Medicine and Surgery

Activity type

Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica

SSD

MED/06

Year

5th year

Semester

2nd semester

CFU

1

Hours distribution

13 classroom hours

Lecturers

FEDERICA MAZZUCA

Activity type

Attività formative affini o integrative

SSD

MED/36

Year

5th year

Semester

2nd semester

CFU

1

Hours distribution

13 classroom hours

Lecturers

MATTIA FALCHETTO OSTI

Activity type

Clinica generale medica e chirurgica

SSD

MED/18

Year

5th year

Semester

2nd semester

CFU

2

Hours distribution

25 classroom hours

Lecturers

FRANCESCO MARIA CARRANO

Activity type

Clinica generale medica e chirurgica

SSD

MED/09

Year

5th year

Semester

2nd semester

CFU

2

Hours distribution

25 classroom hours

Lecturers

ALESSANDRO LAVIANO

Main teaching objectives:
The rationale for an integrated approach to clinical medicine and general surgery with clinical oncology and radiotherapy.

General Objectives of the Integrated CourseAcquire the ability to frame, analyze, and solve clinical problems of an oncological, surgical, and internal medicine nature.Identify symptoms, understand therapies, and evaluate the relationships between benefits, risks, and costs. Recognize and manage the side effects of oncological treatments. Develop clinical reasoning skills to be able to solve the most common and relevant clinical problems, whether of medical, surgical, or oncological interest. Understand epidemiological data and the importance of disease prevention in individuals and communities.

Specific Objectives of the Integrated CourseKnowledge and understanding: passing the exam involves acquiring the ability to analyze and solve clinical problems in oncology, internal medicine, and surgery.Ability to apply knowledge and understanding: passing the exam involves acquiring clinical reasoning, problem analysis, and the ability to evaluate epidemiological data and risk factors for development and prevention.Autonomy of judgment: passing the exam involves acquiring the ability to frame a comprehensive and unified assessment of an individual’s overall health status, symptoms, and conditions related to disease.Communication skills: passing the exam involves the ability to clearly and effectively present clinical reasoning from correct diagnosis to the most appropriate therapy, rehabilitation, and prevention.Learning ability: passing the exam involves the

Module: INTERNAL MEDICINE AND GENERAL SURGERY I Oncologia Medica
Requirements: No requirements.


Module: INTERNAL MEDICINE AND GENERAL SURGERY I Medicina Interna
Requirements: No requirements.


Module: INTERNAL MEDICINE AND GENERAL SURGERY I Chirurgia Generale
Foundational Medical Knowledge:
- Human Anatomy and Physiology: A thorough understanding of human body structure and function is critical for comprehending the surgical approach to various oncological presentations. This knowledge base allows students to grasp the anatomical relationships between tumors, surrounding structures, and vital organs, informing surgical decision-making.
- Pathology: Familiarity with fundamental pathological principles and cancer biology is crucial. Students who understand the underlying pathology of different malignancies will be better equipped to appreciate the rationale behind specific surgical interventions.
- General Surgery: Prior exposure to general surgical principles and techniques would be highly beneficial. This course likely builds upon that foundation, assuming a level of knowledge regarding basic surgical approaches and techniques commonly employed in general surgery.

Basic clinical and surgical skills.


Module: INTERNAL MEDICINE AND GENERAL SURGERY I Diagnostica per Immagini e Radioterapia
Successful completion of the propedeutic courses as per decision of the Faculty

Breast cancer: epidemiology, risk factors, diagnosis and therapeutic approach
Esophageal cancer: epidemiology, risk factors, diagnosis and therapeutic approach
Gastric cancer: epidemiology, risk factors, diagnosis and therapeutic approach
Colorectal cancer: epidemiology, risk factors, diagnosis and therapeutic approach
Pancreatic carcinoma: medical and radiotherapeutic approach.
Lung cancer: epidemiology, risk factors, diagnosis and therapeutic approach
Attività Pratiche Professionali (APP):
Treating wounds, ulcers and burns on a simulator
Suturing on a surgical simulator
Removal of superficial skin sutures on a simulator
Performing a systematic examination of the breast on a simulator

Harrison’s Priciples of Internal Medicine, 19th Edition, McGraw Hill.
Sabiston Textbook of Surgery, Elsevier/Saunders

Module: INTERNAL MEDICINE AND GENERAL SURGERY I Oncologia Medica
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Medicina Interna
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Chirurgia Generale
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Diagnostica per Immagini e Radioterapia
N/D

Methods of conducting lessons with frontal teaching

Attendance at the course is mandatory

written/oral examination. There are 30 quizzes in total, with multiple choice. Time available 30 minutes. 1 point for each correct answer
18 is the minimum score to pass the Exam.
The number of oral questions depends on the result of the written exam, and being an integrated course, the final grade is an expression of each teacher's evaluation.

Module: INTERNAL MEDICINE AND GENERAL SURGERY I Oncologia Medica
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Medicina Interna
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Chirurgia Generale
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Diagnostica per Immagini e Radioterapia
Respiratory failure in cancer patients
Intestinal failure in cancer patients receiving curative therapy

Module: INTERNAL MEDICINE AND GENERAL SURGERY I Oncologia Medica
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Medicina Interna
N/D
Module: INTERNAL MEDICINE AND GENERAL SURGERY I Chirurgia Generale

• General principles of oncologic
  surgery
  
   
  
  ·       Historical
  evolution of oncologic surgery and milestones in cancer treatment.
  
  ·       Fundamental
  concepts: oncologic radicality, resection margins, en bloc resection, and
  anatomical barriers.
  
  ·       Lymphadenectomy
  principles and rationale.
  
  ·       Role of
  reconstructive and oncoplastic techniques in modern surgery.
  
  ·       The surgeon’s
  role within the multidisciplinary tumor board (MDT).


• Oncologic emergencies
  
   
  
  ·       Definition
  and classification of oncologic emergencies.
  
  ·       Surgical
  management of obstruction, perforation, hemorrhage, and infection in cancer
  patients.
  
  ·       Palliative
  versus curative intent in emergency settings.
  
  ·       Ethical and
  clinical decision-making in fragile oncologic patients.


• Obesity and cancer
  
   
  
  ·       Epidemiological
  links between obesity and increased cancer risk (GI, breast, endometrial,
  pancreatic).
  
  ·       Pathophysiological
  mechanisms (inflammation, insulin resistance, adipokines).
  
  ·       Bariatric
  surgery as a preventive strategy for cancer.
  
  ·       Long-term
  outcomes and evidence-based perspectives.


• Esophageal cancer
  
   
  
  ·       Epidemiology
  and major risk factors (tobacco, alcohol, Barrett’s esophagus, obesity).
  
  ·       Clinical
  presentation and diagnostic pathways (endoscopy, biopsy, staging with
  CT/PET/endo-US).
  
   
  
  ·       Surgical
  options: transthoracic and transhiatal esophagectomy, minimally invasive and
  hybrid approaches.
  
  ·       Postoperative
  complications (anastomotic leak, pulmonary complications, reflux).
  
  ·       Integration
  with chemotherapy and radiotherapy.


• Gastric cancer
  
   
  
  ·       Epidemiology,
  risk factors (H. pylori, diet, genetics).
  
  ·       Histological
  and molecular classifications.
  
  ·       Diagnostic
  work-up and staging systems (TNM, Lauren classification).
  
  ·       Surgical
  treatment: subtotal vs total gastrectomy, lymphadenectomy (D1 vs D2).
  
  ·       Reconstruction
  techniques (Billroth, Roux-en-Y).
  
  ·       Role of
  perioperative chemotherapy.


• Colon cancer
  
   
  
  ·       Adenoma–carcinoma
  sequence and hereditary syndromes (FAP, Lynch).
  
  ·       Modifiable
  and non-modifiable risk factors.
  
  ·       Screening and
  early detection (FOBT, colonoscopy).
  
  ·       Principles of
  colectomy: segmental resections, extended resections, laparoscopic/robotic
  approaches.
  
  ·       Complications
  and enhanced recovery protocols.


• Rectal cancer
  
   
  
  ·       Epidemiology
  and impact of early-onset rectal cancer.
  
  ·       Role of
  neoadjuvant therapy (chemoradiation).
  
  ·       Principles of
  Total Mesorectal Excision (TME).
  
  ·       Sphincter-preserving
  surgery (low anterior resection, intersphincteric resection) versus
  abdominoperineal resection.
  
  ·       Local
  excision techniques (TEM, TAMIS) and patient selection.
  
  ·       Functional
  outcomes and management of complications (leak, stenosis, low anterior
  resection syndrome).


• Breast cancer
  
   
  
  ·       Epidemiology
  and global trends.
  
  ·       Risk factors:
  genetic (BRCA1/2), reproductive, hormonal, lifestyle.
  
  ·       Molecular
  classification: Luminal A/B, HER2-enriched, triple-negative.
  
  ·       Diagnostic
  work-up (imaging, biopsy, receptor status).
  
  ·       Surgical
  management: breast-conserving surgery vs mastectomy; sentinel lymph node biopsy
  vs axillary dissection.
  
  ·       Oncoplastic
  and reconstructive surgery.
  
  ·       Integration
  of systemic therapies.


• Pancreatic cancer
  
   
  
  ·       Epidemiology,
  risk factors (smoking, chronic pancreatitis, diabetes, genetic syndromes).
  
  ·       Clinical
  presentation and staging.
  
  ·       Surgical
  treatment: pancreaticoduodenectomy (Whipple), distal pancreatectomy, total
  pancreatectomy.
  
  ·       Complications
  (pancreatic fistula, delayed gastric emptying).
  
  ·       Role of
  adjuvant and neoadjuvant therapies.


• Liver cancer
  
   
  
  ·       Primary liver
  cancer: hepatocellular carcinoma (HCC) – risk factors (HBV, HCV, cirrhosis,
  NAFLD).
  
  ·       Secondary
  liver tumors: colorectal liver metastases.
  
  ·       Staging and
  liver function assessment (Child-Pugh, MELD).
  
  ·       Surgical
  techniques: anatomical vs non-anatomical resections, minimally invasive
  approaches.
  
  ·       Principles of
  portal vein embolization, ALPPS, and transplantation.
  
  ·       Integration
  with locoregional therapies and systemic treatments.


• Diverticular disease and differential
  diagnosis with cancer
  
   
  
  ·       Epidemiology
  and pathophysiology of diverticulosis and diverticulitis.
  
  ·       Surgical
  approaches to complicated diverticulitis (Hinchey classification).
  
  ·       Differentiation
  between diverticulitis and colorectal carcinoma.
  
  ·       Surgical
  strategies in the overlap of diverticular disease and cancer.

• Acute respiratory failure
  • Books: Harrison’s Principles of Internal Medicine, 21th Edition, McGraw Hill.Fradà & Fradà. Semeiotica Medica. Piccin EditoreAmoroso & Rossi Fanelli. Medicina Interna, l'essenziale. Antonio Delfino Editore


• Chronic respiratory failure
  • Books: Harrison’s Principles of Internal Medicine, 21th Edition, McGraw Hill.Fradà & Fradà. Semeiotica Medica. Piccin EditoreAmoroso & Rossi Fanelli. Medicina Interna, l'essenziale. Antonio Delfino Editore


• Fever
  • Books: Harrison’s Principles of Internal Medicine, 21th Edition, McGraw Hill.Fradà & Fradà. Semeiotica Medica. Piccin EditoreAmoroso & Rossi Fanelli. Medicina Interna, l'essenziale. Antonio Delfino Editore