Follow-up and relapse

From Oncology for Medical Students
Ideal oncology curriculum > Follow-up and relapse

Objective 5.6

At graduation, the student should be able to:

a) demonstrate an understanding of the aims of follow-up including:
(i) recognition and management of local and distant recurrence;
(ii) complications of treatment;
(iii) detection of new primaries
b) describe manifestations of recurrence of common cancers
c) describe the management of recurrences, including aims, treatments and outcomes
d) demonstrate an understanding of the psychosocial impact of expected and unexpected recurrences
e) demonstrate an understanding of the limitations and cost effectiveness of follow-up itself
f) recognise recurrence patterns of common cancers.

Representative questions that suggest the required depth of knowledge

1. For which cancers are there effective salvage treatment for recurrent disease that offers a >25% chance of cure? (Select the best answer/s, more than one may be correct.)

(a) Hodgkin’s disease

(b) rectal cancer

(c) breast cancer initially treated by lumpectomy and radiotherapy

(d) lung cancer

(e) glioblastoma multiforme

Answer: (a) and (c)

2. What would you tell a patient about the purpose and limitations of follow-up after conservative treatment of colon cancer?

Essential in answer:

  • To detect manageable recurrence
  • To document treatment-related toxicity
  • To establish outcomes including but not exclusively survival
  • Recognition of non-clinical incentives that may drive the desire for follow-up (financial, medico-legal, patient related)