This document discusses the anatomy, etiology, clinical presentation, staging, and treatment options for carcinoma of the tongue. It notes that carcinoma of the tongue most commonly presents as a non-healing ulcer and can cause symptoms like otalgia, odynophagia, and bleeding. Treatment depends on staging and may involve surgery, radiation therapy, chemotherapy, or a combination. Prognosis decreases with more advanced stage at diagnosis.
CARCINOMA OF THE ORAL CAVITY. Diagnosis and management.tDr. RIFFAT KHATTAK
The Oral Cavity, with it's seven subsites,is a host of multiple epithelial, mesenchymal & glandular structures. Thus, if exposed to multiple risk factors, either in isolation or in combination, could undergo drastic histological changes leading to malgnancies. A thorough clinical examination, diagnosis and timely intervention followed by rehabilitation of the patient, via a multi disciplinary approach is the mainstay of treatment.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Anatomy of Oral cavity
Extends from skin- vermilion junction of lips to
junction of hard and soft palate above
Below it is limited to circumvallate papilla of tongue.
3. Structures included
Lips, Buccal mucosa, Upper and lower alveolar
ridges,the retromolar trigone,anterior two thirds of
tongue,floor of mouth and the hard palate.
Again it is divided into external compartment
vestibule and inner oral cavity proper by alveolar
ridges and teeth.
8. Importance of hard palate :
-Mucosa and periosteum are closely
adherent.
-These foraminas are potential route of
spread of malignancies anteriorly to nasal cavity
and posteriorly to skull base.
-Lymphatic drainage through level II if in
posterior hard palate and both primary hard
palate drains into level I nodes.
-Sensation is by V 2
11. Importance of Retromolar trigone
Mucosa is closely adherent to the ascending
ramus of the mandible.
Carcinoma in this region often invades mandible.
Referred otalgia results from innervation by
V3,lesser palatine nerve, and the
glossopharyngeal nerve.
Lymphatic into Level II nodes.
14. Salient features
Sulcus terminalis divides the tongue into anterior
2/3rd and posterior 1/3rd.
Anterior 2/3rd is part of oral cavity and posterior
1/3rd part of oropharynx.
Anterior part is derived from lateral lingual
swellings of first branchial arch and got lingual
nerve as sensory supply.
17. Innervation and Drainage
Motor : Hypoglossal nerve
Sensory : Lingual/Taste by Chorda tymphani via facial
nerve.
V3 also supplies EE,EAC,TM Tongue malignancy has
referred pain over ear.
Arterial : Lingual artery
Lymphatic : Tip – Level I A
Lateral aspect @ Level II nodes
Medial aspect into Level III nodes
Lateral drains only in Ipsilateral nodes
Medial can drain in both ways.
18. Incidence of Oral malignancy
India continues to report the highest prevalence
of oral cancers globally with 75,000 to 80,000
new cases of such cancers reported every year.
57.5 % of global head and neck cancer occurs in
Asia esp in India.
Head and neck cancer accounts 30% of all
cancers in Male and 11-16% of females in India.
Nearly 2/3rd of oral cancer in India occurs in
Gingivo-buccal sulcus and hence it is popularly
called “Indian oral cancer”.
25. Tobacco use in dose dependent fashion.
Alcohol has synergistic effect.
It takes 20 years for a smoker or tobacco chewer
who abstained from above to clear of their risk of
developing tumor.
In India tobacco along with betel nut chewing
contributes 25 % of cancers in oral cavity.
75% of Squamous cell carcinoma occurs only in 10
% of mucosal areas.
Those are Gingivobuccal sulcus,lateral border of
tongue to retromolar trigone and the anterior tonsillar
pillar.
This is due to flow and pooling of carcinogen
contaminated saliva in these regions.
26. Human papillomaviruses (HPVs) have been
associated with a risk for oral cavity .
These carcinomas may carry a better prognosis and
may respond better to therapy such as radiotherapy.
A nested case-control study suggested that the risk
may be with the HPV-16 serotype, with 50% and
14% of oropharyngeal and oral tongue carcinomas,
respectively, containing HPV-16 DNA.
The EBV is a human herpesvirus that has been
implicated in a number of human malignancies,
including nasopharyngeal carcinoma (NPC).
29. Pathology
Squamous cell carcinoma accounts for 95% of all
malignant tumors in the oral cavity.
Other malignancies involving the oral cavity
include malignant salivary gland lesions, mucosal
melanoma, lymphoma, and sarcoma.
In the earliest recognizable stage, squamous cell
carcinoma appears as firm, pearly plaques or as
irregular, roughened, or verrucous areas of
mucosal thickening.
30.
31. Clinical presentation
Non healing ulcer
Other tell-tale sign of head and neck malignancy
1) Otalgia
2) Odynophagia
3) Bleeding
4) Dysphagia
Pertaining to tongue : Restriction of movement of
tongue,difficulty in pronounciation.
32. Pretreatment evaluation
Complete head and neck examination
Examination under anaesthesia if necessary.
Biopsy(Wedge biopsy) of primary lesion or
suspicious ones.
FNAC of suspicious/enlarged/palpable
lymphnodes.
CT/MRI of primary and neck.
X-ray chest to rule out synchronous primary.
33. Other important things
Dental evaluation
Examination under anaesthesia
1) Direct laryngoscopy and pharyngoscopy
2) Esophagoscopy.
3) Bronchoscopy.
4) Palpation of tongue and oropharynx.
Councelling about speech loss and therapy.
36. Treatment Options
Dr.Haris PS/ OMR36
T1N0, T2N0 Surgery ± RT
RT -External Beam
-Brachytherapy
T3N0, T4N0 Surgery and Post op RT
N+ ± Chemotherapy
T4b, N3, M+ PALLIATION
- Primarily RT ± Chemo
CURATIVE
37. Management
T1-2 => Either Surgery or Radiotherapy.
T3-4 => Combination of chemoradiotherapy
and Surgery.
38.
39. Dr.Haris PS/ OMR39
Advantages
Short time – compliance
Specimen available for HPE
Helps in planning adjuvant treatment
No radiation sequelae
Disadvantages
Tissue & functional loss
Disfigurement
Infection
Bleeding
Mortality
40. Radiation Therapy
They have equal success in controlling T1
lesions.
They are part of treatment
Curative.
Combination of therapy.
Palliative.
41. Pros and Cons of Radiotherapy
Provide better functional result with superior
speech and swallowing.
Disadvantage of altered taste,xerostomia and the
protracted nature of treatment course.
Requires atleast 6 weeks of treatment.
Osteonecrosis of mandible.
Newer technique of IMRT and brachytherapy
reduces above side effects.
46. Prognostic factors
Predictors of Poor prognosis:
Increasing tumor thickness(>4mm)
Poorly differentiated
High grade tumors
Perineural,Vascular and lymphatic invasion.
DNA ploidy status such as aneuploid carry
worst prognosis
Verrucuous Ca has better one