曝光臺 注意防騙 網曝天貓店富美金盛家居專營店坑蒙拐騙欺詐消費者

Defining acceptable risk....................................................................... III-15-2
Defining the risk of recurrence............................................................. III-15-3
Defining the site of recurrence ............................................................. III-15-5
Defining the risk of a particular metastasis
causing incapacitation ....................................................................... III-15-6
Defining the total risk of incapacitation ............................................... III-15-6
Presenting the total risk of incapacitation ............................................ III-15-8
Using certification assessment charts................................................... III-15-8
Tumour markers ...................................................................................III-15-9
References.................................................................................................. III-15-9
ICAO Preliminary Unedited Version — October 2008 III-15-1
Note.— This chapter has been adapted from Chapter 17 of the Joint Aviation Authorities Manual of Civil
Aviation Medicine, 2006.
INTRODUCTION
Every applicant who has been treated for malignant disease will need an individual assessment before
exercising licence privileges, and although this chapter is concerned with pilot certification, many
principles also apply to other categories of licence applicants. Recovery from surgery or radiotherapy
should be assessed. Current curative or adjuvant chemotherapy is incompatible with certification, and
recovery from the effects of such treatments will demand a period of unfit assessment after itt has
finished. If the pilot has recovered from the primary treatment and, as far as can be assessed with
available techniques, there is no residual tumour, then the level of certification will depend on the
likelihood of recurrent disease. This chapter of the guidance material will explore methods that enable the
risk to flight safety posed by air crew who have received treatment for malignant disease to be assessed.
In addition to ensuring that treatment has been effective, pre-requisites for certification after treatment for
malignant disease include satisfactory haematological parameters and no on-going side effects from
therapy.
PRIMARY TREATMENT FOR MALIGNANT DISEASE
Surgery
Surgery is the commonest primary treatment for malignant disease, and is frequently the only treatment.
A return to flying, from the purely surgical aspect, depends on the extent of the surgical operation, and
this can be conveniently broken down into minor, intermediate and major surgery. Examples of minimum
times assessed as unfit for various types of surgery are shown in Table 1. It is stressed that these are
minimum times, and more extensive procedures or any complications with, for example, wound healing
will extend these times.
Extent of surgery Operation example Minimum time assessed as unfit
Minor Excision of mole
Biopsy of lymph node
One week
Intermediate Orchidectomy
for testicular cancer
Four weeks
Major Hemicolectomy
for carcinoma of colon
Twelve weeks
Table 1.– Minimum periods of unfitness after surgery
The medical assessor may consider earlier recertification if recovery is complete, the applicant is
asymptomatic, and there is a minimal risk of complications.
Radiotherapy
Radiotherapy treatment for malignant disease is usually given as an intensive course. The aim of this may
be curative, for example when given to an isolated group of lymph nodes which have proved by biopsy to
contain lymphoma; or as adjuvant treatment, for example to the abdominal nodes following orchidectomy
for a seminoma of the testis, on the assumption that they may contain metastatic tumours. Since most
ICAO Preliminary Unedited Version — October 2008 III-15-2
courses are intensive, there is little time to fly even if the pilot wished to, but many patients undergoing
radiotherapy suffer non-specific systemic effects (tiredness, malaise and nausea) which make it
inadvisable for any pilot to fly whilst receiving such treatment.
Apart from physical symptoms, there are often psychological effects and worries associated with
radiotherapy, which, in common with chemotherapy, may also affect flying ability. Consequently, pilots
should be assessed as unfit during any course of radiotherapy.
Chemotherapy
Pilots should be assessed as unfit during any period of treatment with cytotoxic chemical agents.
These medicines are toxic to normal cells, and in particular to rapidly dividing cells in the bone marrow.
During chemotherapy the patient is routinely tested for normal blood levels of red blood cells and
　
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