PGY 5

PATIENT CARE

1. Management of Leukemic Patients
   1. To identify which patients need treatment
   2. To know the difference of treatment between the different leukemia’s
   3. To know the management of refractory and relapsed Leukemia’s

.

2. Local Treatment of Breast Cancer
3. Counsel patients about the option of surgical management of primary tumor. Be able to describe modified radical mastectomy as compared to breast-conserving surgery with axillary dissection
4. Identify patients who require local postoperative breast irradiation
5. Counsel patients about the use of breast reconstructive surgery
6.      Identify patients who should receive neoadjuvant chemotherapy.

MEDICAL KNOWLEDGE

1. Understanding of Molecular Biology of Cancer (Lectures, molecular Biology Rotation).
2. Growth Factors:
   1. Recognize which oncogenes are associated with growth factors
   2. List known growth factors, their sources and their target cells
   3. List Growth inhibitory cytokines

1. Chromosomal Abnormalities:
2. List the known chromosomal abnormalities associated with

       malignancies

2. Describe the different methods of identifying chromosomal

                      deletions, inversions, translocations and duplications

3. Demonstrate the application of chromosome analysis in the
                       management of malignancies

2. Clinical Pharmacology (Basic Science Lectures, Oncology Inpatient and Clinics)
3. Pharmacokinetics:
4. Describe dose-response curves and the factors that influence 

                           pharmacodynamics

1. Methods of Delivery:
2.     Describe the use of intra pleural and intraperitoneal chemotherapy
3. Discuss the factors involved in determination of the schedule of    

                         administration of chemotherapy

3. Define neoadjuvant chemotherapy, potential advantages and

the disadvantages

1. Toxicity:

3. Radiation Therapy – See RT Elective Goals and Objectives

4. Biologic Response Modifiers (Clinical Rotations)

1. Describe the pharmacology of the different biologics
2. Demonstrate an understanding of the role of biologic therapy in the management of solid tumors and lymphoproliferative disorders
3. Describe the potential use and disadvantages of monoclonal antibodies

5. Bone Marrow Transplantation – See BMT Elective Goals and Objectives

6. Research - design and conduct of clinical trials (Journal Club, Dr. Debari’s course,

     Review of Clinical Trials)

1. Demonstrate an understanding of the different types of clinical trials utilized
2.     Demonstrates an understanding of the descriptive terminology utilized in

                     both epidemiologic treatment trials and statistical analyses

1.    Understand what the endpoints are of different clinical trials
2.     Understand what size and duration of study are necessary to reach

                    statistical significance

1.    Demonstrate a knowledge of the need for informed consent
2. Understand the usefulness and limitations of meta-analyses

7. Leukemia’s (Ward experience, blood bank and flow cytometry rotations, morphology sessions).
8. To know the difference between various types of Leukemia’s.
9. Diagnosis:

1. To know different cyto chemical stains used to evaluate Leukemia’s and interpret them.
2. To be able to interpret flow cytometry results.
3. To know the characteristic cytogenetic abnormalities of different leukemia’s and their significance.
4. To be able to interpret bone marrow aspirate smear morphology and differentiate between various Leukemia’s.

8. Lymphomas (Oncology inpatient, clinics, tumor board, lectures)
9. Pathology
10. Know the difference pathological classification of NHL and their clinical significance.
11. Prognosis
12. Know the various prognostic factors in HD and NHL.
13. Know the prognostic significance of cytogenetic abnormalities and immunophenotyping.

1. Treatment
2. Be able to decide the type of treatment modality (RT versus chemotherapy) in the treatment of HD
3. Know the indications for ABMT and peripheral stem cell transplantation in HD and NHL
4. Be able to appropriately recognize and treat both infectious and immunological complications of bone marrow transplant

9. Carcinoma of the Breast (Oncology rotations, clinics, radiation elective)
10. Diagnosis:
11. State the ACS recommendations for the use of screening mammography
12. Describe the role of ultrasonography for diagnosis of breast mass
13. Be able to demonstrate physical examination of the breast and axilla. Teach a patient self-breast examination
14. Discuss the indications for biopsy of breast mass
15. Discuss the indications for fine needle aspiration of a breast mass

1. Staging and Prognostic Features:
2. Describe the use of tumor markers, CEA and CA 15-3, for diagnosis and follow up of patients

10. Gastrointestinal Cancers (Inpatient and outpatient rotations, RT elective)

1. Esophageal Cancer:
2. Understand the benefits and toxicities of combine modality therapy
3. Understand the importance of nutritional support in esophageal cancer and the techniques employed, e.g. Hyper alimentation with PEG, gastrostomy, TPN, PPN

1. Gastric Cancer
2. Describe the risk factors for development of gastric carcinoma
3. Understand the pattern of spread
4. Utilize the appropriate non-invasive tests for diagnosis and staging
5. Understand the surgical management of primary disease
6. Understand the role of chemotherapy in advance disease

1. Pancreatic Cancer:
2. Utilize the appropriate non-invasive procedures for diagnosis.
3. Describe the role of the Whipple’s procedure in primary management
4. Understand the use of radiation therapy in management
5. Describe palliative surgical procedures
6. Discuss the use of 5FU as a radiation sensitizer and its use a primary treatment
7. Understand new chemotherapeutic agents in management of pancreatic cancer

1. Hepatocellular Cancer:
2. Define the risk factors for the development of hepatocellular cancer
3. Understand which patients may benefit from surgery
4. Describe the use of hepatic artery infusion
5. Know what chemotherapy is active in treatment of hepatoma

1. Anal Cancer:
2. List risk factors and histopathologic subtypes of anal cancer
3. Know the appropriate staging procedures
4. Describe the surgical management and the role of radiation therapy
5. Understand the benefits of multimodality therapy including chemotherapy

1. Neuroendocrine Tumors:
2. Describe the clinical syndromes associated with carcinoid tumors and pheochromocytomas.
3. Recognize the sites of origin of neuroendocrine tumors.
4. Understand the role of surgery and chemotherapy in management.
5. Describe palliative treatment options.

11. Genitourinary Tract Cancer (inpatient and outpatient rotations, RT elective)
12. Testicular Cancer:
13. Be able to recognize clinical presentation
14. Describe histopathology
15. Be able to utilize tumor markers for clinical stating in non seminomatous tumors
16. Perform appropriate noninvasive imaging for post-orchiectomy staging
17. Understand the role of retroperitoneal lymph node dissection vs. surveillance
18. Define the role of RT in post-op management of seminars.
19. Describe which patients with pure seminomas require chemotherapy
20. Be able to list poor prognostic features associated with non-siminomatous tumors and utilize this to select appropriate chemotherapy
21. Understand management of patients with PR or recurrent disease
22. Describe complications of disease and treatment e.g. vascular, bleomycin pulm toxicity

1. Bladder Cancer:
2. List risk factors for development of bladder cancer
3. Describe the roles of surgery and intravesical treatment for patients with superficial bladder cancer
4. Understand the surgical management of invasive cancer
5. Understand the role of pre-and/or post-op radiation therapy
6. Identify the patients who are appropriate candidates for neoadjuvant chemotherapy
7. Understand the active chemotherapeutic regimens for metastatic disease and their response rates

1. Prostate Cancer:

1.      Understand the use of PSA screening

2. Understand the staging and histologic classification
3. Utilize approach staging tests
4. Identify patients who are appropriate for surgical management
5. Describe the toxicities associated with total prostatectomy
6. Describe the toxicity of radiation therapy
7. Understand the role of hormone therapy in the management of prostate cancer and the available hormone manipulations
8. Describe the pattern of metastasis

12. Gynecologic Malignancies (Gyn elective, oncology inpatients, clinics, RT elective)
13. Ovarian Cancer:
14. Management:
    1. Know the standard surgical treatment and importance of debunking
    2. Know the stages which require chemotherapy and which
    3. Chemotherapeutic agents to use
    4. Know the indications of radiation treatment for different stages of disease
    5. Know the significance and importance of a second look laparotomy
    6. Know the management of recurrent disease

             b. Endometrial Cancer:

                            1.   Know the importance of different risk factors and the association

                                  between tamoxifen and endometrial cancer

2. Describe the clinical presentation and the appropriate diagnostic 

       procedures

3.    Know the FIGO staging
4.     Understand the management of the different stages and the

                                                     role surgery, radiation therapy and chemotherapy

1. Understand the management of recurrent disease

1. Know the management of uterine sarcoma

                          d. Cervical Cancer:

1.      Know the risk factors and the importance of herpes simplex virus and human papilloma virus

2. Know the natural history and the patterns of spread
3. Know the diagnostic procedures and the importance of screening (PAP)
4. Know the standard clinical evaluation needed for preop staging
5. Know the FIGO staging of cervical cancer
6. Understand the management of the different stages of disease and the role of radiation and surgery
7. Understand the techniques and doses of radiation utilized in treatment
8. Describe the expected response rates with chemotherapy and its role of palliative management

13. Head and Neck Cancer (Lectures, outpatient clinics, RT elective, tumor board)
14. Squamous Cell Carcinoma:

                          1.    Understand the anatomy and the different sites of origin of

                                 carcinoma

2.      Demonstrate the use of appropriate staging in the management.

3.    Know the roles of surgery and radiation in each of the different subtypes

4. Understand the risks and benefits of larynx sparing surgery
5. Understand the role of neoadjuvant chemotherapy

1. Thyroid Cancer:
2. Understand the incidence and classification of thyroid cancer
3.    Know the TNM staging
4. Know the risk factors for the development of thyroid cancer e.g.

                                  goiter, RT

4. Demonstrate how to evaluate a thyroid nodule with nonnative testing and use of FNA
5. Understand how to manage patients with well-differentiated thyroid cancer and the prognosis (surgery, suppression, I-131).

14. Sarcomas/Mesothelioma (Outpatient and inpatient rotations)
15. Mesothelioma:
16. Understand the association with asbestos and who is at risk for mesothelioma
17. Know what biopsy procedures are available for diagnosis
18. Understand the role of surgery, RT and chemotherapy in the management and the prognosis

15. Melanoma (Outpatient rotations)
    1. List the risk factors for development of malignant melanoma
    2. Describe the different histologic subtypes of melanoma
    3. Understand the different staging systems – Clark, Breslow
    4. Define the prognostic features
    5. Understand the surgical management of melanoma
    6. Discuss the role of elective lymph node dissection
    7. Understand the role of adjuvant therapy
    8. Understand the different treatment modalities for metastatic disease including chemotherapy, radiation therapy, hormone therapy, biologic response modifiers, and adoptive immunotherapy and tumor vaccines

16. Complications of Malignancy (Lecture series, oncology rotation)

1. Hospice – See Hospice Elective Goals and Objectives

1. Pain Management – See Pain Management Elective Goals and Objectives

1. Neutropenic Fever:

1.      Understand the common organisms which cause infection in the febrile neutropenic patient

2. Know when and which antibiotics to start
3. Understand the use of growth factors in the management of the neutropenic patient
4. Know when to utilize antifungal therapy

PRACTICE BASED LEARNING

1. Regularly self-assesses his opinion on new patients and the opinion of the teaching faculty
2. Looks at literature to decide on controversial issues

INTERPERSONAL SKILLS AND COMMUNICATIONS

1. Demonstrate to teaching faculty an ability to honestly and in lay terms explain  

             the prognosis to patients

2. Perform a psychosocial assessment of patients with cancer
3. Participate in counseling sessions attended by patients, family members and   

       psychosocial professionals

4. Know how to utilize appropriate resources to assist patients and their families

       with coping

PROFESSIONALISM

1. Be able to demonstrate a commitment to patients from diverse ethnic and

             educational levels

2. Responds appropriately to constructive criticism
3. Demonstrates on “360” evaluations a thorough commitment to ethical

             principals for our demographically diverse patient population

SYSTEM BASED PRACTICE

1. Actively participates in rounds with the attending hematology/oncologists

          and Inter Hospital Conferences

PGY-6

PATIENT CARE

1. Management of Leukemic Patients
2. To identify which patients need treatment
3. To know the difference of treatment between the different Leukemia’s
4. To know the management of refractory and relapsed Leukemia’s

MEDICAL KNOWLEDGE

1. Understanding of Molecular Biology of Cancer (Lectures, molecular Biology Rotation).

1. Chromosomal Abnormalities:

• List the known chromosomal abnormalities associated with malignancies
• Describe the different methods of identifying chromosomal deletions, inversions, translocations and duplications
• Demonstrate the application of chromosome analysis in the management of malignancies

2. Clinical Pharmacology (Basic Science Lectures, Oncology Inpatient and Clinics)
3. Pharmacokinetics:

1. Describe dose-response curves and the factors that influence pharmacodynamics
2. Methods of Delivery:
3. Describe the use of intrapleural and intraperitoneal chemotherapy
4. Discuss the factors involved in determination of the schedule of administration of chemotherapy
5. Define neoadjuvant chemotherapy, potential advantages and the disadvantages
   1. Toxicity:
   2. Define the mechanisms of drug resistance and associate with

                               individual drugs

5. Describe new modalities for overcoming drug resistance

3. Radiation Therapy – See RT Elective Goals and Objectives

4. Biologic Response Modifiers (Clinical Rotations).

1. Describe the pharmacology of the different biologics
2. Demonstrate an understanding of the role of biologic therapy in the management of solid tumors and lymphoproliferative disorders
3. Describe the potential use and disadvantages of monoclonal antibodies
4. Bone Marrow Transplantation – See BMT Elective Goals and Objectives

6. Research - design and conduct of clinical trials (Journal Club, Dr. Debari’s course,

     Review of Clinical Trials)

1. Demonstrate an understanding of the different types of clinical trials utilized
2.     Demonstrates an understanding of the descriptive terminology utilized in

                     both Epidemiologic treatment trials and statistical analyses

1. Understand what the endpoints are of different clinical trials
2. Understand what size and duration of study are necessary to reach

                   statistical significance

1. Demonstrate knowledge of the need for informed consent
2.    Understand the usefulness and limitations of meta-analyses

7. Leukemias (Ward experience, blood bank and flow cytometry rotations, morphology

       sessions)

1. To know the difference between various types of Leukemia’s

1. Diagnosis:
2. To be able to interpret flow cytometry results
3. To know the characteristic cytogenetic abnormalities of different

      Leukemia’s and their significance

3. To be able to interpret bone marrow aspirate smear morphology and 

               differentiate between various Leukemia’s

8. Lymphomas (Oncology inpatient, clinics, tumor board, lectures)
9. Pathology

1. Know the difference pathological classification of NHL and their clinical significance

1. Prognosis
2. Know the impact of histological grade on prognosis

1. Treatment
2. Be able to decide the type of treatment modality (RT versus chemotherapy) in the treatment of HD
3. Know the indications for ABMT and peripheral stem cell transplantation in HD and NHL
4. BE able to appropriately recognize and treat both infectious and immunological complications of bone marrow transplant
5. Understand the long term complications (benign and malignant) seen in patients with HD treatment with RT, chemotherapy or both

9. Gastrointestinal Cancers (Inpatient and outpatient rotations, RT elective)

1. Esophageal Cancer:
2. Understand the benefits and toxicities of combine modality therapy

2. Understand the importance of nutritional support in esophageal cancer and

      the techniques employed, e.g. Hyper alimentation with PEG, gastrostomy   

      TPN, PPN.

1. Gastric Cancer
2. Describe the risk factors for development of gastric carcinoma
3. Understand the pattern of spread
4. Utilize the appropriate non-invasive tests for diagnosis and staging
5. Understand the surgical management of primary disease
6. Understand the role of chemotherapy in advance disease

1. Pancreatic Cancer:
2. Utilize the appropriate non-invasive procedures for diagnosis
3. Describe the role of the Whipple’s procedure in primary management
4. Understand the use of radiation therapy in management
5. Describe palliative surgical procedures
6. Discuss the use of 5FU as a radiation sensitizer and its use a primary treatment
7. Understand new chemotherapeutic agents in management of pancreatic cancer

1. Hepatocellular Cancer:
2. Define the risk factors for the development of hepatocellular cancer
3. Understand which patients may benefit from surgery
4. Describe the use of hepatic artery infusion
5. Know what chemotherapy is active in treatment of hepatoma.

1. Anal Cancer:
2. List risk factors and histopathologic subtypes of anal cancer
3. Know the appropriate staging procedures
4. Describe the surgical management and the role of radiation therapy
5. Understand the benefits of multimodality therapy including chemotherapy

1. Neuroendocrine Tumors:
2. Describe the clinical syndromes associated with carcinoid tumors and pheochromocytomas
3. Recognize the sites of origin of neuroendocrine tumors
4. Understand the role of surgery and chemotherapy in management
5. Describe palliative treatment options

10. Genitourinary Tract Cancer (inpatient and outpatient rotations, RT elective)

1. Testicular Cancer:
2. Be able to recognize clinical presentation
3. Describe histopathology
4. Be able to utilize tumor markers for clinical stating in nonseminomatous tumors
5. Perform appropriate noninvasive imaging for post-orchiectomy staging
6. Understand the role of retroperitoneal lymph node dissection vs. surveillance.
7. Define the role of RT in post-op management of seminars
8. Describe which patients with pure seminomas require chemotherapy
9. Be able to list poor prognostic features associated with non-siminomatous tumors and utilize this to select appropriate chemotherapy
10. Understand management of patients with PR or recurrent disease
11. Describe complications of disease and treatment e.g. vascular, bleomycin palm toxicity

1. Bladder Cancer:
2. List risk factors for development of bladder cancer
3. Describe the roles of surgery and intravesical treatment for patients with superficial bladder cancer
4. Understand the surgical management of invasive cancer
5. Understand the role of pre-and/or post-op radiation therapy
6. Identify the patients who are appropriate candidates for neoadjuvant chemotherapy
7. Understand the active chemotherapeutic regimens for metastatic disease and their response rates

1. Prostate Cancer:

1.      Understand the use of PSA screening

2. Understand the staging and histologic classification
3. Utilize approach staging tests
4. Identify patients who are appropriate for surgical management
5. Describe the toxicities associated with total prostatectomy
6. Describe the toxicity of radiation therapy
7. Understand the role of hormone therapy in the management of prostate cancer and the available hormone manipulations
8. Describe the pattern of metastasis

11. Gynecologic Malignancies (Gyn elective, oncology inpatients, clinics,

          elective)

1. Ovarian Cancer:
2. Pathology:  Know the different histologic subtypes of ovarian

            cancer, epithelial and germ cell

2. Understand the management of germ cell tumors and borderline

                        tumors

                    b. Cervical Cancer:

1.      Know the risk factors and the importance of herpes simplex virus and human papilloma virus

2. Know the natural history and the patterns of spread
3. Know the diagnostic procedures and the importance of screening (PAP)
4. Know the standard clinical evaluation needed for preop staging.
5. Know the FIGO staging of cervical cancer
6. Understand the management of the different stages of disease and the role of radiation and surgery
7. Understand the techniques and doses of radiation utilized in treatment
8. Describe the expected response rates with chemotherapy and its role of palliative management

12. Head and Neck Cancer (Lectures, outpatient clinics, RT elective, tumor board)
13. Squamous Cell Carcinoma:

1.      Understand the anatomy and the different sites of origin of carcinoma

2.      Demonstrate the use of appropriate staging in the management.

3.      Know the roles of surgery and radiation in each of the different subtypes

4. Understand the risks and benefits of larynx sparing surgery.

5.      Understand the role of neoadjuvant chemotherapy

1. Thyroid Cancer:
2. Understand the incidence and classification of thyroid cancer.
3.    Know the TNM staging
4. Know the risk factors for the development of thyroid cancer e.g.

                                 goiter, RT

4. Demonstrate how to evaluate a thyroid nodule with nonnative testing and

use of FNA

4. Understand how to manage patients with well-differentiated thyroid cancer

 and the prognosis (surgery, suppression, I-131)

13. Sarcomas/Mesothelioma (Outpatient and inpatient rotations)
14. Soft tissue sarcomas:
15. Be able to distinguish between benign and malignant tumors.
16. Understand the characteristics of different histologic subtypes and grading
17. Discuss the role of surgery and radiation in the primary management
18. Describe the chemotherapeutic agents that are active and the response rates in patients with metastatic disease

1. Bone sarcomas:
2. Understand the classification, staging and patters of spread
3. Demonstrate knowledge of appropriate biopsy techniques
4. Describe the role of neoadjuvant chemotherapy and adjuvant chemotherapy
5. Understand the results of limb sparing surgical procedures
6. Describe role of radiation therapy in management
7. Understand the role of surgery in solitary metastatic pulmonary nodules
8. Mesothelioma:
   1. Understand the association with asbestos and who is at risk for mesothelioma
   2. Know what biopsy procedures are available for diagnosis
   3. Understand the role of surgery, RT and chemotherapy in the management and the prognosis

14. Complications of Malignancy (Lecture series, oncology rotation).
15. Hospice – See Hospice Elective Goals and Objectives

1. Pain Management – See Pain Management Elective Goals and Objectives

1. Neutropenic Fever:

1.      Understand the common organisms which cause infection in the febrile neutropenic patient

2. Know when and which antibiotics to start
3. Understand the use of growth factors in the management of the neutropenic patient
4. Know when to utilize antifungal therapy

PRACTICE BASED LEARNING

1. Be able at outpatient clinic to use evidence based data regarding patient care.

2. Regularly self-assesses his opinion on new patients and the opinion of the teaching faculty.

Looks at literature to decide on controversial issues

INTERPERSONAL SKILLS AND COMMUNICATIONS

1. Demonstrate to teaching faculty an ability to honestly and in lay terms explain the prognosis to patients.
2. Perform a psychosocial assessment of patients with cancer.
3. Participate in counseling sessions attended by patients, family members and psychosocial professionals.

1. Know how to utilize appropriate resources to assist patients and their families with coping

PROFESSIONALISM

1. Be able to demonstrate a commitment to patients from diverse ethnic and

               educational levels

2. Responds appropriately to constructive criticism

3. Demonstrates on “360” evaluations a thorough commitment to ethical

             principal for our demographically diverse patient population

SYSTEM BASED PRACTICE

1. Actively participates in rounds with the attending hematology/oncologists

             and Inter Hospital Conferences