CME : Your SA Journal of CPD - Volume 25, Issue 2, 2007
Volume 25, Issue 2, 2007
Source: CME : Your SA Journal of CPD 25, pp 51 –53 (2007)More Less
Large-bowel cancer is a common disease, especially in ageing Western populations.
Diet is an important aetiological factor.
Screening is critical in order to reduce the incidence of the disease. In symptomatic patients (change of bowel habit, rectal bleeding), clinicians should have a high index of suspicion and refer patients for investigation.
There is good long-term survival after treatment of early lesions.
Advances in surgical techniques, especially the introduction of total mesorectal excision, have resulted in lower recurrence rates.
Improvements in the timing, and delivery of radiation have resulted in lower local recurrence rates and complication rates.
Recent developments in chemotherapy and targeted agents have produced a marked improvement in survival of patients with metastases, allowing patients with metastases to survive 2 years and more.
Multidisciplinary management improves outcomes of treatment by optimal co-ordination of all treatment modalities.
Source: CME : Your SA Journal of CPD 25, pp 55 –58 (2007)More Less
Cancer of the oesophagus is the third leading cancer in males, comprising about 5.6% of all cases in males, and 4th most common in females, comprising 3% of all cancers.
Patients present with difficulty in swallowing, loss of weight, and backache.
Essential investigations should include a barium swallow, endoscopy and a CT scan of the chest and upper abdomen for local extent, extra-oesophageal spread, nodal disease and liver involvement.
Early referral to a specialist centre by the general physician would help in proper treatment selection.
Treatment can be palliative (80%) or curative (20%). Treatment should be individualised for each patient.
The choice of treatment depends on expertise and facilities available, tumour and patient factors and local economics.
Source: CME : Your SA Journal of CPD 25, pp 59 –64 (2007)More Less
Management of pain and symptoms extends beyond just physical relief.
Approach requires evaluation, explanation, individualised treatment, supervision and attention to detail.
Causal factors include cancer, treatment, debility and concurrent disorder.
Treatment depends on the underlying pathological mechanism.
Flexibility is key to managing cancer patients.
Morphine is the opioid of choice.
Choose drugs carefully as their side-effects can also compromise quality of life.
Source: CME : Your SA Journal of CPD 25, pp 65 –68 (2007)More Less
Human papillomavirus infection is the primary aetiological agent in cervical cancer.
HPV vaccinations have decreased persistent HPV infection in 2 large RCTs.
Cervical cytology is an effective screening tool in preventing cervical carcinoma.
The National Screening Programme in SA, if effective, should reduce the rate of cervical cancer by two-thirds.
Radical hysterectomy and pelvic lymph node dissection is standard surgical therapy for early invasive cancer.
Most recurrences after radiotherapy in locally advanced cervical cancer have a local component.
Concomitant cisplatin chemoradiation improves survival in cervical cancer.
Intracavitary brachytherapy is an integral part of radiotherapy for cervical cancer.
Author Zainab MohamedSource: CME : Your SA Journal of CPD 25, pp 70 –74 (2007)More Less
The AIDS-defining malignancies are Kaposi's sarcoma, aggressive B-cell lymphoma, primary CNS lymphoma and cervix carcinoma.
Non-AIDS-defining malignancies like Hodgkin's lymphoma and anal carcinoma occur more frequently in the HIV-positive population but are not necessarily related to the level of immune suppression.
Kaposi's sarcoma is a vascular tumour caused by human herpesvirus 8 and occurs mainly in the skin and mucous membranes but can involve any organ.
Management of Kaposi's sarcoma starts with HAART and, if clinically indicated, either local therapy like radiotherapy or systemic chemotherapy.
AIDS-related lymphomas present at an advanced stage, are usually associated with B-symptoms and extranodal disease, and often involve unusual sites.
The commonest histologies are diffuse large B-cell and Burkitts's lymphoma. Those seen almost exclusively in HIV are plasmablastic and primary effusion lymphoma.
Primary CNS lymphoma in HIV is associated with a CD4 count < 50, EBV in the tumour and CSF, and a very poor prognosis.
Cancer in HIV-infected individuals is usually associated with a viral cause, e.g. HPV in cervix and anal carcinoma and EBV and HHV8 in ARLs.
Patients with unusual and aggressive cancers should be tested for HIV.
With HAART the incidence of AIDS-defining malignancies has decreased but non-AIDS-defining malignancies are increasing as HIV has become a chronic disease.
Author Marthinus KahlSource: CME : Your SA Journal of CPD 25, pp 75 –76 (2007)More Less
Lung cancer is one of the most common cancers in men and has a rising incidence in the female population as well.
Smokers have a 16-fold increased risk of developing lung cancer compared with non-smokers. Asbestos and silica fibre exposure, diesel fumes, air pollution, industrial exposure to nickel and chromium, arsenic exposure, mine work and exposure to radon gas and uranium all increase the risk for lung cancer.
Lung cancers are divided into 2 main groups histologically: small-cell and non-small-cell lung cancer. Differences are on grounds of behaviour, features, treatment and prognosis.
NSCLC can be located either centrally or in the periphery of the lungs, and tends to metastasise a bit later than SCLC. Therefore surgery plays a much more important role in the management of NSCLC.
Nonspecific symptoms include weight loss, muscle weakness and clubbing of fingers and toes. Specific symptoms can include recurrent chest infections not responding to antibiotic treatment, dyspnoea, haemoptysis, chest pain due to chest wall infiltration or pleural effusion and hoarseness due to recurrent laryngeal nerve infiltration.
A simple chest X-ray with PA and lateral views is the first and probably the most important special investigation that should be done.
In SCLC the mainstay of treatment remains chemotherapy. In limited-stage disease chemotherapy is started with concurrent radiotherapy early in the treatment course.
In NSCLC the staging system is a bit more complicated and the choices of treatment depend on stage, co-morbid conditions and risk factors.
Source: CME : Your SA Journal of CPD 25, pp 81 –84 (2007)More Less
In all patients on anticancer drugs, drug interactions should be considered before prescribing concomitant medication by consulting the package inserts or other medicine information sources.
Patients on anticancer drugs are at high risk of drug-drug interactions as they are prescribed multiple drugs and are often elderly.
It is important to take a detailed medication history, including complementary / alternative and over-the-counter medicines.
Enhance monitoring for signs and symptoms of interactions when potentially interacting drugs need to be co-administered.