The document provides guidelines for the treatment of cutaneous melanoma. It was created by the National Comprehensive Cancer Network (NCCN) and outlines recommendations for evaluating and managing melanoma based on the stage of disease. The guidelines are reviewed regularly and updated based on the latest evidence and consensus among experts. They provide information on diagnosis, pathology, imaging, surgery, radiation, systemic therapies, management of toxicities, follow-up care, and special considerations for different stages of melanoma from 0 to IV.
Soft Tissue Sarcoma, Can we refine the approachMohamed Abdulla
Soft Tissue Sarcoma: Can We Refine The Approach?
1) Soft tissue sarcomas are a heterogeneous group of cancers accounting for 1% of malignancies with over 50 histological subtypes and poor outcomes for metastatic disease.
2) The PALETTE trial found that treatment with pazopanib resulted in a median progression-free survival of 20 weeks compared to 7 weeks for placebo, representing a 65% reduction in risk of disease progression or death.
3) Subgroup analyses showed benefit of pazopanib across patient characteristics including number of prior therapies. Pazopanib was generally well-tolerated with mainly grade 1-2 adverse events.
Melanoma clinical features, pathology and managementsanyal1981
This document discusses malignant melanoma, including its pathogenesis, epidemiology, risk factors, clinical features, histological types, staging, management, and prevention. Key points include:
- Melanoma arises from the malignant transformation of melanocytes. It most commonly occurs on the skin.
- Incidence is highest in fair-skinned populations with a lifetime risk of 1 in 56 for Caucasian males. Risk factors include sun exposure, family history, and numerous moles.
- Clinical features depend on location and include changes to existing moles. Staging uses Breslow depth and Clark level to assess prognosis.
- Management involves wide local excision with sentinel lymph node biopsy for early stages and lymphadenectomy
Poly-ADP-ribose polymerase inhibitors (PARPis) are the most active and interesting therapies approved for the treatment of epithelial ovarian cancer. They have changed the clinical management of a disease characterized, in almost half of cases, by extreme genetic complexity and alteration of DNA damage repair pathways, particularly homologous recombination (HR) deficiency. It is causing a paradigm shift in the first-line treatment of patients with advanced ovarian cancer
This document provides information about brachytherapy treatment for lip cancer. It discusses that lip cancer most commonly affects men over 50 and is usually located on the lower lip. Brachytherapy involves placing radioactive sources inside or near the tumor and is commonly used to treat lip cancers from T1-T3 in size. The document describes the brachytherapy technique which involves inserting applicators such as needles or tubes into the lip under local anesthesia. A dosimetry study is then performed to plan radioactive source placement and treatment times/doses. Brachytherapy allows high dose delivery to the tumor while sparing surrounding healthy tissues.
This document discusses the changing landscape of cancer of unknown primary (CUP) over four decades from 1976 to the present. It describes the evolution from recognition of favorable prognostic subsets in 1976-1986, to improved diagnostic techniques in 1986-1996, to empiric chemotherapy in 1996-2006, and currently to improved pathologic and genetic diagnostic technologies and better outcomes for many CUP patients from 2006 onward. The document provides details on histologic classification, clinicopathologic entities, diagnostic approaches including imaging, histopathology, immunohistochemistry, and molecular analysis, as well as discussion of favorable and unfavorable prognostic subsets and treatment approaches.
This document discusses the A-B-C-D-E's of examining moles and lesions for signs of melanoma. It describes asymmetry, irregular borders, multiple colors, diameters larger than 6mm (eraser size), and elevation as warning signs. The document emphasizes close examination with magnification and monitoring any changing lesions over time. Several pathology reports of excised lesions are then listed.
monarchE trial studied the benefit of adding abimaciclib to endocrine therapy (the standard of care for HR+/Her- early breast cancer) compared to endocrine therapy alone.
Soft Tissue Sarcoma, Can we refine the approachMohamed Abdulla
Soft Tissue Sarcoma: Can We Refine The Approach?
1) Soft tissue sarcomas are a heterogeneous group of cancers accounting for 1% of malignancies with over 50 histological subtypes and poor outcomes for metastatic disease.
2) The PALETTE trial found that treatment with pazopanib resulted in a median progression-free survival of 20 weeks compared to 7 weeks for placebo, representing a 65% reduction in risk of disease progression or death.
3) Subgroup analyses showed benefit of pazopanib across patient characteristics including number of prior therapies. Pazopanib was generally well-tolerated with mainly grade 1-2 adverse events.
Melanoma clinical features, pathology and managementsanyal1981
This document discusses malignant melanoma, including its pathogenesis, epidemiology, risk factors, clinical features, histological types, staging, management, and prevention. Key points include:
- Melanoma arises from the malignant transformation of melanocytes. It most commonly occurs on the skin.
- Incidence is highest in fair-skinned populations with a lifetime risk of 1 in 56 for Caucasian males. Risk factors include sun exposure, family history, and numerous moles.
- Clinical features depend on location and include changes to existing moles. Staging uses Breslow depth and Clark level to assess prognosis.
- Management involves wide local excision with sentinel lymph node biopsy for early stages and lymphadenectomy
Poly-ADP-ribose polymerase inhibitors (PARPis) are the most active and interesting therapies approved for the treatment of epithelial ovarian cancer. They have changed the clinical management of a disease characterized, in almost half of cases, by extreme genetic complexity and alteration of DNA damage repair pathways, particularly homologous recombination (HR) deficiency. It is causing a paradigm shift in the first-line treatment of patients with advanced ovarian cancer
This document provides information about brachytherapy treatment for lip cancer. It discusses that lip cancer most commonly affects men over 50 and is usually located on the lower lip. Brachytherapy involves placing radioactive sources inside or near the tumor and is commonly used to treat lip cancers from T1-T3 in size. The document describes the brachytherapy technique which involves inserting applicators such as needles or tubes into the lip under local anesthesia. A dosimetry study is then performed to plan radioactive source placement and treatment times/doses. Brachytherapy allows high dose delivery to the tumor while sparing surrounding healthy tissues.
This document discusses the changing landscape of cancer of unknown primary (CUP) over four decades from 1976 to the present. It describes the evolution from recognition of favorable prognostic subsets in 1976-1986, to improved diagnostic techniques in 1986-1996, to empiric chemotherapy in 1996-2006, and currently to improved pathologic and genetic diagnostic technologies and better outcomes for many CUP patients from 2006 onward. The document provides details on histologic classification, clinicopathologic entities, diagnostic approaches including imaging, histopathology, immunohistochemistry, and molecular analysis, as well as discussion of favorable and unfavorable prognostic subsets and treatment approaches.
This document discusses the A-B-C-D-E's of examining moles and lesions for signs of melanoma. It describes asymmetry, irregular borders, multiple colors, diameters larger than 6mm (eraser size), and elevation as warning signs. The document emphasizes close examination with magnification and monitoring any changing lesions over time. Several pathology reports of excised lesions are then listed.
monarchE trial studied the benefit of adding abimaciclib to endocrine therapy (the standard of care for HR+/Her- early breast cancer) compared to endocrine therapy alone.
This document compares different staging systems for hepatocellular carcinoma (HCC), including TNM, BCLC, CLIP, Okuda, and others. It discusses the limitations of TNM staging for HCC, as TNM does not consider factors like underlying liver function which are important for prognosis and treatment selection. Other staging systems like BCLC and CLIP provide more prognostic information by incorporating tumor characteristics and liver reserve. While no system is perfect, studies have found BCLC and CLIP provide good stratification of survival for HCC patients treated with different modalities. Ongoing research aims to develop more accurate staging models for HCC given the complexity of the disease and factors influencing prognosis and treatment.
Management of ewings sarcoma & osteosarcomaPRARABDH95
EBRT can play an important role in the management of Ewing sarcoma and osteosarcoma.
For Ewing sarcoma, radiotherapy is commonly used pre-operatively to sterilize the tumor bed, post-operatively for positive or close margins, or definitively when surgery is not possible. Treatment planning aims to cover the pre-treatment tumor volume plus a 2-2.5cm margin using IMRT or 3D-CRT.
For osteosarcoma, radiotherapy can be used definitively for unresectable tumors or adjuvantly after surgery if margins were positive. A dose of 70.2Gy is typically prescribed for definitive cases and 64.8Gy for
Robert L. Ferris, MD, PhD, Ezra Cohen, MD, FRCPC, FASCO, and Quynh-Thu Le, MD, FACR, FASTRO, discuss immunotherapy in head and neck cancer in this CME/CE/CPE activity titled "Understanding the Impact of Immunotherapy on Head and Neck Cancer: A Look at the Science, Practice, and Future of Multimodal Treatment." For the full presentation, downloadable Practice Aids, monograph, complete CME/CE/CPE information, and to apply for credit, please visit us at http://bit.ly/2yqhYFX. CME/CE/CPE credit will be available until November 1st, 2018.
The document discusses contouring and delineation of target volumes for breast cancer radiation therapy. It provides detailed descriptions of the cranial, caudal, medial, lateral, anterior and posterior borders for clinical target volumes (CTVs) in different lymph node regions including axillary levels I-III, supraclavicular, internal mammary, and breast/chest wall. Precise delineation of targets is important for effective radiation treatment while minimizing dose to surrounding healthy tissues.
This document discusses esophageal cancer. Some key points:
- Squamous cell carcinoma and adenocarcinoma are the most common histologies. Risk factors include smoking, alcohol, obesity, and Barrett's esophagus.
- Staging uses the TNM system. Treatment depends on stage but may include surgery, chemotherapy, radiation therapy, or a combination.
- For locally advanced stages, neoadjuvant chemoradiation can improve resectability and survival compared to surgery alone. The MAGIC trial showed improved survival with perioperative chemotherapy compared to surgery alone.
- Prognosis remains poor with 5-year survival rates of 15-20%, though outcomes have improved with multimod
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
Carcinoma of unknown primary (CUP) refers to metastatic cancers where the primary site cannot be identified. It accounts for 2-3% of cancers. Diagnostic workup includes biopsy of the most accessible site and immunohistochemistry (IHC) to identify lineage and potential primary sites. Management depends on specific clinical and pathological features. For cervical adenopathy presentations, combined modality therapy with surgery and radiation is recommended, along with unilateral tonsillectomy to identify potential head and neck primaries. Identification of the primary site can improve treatment by limiting radiation fields.
This document discusses a clinical trial evaluating the combination of ribociclib and endocrine therapy for pre/perimenopausal women with HR+, HER2- advanced breast cancer. The trial aimed to assess whether ribociclib plus an aromatase inhibitor and goserelin improved progression-free survival compared to placebo plus the same endocrine therapies. Key findings were that the combination led to a statistically significant improvement in progression-free survival. Overall survival data were also collected as a secondary outcome.
This document discusses treatment options for triple negative breast cancer (TNBC). It begins with a case study of a 56-year-old female patient diagnosed with TNBC. It then provides details on the characteristics and subtypes of TNBC, noting that it is an aggressive disease with poor prognosis. Current treatment approaches for metastatic TNBC are discussed, including sequential single-agent chemotherapy with taxanes, anthracyclines, antimetabolites, and platinum agents. Several key clinical trials comparing different chemotherapy regimens for TNBC are summarized, such as the TNT trial comparing carboplatin and docetaxel, and the TNACITY trial evaluating nab-paclitaxel plus carboplatin
Brain metastasis is common in solid tumors, occurring in 30% of cancer patients. Lung cancer accounts for 50% of cases, with breast cancer and melanoma also frequently metastasizing to the brain. Symptoms depend on location but include headaches, weakness, and seizures. MRI is the primary diagnostic tool. Whole brain radiation remains standard treatment, while surgery or stereotactic radiosurgery are used for solitary metastases. Systemic therapies are also increasingly used depending on tumor type, with targeted drugs and immunotherapies showing promise for cancers like lung cancer, breast cancer, melanoma, and renal cell carcinoma. Outcomes remain poor for leptomeningeal carcinomatosis.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
RADIOTHERAPY IN CARCINOMA BREAST (EARLY AND LOCALLY ADVANCED)DrAnkitaPatel
This document discusses radiation therapy for breast cancer. It begins by outlining the important role of radiation therapy at various stages of breast cancer, including as part of breast conservation and after mastectomy. It then discusses indications for adjuvant radiation therapy based on factors like tumor size and lymph node involvement. The document reviews evidence from clinical trials demonstrating the benefits of radiation therapy after breast-conserving surgery in reducing recurrence rates and improving survival. It also discusses techniques, dosing, and toxicity considerations for radiation therapy delivery.
The document summarizes key landmark breast cancer trials that helped establish modern standards of care. The NSABP B-04 trial showed that modified radical mastectomy was as effective as radical mastectomy. The NSABP B-06 and Milan trials established breast-conserving surgery plus radiation as an equivalent alternative to mastectomy. The NSABP B-32 trial demonstrated sentinel node biopsy alone had similar outcomes as axillary dissection for node-negative cancer. Subsequent trials like ALMANAC and Z011 found sentinel node biopsy reduced arm morbidity without compromising survival. These trials provided critical evidence supporting less invasive surgical approaches for breast cancer.
1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
3) Treatment options include chemotherapy to shrink the tumor and make it operable, radiation therapy to the breast and nearby lymph nodes, and hormone therapy for hormone receptor-positive cancers.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
- Non-small cell lung cancer is the most common malignancy worldwide and a leading cause of cancer death. It accounts for the majority (70-80%) of lung cancers.
- Imaging techniques like CT scans are important for accurately assessing the primary tumor and detecting metastasis. Positron emission tomography (PET) CT is more sensitive than size-based criteria alone for detecting lymph node involvement.
- Staging involves classifying the size and extent of the primary tumor and determining if the cancer has spread to lymph nodes or distant organs. Higher stages indicate larger primary tumors or spread beyond the lungs.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Head and Neck Cancers. It includes updates made in Version 3.2021, which add a footnote regarding biosimilar substitutes for trastuzumab. The guidelines provide evidence-based recommendations for multidisciplinary treatment of various head and neck cancers, including cancer of the oral cavity, oropharynx, hypopharynx, larynx, paranasal sinuses, and salivary glands. Recommendations cover evaluation, staging, surgery, radiation, systemic therapies, follow-up, and management of advanced or recurrent cancers.
This document compares different staging systems for hepatocellular carcinoma (HCC), including TNM, BCLC, CLIP, Okuda, and others. It discusses the limitations of TNM staging for HCC, as TNM does not consider factors like underlying liver function which are important for prognosis and treatment selection. Other staging systems like BCLC and CLIP provide more prognostic information by incorporating tumor characteristics and liver reserve. While no system is perfect, studies have found BCLC and CLIP provide good stratification of survival for HCC patients treated with different modalities. Ongoing research aims to develop more accurate staging models for HCC given the complexity of the disease and factors influencing prognosis and treatment.
Management of ewings sarcoma & osteosarcomaPRARABDH95
EBRT can play an important role in the management of Ewing sarcoma and osteosarcoma.
For Ewing sarcoma, radiotherapy is commonly used pre-operatively to sterilize the tumor bed, post-operatively for positive or close margins, or definitively when surgery is not possible. Treatment planning aims to cover the pre-treatment tumor volume plus a 2-2.5cm margin using IMRT or 3D-CRT.
For osteosarcoma, radiotherapy can be used definitively for unresectable tumors or adjuvantly after surgery if margins were positive. A dose of 70.2Gy is typically prescribed for definitive cases and 64.8Gy for
Robert L. Ferris, MD, PhD, Ezra Cohen, MD, FRCPC, FASCO, and Quynh-Thu Le, MD, FACR, FASTRO, discuss immunotherapy in head and neck cancer in this CME/CE/CPE activity titled "Understanding the Impact of Immunotherapy on Head and Neck Cancer: A Look at the Science, Practice, and Future of Multimodal Treatment." For the full presentation, downloadable Practice Aids, monograph, complete CME/CE/CPE information, and to apply for credit, please visit us at http://bit.ly/2yqhYFX. CME/CE/CPE credit will be available until November 1st, 2018.
The document discusses contouring and delineation of target volumes for breast cancer radiation therapy. It provides detailed descriptions of the cranial, caudal, medial, lateral, anterior and posterior borders for clinical target volumes (CTVs) in different lymph node regions including axillary levels I-III, supraclavicular, internal mammary, and breast/chest wall. Precise delineation of targets is important for effective radiation treatment while minimizing dose to surrounding healthy tissues.
This document discusses esophageal cancer. Some key points:
- Squamous cell carcinoma and adenocarcinoma are the most common histologies. Risk factors include smoking, alcohol, obesity, and Barrett's esophagus.
- Staging uses the TNM system. Treatment depends on stage but may include surgery, chemotherapy, radiation therapy, or a combination.
- For locally advanced stages, neoadjuvant chemoradiation can improve resectability and survival compared to surgery alone. The MAGIC trial showed improved survival with perioperative chemotherapy compared to surgery alone.
- Prognosis remains poor with 5-year survival rates of 15-20%, though outcomes have improved with multimod
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
Carcinoma of unknown primary (CUP) refers to metastatic cancers where the primary site cannot be identified. It accounts for 2-3% of cancers. Diagnostic workup includes biopsy of the most accessible site and immunohistochemistry (IHC) to identify lineage and potential primary sites. Management depends on specific clinical and pathological features. For cervical adenopathy presentations, combined modality therapy with surgery and radiation is recommended, along with unilateral tonsillectomy to identify potential head and neck primaries. Identification of the primary site can improve treatment by limiting radiation fields.
This document discusses a clinical trial evaluating the combination of ribociclib and endocrine therapy for pre/perimenopausal women with HR+, HER2- advanced breast cancer. The trial aimed to assess whether ribociclib plus an aromatase inhibitor and goserelin improved progression-free survival compared to placebo plus the same endocrine therapies. Key findings were that the combination led to a statistically significant improvement in progression-free survival. Overall survival data were also collected as a secondary outcome.
This document discusses treatment options for triple negative breast cancer (TNBC). It begins with a case study of a 56-year-old female patient diagnosed with TNBC. It then provides details on the characteristics and subtypes of TNBC, noting that it is an aggressive disease with poor prognosis. Current treatment approaches for metastatic TNBC are discussed, including sequential single-agent chemotherapy with taxanes, anthracyclines, antimetabolites, and platinum agents. Several key clinical trials comparing different chemotherapy regimens for TNBC are summarized, such as the TNT trial comparing carboplatin and docetaxel, and the TNACITY trial evaluating nab-paclitaxel plus carboplatin
Brain metastasis is common in solid tumors, occurring in 30% of cancer patients. Lung cancer accounts for 50% of cases, with breast cancer and melanoma also frequently metastasizing to the brain. Symptoms depend on location but include headaches, weakness, and seizures. MRI is the primary diagnostic tool. Whole brain radiation remains standard treatment, while surgery or stereotactic radiosurgery are used for solitary metastases. Systemic therapies are also increasingly used depending on tumor type, with targeted drugs and immunotherapies showing promise for cancers like lung cancer, breast cancer, melanoma, and renal cell carcinoma. Outcomes remain poor for leptomeningeal carcinomatosis.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
RADIOTHERAPY IN CARCINOMA BREAST (EARLY AND LOCALLY ADVANCED)DrAnkitaPatel
This document discusses radiation therapy for breast cancer. It begins by outlining the important role of radiation therapy at various stages of breast cancer, including as part of breast conservation and after mastectomy. It then discusses indications for adjuvant radiation therapy based on factors like tumor size and lymph node involvement. The document reviews evidence from clinical trials demonstrating the benefits of radiation therapy after breast-conserving surgery in reducing recurrence rates and improving survival. It also discusses techniques, dosing, and toxicity considerations for radiation therapy delivery.
The document summarizes key landmark breast cancer trials that helped establish modern standards of care. The NSABP B-04 trial showed that modified radical mastectomy was as effective as radical mastectomy. The NSABP B-06 and Milan trials established breast-conserving surgery plus radiation as an equivalent alternative to mastectomy. The NSABP B-32 trial demonstrated sentinel node biopsy alone had similar outcomes as axillary dissection for node-negative cancer. Subsequent trials like ALMANAC and Z011 found sentinel node biopsy reduced arm morbidity without compromising survival. These trials provided critical evidence supporting less invasive surgical approaches for breast cancer.
1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
3) Treatment options include chemotherapy to shrink the tumor and make it operable, radiation therapy to the breast and nearby lymph nodes, and hormone therapy for hormone receptor-positive cancers.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
- Non-small cell lung cancer is the most common malignancy worldwide and a leading cause of cancer death. It accounts for the majority (70-80%) of lung cancers.
- Imaging techniques like CT scans are important for accurately assessing the primary tumor and detecting metastasis. Positron emission tomography (PET) CT is more sensitive than size-based criteria alone for detecting lymph node involvement.
- Staging involves classifying the size and extent of the primary tumor and determining if the cancer has spread to lymph nodes or distant organs. Higher stages indicate larger primary tumors or spread beyond the lungs.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Head and Neck Cancers. It includes updates made in Version 3.2021, which add a footnote regarding biosimilar substitutes for trastuzumab. The guidelines provide evidence-based recommendations for multidisciplinary treatment of various head and neck cancers, including cancer of the oral cavity, oropharynx, hypopharynx, larynx, paranasal sinuses, and salivary glands. Recommendations cover evaluation, staging, surgery, radiation, systemic therapies, follow-up, and management of advanced or recurrent cancers.
This document provides the updated NCCN Clinical Practice Guidelines for Acute Lymphoblastic Leukemia (ALL). It summarizes changes made in Version 3.2023, including adding a footnote specifying that a FDA-approved biosimilar is an appropriate substitute for tocilizumab for supportive care. It also lists other modifications made in Version 2.2023, such as updates to consolidation therapy regimens, footnotes, and response criteria. The guidelines are reviewed and updated regularly by the NCCN ALL Panel to incorporate the latest evidence and clinical expertise for the treatment of ALL.
This document provides the updated National Comprehensive Cancer Network (NCCN) clinical practice guidelines for pancreatic adenocarcinoma. The updates include revisions to recommendations for imaging, biomarkers, molecular profiling, neoadjuvant therapy duration, and performance status criteria. Key changes are noted for pages addressing workup, resectable vs. borderline resectable disease, neoadjuvant therapy options, and eligibility for first-line systemic therapy. The guidelines are developed by the NCCN pancreatic cancer panel to aid treatment decisions based on the latest evidence and consensus.
This document provides updates to the 2022 National Comprehensive Cancer Network (NCCN) clinical practice guidelines for pancreatic adenocarcinoma. Key updates include revising terminology related to genetic testing and molecular profiling, emphasizing multidisciplinary review for diagnosis and treatment planning, and recommending genetic testing for inherited mutations and tumor molecular profiling to identify potentially targetable biomarkers. The guidelines provide evidence-based recommendations for diagnosis, staging, treatment and surveillance of pancreatic adenocarcinoma.
- The document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Acute Lymphoblastic Leukemia Version 4.2023.
- It was last updated on February 5, 2024 and includes updates from previous versions, including modifications to terminologies to advance equity, inclusion, and representation.
- The guidelines provide evidence-based recommendations for diagnosis, treatment, surveillance, and management of relapsed or refractory disease for acute lymphoblastic leukemia.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for B-Cell Lymphomas. It describes updates made in versions 2.2023 and 1.2023 of the guidelines, including revisions to recommendations for mantle cell lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, and extranodal marginal zone lymphoma. New systemic therapies were added for certain disease subtypes and clinical scenarios. Terminology and classifications were updated based on recent international consensus standards.
This document provides the panel members, guidelines updates, and table of contents for the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Thyroid Carcinoma. The panel members are experts in fields related to thyroid cancer from NCCN member institutions. The guidelines were updated in November 2022 to include additional treatment options for recurrent and metastatic thyroid cancer. The table of contents provides an outline of the guidelines contents covering diagnosis and treatment of the main thyroid cancer types.
This document contains the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Breast Cancer Version 2.2020. It lists the panel members and provides summaries of guideline updates, including the addition of fam-trastuzumab deruxtecan-nxki as a systemic therapy option for recurrent or stage IV HER2-positive breast cancer. Recommendations are provided for workup, treatment, surveillance, and management of recurrent or metastatic disease for both noninvasive and invasive breast cancers.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Esophageal and Esophagogastric Junction Cancers Version 2.2023. It lists the panel members and provides an overview of the guideline updates. The guidelines provide recommendations on screening, diagnosis, staging, treatment and surveillance for squamous cell carcinoma and adenocarcinoma of the esophagus and esophagogastric junction.
The document summarizes updates made in Version 1.2019 of the NCCN Guidelines for Anal Carcinoma from Version 2.2018. Key updates include:
1) Addition of PET/CT or PET/MRI to the workup for anal canal and perianal cancer.
2) Addition of FOLFCIS ± RT as a treatment option for metastatic disease.
3) Revision of surveillance recommendations to include abdominal/pelvic CT or MRI annually for 3 years.
4) Significant revisions to the principles of radiation therapy.
- This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Thyroid Carcinoma.
- Version 3.2022 was published on November 1st, 2022 and includes updates to systemic therapy recommendations for papillary, follicular, and Hürthle cell carcinomas.
- The guidelines provide evidence-based recommendations for the evaluation, diagnosis and treatment of the main types of thyroid carcinoma.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for colon cancer. It includes updates made in 2020 to the guidelines for diagnosis, staging, treatment and surveillance of colon cancer. A multidisciplinary panel provides recommendations for evaluating and treating colon cancer based on an evidence-based review of the literature. The guidelines provide consensus recommendations for diagnostic workup, surgical and medical management, as well as principles of imaging, pathology, surgery, systemic therapy and survivorship care for patients with colon cancer.
- This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for colon cancer. It provides recommendations on diagnosis, treatment including surgery, chemotherapy and radiation, surveillance, and management of recurrence for colon cancer.
- The guidelines were updated in February 2022. Key updates include clarifying use of targeted therapies like cetuximab and panitumumab for left-sided tumors only, modifying recommendations for local ablative therapies versus surgery for resectable metastases, and adding dosing information for chemotherapy regimens.
- The panel members who developed and updated the guidelines are listed, including their specialties and affiliated cancer centers.
The document outlines updates made in Version 3.2023 of the NCCN Guidelines for Multiple Myeloma from the previous version. Key updates include:
- Adding teclistamab-cqyv and noting belantamab mafodotin-blmf as useful in certain circumstances for patients with late relapses.
- Extensive revisions to MYEL-5 regarding response after primary therapy and follow up.
- Incorporating content from MYEL-6 into other pages regarding additional treatment for relapse or progressive disease.
- Adding a table of factors considered high risk for multiple myeloma.
This document provides guidelines for the treatment of central nervous system cancers. It was last updated on September 11, 2020 and is version 3.2020. It includes treatment guidelines for various types of brain and spinal cord tumors in adults and children. For each tumor type, it provides recommendations on diagnosis, staging, treatment including surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy and clinical trials. It also includes principles and recommendations regarding imaging, pathology, surgery and radiation therapy for brain and spinal cord tumors.
The document provides guidelines for the treatment of cervical cancer. It was updated in 2019 to reflect the 2018 FIGO staging system. The guidelines include algorithms outlining treatment recommendations based on cancer stage. There is discussion of surgical and non-surgical primary treatment options, as well as treatment of recurrence or metastases. Guidelines are provided for pathology assessment, imaging, surgical staging, radiation therapy, and systemic therapies.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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