1. Lung 58

2. Colon 27

3. Liver 26

4. Breast 25

5. Nasopharynx 18

6. Rectum 17

7. Stomach 16

8. Bladder 9

9. Lymphoma 9

10. Oesophagus 8

Surgery primary mode of cure in all except lymphoma (oncology/ haematology)

1. Lung 45

2. Liver 19

3. Colon 12

4. Stomach 10

5. Rectum 7

6. Nasopharynx 7

7. Oesophagus 6

8. Breast 6

9. Pancreas 4

10. Lymphoma 4

1. Asymptomatic disease detected by screening: breast cancer (br exam), liver cancer (US)
2. Bleeding: GI bleeding, haematuria, haemoptysis
3. Obstruction: intestinal obstruction, obstructive jaundice
4. Mass effect: palpable mass, pain
5. Systemic symptoms: anorexia, weight loss, lethargy, fever

Least invasive procedures first

1. Hx + P/E
2. Lab tests (1) Urine/stool (2) Blood tests (incl tumour markers)
3. Ix: Radiology/ Endoscopy/ Laparoscopy/ Surgery
4. Path study: "gold standard" (1) Cytology study of body fluid (2) Biopsy

• Sensitivity: can tumour marker detect all Pt's with tumour
• Specificity: can tumour marker detect Pt's without tumour
• NO: used alone for Dx (used to support other Ix)
• YES: progress of disease

1. GIT: CEA, CA 19-9, CA 195
2. Prostate: PSA
3. Liver: AFP
4. Br: CEA, CA 15-3
5. Thyroid: Thyroglobulin, Calcitonin
6. Testicle: AFP, beta-HCG

1. Melanoma: malignant mole
2. Ulcerating basall cell carcinoma: older patients present late b/c rationalise everything
3. Cancer of tail of pancreas with metsastasis to liver (incidental finding). Pt presented with vague upper ab pain (minimal symptoms, at time of presentation metstatic disease already present; not resectable)
4. Ca gallbladder: minimal symptoms, liver metastases common at presentation (not resectable)

TNM staging

• T = primary tumour
• N = lymph node
• M = distant metastasis

1. Neoadjuvant: before surgery (eg. Radio/ chemo; improve surg outcome)
2. Extent of surgery/ resection
3. Adjuvant: after surgery (eg. Additional radio/chemo: combination therapy)
4. Prognosis
5. Standard for comparison of results

1. 1. Primary mode of curative treatment (1) Best chance of cure (2) Low resection rate
2. Secondary mode of curative treatment - after failure of non-operative therapy (eg. Ca laryngx: try radiotherapy first to retain voice; if fails, then laryngectomy)
3. Part of multi-modality treatment - remove bulk of tumour then combine with chemo/ radio/ immunotherapy
4. Palliative treatment - for obstruction, bleeding or other symptoms (eg. Colonic ca with liver metastasis - no cure - but remove primary tumour because it obstructs or bleeds)

• Eg. Liver cirrhosis with tumour - total hepatectomy (cannot remove part b/c of underlying cirrhosis) - then transplant from donor
• Eg. Tongue ca involving floor of mouth, failed radiotherapy, secondary attempt at cure by resection. Complex resection + reconstruction (from iliac crest). Combined: surgeon, plastic + reconstructive surgeon, dentist (dentures)

1. Open biopsy for histologic diagnosis and staging
2. Surgical bypass for obstruction (eg. Bile duct)
3. Neurolytic therapy for pain relief
4. Palliation of other complications eg. Bleeding (stents for dysphagia/ oesophagus, can be passed through tiny hole then expanded)
5. Facilitate other Tx modalities (a) Central line for chemo (b) Devices for local radio (c) Tx complications of non-surgical Tx (eg. Radio)

1. Endoscopic therapy
2. Radiologic procedures: interventional radiol: percutaneous catheter into bile duct - liver - biliary tree (relieve jaundice)
3. Chemotherapy (a) Systemic (b) Regional
4. Radiotherapy (a) External (b) internal (brachytherapy)
5. Immunotherapy
6. Neoadjuvant therapy (before operation) (a) Downstage disease by shrinking tumour (b) Increase resection rate by tumour shrinkage (c) Improve chance of cure
7. Adjuvant therapy (after operation) (a) Prevent recurrence (b) Delay recurrence
8. Therapy for post-op recurrence (a) Prolong survival (b) Palliation