Syllabus
Syllabus of the subject ?Cancer 2008
The aim of the subject:
Learning about clinical symptoms of cancerous diseases, gaining differential diagnostics ability, determination of algorithm of staging check-up and determination of the extent of the disease and probable prognosis according to the symptoms. Further aim is to teach students complex therapy of oncogenous diseases.
Introduction:
In the large majority of cases, the treatment of malignant tumours is complex and highly specialized. It can be guided only by a specialist-oncologist. The training of medical students in the subject ?Cancer? is not aimed at making such specialists, only teaching of basic knowledge and practice of oncology, strictly relevant for other areas in medicine.
The teaching will be based on pathophysiological, pathological and clinical features of a particular malignant diseases. Logical approach to the relevant investigations and treatment strategy will be required.
One of the main problems in oncology is a late diagnosis of a malignancy, causing delay in instituting an appropriate treatment. It will be repeatedly stressed that tumours must not be forgotten in the differential analysis of most symptoms.
The teaching should go along following baselines:
Terminology and nomenclature of malignant diseases
Symptomatology of malignancies
Rational indication of addinitional investigation procedures including the assessment of their results
Principles of treatment modalities in oncology
Indication, timing and sequence of treatment modalities in a particular malignant disease
Explaining the necessity of a complex treatment
Basic follow-up guidelines
Possible side-efects of oncology therapy, their early diagnosis and treatment
Ways and possibilities of cancer prevetion
In view of the introduced concept of study in the 3rd Medical Faculty, there is a substantial overlap between oncology and other medical specialities.
Clinical importance:
Malignant diseases are the second cause of death in the Czech population. At present, approximately one in three persons will be diagnosed having a malignant tumor and every fifth one will die of it.
Definitions of malignant and benign tumours (characteristics)
Epidemiology:
Risk assessment and methods of risk defitition
Incidence and prevalence
Most common malignancies (acc. To age and sex)
Principles of treatment of malignant tumours:
Radical therapy
Palliation
Symptomatic treatment
Sequencing and timing
Neoadjuvant, basic, adjuvant
Induction, maintenance, consolidation, salvage
Concomitan, sequential
Treatment modalities:
Surgrery
Oncologic surgery is part of training in general surgery.
Radiotherapy
Basic definition
Types of ionizing radiation and examples of clinical use
Absorption of ionizing radiation in the matter. Possibilities how to influence the dose distribution
Mechanism of action in malignant and healthy tissues
Teleradiotherapy vs brachytherapy
Radiotherapy planning
Definition of the target volume
Basic radiobiology
Kinetics of cell killing by ionizing radiation
Differences between healthy and malignant cell and possibilities of its positive exploration.
Total dose, dose per fraction. Overall treatment time
Hyperfractionation, hypofractionation, acceleration of radiotherapy
Dose rate and its influence on therapeutic index
Acute, chronic and late radiation toxicity
Integration of radiotherapy into a complex oncological treatment
Basic of radiobiology
Chemotherapy
Basic definition. Kinetics of oncogenous progression and respond to the effect of cytostatics. Cytostatistics groups according to mechanism of effect and chemical structure. Principles of combining cytostatics. Modes of administration, dosage, chemotherapy intensity. Timing. Resistance to cytostatics. Acute, chronic and late toxicity of chemotherapy. Integration of chemotherapy into complete oncological treatment.
Hormonal therapy
Mechanisms of effectiveness, examples of hormonally dependent tumours.
Immunotherapy and biological treatment
Principles of antitumour immunotherapy and biological treatment.
Supportive treatment
Pain. Causes and types of oncological pain. Pain degree determination. Pain treatment. Infection in oncological patients. Most frequent causes of infection. Prevention and treatment. Nutrition of oncological patients, metabolic disorders, causes and treatment. Psychological support.
Special oncology
Brain tumors
The subject also includes ?Nervous system disorders? and ?Mental changes?
Head and neck tumours
Incidence
Anatomy, histopathology - Epidermoid carcinoma, Malignant lymphoma, , Adenocarcinoma, Adenoid cystic carcinoma, Mucoepidermoid carcinoma
Grouping according to anatomy (oral cavity, naso- , oro- and hypopharynx, larynx, nasal cavity and sinuses, salivary glands, ear)
Diagnosis and diferential diagnosis
History
Physical examination- incl. endoscopy (direct and indirect laryngoskopy, epipharyngoscopy, rhinoskopy)
Additional investigations - CT, MRI, ultrasonography of the neck
Biopsy. Indication and types
Clinical picture
Treatment ? surgery, radiotherapy, radiochemotherapy, combination of radiotherapy and surgery and/or chemotherapy with regard to organ and function saving procedures
Pain in the neck, dysphagia and odynophagia, bleeding, voice change, neck lymphadenopathy. Symptoms according to the localisation of primary lesion
Risk factors: Smoking, Alcohol abuse. Prevention.
Results and prognosis, scheme of follow-up
Tumours of the mediastinum
Also part of subjects ?Dyspnoe and pain on the chest? and ?Abdominal symptomatology - dysphagia, nausea, vomiting, regurgitation..?
Anatomy of the mediastinum, topography
Symptomatology
Dysphagia, odynophagia, loss of weight, pain on the chest, recurrent pneumonia
Special problematics (e.g. thymoma - myasthenia gravis, aplastic anemia, hypogamaglobulinemia, collagenosis)
Basic groups
Carcinoma of the oesophagus
Thymoma
Neurogenic tumours
Germinal tumours
Lymphomas
(Tumours of the thyroid gland- if thyroid localised in the mediastinum)
Ethiology
Histopathology of mediastinal tumours
Adenocarcinoma and epidermoid carcinoma, malignant lymphomay, adenoma, thymoma, neurogenic tumours, germinal tumours
Diagnosis and differential diagnosis
History, Physical examination
Additional investigations - chest X-ray, MRI, CT of the mediastinum, esophagoscopy, mediastinoscopy, liver sonography
Differential diagnosis of enlarged mediastinum
Treatment
Indication of radical and palliative treatment- in general. Surgery. Basic surgical procedures in oesophageal carcinoma. Radiotherapy- indication of radical and adjuvant radiotherapy. Brachytherapy and teletherapy. Indication of chemotherapy.
Results and prognosis
Lung carcinoma, mesothelioma
Definition and clinics- also part of the subject ?Dyspnea and pain on the chest?
Lung anatomy, physiology of gas exchange, interpretation of lung function tests
Etiology and patophysiology
Histopathology
Benign lung tumours
Small-cell and non-small-cell lung carcinoma
Mesothelioma
General and chest symptoms
Loss of weight, cough, dyspnea, pain on the chest, hemoptysis, stridor, superior vena cava syndrome, dysphagia, Horner´s syndrome, Pancoast syndrome
Extrathoracic symptomatology caused by metastases
Paraneoplastic symptoms
Also part of the subject ?Endocrine and metabolic disorders?
Diagnosis and differential diagnosis
History, Physical examination
Additional investigations - chest X-Ray, CT, bronchoscopy, mediastinoscopy and thoracoscopy, biopsy
Differential diagnossis of pleural effusion
Treatment
Indication and basic thoracosurgical approaches. Radiotherapy (indication, techniques). Chemotherapy (indication, basic drugs and combinations)
Indication of ?prophylactic? cranial irradiation in small-cell lung carcinoma.
Results and prognosis
Prevenion
Tobacco abuse. Mesothelioma as a result of occupational hazard
Gastrointestinal tumours
Basic grouping
Carcinoma of the stomach
Tumours of the liver and subhepatic region, carcinoma of the pancreas and biliary ducts
Tumours of the small intestine
Colorectal carcinoma
Anal cancer
Anatomy of the organs of the abdomen, portal system
Lymphatic drainage of particular abdominal organs
Definition and clinics- also part of the subject ?Pain in the abdomen?
Pain, loss of appetite, loss of weight, cachexy
Nausea, vomiting, disorders of the passage up to the acute ileus
Changes in the stools habits, changes of the stools colour and consistency
Obstructive icterus, hematemesis, melaena, hypochromic anemia, fatigue, enlargement of the abdomen, bleeding
Symptoms due to hormone overproduction (carcinoid, islet-cell tumours of the pancreas)
Risk factors, genetic
Patology of GIT tumours - adenocarcinoma, malignant lymphoma, carcinoid. Islet-cell tumours of the pancreas.
Diagnosis and differential diagnosis
History, Physical examination incl. per rectum examination
Additional investigations: X-Ray of the stomach (double contrast method), gastroscopy, ultrasonography and CT of the abdomen, ERCP, i.v. urography, cystoscopy, colonoscopy, rectoscopy, irrigography
Importance of tumour markers in the diagnostics and follow-up of GIT carcinoma
Treatment
Surgery of the stomach, intestine, lymphadenectomy
Chemotherapy- basic indication
Radiotherapy- basic indication
Biological treatment
Possibilities of screening and prevention of colorectal carcinoma
Prognosis
Carcinoma of the anus
Clinical picture
Anatomy of the anus and anal region, lymphatic drainage
Risk factors
Diagnosis
History, Physical examination
Additional investigations- CT, bipedal lymphography, lung X-ray
Treatment
Radiotherapy. Radio-chemotherapy. Surgery. Indication of particular tretment modalities, especially from the point of an organ and function preservation
Results and prognosis
Breast cancer
Incidence, risk factors
Genetic
Non-fam
Annotation
Independently oriented course that is part of the subject Basic Clinical Problems. The course also includes teaching of patological anatomy, patological physiology and pharmacology.
Partial course of II C module.