Evolution of Oncology and Nuclear Medicine Services BMC

Evolution of Oncology and Nuclear Medicine Services- BMC. Dr. Beda M. Likonda Radiation oncologist Department of oncology Bugando medical centre March 26 2015

Objectives § Introduction to Oncology § Epidemiology § Medical Oncology Services § Nuclear Medicine Services § Radiotherapy Services § Research and projects § Education § Challenges § Future perspective

Introduction § Oncology is a branch of medicine which deals with tumors(cancers). § Oncologists are medical professionals trained to deal with tumors. Roles are § Diagnosis and staging of any cancer (pathology, radiology, Labs) § Therapy (Surgery, Chemotherapy, Radiotherapy and other) § Follow up after successful treatment § Palliative care of patients with terminal malignancies § Screening of general and high risk population

Introduction § Onkos (όγκος) meaning “Crab", "volume" or "mass". § Cancers are › 100 different diseases arising from any cell type. § Result of genetic mutation in genes responsible for regulation of cell division (proto/suppressor Oncogenes) and DNA repair.

Introduction § History dates back to antiquity § 3000 -2500 BC refer to cautery for 8 cases of ulcers of the breast § Hippocrates (ca. 460 -377) description of malignant tumors § Pre-christian era “carcinos” and “carcinoma” appears

Introduction § Galen (ca. 129 -200 A. D) humoral theory of cancer causation, an excess of black bile § 180 AD breast cancer excision § 1740 first hospital for cancer (Rheims) 12 beds later moved outside (belief that cancer is contagious) § 1850 UK cancer hospital (now Royal marsden)

Epidemiology

Epidemiology Globally Less developed § Incidence 14. 1 million § Mortality 8. 2 million § 5 -years prevalence 32. 6 § 8 million, (57%) Global incidence § 5. 3 million , (65%) global mortality § 15. 6 million , (48%) 5 years global prevalence

Global pathologies both sex

Global pathologies by sex Men women

Tanzania pathologies both sex

Tanzania pathologies by sex Men women

Care and Treatment -BMC § Oncology services started with the medical part in 2009. Led by Dr. N. Masalu-Medical oncologist with the support from Italian allies (TISON) § Basically we started with provision of care and treatment. § Diagnosis and staging established with the help of pathology , Laboratory and Radiology departments.

Care and Treatment -BMC § Therapeutic wise major modality of treatment has been chemotherapy. § Hormonal , targeted agents (lesser extent) § Surgical procedures done by non-onco surgeons § Radiotherapy referred to ORCI § Nuclear medicine services to ORCI § Over 60% patients presented late (no

Care and Treatment -BMC § Therapeutic wise major modality of treatment has been chemotherapy. § Hormonal , targeted agents (lesser extent) § Surgical procedures done by non-onco surgeons § Radiotherapy referred to ORCI § Nuclear medicine services to ORCI § Over 60% patients presented late (no

Bugando All Pathologies

Pathologies-Children

Pathologies-Adults Males

Pathologies-Adults-Females

Palliative Care § Offered to patients with advance pathologies (no cure) to prolong life and improve the quality of life § Provided in the form of chemotherapy § Introduction of oral morphine (syrup) § Pay home visits in collaboration with FOCC

Home visits

Preventive and early detection -BMC § Every Monday screening for cervical and breast cancer § Through Vanda project (Italian allies) 3000 women in 8 districts reached as outreach program. § 10% had pre-invasive disease(Cryotherapy) § 4% had gross disease (referred to BMC)

Preventive and Early detection -BMC § In collaboration with Pink Ribbon Red Ribbon CTC BMC Invites us for capacity building of its staff and now they do screening for non-pregnant HIV women attending their clinic. § Plans are for prostate cancer screening program

Nuclear Medicine Services § A branch of medicine which uses unsealed radioactive sources for diagnostic or therapeutic purposes. § At BMC diagnostic part was started 2011 after installation of the gamma camera. Led by Dr P. Ngoya NMphysician. § Technetium-99 radioisotope

Radioisotope scintigraphy

Nuclear Medicine Services § § § § Reno gram Bone scan Myocardial perfusion Brain scan Thyroid scan GIT study In total around 400 patients has been examined

Radiotherapy Services § Radiotherapy is the use of ionizing electromagnetic radiations to control tumour growth. § Can be guided from far (teletherapy) or from close by (brachytherapy) § The electromagnetic energy( gama/xray) are either from radio-isotope (Co 60) or accelerators.

Radiotherapy Services § At BMC the Radiotherapy infrastructure built by the Go. T and was certified by IAEA/TAEC. § Built with capacity to host machines with max 18 MV. § Basic human resource to start is in place § Led B. M. Likonda-Radiation Oncologist

Basic requiements EQUIPMENT QUANTITY 2 D SIMULATOR 1 3 D SIMULATOR 1 COBALT 60 UNIT 1 LINEAR ACCELERATOR 1 HDR-BRACHTERAPY UNIT 1 MOULD ROOM AND DOSIMETRY

Teletherapy

Simulation and planning

Brachytherapy Cobalt-60 Iridium -192

Catheters insertion

Radiotherapy Services § Installation § Commissioning § Commencement of services

Research and projects § Molecular and clinical researches has been done and on going § § Emblem INCTR Vitamin D for breast ca Retinoblastoma § Hospital based Cancer Registry project (yet to start)

Education § Social media program § health education during outreach visits § School education to all children during all period of cancer treatment ( Coordinated in collaboration with Friends of Children with Cancer -FOCC)

Hospital based school

Hospital based school 2014

Challenges-Care and Treatment § Inadequate diagnosis (tumor characterization) § Inadequate staging –lack of some imaging modalities eg CT-scan, MRI, PET-CT § Inadequate lab Investigations (CEA, CA -25, CA 19 -9, Thyroglobulin) § Poor Multi Disciplinary Team (MDT) practice

Challenges-Care and Treatment § Unreliability of the drugs-donor dependant § Late presentation of patients (missed opportunity for cure) § Unaffordability of the services by patients § High rate of lost to follow-up patients

Challenges-Palliative Care § Lack of home based /hospice units and network § Unreliability of drugs(morphine) § Poor logistics to pay home visits § Inadequate contact address information

Challenges-Preventive and early diagnosis § § Inadequate human resources Inadequate fund for outreach services Poor community awareness Poor infrastructure

Challenges-Nuclear Medicine § Inadequate requisitions from practitioners ( ? knowledge) § Nature of the radiopharmaceuticals, short half life. § Patients registered first and then radiopharmaceutical is ordered.

Future perspectives § High quality data cancer registry/information § Hospital based to population based cancer registry § Adequate diagnosis and staging § Tumor markers assays § Immuno-histrochemistry analysis (Er, Pr, HEr 2, CD 20…) § Fluorescence In-Situ Hybridization (FISH) § High Resolution Computerized Tomography (HRCT)

Future perspectives § Evidence based therapy and follow-up § Surgical Oncology services by organ-system § Medical oncology services towards biological agents § Bone marrow transplant services (Intense therapy) § Intervention radiology therapeutic services e. g liver TACE, TARE…. § Unsealed radioisotope treatment (RIA, Strontium-90)

Future perspectives § Strong MDT culture (Organ-system based units) § High early detection rate § Strong palliative network

“Cancer is curable if detected early”