1) Ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer, accounts for 20% of breast cancers in the US and represents the earliest non-invasive form.
2) Treatment options for DCIS include lumpectomy with or without radiation or total mastectomy. Factors such as tumor size, grade, and margin status help determine a patient's risk of recurrence and guide treatment decisions.
3) Short term side effects of breast radiation for DCIS typically include skin irritation, breast tenderness, and fatigue. Long term risks are generally low but may include lymphedema, lung inflammation, and fibrosis. Radiation reduces the risk of local recurrence by 50% compared to lumpectomy alone
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
MICROCALCIFICATION IDENTIFICATION IN DIGITAL MAMMOGRAM FOR EARLY DETECTION OF...Nashid Alam
Digital mammogram has become the most effective technique for early breast cancer detection modality. Digital mammogram takes an electronic image of the breast and stores it directly in a computer. High quality mammogram images are high resolution and large size images. Processing these images require high computational capabilities. The transmission of these images over the net is sometimes critical especially if the diagnosis of remote radiologists is required. The aim of this study is to develop an automated system for assisting the analysis of digital mammograms. Computer image processing techniques will be applied to enhance images and this is followed by segmentation of the region of interest (ROI). Subsequently, the textural features will be extracted from the ROI. These texture features will be used to classify the microcalcifications as either malignant or benign.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
Breast Cancer Management & Surgical ConsiderationsRiaz Rahman
Clinical overview and surgical considerations for management of Primary Breast Cancer and other subtypes. Covers screening recommendations, mammography (including BIRADS score interpretation), pathophysiology, staging, prognosis, surgical management, breast anatomy, non-surgical management, follow-up considerations. Given at Jackson Park Medical Center on 1/30/2014. Includes references.
Dr. Patty Tenofsky of Via Christi Clinic spoke at the Via Christi Women's Connection luncheon about breast cancer statistics, screening for breast cancer, treatment options, radiation therapy and chemotherapy.
Breast Carcinoma.
Breast cancer is a malignant (cancerous) tumor that starts in the cells of the breast and spread to other tissues.
The most common form of cancer among women
It is estimated that each year more than 83,000 cases of breast cancer are reported in Pakistan. Nearly 40,000 women die, just due to this deadly disease
Carcinoma of the breast occurs commonly in the western world,accounting for 3–5% of all deaths in women. In developing countries it accounts for 1–3% of death
The most common form of cancer among women
The second most common cause of cancer related mortality
1 of 8 women (12.2%)
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
1. Ductal Carcinoma In Situ
(Stage 0 Breast Cancer)
Robert Miller MD
www.aboutcancer.com
2. 20% of breast
cancers in the US
are stage 0 or noninvasive (ducal
carcinoma in situ
DCIS or lobular
carcinoma in situ
LCIS)
3. Age Distribution For In Situ versus Invasive
NCDB Data
30
25
20
15
In Situ
Invasive
10
5
0
30
40
50
60
70
80
4. Observed 5 Year Survival Breast
Cancer 2003-2006 NCDB
100
90
80
70
60
50
40
30
20
10
0
Stage 0
Stage I
Stage II
Stage III Stage IV
5. What You Need to Know About Breast Cancer
Before Deciding on Treatment
• Understand the basic anatomy (lobules, ducts and lymph nodes)
• Biopsy or pathology report tell you about the biology (how
aggressive) of the cancer
• Breast imaging studies (mammograms or ultrasound)
CT, MRI, PET
• Stage (particularly lymph node status)
6.
7.
8.
9. Earliest form of cancer
is often DCIS (ductal
carcinoma in situ) then
it progresses to
invasive ductal
carcinoma
12. Basement Membrane
DCIS
Cancer cells are confined
within the milk duct
basement membrane so still
in situ or non-invasive
Normal
Duct cells
Cancer Cells
13. Basement Membrane
Invasive
Cancer
Once the cells have invaded
through the basement
membrane and outside the
duct it is called invasive or
infiltrating
Normal
Duct cells
Cancer Cells
15. Lymph Nodes
supraclavicular
Internal mammary
axillary
DCIS should not spread to the lymph nodes unless there is some invasion
(may be focal micro-invasion) but 10 to 20 percent of lesions interpreted as
DCIS on a core biopsy are upgraded to invasive cancer after excision
18. Understanding a Pathology
Report
1. Invasive or Not (DCIS, LCIS)
2. Histology: what type of cancer
3. Grade: fast or slow growing
4. Hormone Receptors: is it sensitive to estrogen or
progesterone
5. HER2 (human epidermal growth factor receptor 2) a
genetic mutation
19. Imaging
The cells often die in
place (necrosis) and
then calcify. The
radiologist is looking
for abnormal areas of
calcification
20. Mammograms often show areas of
calcification, which can be benign or
malignant
Ninety percent of women with DCIS have microcalcifications on
mammography and DCIS accounts for 80 percent of all breast
cancers presenting with calcifications
21. Mammograms
In ductal carcinoma in situ (DCIS), there is
normally no mass but just an area of
calcification (very small areas called
microcalcifications)
25. Looking for advice on treatment decisions for
ductal carcinoma in situ of the breast
26. Treatment Decisions with
DCIS
1. Surgery: total mastectomy versus conservation
(lumpectomy) and ? nodes
2. Adjuvant Therapy: hormone therapy or as
preventative strategy
3. Radiation: whole breast or can it be skipped
27. Treatment Decisions
The woman should be assisted by a multidisciplinary team, including a
surgeon, possibly a plastic surgeon, medical
oncologist and a radiation oncologist
34. Complete axillary lymph node resection should not be
performed in the absence of evidence of invasive cancer
or proven metastatic disease in women apparent pure
DCIS.
However, a small proportion of patients with apparent pure
DCIS will be found to have invasive cancer at the time of
their definitive surgical procedure. Therefore, the
performance of a sentinel lymph node procedure should be
strongly considered if the patient with apparent pure DCIS
is to be treated with mastectomy or with excision in an
anatomic location compromising the performance of a
future sentinel node procedure.
35. Deciding on Surgery
Lumpectomy
Total Mastectomy
The risk of cancer-related death in women with DCIS is low, estimated at
1.9 percent within 10 years.
Mastectomy is curative for over 98 percent of patients with DCIS.
Disease recurrence is rare after mastectomy (1 to 2 percent)
36. Breast Conservation
Lumpectomy
(remove the cancer
with a small rim of
normal tissue, clear
margins)
Sentinel node biopsy
occasionally will be
performed at the
same time
37. At the time of the lumpectomy the
surgeon tries to remove the cancer
with a margin of normal breast tissue
around the mass
X-ray image of the lumpectomy specimen
40. Long-term outcomes of invasive ipsilateral
breast tumor recurrences after
lumpectomy in NSABP B-17 and B-24
randomized clinical trials for DCIS.
Local Relapse in the Breast Over 15 Year
Follow Up
Lumpectomy Alone
19.4%
Lump + Radiation
8.9 – 10%
Lump + Radiation + Tamoxifen 7.3%
Survival was the same in all
groups
Natl Cancer Inst. 2011;103(6):478.
41. Breast-Conserving Treatment With or Without Radiotherapy in
Ductal Carcinoma In Situ: 15-Year Recurrence Rates and Outcome
After a Recurrence, From the EORTC 10853 Randomized Phase III
Trial
JCO. 2013.49.5077
42. Fifteen-year results of breast-conserving surgery and definitive
breast irradiation for the treatment of ductal carcinoma in situ of the
breast.
Cause specific survival
Over all survival
Years
JCO Mar 1, 1996:754-63
43. Whole breast radiation following lumpectomy reduces the
recurrence rates in DCIS by about 50%. Approximately half the
recurrences are invasive and half are still DCIS.
A number of factors determine the local recurrence risk: palpable
mass, large size, higher grade, close or involved margins, and age
< 50y.
If the patient and physician view the individual risk as “low” some
patients may be treated with excision alone.
All data evaluating the three local treatments (lumpectomy
alone, lumpectomy plus radiation or total mastectomy) show no
difference in patient survival.
44. Van Nuys Index for Treatment of DCIS
Score
#1
#2
#3
Path
Other
Comedo
Size
<15mm
16-40mm
High
Grade
>40mm
Margins
>10mm
1-9mm
< 1mm
Score 3 – 4 : Lumpectomy alone (local control is 100%
vs 97%)
Score 5 – 7: Lumpectomy + Radiation (local control
from 68% up to 85%)
Score 8-9: Mastectomy
Cancer 1996 Jun 1;77(11):2267-74
45. Van Nuys Index for Treatment of DCIS
Score
#1
#2
#3
Path
Other
Comedo
Size
<15mm
16-40mm
High
Grade
>40mm
Margins
>10mm
1-9mm
< 1mm
Score 3 – 4 : Lumpectomy alone (local control is 100%
vs 97%)
Score 5 – 7: Lumpectomy + Radiation (local control
from 68% up to 85%)
Score 8-9: Mastectomy
Cancer 1996 Jun 1;77(11):2267-74
46. Updated Van Nuys Prognostic
Index
Parameter
1 Point
2 Points
3 Points
Size
<15mm
16-40mm
>40mm
Grade
1/II
1/II Necrosis
III
Margin
10mm
1-9mm
<1mm
Age
>60
40-60
<40
4,5, 6 = Lumpectomy Alone
7, 8, 9 = Lumpectomy + Radiation
10, 11, 12 = Mastectomy
2003 Update PMID 14682107 -- "An argument against routine use of radiotherapy for ductal
carcinoma in situ." (Silverstein MJ, Oncology (Williston Park). 2003 Nov;17(11):1511-33; discussion
1533-4, 1539, 1542 passim.)
47. Online Breast Cancer Calculators
http://aboutcancer.com/breast_calculators.htm
http://www.mskcc.org/cancer-care/adult/breast/prediction-tools
51. CT scan is obtained at the time of simulation
CT images are then imported into
the treatment planning computer.
Note that at the time of the
simulation the patient may receive 3
small tattoo marks
52. Computer generated anatomy images that will identify all the
important structures to be sure the radiation covers the area
of breast cancer and limits the dose to other areas
57. Radiation
Fields
After a lumpectomy the
whole breast is radiated
for about 5 weeks (the red
box) and then a boost
dose (5 – 7 treatments) is
given to the lumpectomy
site (blue circle)
59. Short Term Side Effects of
Breast Radiation
Generally the side effects of breast radiation do not
become noticeable until the woman has received about 10
to 15 treatments, and then become somewhat more
noticeable through the rest of the treatment. The most
common side effects:
•skin irritation - the skin that is radiated gets red, itchy
and may blister (like a sun burn) may lose hair in arm pit
(biafine, prutect, myaderm, aquaphor, silvadene, triamcinalone, Radiaderm)
•breast or chest wall tenderness or mild pain
•tiredness or fatigue (some women feel a little lightheaded)
•are swelling or edema
60. Long Term Side Effects of
Breast Radiation
• Arm swelling or lymphedema is probably less than
3%
• Lung inflammation (pneumonitis) is 5% or less
• Risk of rib fracture is less than 3%
• Risk of nerve damage (brachial plexopathy) < 1%
• Radiation fibrosis to breast
• Risk of causing a new cancer is less than 1%