Journal Of Family Practice Oncology - BC Cancer
Journal ofFamily Practice OncologyProvincial Health Services AuthorityBEST PRACTICECANCER CARE GEMSIN THIS ISSUE3Melanoma Insight3Benefits of Quitting Smoking Aftera Cancer Diagnosis4Fertility After Cancer Care6Breast Screening Q&A8BRCA Genes in the AshkenaziJewish Population9HPV Vaccination Update10 Nasopharyngeal Cancer, PrimaryCare Primer11Prostate Cancer Screening Q&A12Bladder Cancer for FamilyPhysicians14Immune Checkpoint Inhibitors:A Team Approach to Care14Lidocaine Infusions and SevereCancer Pain16Immune Checkpoint Inhibitionin Renal Transplant RecipientsDr. Harvey Lui is a dermatologiston staff at BC Cancer andVancouver General Hospital,and a highly regarded educatorwith the Family PracticeOncology Network.Dr. Sunil Kalia is a dermatologist,and part of BC Cancer’s SkinTumour Group and BC CancerResearch’s Cancer ControlGroup.Dr. Francis Zih is asurgical oncologist atSurrey Memorial Hospital.Issue Number 35, Fall 2020 www.fpon.caHow to recognize skin cancers thatdon’t obviously look like skin cancerby Dr. Harvey Lui, Dermatologist,BC Cancer andDepartment of Dermatology and SkinScience, University of British Columbia,and Dr. Sunil Kalia, Dermatologist, andAssociate Professor, Department ofDermatology and Skin Science, UBCDuring medical school, all physicians learnthat there are 3 main forms of skin cancerby committing their visual memories to theclassic clinical features of each of theseconditions (Table 1). Although accurate andtimely visual recognition of these featuresfollowed by confirmatory skin biopsy willdiagnose a significant majority of skincancers, there are many instances wherecutaneous neoplasms are missed, particularlyfor the superficial or in situ variants of eachof these tumours.Superficial skin cancers (Table 2) are oftenmissed because physicians may not be asfamiliar with their clinical features as theyare with the more classic presentations. Ingeneral, superficial skin cancers: are usually asymptomatic and thereforedo not arouse as much alarm or concernfor patients and their physicians; do not present as “tumours”, i.e. lumps orbumps within the skin; evolve very slowly and insidiously; manysuperficial skin cancers may be presenton the skin for many years before beingrecognized or investigated; and grow by lateral extension rather than viavertical dermal invasion.continued on page 2Don’t miss our virtual fall conference:November 13, 2020 on skin cancerRegistration is now open at fpon.ca forthe Family Practice Oncology Network’sfirst-ever virtual conference, Skin Cancer:Interactive Scenarios & Practical Approachesfor Primary Care. The event will run from1-4 p.m., November 13, 2020 featuring, a100% case-based format targeted directly toprimary care needs.The afternoon includes a two-part focuscovering both a dermatological approachto preventing, diagnosing and managingcommon skin cancers, and a surgicalapproach to staging and managingmelanoma from a primary care perspective.Expert dermatologists, Drs. Harvey Lui andSunil Kalia, will lead the dermatology portionof the conference, and leading surgicaloncologist, Dr. Francis Zih, will present onmelanoma and guide ensuing discussion.The event includes a strong interactivecomponent with ample opportunity toengage with the speakers and maximizelearning to enhance the cancer care youprovide.Register today at www.fpon.ca2.75 Mainpro creditsCost: 50 all disciplinesFor full details visit www.fpon.ca or contactDilraj Mahil at dilraj.mahil@bccancer.bc.ca
Figure 1a – superficial basal cell carcinomaFigure 1b – squamous cell carcinoma in situ Figure 1c – lentigo malignaHow to recognize skin cancerscontinued from page 1solar lentigines, and seborrheic keratosis.By the time a superficial skin cancer isdiagnosed (e.g. figures 1 a, b, & c), thelesion will often have had a history of beingunsuccessfully treated with topical steroids,antifungal agents, topical antibiotics, and/orattempted liquid nitrogen cryotherapy.Perhaps the biggest challenge in diagnosingsuperficial skin cancers is that they caneasily mimic benign skin disorders includingpsoriasis, eczema, tinea fungal infection,Table 1: Classic visual features of skin cancerBasal cell carcinoma (BCC) eroded or ulcerated nodule or papule translucent pearly appearance with rolled edges thatbecome more apparent when the skin is stretched telangiectasiaSquamous cell carcinoma (SCC) solid nodule or papule firm and indurated thick, irregular adherent scaleContact Dr. Harvey Lui atharvey.lui@ubc.ca andDr. Sunil Kalia at sunil.kalia@ubc.caMelanoma “ABCDE” rule, i.e. Asymmetry, Border irregularity, Colourvariegation, Diameter 6 mm, Evolution or EccentricityClinical Pearls for DiagnosingSuperficial Skin CancerTable 2: Superficial variants of skin cancer Become familiar with the unique andcharacteristic features of superficialskin cancers;Tumour category Superficial variantBCCKey featuresSuperficial BCC thin plaque or papule that is often red, scaly, and(Figure 1a) mistaken for an inflammatory dermatosis usually well-circumscribedSCCSCC in situ, also known asBowen disease (Figure 1b)may often occur on the trunk or extremities insteadof the facein the case of superficial BCC, look for a subtle,thin, thread-like rolled pearly border along themargins (more apparent when the skin is stretched)MelanomaLentigo maligna, an in situ variantof melanoma (Figure 1c)2The usual treatment of choice for superficialskin cancer is surgery. In selected cases,topical therapy with imiquimod orfluorouracil, curettage and electrosurgery,cryotherapy, or radiation therapy can beused. Although the overall prognosis forsuperficial skin cancer is good to excellent,delays in diagnosis can result in the lesionbecoming relatively large, thus requiringmore extensive surgery which in turnresults in greater disfigurement and patientmorbidity. It is also possible that the lesionscan become invasive and then have a poorerprognosis.usually occurs on the head and neck region withinareas of extensive sun damage (i.e. photoaging)flat patches or macules with significant colourvariegation usually larger than most solar lentiginesFAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 2020 Maintain a high index of suspicionfor superficial skin cancer andrecognize that these lesions are verycommon; If a lesion that initially looks likeit is primarily inflammatory inappearance, but doesn’t respondto topical therapy, reconsider yourdiagnosis, especially if the lesion issolitary; and If in doubt, it’s usually easy to biopsythe lesion in question; for suspectedlentigo maligna of the face, multiplesmall biopsies or one broadersuperficial “shave-type” biopsymight be acceptable.
Melanoma insight for primary careBy Dr. Francis Zih, Surgical Oncologist,Surrey Memorial HospitalMelanoma is the 7th most commonlydiagnosed cancer in Canada. In 2020,approximately 8,000 Canadians will bediagnosed with melanoma, and about 1,300will die from melanoma. Risk factors includeUV radiation exposure, skin type, personalor family history of melanoma, and a historyof atypical nevi or moles. The majority ofpatients will initially present with localizeddisease. Prognosis for early stage melanomais excellent. Patients with a primary tumourthickness of 1mm or less (T1), with no otheradverse features, have a 5-year survival ofover 90%. If there is local regional nodalspread, the 5-year median survival in stageIII patients is about 65%. Patients with stageIV metastatic disease have a 5-year survivalapproaching 25%.Patients presenting with a suspiciouspigmented lesion should undergo athorough skin examination and all drainingnodal basins should be evaluated. Forthe primary tumour, T-stage is definedby tumour thickness. Shave biopsy mayunderestimate the full depth of the tumourand is discouraged. Preferred modalitiesinclude punch or excisional biopsy. Apotential disadvantage for upfront excisionalbiopsy is margin status. There are welldefined guidelines for excision marginbased on tumour thickness. For example,any primary tumour over 2mm in depthrequires a 2cm margin. The 2cm margin willbe measured from the scar of the excisionalbiopsy. At certain sites of the body, thismay result in the need for a skin graft. Afull -thickness punch biopsy can provideaccurate T staging without potentiallycompromising local therapy.Clinically node-negative patients witha primary tumour over 1mm should beoffered sentinel lymph node biopsy (SLNB)to complete staging and to help guideadjuvant therapy. Thin melanomas ( 1mm),in general, have a low risk of a positivesentinel node ( 5%). However, if there areadverse pathologic features like ulcerationor high mitotic rate, then an SLNB should bediscussed and offered. Sentinel node biopsytypically includes the use of preoperativelymphoscintigraphy as well as intraoperativesubdermal injection of isosulfan ormethylene blue dye to help identify thenode(s). On average, 2-3 nodes are excisedduring SLNB. The morbidity of SLNB is low,and lymphedema rate is less than 5%.In 2017, the landmark MulticenterSelective Lymphadenectomy Trial (MSLT-II)demonstrated no survival benefit afterimmediate completion of lymph nodedissection in patients with a positive sentinelnode. In general, patients with node-positivedisease will be offered close nodalsurveillance with ultrasound as well asadjuvant therapy. Stage III and IV melanomapatients are eligible for systemic therapy,namely either BRAF-targeted therapy orimmune checkpoint inhibitors.Don’t miss Dr. Francis Zih’s case-basedpresentation at our Nov 13 Virtual FallConference: Skin Cancer – InteractiveScenarios & Practical Approaches forPrimary Care. Register at www.fpon.caPatients with resected early stage melanoma(Stage I and II) should undergo activesurveillance with examination every 6months for 5 years. Examination shouldinclude a complete skin exam looking fornew lesions, local recurrence, and in-transitdisease. All nodal basins should also beevaluated. Routine imaging is not necessary.Stage III patients with a positive sentinelnode should undergo regular ultrasoundsurveillance of the involved nodal basins.Additional cross-sectional imaging may beindicated in the presence of new symptoms.Contact Dr. Francis Zih atfrancis.zih@fraserhealth.caNew video on benefits of quitting smoking after acancer diagnosisBC Cancer’s Smoking Cessation Program proudly presents QuittingSmoking After a Cancer Diagnosis – a 2 minute video with patientpartners, Bill and Anita Callahan, and Project Lead, Dr. Renelle Myers,exploring the journey of quitting smoking, and the benefits of quittingafter a cancer diagnosis: www.youtube.com/watch?v GH9tzvS6Ekk"Dr. Myers advised me before my bronchoscopy that stopping smokingprior to surgery would benefit my recovery and my fight against cancer.I could not ignore this advice and, with the support of my patient andunderstanding wife, I was able to quit smoking immediately after thebronchoscopy. For me, quitting smoking for any length of time hadbeen impossible until I was told I had cancer in my lung.”– Patient Partner Bill Callahan.continued on page 4FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 20203
Fertility after cancer careBy Dr. Beth Taylor MD, FRCSC, GynecologicReproductive Endocrinology & Infertility,Olive Fertility Centre, Vancouver, BCReproductive-agedmen and women aresurviving cancer and itstreatment more thanever. Five-year survivalrates for testicularcancer, hematologicmalignancies, breast cancer, and others maybe 90% or greater. However, achieving suchhigh survival rates often comes with a costto the survivor’s fertility, an important part ofquality of life.1View the full webcaston this topic at www.fpon.ca– Continuing Medical Education.Treatments like chemotherapy, radiationand surgery can all impact the quantity andquality of sperm and eggs. Pelvic radiationand surgery for gynecologic cancers canharm the uterus.How can we help our cancer patientspreserve their fertility?MalesThe most common strategy to preservefertility is cryopreservation (freezing) ofsperm before treatment for later use.Ideally, sperm is ejaculated, washed andNew video on benefits of quitting smokingcontinued from page 3Smoking cessation is considered first linetherapy for cancer patients. Stoppingsmoking at the time of a cancer diagnosiscan improve a patient’s treatment responseand reduce side-effects. Empoweringpatients who are smokers with education– advising them to stop smoking at thetime of a cancer diagnosis – is one of themost important parts of their treatment.People live longer and live better if theystop smoking at the time of their treatment.Evidence shows as well that patients aremost successful when supported by healthcare professionals in their attempt to quit,and when the approach includes bothcounselling and pharmacotherapy.4then frozen. In some instances, testicularsperm aspiration may be appropriate.Cryopreservation of testicular tissue fromprepubescent males is promising, but notcurrently available in British Columbia.Frozen ejaculated sperm can be usedfor intrauterine insemination or In VitroFertilization (IVF) in the future, while spermextracted from the testes or frozen as tissuenecessitates the use of IVF.FemalesPreservation of female fertility is morecomplex than in males.Suppression of ovarian function with an oralcontraceptive pill or a GnRH Agonist (e.g.Lupron) may “shield” the ovaries from thegonadotoxic effect of some chemotherapies,particularly in women with breast cancer.2Conservative fertility-sparing treatment suchas ovarian transposition, radical trachelectomyin cervical cancer, hormonal treatment ofearly endometrial cancer, and conservativesurgical management of early-stage epithelialovarian cancer may be possible for certainwomen with early invasive disease. However,the majority of women with genital tractmalignancies will require more aggressive andfertility limiting treatment.Cryopreservation of eggs or embryos is aviable option for those facing gonadotoxictherapy. In this technique, the ovaries arestimulated with follicle stimulating hormoneDr. Myers is the leader and visionary forBC Cancer’s Smoking Cessation Programlaunched in September 2019 as part ofa national initiative to provide smokingcessation to cancer patients. At BC Cancer,this program is now part of every patient’sinitial visit designed to screen all new cancerpatients for tobacco use, to educate themon the benefits of quitting smoking, and toprovide them with tools to quit. The latterincludes referral to Quit Now (www.quitnow.ca) delivered by the BC Lung Association onbehalf of the Government of BC.Our hope is that Bill’s story will inspirepatients to quit smoking when faced witha cancer diagnosis. The more they can besupported, the better chance they will haveof successfully quitting smoking, and ofFAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 2020(FSH) injectionsfor 8-12 days,and eggs arethen extractedtransvaginally.They can befertilized with spermor frozen as unfertilized eggs.Depending on the woman’s age and ovarianreserve, success rates are as high as 70%.Cost and time are often limiting factors: thecost is 8,000 to 10,000, and many womendo not wish to delay cancer treatment.For those who are unable to preserve theirfertility, parenthood can still be achievedthrough the use of donor sperm, donor eggs,surrogacy and adoption.Discussing fertility preservation is animportant part of modern oncology care.Contact: Dr. Beth Taylor atbtaylor@olivefertilty.comReferences1. Barr RD, Ferrari A, Ries L, Whelan J, BleyerWA. Cancer in Adolescents and YoungAdults: A Narrative Review of the CurrentStatus and a View of the Future. JAMAPediatr. 2016;170(5):495-501.2. Findeklee S, Radosa JC, Takacs Z, et al.Fertility preservation in female cancerpatients: current knowledge andfuture perspectives. Minerva Ginecol.2019;71(4):298-305.responding better to cancer treatment.Smoking cessation is especially importantduring the COVID- 19 pandemic as evidencesuggests outcomes are worse for patients whosmoke and who are going through cancertreatment ents/COVID-19%20smoking%20and%20cancer.pdf)Smoking Cessation ProgramFor health care ls/clinical-resources/smoking-cessation-programFor patients/public: www.bccancer.bc.ca/health-info/prevention/tobacco
Teamwork @ the heart of Comox cancer careCancer patients in thewe can meaningfully supportComox Valley on Vancouvertheir treatment journey.Island are fortunate to haveBuilding a relationship witha dedicated team of fiveeach patient, understandingGeneral Practitioners intheir goals, and seeingOncology (GPOs) leadingthem regularly, enable us tolocal cancer care inprovide a high level of care.partnership with BC CancerThe GPO Education Programoncologists. Four juggle thewas priceless in terms of thedemands of family practicesknowledge and experienceworking one/two days asgained. I feel lucky anda GPO at the North Islandprivileged to be part of aHospital Comox Valleygreat GPO team.Community Oncology Clinic,Contact Dr. Tsveta Nikova atwhile the other brings thetsveta.nikova@gmail.comfocus of an experiencedhospitalist to high acuity care.Dr. Madelein Smit, GPO sinceTeam Comox (left to right): GPOs Drs. Amitabh Bakshi, Wai Ling Dan,In sharing perspectives on2019: The opportunity toTsveta Nikova, and Madelein Smit. Missing, Dr. Aléjandra Farias Godoy.their GPO roles, all remarkedplay a vital role in a person’son the teamwork that drivescancer journey is a privilege,their efforts, and the positive impact onthrough a tough time, and enabling themand I continue to build my knowledge. Ipatient care.to complete treatment. GPOs serve as a linkappreciate, too, that the GPO role is not asbetweenspecialistsandfamilyphysicians,rushed as that of a family physician, and findDr. Wai Ling Dan, GPO since 2015: As aadvancingcarewhilehelpingpatientsthe medical challenge good for the brain!long-time practitioner of hospital medicine,understandtheirdiseaseandtreatment.OurI am impressed by the cooperation andThe GPO Education Program providedpatients are grateful to receive treatmentdedication our team brings to cancer care.excellent foundational knowledge inlocally, and both they and their familiesOur lab, for example, processes neededoncology, and the rotations with BC Cancerappreciate the education and insightblood work right away while imaging is– Victoria oncologists prepared me well forprovided by the team here, especially by ourcompleted promptly, and admissionsthe responsibilities involved. All the GPOsnurses.handled immediately if required. Ourhere feel well supported by BC CancerEmergency Department sees our patientsThe GPO Education Program is welland appreciate their quick replies to ourquickly, too, should the need arise, whileorganized and provides a broad overviewqueries. We, in turn, keep patients’ familyour nurses and pharmacists go the extraof how the system works. It was helpful tophysicians informed of their patients’ caredistance every day to ensure chemotherapymeet experts and colleagues from differentand troubleshoot along the way.is delivered in a safe and timely manner.parts of the province – all adding to a senseThere is a growing need, however, for GPOof team.I especially like the medical challenge ofexpertise as referrals are increasing weekly.GPO work, the pace at which care proceeds,Contact Dr. Amitabh Bakshi atThe continuing education that the Familyand getting to know patients well. Thereabakshi07@gmail.comPractice Oncology Network provides helpsare times of sadness and reflection whenkeep us current.Dr. Tsveta Nikova, GPO since 2018: I enjoysomeone is doing poorly, but there is muchthe balance that GPO work adds to myContact Dr. Madelein Smit atlaughter in our days, too, and the work isfamily practice, and have always beenmaria.smith@viha.cafulfilling. More GPOs are needed though, asinterested in oncology as a fast-evolvingDr. Aléjandra Farias Godoy, GPO since 2018:we strive to meet increasing demands andfield of medicine. Fortunately, new lines ofDr. Farias Godoy is another valued memberrisk losing resilience.therapy are available, and it is rewarding toof the Comox GPO team who providesWe’ve built a beautiful team here, and thesee our patients enjoy a good quality of life.additional GPO expertise to Campbell Riverpatients are amazing.As GPOs, we step into a person’s life whenas needed, maintains a family practice, andContact Dr. Wai Ling Dan at the Northhe/she is vulnerable, and I cherish momentsserves on the local palliative care team.Island Hospital Comox Valley CommunityOncology Clinic.Dr. Amitabh Bakshi, GPO since 2014:Teamwork is the backbone of our abilityto coordinate cancer care locally. My roleinvolves maintaining a good rapport andcommunication with patients, helping themNext GPO Education course begins February 1, 2021The GPO Education Program includes a two-week didactic Introductory Module held twiceyearly followed by 30 days of flexibly scheduled clinical rotation. Full details at www.fpon.caFAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 20205
Corridor Consult – Breast Screening Q&A1. What are the current BC breast screening recommendations?2. Can women without a primary careprovider access BC’s breast screeningprogram?A primary care provider (e.g. physician, nursepractitioner) is required to book a screeningmammogram, to receive screening resultsand arrange follow-up procedures.View the full webcaston this topic at www.fpon.ca– Continuing Medical Education.3. When is a diagnostic mammogram, asopposed to a screening mammogram,indicated, and how do the two testsdiffer?Diagnostic mammography is indicatedfor individuals with breast symptoms (e.g.palpable lump, nipple discharge), thosewith breast implants, and those with apersonal history of breast cancer. It mayalso be considered for those not includedin the screening recommendations above.The screening program recommends thatindividuals discuss breast concerns withtheir primary care provider. If diagnostic6mammography is deemed appropriate, thenan imaging requisition is required, and theexam is performed at a diagnostic imagingfacility. Screening mammography is indicatedfor asymptomatic individuals, and is availableat screening centres based on the aboverecommendations. Self-referral is generallypermitted, except for those at high risk(e.g. BRCA gene mutation) and under theage of 40.More information related to diagnosticimaging: ncer-anddisease-diagnosis4. How are women with breast implantsscreened?Individuals with breast implants are screenedthrough a diagnostic imaging service.This requires an imaging requisition fromtheir health care provider. The reasonfor provision through diagnostic ratherthan screening services is the inclusion ofspecialized mammographic views requiringadditional time and expertise.FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 20205. Is there a role for MRI in breastscreening?Although routine screening with breastMRI of women at average risk is notrecommended, exceptions apply for highrisk groups. The following groups arerecommended for routine breast MRI: BRCA1 and/or BRCA2 carriers; First degree family relatives of BRCA1and/or BRCA2 not tested; and Chest radiation treatment duringchildhood.More information related to diagnosticimaging: ncer-anddisease-diagnosis6. We know that risk is higher than averagefor patients with a first degree relativewith a history of breast cancer. Does theage of the relative at diagnosis affectscreening recommendations?The screening program suggests thatcontinued on page 7
Change is upon us, and opportunties presentBy Dr. Cathy Clelland, ProgramMedical Director, Primary Caresaw family physicians shift rapidly to providemost care through virtual means. The needto provide in-person, hands-on services forconditions not appropriatefor virtual care, however, washampered by a lack of PPE.As I look out my window, I see the changeof season is upon us. Inhealthcare, however, weare coming through themost unpredictable andMany Divisions of Familyunprecedented of times. ThePractice worked rapidly toCOVID-19 pandemic saw adevelop strategies to addressshutdown of “elective” caretheir communities’ need for into help flatten the curve andperson care optimizing accessavoid overwhelming our acuteto PPE – often in a centralizedcare system. Efforts werelocation – to supplementmade to ensure hospitals andvirtual care. As communityemergency services would bepractices reopen to provideDr. Cathy Clellandable to care for patients in asmore in-person care, manysafe a way as possible. One ofwill continue to embracethe unanticipated consequences, however,virtual care as a means of expanding access.was the impact on community primary care.The commitment of community providersAfter years of barriers to widespreadto support patients shows that the broaderimplementation of virtual care in BC, wehealthcare system needs a strong primaryCorridor Consult – Breast Screening Q&Acontinued from page 6a complete family history be obtained when assessing anindividual’s breast cancer risk. Some patients may then be eligiblefor referral to the BC Cancer Hereditary Cancer Program ry-cancer). If a firstdegree relative (e.g. sister) is diagnosed (with no high risk factors),then the recommendation is to begin screening within the BreastScreening Program at age 40. If the relative was diagnosed underthe age of 50, then an individualized consideration of the otherrelevant risk factors, along with costs and benefits of screening,should be factored into the decision to refer to diagnosticimaging for screening.7. What is the recommendation regarding routine breast selfexams and routine clinical breast exams by family physicians?Breast self-examsRoutine breast self-examinations (when used as the onlymethod to screen for breast cancer) are not recommendedfor asymptomatic women at average risk of developing breastcancer. Women are encouraged to be familiar with their breasttexture and appearance and raise any concerns with their healthcare provider.Clinical breast examsThere is insufficient evidence to either support or refute routineclinical breast exams (in the absence of symptoms) alone orin conjunction with mammography. The patient and healthcare provider should discuss the benefits and limitations ofthis procedure to determine what is best for the patient.This excludes women with a prior breast cancer history.care base to function across the continuum.I thank my community colleagues, and allhealth care providers, for their efforts to keepus all healthy and safe these past months.The cancer care system can learn, too, fromthis experience especially regarding theneed for enhanced connectivity (both virtualand in-person). A community approach tocancer prevention and screening, plus stronglinkages between community and tertiarycare have never been more important.A strong, well supported primary carecommunity is critical for sustainability, fortimely access to care, and follow-up. Toparaphrase Dr. Bonnie Henry, we are in thistogether, and together we can improve theexperience of our patients and their familiesthrough their cancer care journey.Contact Dr. Cathy Clelland atcathy.clelland@bccancer.bc.caBC Cancer screening resumption updateColon Screening UpdateFecal immunochemical testing (FIT), part of the early screeningprocess for colon cancer, has now resumed in BC after thedistribution of FIT kits was temporarily suspended in March2020 due to COVID-19.Individuals eligible for a FIT test can pick up a kit at any public orprivate lab across the province with a referral from their healthcare provider. Individuals, who had picked up a FIT kit prior toscreening suspension and have yet to complete it, can nowcomplete and return their kit to the lab.Breast Screening UpdateBreast Screening centres across the province are now rebooking previously cancelled appointments for June andbeyond. Screening reminders are also being sent to those whowere due for screening at the time of suspension ahead of thosewho are coming due. Patients are encouraged to wait to receivetheir reminder letter before calling to book their screeningmammography appointment. The Mobile MammographyService is now resuming operation, but at a modified scheduleto protect both staff and patients. Patients are encouraged tovisit the clinic locator at screeningbc.ca to determine when themobile unit is visiting their community.The BC Cancer Breast Screening Program is committed to thesafety of both patients and staff, and has introduced measuresto promote safe cancer screening.More information: bccancer.bc.ca/screeningFAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / FALL 20207
It begins with you:the BRCA genes in the Ashkenazi Jewish populationBy Allison Mindlin, Genetic Counsellor,BC Cancer Hereditary Cancer Program andDr. Rona Cheifetz, Medical Lead, HereditaryHigh Risk Clinic, BC CancerHe was your typical patient:Caucasian, male newlydiagnosed with metastaticprostate cancer at 72. “Howdid this happen?” he asks. Youexplain that cancer is commonand usually sporadic. Yourefer him for treatment, butwait, did you ask about hisancestry? Did you considerthat he might be predisposedto cancer?cumulative lifetime risk of 72% of developingbreast cancer, and a 44% risk of developingovarian cancer, while women with a BRCA2mutation have risk profiles of 69% and 17%,respectively1. For men, the lifetime risks ofprostate cancer and breastcancer are substantiallyelevated, while both gendersmay face an increased riskof pancreatic cancer andmelanoma.Identifying a mutation inwomen means access toscreening breast MRI fromage 25 and consideration ofprophylactic mastectomieswith a strong recommendationfor prophylactic s
include punch or excisional biopsy. A potential disadvantage for upfront excisional biopsy is margin status. There are well-defined guidelines for excision margin based on tumour thickness. For example, any primary tumour over 2mm in depth requires a 2cm margin. The 2cm margin will be measured from the scar of the excisional biopsy.
Journal of Oncology Practice 11, no. 3 (May 01, 2015). Published online April 14, 2015. DOI: 10.1200/JOP.2014.003350 15.ASCO Journal of Oncology Practice: Special Series: NCI-ASCO Teams Journal of Oncology Practice 12, no. 11 (November 1, 2016). 16.ASCO Journal of Oncology Practice: Results of the ASCO Study of Collaborative
6 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies Overview Key Terms Used in This Document Oncology nurse navigator: An oncology nurse navigator (ONN) is a professional registered nurse with oncology-specific clinical knowledge who offers individualized assistance to patients, families, and caregivers to help overcome healthcare
oncology pharmacists in an effort to unify practice. History of the Hematology/Oncology Pharmacy Association HOPA, a professional society for hematology/oncology pharmacists and associates, was launched in 2004. The goal of HOPA is to have an oncology pharmacist as an integral member of the care team for all individuals affected by can-cer.
for Oncology for hospitals, clinics, and office practice settings that offer oncology services. This project was made possible through a grant from the International Society of Oncology Pharmacy . (ISOPP), the American Society of Clinical Oncology (ASCO), and the
Oncology - out of hours - 02476968234 . Acute Oncology Nurses : Pet Mukuzvazva . Tel: 07956362154 or 02476153625 (Monday-Friday 8am-4pm) Petronilla.Mukuzvazva@geh.nhs.uk . Acute Oncology Consultants . Acute Oncology Service Lead – Dr Penny Kechagioglou : Consultant Oncologist – Penny.Kechagioglou@uhcw.nhs.uk . Cancer of Unknown Primary
Part 2 – Radiology: Oncology Radiology: Oncology Page updated: December 2020 This section describes policies and guidelines for billing radiation oncology procedures. Radiation oncology services include initial consultation, clinical treatment planning, simulation, medical radiation physics
Director, Scripps Green Cancer Center, Division of Hematology/Oncology, Scripps Clinic, La Jolla, California, USA Roberto Ivan Lopez, MD Centro Oncologico Punta Pacifica, Medical Oncology, Panama, Panama Jean-Pierre Lotz, MD, Professor Head of the Department of Medical Oncology and Cellular Therapy, Medical Oncology Department, Tenon
Introduction The Oncology Nursing Society (ONS) has been defining the scope and standards for oncology nursing practice since 1979. Over the years, these standards have evolved to reflect changes in cancer care in general and in oncology nursing practice more spe-cifically. T
