Principles of Management of (Gynaecological) Cancer
While this is written with respect to gynaecological
malignancies it applies to all cancer patients.
Of all diseases cancer is probably one of the most unforgiving
of other than optimal management. The best chance of providing a "cure" is
at the first treatment of the disease. With most solid tumours
(non-haematological) the number of patients that can be salvaged back to cure
after a recurrence has occurred is quite small. It is therefore of
paramount importance that the so called "first bite of the cherry" is the
right one.
There are certain principles of management that are very
important in this process. These are set out below:
-
Make the Diagnosis - while this may seem
axiomatic most oncologists have seen patients who have been treated for cancer
incorrectly before the diagnosis had been established.
-
Determine the Disease Distribution - in a
patient with untreated primary cancer this may be the same as staging.
It involves a series of tests (a full blood count, biochemical screen, liver
function tests and chest x-ray being the minimum). It will often also
involve other investigations such as ultrasound, CT scan, nuclear medicine scan etc.
-
Ask the question: "What is the aim of treatment?"
- this is probably the most frequently forgotten step. In oncology there
are two aims, cure or palliation. It is imperative that you decide in the
light of the diagnosis and disease distribution what you are trying to
accomplish.
-
What does the literature say is the best way to
achieve the desired aim?
The options are: Surgery, Chemotherapy, Radiotherapy, some
combination of the former or doing nothing. It should be remembered that
sometimes doing nothing is the best option. Just because you can do an
operation or give chemotherapy it does not mean that you should.
If you want to know anything about your patients progress, disease or treatment
please feel free to ask although I will write to you at each stage of your patients care
with me and all patients will be given a short legibly hand-written Discharge
Summary prior to leaving hospital.
