1. Clinical Content Update: Cancer John Horton, M.B., Ch.B. October, 2004

2. Clinical Content Update - Cancer- Reasons: 1. Important cause of mortality and morbidity 2. Will remain important during the next 10 years. 3. Medical care is effective in reducing mortality and morbidity.

3. Significant Causes of Cancer incidence and Mortality in Central Asia 1. Lung and upper respiratory passages 2. Colorectal 3. Breast 4. Cervix 5. Others

4. Information/experiences needed for students to address problems in oncology: 1.Knowledge of etiologic factors (including genetic) and progression of cancer from pre-cancerous lesions through metastasis 2.Identification of persons at high risk for cancer 3.Promotion of healthy lifestyles to minimize cancer risk 4.Organization/implementation of effective cancer screening

5. Information (continued): 5. Knowledge of presenting symptoms and signs of cancer 6. Referral techniques and resources for diagnosis and treatment of established cancer 7. Cancer treatment methods 8. Recognition and management of symptoms, i.e., pain, nausea, constipation 9. Capability of providing/assisting with terminal care.

6. Approaches/techniques to consider in addressing objectives in Oncology 1. Link basic science closely with clinical examples. 2. Do not attempt to “cover” all types of cancer. Use only the most common ones in Central Asia, 3. Identify the key issues regarding 3 or 4 types of cancer chosen to illustrate the basic science and clinical approaches used.

7. Possible tumor-types to serve as examples: 1. Lung 2. Breast 3. Cervix 4. ?

8. Summary of interventions known to impact most on various cancer types: Intervention Lung Breast Cervix Prevention  Early detection/   Screening Treatment  

9. Describe and demonstrate diagnostic methods for cancer: Biopsy Needle aspiration Imaging Limitations of clinical-only diagnosis

10. Describe and demonstrate cancer treatment techniques: 1.Surgery 2.Radiation therapy 3.Systematic therapy-chemotherapy -hormone therapy -targeted therapy 4.Support-medical -psychological Note: Importance of multimodal approach

11. Examples of linkages between basic science and clinical education: a. Primary prevention- Carcinogenic sequence and progression with smoking prevention and cessation b. Early detection/screening- i) Etiology (papilloma/cervix) with cytology screening programs for cervix cancer ii) Biases and limitations of screening programs with breast cancer c. Clinical presentation and progression- i) Use any/all to illustrate typical symptoms of initial tumor eg. regional and distant (metastatic) spread ii) Emphasize pathology/genetics/molecular oncology.

12. Issues to emphasize: 1. Design the objectives/competencies to address the future needs of the country. 2. Link basic science with clinical education and experience in the key tumor types. 3. Emphasize primary and secondary prevention, presenting symptoms/findings, and symptom control. 4. Evaluate the competencies.