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Ebook Goldman's cecil medicine (24th edition): Part 2

(BQ) Part 2 book "Goldman's cecil medicine" presents the following contents: Social and ethical issues in medicine, principles of evaluation and management, preventive and environmental issues, clinical pharmacology, cardiovascular disease, gastrointestinal diseases,. | 1164 CHAPTER 182 APPROACH TO THE PATIENT WITH CANCER TREATMENT APPROACH TO THE PATIENT WITH CANCER MICHAEL C. PERRY DIAGNOSIS Few diagnoses produce such emotional responses as cancer or leukemia and in the rst few moments a er those words are u ered the patient o en experiences a storm of feelings that limit useful discussion. When the time is right however the physician and the patient must discuss the diagnosis its implications and the therapeutic alternatives. It is o en best for the patient if family members or close friends are present in the consulting room both to provide emotional support and to be another set of ears. It is o en useful to ask What do you understand about your diagnosis If the physician is not familiar with the latest treatments consultation in advance with for example the National Cancer Institute s Physician Data Query will make the interview more meaningful. Prompt referral to a specialist whether a surgical oncologist radiation oncologist or medical oncologist is imperative. e generalist should not be a therapeutic nihilist unless he or she is intimately involved in the eld and knows about all the current therapies and clinical trials. e consulting medical oncologist o en advised by a local tumor board comprising medical surgical and radiation oncologists usually outlines the prognosis and the alternatives standard therapy possible clinical trials a second opinion or no treatment. Many oncologists actively participate in clinical trials and may have investigational drugs available or they may suggest referral to a tertiary cancer center as appropriate. Diagnostic Procedures In most se ings a lesion has been found on physical examination or by abnormal laboratory or radiographic studies and a biopsy has con rmed the diagnosis. It is critical that the biopsy be representative of the entire tumor and that appropriate investigations e.g. special stains ow cytometry cytogenetics hormone assays be performed before treatment is initiated. If .