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Bohomolets 3rd year Surgery Tumors
 

Bohomolets 3rd year Surgery Tumors

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By PROF.O. DRONOV ,the head of Surgery department#1

By PROF.O. DRONOV ,the head of Surgery department#1

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    Bohomolets 3rd year Surgery Tumors Bohomolets 3rd year Surgery Tumors Presentation Transcript

    • National Medical O. Bogomolets University General Surgery Department N1 (Head of General Surgery Department - Professor O.I. Dronov ) BASIC OF ONCOLOGY LECTOUR - PROF.O. DRONOV
          • NOMENCLATURE AND CLASSIFICATION
          • NEOPLASIA and NEOPLASM are the scientific designations for cancerous diseases. This group contains a large number of different diseases. Neoplasms can be BENIGN or MALIGNANT
          • CANCER is a widely used word that is usually understood as synonymous with malignant neoplasm . It is occasionally used instead of CARCINOMA , a sub-group of malignant neoplasms. Because of its overwhelming popularity relative to 'neoplasia', it is used frequently instead of 'neoplasia', even by scientists and physicians, especially when discussing neoplastic diseases as a group.
      • TUMOR in medical language simply means swelling or lump, either neoplastic, inflammatory or other. In common language, however, it is synonymous with 'neoplasm', either benign or malignant. This is inaccurate since some neoplasms usually do not form tumors, for example LEUKEMIA or CARCINOMA IN SITU
      • PARANEOPLASIA is a disturbance associated with a neoplasm but not related to the invasion of the primary or a secondary (metastatic) tumour. Disturbances can be hormonal, neurological, hematological, biochemical or otherwise clinical
    • The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 B.C.), considered the "Father of Medicine" Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors HIPPOCRATES (460-370 B.C.)
    • GIOVANNI BATTISTA MORGAGNI (1682-1771) In 1761, Giovanni Morgagni of Padua was the first to do something considered routine today. He performed autopsies to relate the patient's illness to the pathologic findings after death. This laid the foundation for scientific oncology, the study of cancer
    • The famous Scottish surgeon John Hunter (1728-1793) suggested that some cancers might be cured by surgery and described how the surgeon might decide which cancers to operate on. If the tumor had not invaded nearby tissue and was "moveable," he said, "There is no impropriety in removing it" JOHN HUNTER (1728-1793)
    • One of the most famous surgeons of his day, Billroth performed the first oesophagectomy, laryngectomy and gastrectomy for stomach cancer CHRISTIAN ALBERT THEODUR BILLROTH (1829-1873) His work led to "cancer operations" designed to remove all of the tumor together with the lymph nodes in the region where the tumor was located
    • Percival Pott of Saint Bartholomew's Hospital in London described in 1775 an occupational cancer in chimney sweeps, cancer of the scrotum, caused by soot collecting under their scrotum. This research led to many additional studies that identified a number of occupational carcinogenic exposures and led to public health measures to reduce cancer risk PERCIVAL POTT(1715 – 1788)
    • William Stewart Halsted, professor of surgery at Johns Hopkins University, developed the radical mastectomy during the last decade of the 19th century. His work was based in part on that of W. Sampson Handley, the London surgeon who believed that cancer spread outward by invasion from the original growth William Stewart Halsted(1852-1922)
    • He first use of aminopterin and methotrexate in the control of acute childhood leukemia, he has constant leadership in the search for chemical agents against cancer SIDNEY FARBER, M.D.-1903-1973 «FATHER OF CHEMOTHERAPY»
    • Cancers are classified by the type of cell that resembles the tumor and, therefore, the tissue presumed to be the origin of the tumor. The following general categories are usually accepted: CARCINOMA malignant tumors derived from EPITELIAL cells. This group represent the most common cancers, including the common forms of BREAST, PROSTATE, LUNG and COLON cancer. LYNPHOMA and LEUCEMIA: malignant tumors derived from BLOOD and BONE MARROW cells SARCOMA: malignant tumors derived from CONNECTIVE TISSUE, or MESENCHYMAL cells
    • MESOTELIOMA : tumors derived from the MESOTELIAL cells lining the PERITONEUM and the PLEURA GLIOMA: tumors derived from glia, the most common type of BRAIN cell GERMINOMA: tumors derived from germ cells, normally found in the TESTICAL and OVARY CHORIONCARCINOMA: malignant tumors derived from the PLACENTA
    • GASTRIC LYMPHOMA
    • SARCOMA
    • MESOTELIOMA
    • MELANOMA
    • METASTATIC MELANOMA
          • OVERALL STAGE GROUPING
      • This system uses numerals I, II, III, and IV (plus the 0) to describe the progression of cancer.
      • Stage 0
      • Stage I cancers are localized to one part of the body
      • Stage II cancers are locally advanced, as are Stage III cancers. Whether a cancer is designated as Stage II or Stage III can depend on the specific type of cancer; for example, in Hodgkin’s disease, Stage II indicates affected lymph nodes on only one side of the diaphragm, whereas Stage III indicates affected lymph nodes above and below the diaphragm. The specific criteria for Stages II and III therefore differ according to diagnosis
      • Stage IV cancers have often metastasized, or spread to other organs or throughout the body
      • Within the TNM system, a cancer may also be designated as recurrent, meaning that it has appeared again after being in remission or after all visible tumor has been eliminated. Recurrence can either be local, meaning that it appears in the same location as the original, or distant, meaning that it appears in a different part of the body
    • TNM CLASSIFICATION OF MALIGNANT TUMOURS (TNM) is the cancer staging system developed and maintained by the International Union Against Cancer (UICC) to achieve consensus on one globally recognised standard for classifying the extent of spread of cancer The TNM classification is also used by the American Juint Commette of Cancer (AJCC) and the International Federation of Gynecologi and Obstetrics (FIGO). In 1987, the UICC and AJCC staging systems were unified into a single staging system
      • T (a,is,(0),1-4): size or direct extent of the primary tumour
      • N (0-3): spread to regional lymph nodes
      • M (0/1): distant metastasis
            • MANDATORY PARAMETERS ('T', 'N', AND 'M')
      • OTHER PARAMETERS
      • G (1-4): the grade of the cancer cells (i.e. they are "low grade" if they appear similar to normal cells, and "high grade" if they appear poorly differentiated)
      • R (0/1/2): the completeness of the operation ( resection-boundaries free of cancer cells or not)
      • L (0/1): invasion into lymphatic vessels
      • V (0/1): invasion into vein
      • C (1-4): a modifier of the certainty (quality) of the last mentioned parameter
      • PREFIX MODIFIERS
      • c: stage given by clinical examination of a patient. The c-prefix is implicit in absence of the p-prefix
      • p: stage given by pathologic examination of a surgical specimen
      • y: stage assessed after neoadjuvant therapy
      • For the T, N and M parameters exist subclassifications for some cancer-types (e.g. T1a, Tis, N1i)
      • The age of peak incidence of cancer in children occurs during the first year of life. LEUCEMIA (usually ALL) is the most common infant malignancy (30%), followed by the CENTRAL NERVOUS SYSTEM CANCERS and NEUROBLASTOMA. The remainder consists of WILMS’ TUMOR, LYMPHOMAS, RABDOMYOSARCOMA (arising from muscle), RETINOBLASTOMA, OSTEOSARCOMA and EWING’S SARCOMA
      CHILDHOOD CANCERS
    • ADRENAL NEUROBLASTOMA
    • RETINOBLASTOMA
    • EWING’S SARCOMA
    • WILMS’ TUMOR
    • Female and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types Relative survival for infants is very good for neuroblastoma, WILMS’ TUMOR and RETINOBLASTOMA, and fairly good (80%) for leukemia, but not for most other types of cancer
            • Evading APOPTOSIS
            • unlimited growth potential (immortalitization) due to overabundance of TELOMERASE
            • self-sufficiency of GROWTH FACTORS
            • insensitivity to anti-growth factors
            • increased CELL DIVISION rate
            • altered ability to DIFFERENTIATE
            • no ability for CONTACT INHIBITION
            • ability to invade neighbouring TISSUES
            • ability to build METASTASES at distant sites
            • ability to promote blood vessel growth (ANGIOGENESIS)
      MALIGNANT TUMORS CELLS HAVE DISTINCT PROPERTIES:
    • METASTASIS IS THE SPREAD OF CANCER FROM ITS PRIMARY SITE TO OTHER PLACES IN THE BODY Over 10% of patients presenting to oncologial units will have metastases without a primary tumor found. In these cases, doctors refer to the primary tumor as "unknown" or "occult", and the patient is said to have cancer of unknown primary origin The use of immunohistochemystri has permitted pathologists to give an identity to many of these metastases. However, imaging of the indicated area only occasionally reveals a primary. In rare cases (e.g. of melanoma ) no primary tumor is found even on autopsy. It is therefore thought that some primary tumors can regress completely, but leave their metastases behind
    • Lymph node with clusters of tumor cells, atypical, with carcinomatous character (H&E, ob. x10)
    • BRAIN METASTASES
    • BONE METASTASES
    • LIVER METASTASES
    • SKIN METASTASES
      • Most forms of cancer are "sporadic", and have no basis in heredity. There are, however, a number of recognised syndromes of cancer with a hereditary component, often a defective tumor suppressor allaele.
      • Examples are:
      • certain inherited mutations in the genes BRCA 1 and BRCA2 are associated with an elevated risk of breast cancer and ovarian cancer
      • tumors of various endocrine organs in multiple endocrine neoplasia (MEN types 1, 2a, 2b)
      HEREDITY CANCER
      • Li-Fraumeni syndrom (various tumors such as osteosarcoma, breast cancer, soft-tissue sarcoma, brain tumors) due to mutations of p 53
      • Turcot syndrome ( brain tumors and colonic polyposis)
      • Familial adenomatous polyposis an inherited mutation of the APC gene that leads to early onset of colon carcinoma
      • Retinoblastoma in young children is an inherited cancer
      • Roughly, cancer symptoms can be divided into three groups:
      • Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice
      • Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptisys, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain , it is often not the first symptom
      SIGNS AND SYMPTOMS
    • Systemic symptoms : weight loss, poor apprtite and caxecia(wasting), excessive sweating (night sweat), anemia and specific paraneoplastic phrenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes Every single item in the above list can be caused by a variety of conditions (a list of which is referred to as the differential diagnosis). Cancer may be a common or uncommon cause of each item
    • X-RAY EXAMINATION LUNG METASTASES
          • MODERN IMAGING TECHNOLOGY FOR DIAGNOSIS OF CANCER
    • CT SCAN: PANCREATIC TUMOR WITH LIVER METASTASES
    • Transverse and sagittal ultrasound images show an hepatocellular carcinoma in a cirrhotic liver In same patient, Gadolinium contrast MR image shows transient enhancement of the tumor during the arterial phase
    • Unfavourable prognosis tumour. High-resolution T2-weighted fast spin-echo image and corresponding histological wholemount section. The MRI scan shows widespread discontinuous tumour deposits (arrows) (representing either nodes replaced by tumour or tumour satellites) within the mesorectum, but not extending to the mesorectal fascia (arrow heads). This is confirmed as node-positive disease on corresponding wholemount histology section
    • MRI: LUNG’S TUMOR
    • MRI: BRAIN’S TUMOR
    • PET scans show the metabolic activity of different areas in the body using radioactively labelled glucose. Areas of high glucose consumption are represented as dark spots, and signify areas of growth. The PET scan can also show whether the cancer has metastasized, or spread to other areas in the body .In this picture the brain and genitalia show high metabolic activity as well - this is because the brain requires a vast amount of energy to function, and the genitalia are the site of sperm production (meiosis) PET SCAN
    • PET SCAN
            • TUMOR MARKERS are substances that can be found in abnormal amounts in the blood, urine, or tissues of some patients with cancer
            • Different tumor markers are found in different types of cancer
            • Tumor markers may be used to help diagnose cancer, predict a patient’s response to particular therapies, check a patient’s response to treatment, or determine if cancer has returned
            • In general, tumor markers cannot be used alone to diagnose cancer; they must be combined with other tests
            • Researchers continue to study tumor markers and to develop more accurate methods to detect, diagnose, and monitor cancer
    • IMMUNOHISTOCHEMISTRY is a method of analyzing and identifying cell types based on the binding of antibodies to specific components of the cell. It is sometimes referred to as immunocytochemistry CD 117 positive
          • EXAMPLES OF DIAGNOSTIC IMMUNOHISTOCHEMICAL MARKERS
          • Carcinoembryonic antigen (CEA): used for identification of Adenocarcinomas. Not specific for site.
      • CD 15 and CD30: used for Hodgkin ’s disease
      • Alfafetoprotein: for yolc sac tumors and hepatocellular carcinoma
      • CD117: for gastrointestinal stromal tumors (GIST)
      • Prostate specific antigen (PSA): for prostate cancer
        • BREAST CANCER
        • CASE STUDY
        • BREAST CANCER
          • HISTORY & SYMPTOMS:
      • A fifty-nine year old white woman presented to the radiology department for her routine yearly mammogram. Her family has a history of breast cancer, both her mother and her sister had developed breast cancer. The woman had 2 children both of whom were born after her 35th birthday. This late menopausal woman recently experienced breast pain. Previous mammogram and ultrasound examinations had not revealed any abnormal findings
    • PHYSICAL EXAMINATION Breasts were assymetric, the left being enlarged, reddened and painful. There was some nipple discharge. The left breast was tender with a single, firm and irregular mass evident on palpation . The supraclavicular lymph nodes were enlarged
          • DIAGNOSTIC TESTS
      • Bilateral mammography: dense irregular mass approximately 5 cm in diameter, clustered polymorphic microcalcifications. Right breast normal
      • Chest radiographs : no evidence of metastases
      • Open excisional lymph node biopsy: positive involvement of supraclavicular nodes
      • Needle biopsy: infiltrating ductal adenocarcinoma with fibrosis
      • Hormone receptor assay: estrogen receptor positive
      • Genetic screening: mutation in BRCA1 gene
          • Diagnosis Ductal carcinoma of the breast with regional lymph node involvement (stage III)
    • CHEMOTHERAPY is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. It interferes with cell division in various possible ways, e.g. with the duplication of DNA or the separation of newly formed chromosomes. Most forms of chemotherapy target all rapidly dividing cells and are not specific for cancer cells. Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (e.g. intestinal lining). These cells usually repair themselves after chemotherapy
    • COMBINED MODALITY CHEMOTHERAPY is the use of drugs with other CANCER TREATMENT, such as RADIATION THERARYor SURGERY. Most cancers are now treated in this way COMBINATION CHEMOTHERAPY is a similar practice which involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest advantage is minimising the chances of resistance developing to any one agent
    • In NEOADJUVANT chemotherapy ( pre operative treatment) initial chemotherapy is aimed for shrinking the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective
    • ADJUVANT CHEMOTHERAPY ( post operative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. This can help reduce chances of resistance developing if the tumour does develop. It is also useful in killing any cancerous cells which have spread to other parts of the body. This is often effective as the newly growing tumours are fast-dividing, and therefore very susceptible
    • PALLIATIVE CHEMOTHERAPY is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, a better toxicity profile is generally expected
      • Radiation therapy(also called radiotherapy, X-ray therapy, or irradiation) is the use of ionizing radiation to kill cancer cells and shrink tumors. Radiation therapy can be administered externally via external beam radiotherapy (EBRT) or internally via brachytherapy
      • The effects of radiation therapy are localised and confined to the region being treated. Radiation therapy injures or destroys cells in the area being treated (the "target tissue") by damaging their genetic material, making it impossible for these cells to continue to grow and divide
      RADIATION THERAPY
    • PREVENTIVE (PROPHYLACTIC) SURGERY is done to remove body tissue that is not malignant (cancerous) but is likely to become malignant. For example, this type of surgery may be used if you have a precancerous condition such as polyps in the colon
    • FAMILIAL ADENOMATOUS POLYPOSIS
    • DIAGNOSTIC SURGERY is used to get a tissue sample to tell whether or not it is cancerous or to tell what type of cancer it is The diagnosis of cancer often can be confirmed only by looking at the cells under a microscope. Several surgical techniques can be used to obtain a sample. These are described in the next section
    • FINE NEEDLE ASPIRATION BIOPSY Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to withdraw a small amount of tissue from a tumor. If the tumor canВ’t be felt near the surface of the body, the needle can be guided into the tumor by viewing it with an imaging technique such as an ultrasound or computed tomography scan. The main advantage of FNA is that it does not require a surgical incision (cutting through the skin). A drawback is that in some cases the needle canВ’t remove enough tissue for a definite diagnosis. A more invasive type of biopsy may then be needed
    • NEEDLE CORE BIOPSY This type of biopsy uses a slightly larger needle. The advantage of core biopsy is that it usually collects enough of a sample to diagnose the tumor. A core biopsy can be aspirated (removed) with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging techniques if the tumor is too deep to be felt
    • EXCISIONAL OR INCISIONAL BIOPSY These procedures involve a surgeon cutting through the skin to remove the entire tumor (excisional biopsy) or a small part of a large tumor (incisional biopsy). They can often be done with local or regional anesthesia (numbing medicine used just in the area of the biopsy). If the tumor is inside the chest or abdomen, general anesthesia (putting you into a deep sleep) may be needed.
    • STAGING SURGERY helps determine the extent and the amount of disease. While the physical exam and the results of lab and imaging tests can help determine the clinical stage of the cancer, surgical staging is usually a more accurate assessment of how far the cancer has spread
    • CURATIVE SURGERY is the removal of a tumor when it appears to be confined to one area. It is done when there is hope of taking out all of the cancer. Curative surgery is thought of as primary treatment of the cancer. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. In some cases, radiation therapy is actually used during an operation (intraoperative radiation therapy)
    • TOTAL MESORECTAL EXCISION (TME)
    • PANCREATECTOMY+GASTRECTOMY+ LYMPHADENECTOMY
    • DEBULKING (CYTOREDUCTIVE) SURGERY is done when removing a tumor entirely would cause too much damage to an organ or surrounding areas. In these cases, the doctor may remove as much of the tumor as possible and then try to treat whatВ’s left with radiation therapy or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary
    • PALLIATIVE SURGERY is used to treat complications of advanced disease. It is not intended to cure the cancer. It can also be used to correct a problem that is causing discomfort or disability. For example, some cancers in the abdomen may grow large enough to obstruct (block off) the intestine. This may require surgery for effective relief. Palliative surgery may also be used to treat pain when it is hard to control by other means
    • RIGHT HEMIHEPATECTOMY+CRYOABLATION OF RESIDUAL TUMOR
    • Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a catheter port can be surgically placed into a large vein. The catheter can then be used to deliver chemotherapy treatments or draw blood for testing, reducing the number of needle sticks needed
    • restorative (reconstructive) surgery is used to restore a personв’s appearance or the function of an organ or body part after primary surgery. examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers RESTORATIVE (RECONSTRUCTIVE) SURGERY
    • RESTORATIVE (RECONSTRUCTIVE) SURGERY The transverse rectus abdominis myocutaneous (TRAM) flap surgery involves construction of a breast from the lower abdominal skin and fatty tissue. In a pedicled TRAM procedure, the tissue's own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision
    • LASER SURGERY A LASER IS A HIGHLY FOCUSED AND POWERFUL BEAM OF LIGHT ENERGY, WHICH CAN BE USED IN MEDICINE FOR VERY PRECISE SURGICAL WORK SUCH AS REPAIRING A DAMAGED RETINA IN THE EYE. IT CAN ALSO BE USED TO CUT THROUGH TISSUE (INSTEAD OF USING A SCALPEL) OR TO VAPORIZE CANCERS OF THE CERVIX, LARYNX (VOICE BOX), LIVER, RECTUM, OR SKIN
    • SOME SURGERIES CAN BE MADE LESS INVASIVE BY USING LASER LIGHT. FOR EXAMPLE, WITH FIBER OPTICS THE LIGHT CAN BE DIRECTED TO PARTS OF THE BODY WITHOUT HAVING TO MAKE A LARGE INCISION LASER SURGERY IS ALSO CALLED PHOTOABLATION OR PHOTOCOAGULATION. THIS TYPE OF SURGERY IS OFTEN USED TO RELIEVE SYMPTOMS, SUCH AS WHEN LARGE TUMORS PRESS ON THE WINDPIPE OR ESOPHAGUS, CAUSING PROBLEMS WITH BREATHING OR EATING
    • CRYOSURGERY CRYOSURGERY INVOLVES THE USE OF A LIQUID NITROGEN SPRAY OR A VERY COLD PROBE TO FREEZE AND KILL ABNORMAL CELLS. THIS TECHNIQUE IS SOMETIMES USED TO TREAT PRECANCEROUS CONDITIONS SUCH AS THOSE AFFECTING THE CERVIX. CRYOSURGERY IS ALSO BEING STUDIED AS A TREATMENT OF SOME CANCERS SUCH AS THOSE OF THE PROSTATE
    • CRYOABLATION OF LIVER METASTASES
    • ELECTROSURGERY HIGH-FREQUENCY ELECTRICAL CURRENT CAN BE USED TO DESTROY CELLS. IT IS USED FOR SOME CANCERS OF THE SKIN AND MOUTH
    • MOHS SURGERY MOHS MICROGRAPHIC SURGERY, ALSO CALLED MICROSCOPICALLY CONTROLLED SURGERY, IS A TECHNIQUE TO REMOVE CERTAIN SKIN CANCERS BY SHAVING OFF ONE LAYER AT A TIME. AFTER EACH LAYER IS REMOVED, A SPECIALLY TRAINED DERMATOLOGIST OR PATHOLOGIST LOOKS AT THE TISSUE LAYER UNDER A MICROSCOPE. WHEN ALL THE CELLS LOOK NORMAL UNDER THE MICROSCOPE, THE SURGEON STOPS REMOVING LAYERS OF TISSUE
    • THIS TECHNIQUE IS USED WHEN THE EXTENT OF THE CANCER IS NOT KNOWN OR WHEN AS MUCH HEALTHY TISSUE AS POSSIBLE NEEDS TO BE PRESERVED (AS IN CANCERS AROUND THE EYE). IT IS PERFORMED UNDER LOCAL ANESTHESIA BY A SPECIALLY TRAINED SURGEON
    • CHEMOSURGERY IS AN OLDER NAME FOR THIS SURGERY AND REFERS TO CERTAIN CHEMICALS APPLIED TO THE TISSUE BEFORE IT IS REMOVED THE PROCEDURE DOES NOT INVOLVE USE OF CANCER CHEMOTHERAPY DRUGS
    • OTHER FORMS OF SURGERY HIGH INTENSITY FOCUSED ULTRASOUND MICROWAVES OR RADIO WAVES (RADIOFREQUENCY ABLATION) GAMMA KNIFE AND CYBERKNIFE
    • PRE- Gamma Knife , 6-weeks POST- Gamma Knife severe left arm paralysis paralysis resolved
    • RADIOFREQUENCY ABLATION
    • Considerable research effort is now devoted to the development of vaccines(to prevent infection by oncogenic infectious agents, as well as to mount an immune response against cancer-specific epitopes) and to potential venues for gene therapy for individuals with genetic mutations or polymorphisms that put them at high risk of cancer As of October 2005, researchers found that an experimental vaccine for HPV types 16 and 18 was 100% successful at preventing infection with these types of HPV and, thus, are able to prevent the majority of cervical cancer cases
            • CANCER VACCINES
    • The American Cancer Society has issued guidelines for the use of the prophylactic human papillomavirus vaccine to prevent cervical intraepithelial neoplasia and cervical cancer. The new guidelines, published in the January/February issue of CA: Cancer Journal for Clinicians , address who should be vaccinated and at what age, and summarize policy and implementation issues and implications for screening, based on a formal review of the available evidence
    • SPECIFIC RECOMMENDATIONS FOR HPV VACCINATION ARE AS FOLLOWS: Routine HPV vaccination is recommended for girls 11 and 12 years old Girls as young as age 9 years can receive HPV vaccination. HPV vaccination is also recommended for teenaged girls 13 to 18 years old to catch up on missed vaccine or to complete the vaccination series.
    • The evidence is insufficient at this time to recommend for or against universal vaccination of women 19 to 26 years old in the general population. A decision about whether to vaccinate a woman 19 to 26 years old should be based on an informed discussion between the woman and her healthcare provider regarding her risk for previous HPV exposure and her potential benefit from vaccination. Ideally, the HPV vaccine should be administered before potential exposure to genital HPV through sexual intercourse, because the potential benefit is likely to decrease with an increasing number of lifetime sexual partners. HPV vaccination is not currently recommended for women older than age 26 years or for males.