EURACAN expertise

 

Key diagnostic tests and highly specialised interventions

  • Biopathology platform with standard pathology, histology, diagnostic molecular biology.
  • Tumour Banks with frozen tissue collection.
  • Network of expert pathologists.
  • Molecular characterization on molecular platform ( FISH, PCR, NGS, CGH…) with capacity of evolution (WES, WGS).
  • Dedicated imaging platform with MRI, CTscan, PET CT and other nuclear medicine platforms with specific tracers.
  • Interventional radiology platforms, with specialized  radioloists capable to perform complex biopsies.
  • Surgical team with dedicated expertises for diagnostic biopsies.
  • Dedicated endoscopic teams for biopsy, staging of upper and lower digestive tract (G5), and thoracic tumor (G8), or lower urinary  tract (G3). Mediastinoscopy. Colposcopy. Anuscopy.
  • Nuclear medicine  with dedicated diagnostic tracers specific for each pathological conditions/domains: PET, gamma camera
  • Genetic counselling and platforms for molecular characterisation of genetic predispositions, for patient with familial history of cancer.
  • Availability of clinical practice guidelines  for diagnosis of the specific tumors in the 10 domains and evidence of their implementation at the HCP level.
  • Diagnostic multidisciplinary tumor board involving all specialists (radiologists, pathologists, surgeons, radiotherapist, medical & specialty oncologist, molecular biologist prior to first treatment.
  • Predictive molecular tests such as DNA tests to identify mutations associated with increased cancer incidence in the  10 domains and predictive markers for response/toxicity of treatment.

 

Key treatments, resources or procedures

  • Expert organ specialist surgery with multidisciplinary assessment  prior to surgery. SLN technique. Mutidisciplinary surgical procedures involving organ specialist, plastic, vascular surgery,...
  • Conventional and highly specialized radiotherapy: tomotherapy, cyberknife,  protonbeam therapy, carbon ion therapy,  brachytherapy
  • Medical oncology a/o organ specialist oncology facilities with access to all  options of  standard  cytotoxic, hormonal & targeted treatments, in  in-patient setting & out-patient settings
  • Dedicated nuclear medicine department  with access to metabolic  radiotherapy in specific rare cancer types & domain
  • Interventional radiology platform, capable to perform complex treatment for local & metastatic diseases in specific conditions : RFA, isolated limb perfusions, cryotherapy…
  • Multidisciplinary tumor board involving all specialists (radiologists, pathologists, surgeon,  radiotherapist,  medical & specialist organ oncologist, molecular biologist prior to first treatment)
  • Dedicated molecular biology platform able to perform and report on predictive and prognostic  biomarkers  (sequencing, others) for response to standard treatment
  • Dedicated clinical research plaforms for all types of clinical trials, from phase I, including first in human, to phase  II, III, and  IV, & cohort studies.
  • Supportive care facility, with psychological support, pain control, rehabilitation,  for optimal patient care , before , during, and after treatment procedures. Cardio, neuro & relevant specialties.
  • Organisation and procedures enabling patient referral within and  across countries for complex diagnostic or treatment  procedures
  • Established databases of patients with rare cancers treated in individual institutions and enabling quantification of activity as well as qualitative description
  • Availability of clinical practice guidelines for treatment and patient management. Evidence of their implementation at the HCP level.

 

Multidisciplinary team (MDT)

Rare cancers are heterogeneous tumours in terms of histology and organs of origin. Molecular classifications are rapidly progressing in all types of cancers, including rare cancers, introducing an additional layer of complexity which needs to be taken in account for the optimal patient management. Fragmentation of rare cancers is therefore a strong trend in rare tumours. In centres of EURACAN, not all expertise may be present in the core and extended multidisciplinary groups of the different domains. Therefore collaboration between EURACAN full members and also forthcoming affiliated centres will be implemented to enable full coverage of such expertise in all domains.

The definition of core multidisciplinary teams and extended multidisciplinary teams is SPECIFIC FOR EACH DOMAIN. It is related with the nature of the disease, its stage, its curability and therapeutic options. Three angles were considered to define the core and the extended centre multidisciplinary teams specific for each domain:

1) The need for a timely accurate histological and molecular diagnosis.

2) The integration of the patients in an efficient therapeutic pathway of excellence.

3) The specific requirements of tumour treatments in each domain

The participation of core multidisciplinary teams should be as early as possible for all patients, ie. at the time of initial histological diagnosis and before any surgical procedure are undertaken. All specialities involved in this aspect of the management must therefore be present: specialized surgeon, specialized radiologist, pathologist, molecular biologist were relevant, medical oncologist, radiotherapist etc., i.e. all specialties involved in the first steps of management of these patients. Depending on the type of disease, additional specialists may be required in this core team (eg. endocrinologist for endocrine tumours, gastroenterologist, and endoscopist for GI tumours, nuclear medicine specialist for NET, etc.). As expected, the extended multidisciplinary specialist team will also vary in the different domains: organ specialists, nutritionist, rehabilitation medicine, stomatherapist, palliative care specialist, medical oncologists involved in early phase clinical trials, social workers maybe part of these extended teams.

When these different specialties are not available on a single site, organized cooperation between two or more reference centers, or between affiliated centers (one or more) and a full member of euracan may take place. This will be a key strategy of euracan to enable the efficient integration of affiliated centers in the activities of euracan. Interactions between affiliated and full member hcp will be organized across borders. For this reason, the chapters 8d and 8e were filled, even though most centers within euracan are equipped on a single site with all core and extended specialist teams.

 

 

 

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