : the goals.
The Tumor Board at KKH: functions & guidelines
The importance of multidisciplinary approach.
10. There is an urgent need for Cancer registry
• Saudi Cancer Registry (population based).
• Hospital based registry
11. Objectives
• Cancer : the size of the problem in Najran
• Cancer unit : the goals.
• The Tumor Board at KKH: functions & guidelines
• The importance of multidisciplinary approach.
12. Goals of the oncology Service:
• A comprehensive evidence based cancer (including the
psycho-social care).
• To be a nucleus for the upcoming cancer center.
• Training Centre for the doctors, medical students,
nurses ,pharmacists, social workers, etc.
• Cancer registry service (both hospital based & population
based).
• Cancer research .
13. Phases of the development
• Phase (I): Medical & surgical oncology (?).
• Phase(II): Nuclear medicine
• Phase (III): addition of radiation oncology service.
25. Modified WHO Analgesic Ladder
Quality of Life
Invasive treatments
Proposed 4 th
Step
Opioid Delivery
Pain persisting or increasing
Step 3
Opioid for moderate to severe pain
± Nonopioid ± Adjuvant
Pain persisting or increasing
The WHO
Ladder
Step 2
Opioid for mild to moderate pain
± Nonopioid ± Adjuvant
Pain persisting or increasing
Step 1
± Nonopioid
± Adjuvant
Pain
Deer, et al., 1999
39. Objectives
• Cancer : the size of the problem in Najran
• Cancer unit : the goals.
• The Tumor Board at KKH: functions &
guidelines
• The importance of multidisciplinary approach.
40. Function
To approve the best evidence based
multidisciplinary diagnostic &
therapeutic approach for tumor cases.
41. Multidisciplinary Tumor Board
Surgical, medical & radiation oncologists,
radiologists, pathologists, nuclear medicine, and
coordinator nurses , social worker & psychologist
specialists
43. What is the NCCN?
An Alliance of 21 Academic Cancer Centers in USA
44. NCCN Levels of Evidence
• Category 1: Based upon high-level evidence
and uniform NCCN consensus that intervention
is appropriate
• Category 2A: Based on lower-level evidence
and uniform NCCN consensus that it
constitutes appropriate care
• Category 2B: Based upon lower-level evidence
and NCCN consensus that it constitutes
appropriate care
• Category 3: Any level of evidence but major
NCCN disagreement that the recommendation
is appropriate.
46. Objectives
•
•
•
•
Cancer : the size of the problem in Najran
Cancer unit : the goals.
The Tumor Board at KKH: functions & guidelines
The importance of multidisciplinary approach.
47. Fundamental questions
When is surgery enough?
Should we use chemotherapy?
difficult to reverse practice
Which treatment should we use?
toxicity-many 'equal' therapies
efficacy
dosage
48. What is the best for the patient?
Neoadjuvant ?
Adjuvant ?
•M astectomy vs.
lumpectomy
•Lymph node
dissection vs.
sentinel lymph node
biopsy
Proposed 4th step – looking at quality of life, changing opioid delivery, looking at invasive treatments
There is evidence for the involvement of EGFR in the progression of CRC. Expression is stronger in tumor than normal mucosa [1] and strongest in tumor regions of deepest invasion [2,3]. EGFR expression correlates with the ability of CRC cells to produce hepatic metastases [4], and EGFR expression was shown to be higher in tumors of more advanced stage [5,6].
Mayer et al showed that pts with EGFR-expressing tumors (>50% of tumors stained) had a shorter median survival than those with non EGFR-expressing tumors (8.7 vs 34.0 mths, p<0.02) [7]. EGFR expression on liver metastases was shown to be a predictor of disease-free survival after partial liver resection [8].
EGFR is expressed in 25–77% of CRC [1,9].
EGFR is expressed in 72–86% of MCRC [2,10–12].
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