1. 《Basic Clinical Oncology》 Lecture Fudan University Cancer Center
Yu Wang M.D,.Ph.D.
Associate Professor

2. Yu Wang M. D,. Ph. D. Associate Professor Dept
Yu Wang M.D,.Ph.D. Associate Professor Dept. of Head & Neck Surgery Fudan University Shanghai Cancer Center 6W of No.3 Building, No.270 DongAn Road Shanghai, China

4. Historically, surgical therapy was the sole method used for treating cancer.
part of a multidisciplinary team
frequently the first oncology specialist that a patient will consult

5. Surgical therapy plays a role in various components of the cancer care continuum, from prevention to diagnosis, curative therapy, survival prolongation, and palliation

6. SURGICAL ONCOLOGIST
1.1Surgical oncology has emerged to play an increasingly important role in the treatment of cancer
(1) the increasing complexity of multidisciplinary cancer care;
(2) the opportunities for clinical and laboratory investigation of cancer biology;
(3) the rapid increase in the number of medical and radiation oncologists, which threatens to diminish significantly the traditional role of the surgeon in coordinating the management of cancer patients (even those with early disease);
(4) the expectation of patients that surgeons have the latest information and newest treatment options

7. SURGICAL ONCOLOGIST 1.2This role requires a sound knowledge of
cancer biology (including cancer prevention and the biology of metastasis),
imaging technologies
chemical and biologic therapy
radiation therapy.

8. SURGICAL ONCOLOGIST 1.3leadership for cancer care cancer research
and cancer teaching within the academic or hospital-based surgical community

9. SURGICAL ONCOLOGIST
1.4responsibility of introducing to the surgical community
new information
new approaches to cancer diagnosis
new approaches to therapy

10. SURGICAL ONCOLOGIST 1.5 leadership in developing community interest in
cancer prevention, including screening and early diagnosis
clinical trials

11. SURGEON'S ROLE IN CANCER MANAGEMENT
2.1Prevention and Screening
The most effective weapons against cancer are prevention and early detection

12. 1. Is the disease an important health problem?
2. Is there effective therapy for patients with localized disease?
3. Are treatment facilities for further diagnosis and treatment readily available?
4. Is there an identifiable latent period or early symptomatic stage of the disease?
5. Is there an effective screening technique?
6. Are the tests acceptable to the screened population, particularly groups at increased risk for disease?
7. Is the natural history of the disease, from its development to clinical manifestation, sufficiently known?
8. Is there a generally acceptable strategy to identify patients who should receive treatment versus careful observation alone?
9. Are the costs of screening acceptable?
10. Does the treatment of early-stage disease have a favorable effect on prognosis?

13. 2.2Diagnosis
Computed tomography (CT), ultrasonography, and magnetic resonance imaging…

14. Four techniques are currently in use for obtaining tissue for diagnosis:
Needle aspiration biopsy
Needle (core) biopsy
Incisional biopsy
Excisional biopsy

15. 2.3Staging
The tumor-node-metastasis (TNM) classification

21. 2.4Multidisciplinary Management radiation:
local and regional cancer therapy
after surgery to improve local disease control rates, or even before surgery, to reduce tumor bulk or downstage the tumor
combined with simultaneous administration of chemotherapy or radiation sensitizer agents

22. medical oncologist
chemotherapy, hormone therapy, and in some instances, biologic therapy
manage the toxicities of intravenous and oral anticancer therapy, and as a result, provide considerable supportive care,

25. SURGICAL TREATMENT OF CANCER
3.1Surgical Risk

27. 3.2Surgery for Primary Cancer

28. 3.3Surgery for Metastases

29. cN1-case1

30. 3.4Surgery for Debulking
The results of experimental studies suggest that cytoreduction, or debulking of recurrent cancer, has important potential benefits.

31. 3.5Palliative Surgery
relief of intestinal obstruction
removal of tumors to control pain or hemorrhage
introduction of a feeding jejunostomy to permit adequate nutrition.

32. 3.6Reconstructive and Rehabilitative Surgery

33. 2009年，首次采用前臂游离折叠皮瓣修复颊粘膜癌术后洞穿缺损

35. 前臂游离皮瓣修复颊粘膜癌术后缺损

36. 股外侧肌皮瓣修复头皮软组织肿瘤术后缺损

37. 3.6Vascular Access

38. 3.7Surgery for Oncologic Emergencies

39. Summary Surgeon is part of a multidisciplinary team.
Surgeon is frequently the “entry point” for patients who are newly diagnosed with cancer.
Surgeon must have knowledge of the biology and natural history of the cancer to be treated.

40. Surgeon must be technically experienced in diagnostic procedures and operative interventions.
Surgeon must have appropriate knowledge base in medical and radiation oncology.
Patients treated in a multimodality setting have improved outcomes.

41. Training of surgical oncologist must encompass the following:
Etiology and genetic predispositions of cancer
Prognostic factors and natural history of specific tumors
Understanding of how to provide cost-effective treatment
Skills to develop, conduct, and manage clinical trials
Guidance in management of advanced disease
Guidance in offering compassionate support
Guidance in determining and evaluating outcomes

42. Surgical oncologist should be a participant in clinical trials, providing guidance in design and monitoring of quality control aspects of surgical intervention component as well as overall leadership design and implementation.
Surgical oncologist should be an educational resource in the community.
Surgical oncologist plays an important role in prevention and screening

43. Recommended Readings:
Abeloff's Clinical Oncology, 4th ed. .
If you have any question, please contact me.
Yu Wang：