Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
Ovarian cancer often goes undetected until it has spread within the pelvis and stomach. At this late stage, ovarian cancer is more difficult to treat and can be fatal.
Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss.
Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Surgery and chemotherapy are generally used to treat ovarian cancer.
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
Ovarian cancer often goes undetected until it has spread within the pelvis and stomach. At this late stage, ovarian cancer is more difficult to treat and can be fatal.
Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss.
Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Surgery and chemotherapy are generally used to treat ovarian cancer.
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
A brief discussion over CA Cervix. All newest updates in management protocol and revised by reknowned gynecologistts. Very much helpful for both under and post graduate students/Doctors.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Definition
• Cervical cancer is a preventable HPV-related
malignancy of the uterine cervical mucosa.
• Cervical mucosa: mean tumor arise from epithelium, i.e: type of
tumor is carcinoma (SCC or adenocarcinoma but SCC is the much
more common type).
• The tumor precisely arise from what’s called TZ.
• HPV – related: b/c of HPV is the most important aetiological factor.
• b/c the natural course of the disease is well known, so it deserve to
have screening test, so the disease is preventable condition.
2
3. Epidemiology
• Cervical cancer is the fourth most common
malignancy in women worldwide.
• More common in developing countries b/c of
early sexual activity due to early marriage, low
socioeconomic state & poor nutrition.
• Incidence mainly in women aged between 20 &
49 years with peak incidence in women aged 40-
49 years & the declines gradually thereafter.
3
4. Epidemiology (Cont.)
• Incidence higher in black people & mortality is
twice higher than white people.
• Incidence less in muslems & jewishs.
• In developed countries, the incidence start to
decline in the last decades b/c of screening
program.
4
5. Aetiology
• The cancer occur following CIN which is widely
regarded as a necessary precursor lesion for
carcinoma of cervix.
• CIN is a histological diagnosis and needs
persistent cervical infection with HPV to develop.
• There are about 15 high risk oncogenic subtypes
of HPV, the most common being 16, 18, 31, and
33 & much more common are 16 & 18.
5
6. Risk factors
• Strong:-
• HPV infection (most common factor ever)
• Age group: women aged between 20 & 49 years with peak
incidence in women aged 40-49 & the declines gradually
thereafter.
• HIV infection.
• Early onset of sexual activity (younger than 18).
• Multiple sexual partners.
• Cigarette smoking (as promoter/ precipitating factor).
• Immunosuppression.
6
7. Risk factors (Cont.)
• Weak:-
• All other STDs.
• Oral contraceptive use (adenocarcinoma).
• High parity.
• uncircumcised male partner.
• micronutrient malnutrition.
• low serum folate.
• low vitamin C and E levels.
• alcohol abuse.
• low socioeconomic status.
7
8. Pathophysiology
• The main site of the cancer is TZ.
• TZ: zone at which transformation from squamous
epithelium to columnar one occur at SCJ.
• This continuous metaplasia suggest high mitotic activity
in this area making TZ is the most susceptible site for the
cancer in the cervix.
• This continuous metaplasia kept by acidic PH of vagina,
so as the age of female progress, then metaplasia tend to
creep upward gradually.
8
9. Pathophysiology (Cont.)
• Therefore, in young female TZ lies in
ectocervix while in older female
(postmenopause) lies in endocervix.
• In presence of presistent HPV infection in
addition to co-factor as smoking, metaplasia
will change to dysplasia & then driving CIN.
9
13. Prevention
• Safe sexual health and effective barrier
contraception.
• Vaccines against HPV-16/18:-
• Vaccination can be done in female aged between 9 to 45 yrs but
recommended age for vaccination is 11 to 12 yrs for all adolescents.
• Regular screening by cervical smear.
13
14. Screening
• The NHS Cervical Screening Programme (NHSCSP)
presented since the 1980s.
• Regular cervical screening reduces the risk of death from
cervical carcinoma by 75% (but does not eliminate it).
• cervical cancer Screening is cytological study based on
the natural course of cervical cancer as it detect
possibility of CIN (dysplasia) & depend on cervical smear
(aka; pap smear).
14
15. Types of abnormalities seen in smear:-
• Dyskaryosis
• Increased nuclear/cytoplasmic ratio
• Koilocytosis
• Poikylocytosis
• Mitosis
• Inflammation
All these
changes
suggest
presence of
dysplasia
15
16. Cervical smear – normal cytology. Cervical smear – severe dyskaryosis.
16
17. Results of cervical smear
• Normal
• Abnormal:-
• Inflammation: HPV infected cells + inflammatory cells.
• Dysplasia
o LSIL: HPV infected cells + mild dysplasia
suggesting possibility of CIN-1 on biopsy.
o HSIL: HPV infected cells + moderate dysplasia
suggesting possibility of CIN-2 or CIN-3 on biopsy.
o Cancer: HPV infected cells + severe grades of
dysplasia suggesting invasion on biopsy.
• CIN-1: 1/3
thickness
• CIN-2: 2/3
thickness
• CIN-3: full
thickness
17
19. • The USPSTF and the ASCCP guideline now recommend
screening in women from age 21 to 65 years as following:-
o For general population (low risk group): every 3 years.
o For high risk group (HPV infection, early sexual activity, smoker……etc): annually.
o After subtotal hysterectomy, after Tx of benign lesion or CIN: annually.
• In 2012, USPSTF guideline introduce HPV test which indicated as a
part of screening program with pap smear provided that screening
performed each 5 years instead of 3 years or can be indicated in
women with borderline nuclear changes in smear or unsatisfactory
smear results in highly suspicious women clinically.
19
20. Spread
• Direct/ local spread (infiltration) :-
o Upwards or down: to body of uterus or vagina.
o Lateral (dangerous): to parametria (including LN) & may affect ureter.
o Ant. or post: to bladder or rectum (ulcer, hge, fistula, edema).
• Distant spread/ metastasis by lymphatic: once para-
arotic LN involved, then this signify poor prognosis &
case is incurable.
• Distant spread/ metastasis by blood (rare & late): BLBL.
20
21. Diagnosis
History & examination:-
• Key diagnostic factors:
o presence of risk factors (common).
o abnormal vaginal bleeding (common).
o postcoital bleeding/ contact bleeding (common).
o pelvic pain, dyspareunia (uncommon).
o cervical mass (uncommon).
o cervical bleeding (uncommon).
21
22. Diagnosis (Cont.)
• Other diagnostic factors:
o mucoid or purulent vaginal discharge (common).
o bladder, renal, or bowel obstruction (uncommon).
o bone pain (uncommon).
o Other manifestations of local or distant spread
(uncommon).
o Other manifestations of complications (uncommon).
22
23. Diagnosis (Cont.)
Investigations:-
• 1st test to order:
ResultsTest
mass or bleeding.vaginal or speculum examination
• Raised edge, irregular contour.
• Abnormal blood vessels (mosaic or punctate).
• Aceto-white areas with acetic acid.
• Yellow-areas with Schiller iodine.
colposcopy
Confirms diagnosis histologically and identifies
subtype.
biopsy
Indicated when pap smear positive but unsatisfactory.HPV testing23
27. Diagnosis (Cont.)
• Differential diagnosis:-
o HPV infection
o Pelvic infection
o Nabothian cyst
o Glandular hyperplasia
o Mesonephric remnants
o Endometriosis
o Cervical polyp
o Cervical fibroid
27
28. FIGO system for staging of cervical cancer
• Stage 0: CIN, preinvasive lesion/ no invasion of
BM.
• Stage 1: confined to cervix:
o Stage 1a: microscopic disease/ invasive carcinoma
but not diagnosed unless by biopsy.
o Stage 1b: macroscopic disease/ visible invasive
carcinoma.
28
29. FIGO system for staging of cervical
cancer (Cont.)
• Stage 2: extend/infiltrate beyond cervix but
not to pelvic side wall (parametria) or extend
to upper 2/3 of vagina:
o Stage 2a: infiltrate upper 2/3 of vagina.
o Stage 2b: infiltrate parametria.
29
30. FIGO system for staging of cervical
cancer (Cont.)
• Stage 3: extend/ infiltrate pelvic side wall or
lower 1 /3 of vagina or associated with non-
functioning kidney or hydronephrosis:
o Stage 3a: infiltrate lower 1 /3 of vagina.
o Stage 3b: infiltrate pelvic side wall or associated
with non-functioning kidney or hydronephrosis.
30
32. FIGO system for staging of cervical
cancer (Cont.)
• Stage 4: extend out of true pelvis or infiltrate
bladder or rectum:
o Stage 4a: locally advanced/ extend to adjacent
organ as bladder or bowel.
o Stage 4b: distant metastasis/ extent out of true
pelvis.
32
33. UICC staging by TMN system
Less commonly used. T staging corresponds to FIGO
staging.
• TX, NX, MX: primary tumor, nodes, or metastases
not assessed.
• N0, M0: Nodes or metastases not involved.
• N1, M1: Nodes or metastases involved.
• Tis: Carcinoma in situ (correspond to higher
grades of CIN).
33
34. Treatment
Patients with cervical cancer classified according stage of disease
at time of presentation for therapeutic purposes into:-
• Non-pregnant patients:-
o Microinvasive disease: stage Ia1.
o Early stage disease: stage Ia2 to IIa.
o Locally advanced disease: stage IIb to IVa.
o Metastatic disease: stage IVb.
• Pregnant patients: same stages & all of them are treated by
same lines of treatment.
In non-
pregnant
patient, each
stage has its
own line of
treatment.
34
37. Complications
• Bleeding.
• Bladder instability after radical hysterectomy
• Radiation complications: vaginal stenosis, atrophy,
fibrosis, bladder instability, lymphoedema & bowel or
bladder fistulae.
• Leg oedema after lymphadenectomy.
• Excision & ablation techniques complications: preterm
birth.
• Long term sexual dysfunction.37
38. Prognosis
• Most recurrence happens within 2 years.
• The 5-year survival depends on the stage of the
tumor:
o Stage IA1 - 100%.
o Stage IB2-IIB - 50% to 70%.
o Stage III - 30% to 50%.
o Stage IV - 5% to 15%.
38
39. Abbreviations:
• USPSTF: United States Preventive Services Task Force
• ASCCP: American Society for Colposcopy and Cervical Pathology
• FIGO: International Federation of Gynecology and Obstetrics
• UICC: International Union Against Cancer
Sources:
• Oxford Handbook of Obstetrics and Gynaecology 3rd Ed. (2013)
• BMJ: Cervical Cancer: Nov 10, 2017
• Gynaecology by Ten Teachers, 19th Ed. (2011)
• Ain-Shams University Gynaecology curriculum (2013)
• Kasr-Alainy University Gynaecology curriculum (2014)
39