Active surveillance: Difference between revisions

Latest revision as of 06:18, 11 December 2024

Active Surveillance

Active surveillance is a management strategy used in the medical field, particularly in the context of certain cancers and other chronic conditions, where the disease is closely monitored through regular check-ups and tests, but treatment is delayed until there are signs of progression. This approach is often chosen to avoid or postpone the side effects of treatments such as surgery, radiation, or chemotherapy.

Overview[edit]

Active surveillance is primarily used for conditions where the disease is known to progress slowly, and immediate treatment may not be necessary. The goal is to maintain the patient's quality of life by avoiding unnecessary treatments while still keeping the disease under control.

Conditions Managed by Active Surveillance[edit]

Active surveillance is commonly used in the management of:

Prostate cancer: Particularly in cases of low-risk, localized prostate cancer, where the cancer is not causing symptoms and is expected to grow slowly.
Chronic lymphocytic leukemia (CLL): A type of cancer that often progresses slowly and may not require immediate treatment.
Renal cell carcinoma: Small kidney tumors that are not causing symptoms may be monitored rather than treated immediately.

Monitoring Protocol[edit]

Patients under active surveillance typically undergo regular monitoring, which may include:

PSA test: For prostate cancer, regular prostate-specific antigen (PSA) tests are conducted.
Imaging studies: Such as MRI or CT scans to monitor tumor size and progression.
Biopsy: Periodic biopsies may be performed to assess the aggressiveness of the cancer.

Criteria for Intervention[edit]

Treatment is initiated if there are signs of disease progression, such as:

Increase in tumor size or PSA levels.
Development of symptoms.
Changes in biopsy results indicating more aggressive disease.

Benefits and Risks[edit]

Benefits[edit]

Avoidance of treatment side effects: By delaying treatment, patients can avoid the side effects associated with surgery, radiation, or chemotherapy.
Maintenance of quality of life: Patients can continue their daily activities without the burden of treatment-related complications.

Risks[edit]

Anxiety: Some patients may experience anxiety knowing they have an untreated cancer.
Risk of progression: There is a risk that the disease may progress more rapidly than expected, potentially reducing the effectiveness of later treatments.

Also see[edit]

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@@ Line 1: / Line 1: @@
-<br>== Active Surveillance in Medicine ==
+Active Surveillance
-Active surveillance is a management strategy used in the medical field, particularly in the context of certain cancers and chronic conditions, where the disease is closely monitored through regular testing and clinical evaluations rather than immediate treatment. This approach is often employed when the condition is not causing any symptoms, is expected to progress slowly, or when the risks of treatment outweigh the potential benefits.
+Active surveillance is a management strategy used in the medical field, particularly in the context of certain cancers and other chronic conditions, where the disease is closely monitored through regular check-ups and tests, but treatment is delayed until there are signs of progression. This approach is often chosen to avoid or postpone the side effects of treatments such as surgery, radiation, or chemotherapy.
-=== Historical Background ===
+==Overview==
-The concept of active surveillance emerged as a response to the overtreatment of certain cancers, particularly prostate cancer. Historically, many patients with low-risk prostate cancer underwent aggressive treatments such as surgery or radiation, which often resulted in significant side effects without substantial benefits in terms of survival. Over time, clinical evidence suggested that many of these cancers were indolent and unlikely to affect the patient's lifespan, leading to the development of active surveillance protocols.
+Active surveillance is primarily used for conditions where the disease is known to progress slowly, and immediate treatment may not be necessary. The goal is to maintain the patient's quality of life by avoiding unnecessary treatments while still keeping the disease under control.
-=== Indications for Active Surveillance ===
+===Conditions Managed by Active Surveillance===
-Active surveillance is primarily indicated for:
+Active surveillance is commonly used in the management of:
-* '''Prostate Cancer''': Particularly in cases of low-risk, localized prostate cancer, where the tumor is small, confined to the prostate, and has a low Gleason score.
+* [[Prostate cancer]]: Particularly in cases of low-risk, localized prostate cancer, where the cancer is not causing symptoms and is expected to grow slowly.
-* '''Thyroid Cancer''': Small papillary thyroid cancers that are not causing symptoms and are confined to the thyroid gland.
+* [[Chronic lymphocytic leukemia]] (CLL): A type of cancer that often progresses slowly and may not require immediate treatment.
-* '''Chronic Lymphocytic Leukemia (CLL)''': In early-stage CLL, where the disease is not causing symptoms or significant changes in blood counts.
+* [[Renal cell carcinoma]]: Small kidney tumors that are not causing symptoms may be monitored rather than treated immediately.
-* '''Renal Masses''': Small renal masses that are suspected to be low-grade renal cell carcinoma.
-=== Protocols and Monitoring ===
+===Monitoring Protocol===
-The active surveillance protocol typically involves:
+Patients under active surveillance typically undergo regular monitoring, which may include:
-* '''Regular Clinical Examinations''': Patients are seen at regular intervals to assess any changes in symptoms or physical findings.
+* [[PSA test]]: For prostate cancer, regular prostate-specific antigen (PSA) tests are conducted.
-* '''Imaging Studies''': Periodic imaging, such as MRI or ultrasound, to monitor the size and characteristics of the tumor.
+* [[Imaging studies]]: Such as MRI or CT scans to monitor tumor size and progression.
-* '''Biomarker Testing''': Blood tests or other biomarker assessments to detect any biochemical changes that might indicate disease progression.
+* [[Biopsy]]: Periodic biopsies may be performed to assess the aggressiveness of the cancer.
-* '''Biopsies''': Repeat biopsies may be performed to reassess the histological characteristics of the tumor.
-The frequency and type of monitoring depend on the specific condition and the individual patient's risk factors.
+===Criteria for Intervention===
+Treatment is initiated if there are signs of disease progression, such as:
-=== Benefits of Active Surveillance ===
+* Increase in tumor size or PSA levels.
-Active surveillance offers several advantages:
+* Development of symptoms.
+* Changes in biopsy results indicating more aggressive disease.
-* '''Avoidance of Overtreatment''': Patients avoid the side effects and complications associated with surgery, radiation, or chemotherapy.
+==Benefits and Risks==
-* '''Quality of Life''': By delaying or avoiding treatment, patients maintain a better quality of life.
-* '''Cost-Effectiveness''': Reduces healthcare costs associated with unnecessary treatments.
-=== Risks and Challenges ===
+===Benefits===
-While active surveillance is beneficial for many patients, it also presents challenges:
+* Avoidance of treatment side effects: By delaying treatment, patients can avoid the side effects associated with surgery, radiation, or chemotherapy.
+* Maintenance of quality of life: Patients can continue their daily activities without the burden of treatment-related complications.
-* '''Anxiety''': Patients may experience anxiety knowing they have an untreated cancer.
+===Risks===
-* '''Risk of Progression''': There is a risk that the disease may progress or become more aggressive, necessitating treatment.
+* Anxiety: Some patients may experience anxiety knowing they have an untreated cancer.
-* '''Compliance''': Requires strict adherence to follow-up schedules, which can be burdensome for some patients.
+* Risk of progression: There is a risk that the disease may progress more rapidly than expected, potentially reducing the effectiveness of later treatments.
-=== Conclusion ===
+==Also see==
-Active surveillance is a valuable strategy in the management of certain low-risk cancers and chronic conditions. It allows patients to avoid the potential harms of overtreatment while ensuring that any progression of the disease is detected early. As research continues, the criteria and protocols for active surveillance are likely to evolve, further refining this approach to patient care.
+* [[Watchful waiting]]
+* [[Prostate cancer management]]
+* [[Cancer staging]]
+* [[Biomarkers in cancer]]
-=== References ===
+{{Medical-stub}}
-* Tosoian, J. J., & Trock, B. J. (2016). Active surveillance for prostate cancer: Current evidence and contemporary state of practice. Nature Reviews Urology, 13(4), 205-215.
-* Brito, J. P., & Morris, J. C. (2016). Active surveillance for thyroid cancer: A systematic review. Thyroid, 26(11), 1443-1450.
+[[Category:Medical management]]
-* Hallek, M. (2017). Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. American Journal of Hematology, 92(9), 946-965.
+[[Category:Cancer treatments]]
+[[Category:Oncology]]