DCIS Margins
•Download as PPTX, PDF•
0 likes•46 views
DCIS is a pre-invasive breast cancer that is often asymptomatic and non-palpable. While most cases of DCIS are unicentric, studies have shown it can also be multifocal with gaps of uninvolved tissue between foci. The rate of recurrence for DCIS ranges from 4% for low-grade to 15% for high-grade disease. Positive margins significantly increase the risk of local recurrence compared to negative margins. Large clinical trials found that clear margins and radiation therapy significantly decrease DCIS recurrence rates. However, the optimal excision width remains unclear. Current consensus guidelines recommend margins of at least 2mm for DCIS treated with radiation based on evidence from over 7,800 patients, though smaller margins may be acceptable
Report
Share
Report
Share
Recommended
The role of sentinel lymph node in microinvasive DCIS
- Microinvasive breast cancer (MIBC) has a low but measurable risk of lymph node metastasis. Several studies found positive lymph nodes in 3.7-7.5% of MIBC patients who underwent sentinel lymph node biopsy (SLNB).
- Factors like lymphatic invasion and positive estrogen receptor status predict higher risk of lymph node metastases in MIBC. However, routine SLNB is not warranted for all MIBC patients. Careful selection based on risk factors is needed to avoid overtreatment.
- Studies of patients with DCIS found lymph node micrometastases in 21-34% of those undergoing SLNB for high-risk features like palpable mass or suspicious imaging. However, the clinical significance
Jornal club pancreas
This study compared total neoadjuvant therapy (TNT), consisting of a minimum of 4 months of chemotherapy followed by chemoradiation, to shorter course neoadjuvant therapy (SNT) for resectable and borderline resectable pancreatic cancer. The study found that patients receiving TNT were more likely to complete at least 5 months of nonsurgical therapy without negatively impacting surgery completion rates. TNT patients did not reach median overall survival while SNT patients had a median OS of 25.1 months. Receiving at least 5 months of nonsurgical therapy decreased the risk of death by 40% compared to those receiving less therapy.
management of locally advanced breast cancer 2022
1) Locally advanced breast cancer (LABC) includes stage IIB-IIIC disease and encompasses operable, inoperable, and inflammatory breast cancer at presentation.
2) Patients with LABC undergo neoadjuvant chemotherapy followed by surgery and radiation therapy. Additional tests are only indicated based on symptoms.
3) The goals of neoadjuvant therapy are tumor response before surgery to enable breast conservation and provide information about response to therapy. Anthracycline and taxane regimens are appropriate, and 15-25% will experience complete pathologic response.
SLNB Comparison with Routine Axillary LN Dissection in Breast Cancer
1. A study randomly assigned 423 breast cancer patients with tumors less than 2 cm to either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (AXD) groups to compare the accuracy of SLNB.
2. SLNB had a sensitivity of 91.2% and specificity of 100% compared to AXD. There was less pain and better arm mobility in the SLNB group.
3. The study concluded that SLNB is a safe and accurate method for evaluating axillary node metastasis in early-stage breast cancer patients.
Journal club nsm
This document summarizes findings from a study examining the oncologic safety of nipple-sparing mastectomy (NSM) in patients with a tumor-to-nipple distance (TND) of less than 1 cm. The study retrospectively analyzed 1,369 patients who underwent NSM at a medical center in Seoul, Korea between 2003-2015. The primary endpoint was locoregional recurrence and secondary endpoints included recurrence-free and disease-free survival rates. The study found that a short TND of less than 1 cm did not compromise long-term oncologic safety as long as the nipple-areolar complex was clinically and radiologically negative and retroareolar margins were clear of tumor cells
Liver first approach for CRLM
THE SAFETY , FEASIBILITY, ONCOLOGICAL OUT COME OF LIVER FIRST APPROACH FOR LIVER METASTASIS IN COLO RECTAL TUMOR
Management of Axilla in Breast Cancer
This document summarizes the current standards and evidence for managing the axilla in breast cancer. It discusses how to evaluate the axilla clinically and with sentinel lymph node biopsy (SLNB). Studies such as NSABP B-32 and ACOSOG Z0011 showed that SLNB alone is sufficient for node-negative patients, reducing morbidity compared to axillary lymph node dissection (ALND). For node-positive patients, completion ALND is still standard, though trials are investigating axillary radiation instead. SLNB accuracy improves with dual tracer use and removing ≥3 nodes. SLNB is now widely used after neoadjuvant chemotherapy in clinically node-negative patients, though false negatives remain higher in clinically node-positive patients
Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection...
Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection...King Hussien Cancer Center
This randomized controlled trial compared low ligation versus high ligation of the inferior mesenteric artery during laparoscopic anterior resection for rectal cancer. The primary outcome was genitourinary dysfunction assessed through validated questionnaires and uroflowmetry at 1 and 9 months postoperatively. Results showed that both techniques resulted in impaired genitourinary function, though low ligation led to less worsening of symptoms over time. There were no significant differences in secondary outcomes like complications or oncological adequacy between the groups. In summary, low ligation of the inferior mesenteric artery better preserved genitourinary function after surgery without compromising other outcomes.Recommended
The role of sentinel lymph node in microinvasive DCIS
- Microinvasive breast cancer (MIBC) has a low but measurable risk of lymph node metastasis. Several studies found positive lymph nodes in 3.7-7.5% of MIBC patients who underwent sentinel lymph node biopsy (SLNB).
- Factors like lymphatic invasion and positive estrogen receptor status predict higher risk of lymph node metastases in MIBC. However, routine SLNB is not warranted for all MIBC patients. Careful selection based on risk factors is needed to avoid overtreatment.
- Studies of patients with DCIS found lymph node micrometastases in 21-34% of those undergoing SLNB for high-risk features like palpable mass or suspicious imaging. However, the clinical significance
Jornal club pancreas
This study compared total neoadjuvant therapy (TNT), consisting of a minimum of 4 months of chemotherapy followed by chemoradiation, to shorter course neoadjuvant therapy (SNT) for resectable and borderline resectable pancreatic cancer. The study found that patients receiving TNT were more likely to complete at least 5 months of nonsurgical therapy without negatively impacting surgery completion rates. TNT patients did not reach median overall survival while SNT patients had a median OS of 25.1 months. Receiving at least 5 months of nonsurgical therapy decreased the risk of death by 40% compared to those receiving less therapy.
management of locally advanced breast cancer 2022
1) Locally advanced breast cancer (LABC) includes stage IIB-IIIC disease and encompasses operable, inoperable, and inflammatory breast cancer at presentation.
2) Patients with LABC undergo neoadjuvant chemotherapy followed by surgery and radiation therapy. Additional tests are only indicated based on symptoms.
3) The goals of neoadjuvant therapy are tumor response before surgery to enable breast conservation and provide information about response to therapy. Anthracycline and taxane regimens are appropriate, and 15-25% will experience complete pathologic response.
SLNB Comparison with Routine Axillary LN Dissection in Breast Cancer
1. A study randomly assigned 423 breast cancer patients with tumors less than 2 cm to either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (AXD) groups to compare the accuracy of SLNB.
2. SLNB had a sensitivity of 91.2% and specificity of 100% compared to AXD. There was less pain and better arm mobility in the SLNB group.
3. The study concluded that SLNB is a safe and accurate method for evaluating axillary node metastasis in early-stage breast cancer patients.
Journal club nsm
This document summarizes findings from a study examining the oncologic safety of nipple-sparing mastectomy (NSM) in patients with a tumor-to-nipple distance (TND) of less than 1 cm. The study retrospectively analyzed 1,369 patients who underwent NSM at a medical center in Seoul, Korea between 2003-2015. The primary endpoint was locoregional recurrence and secondary endpoints included recurrence-free and disease-free survival rates. The study found that a short TND of less than 1 cm did not compromise long-term oncologic safety as long as the nipple-areolar complex was clinically and radiologically negative and retroareolar margins were clear of tumor cells
Liver first approach for CRLM
THE SAFETY , FEASIBILITY, ONCOLOGICAL OUT COME OF LIVER FIRST APPROACH FOR LIVER METASTASIS IN COLO RECTAL TUMOR
Management of Axilla in Breast Cancer
This document summarizes the current standards and evidence for managing the axilla in breast cancer. It discusses how to evaluate the axilla clinically and with sentinel lymph node biopsy (SLNB). Studies such as NSABP B-32 and ACOSOG Z0011 showed that SLNB alone is sufficient for node-negative patients, reducing morbidity compared to axillary lymph node dissection (ALND). For node-positive patients, completion ALND is still standard, though trials are investigating axillary radiation instead. SLNB accuracy improves with dual tracer use and removing ≥3 nodes. SLNB is now widely used after neoadjuvant chemotherapy in clinically node-negative patients, though false negatives remain higher in clinically node-positive patients
Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection...
Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection...King Hussien Cancer Center
This randomized controlled trial compared low ligation versus high ligation of the inferior mesenteric artery during laparoscopic anterior resection for rectal cancer. The primary outcome was genitourinary dysfunction assessed through validated questionnaires and uroflowmetry at 1 and 9 months postoperatively. Results showed that both techniques resulted in impaired genitourinary function, though low ligation led to less worsening of symptoms over time. There were no significant differences in secondary outcomes like complications or oncological adequacy between the groups. In summary, low ligation of the inferior mesenteric artery better preserved genitourinary function after surgery without compromising other outcomes.sentinel lymph node post neoadjuvant
sentinel lymph node post chemo therapy
what about residual disease ,the FNR of sentinel lymph node .
Sentinel lymph node concept in early breast cancer by prof. r. wasike
This document discusses the sentinel lymph node concept in early breast cancer. It presents three case studies of patients who underwent segmentectomy or breast-conserving therapy along with sentinel lymph node biopsy for early-stage breast cancer tumors. The sentinel lymph node biopsy procedure involves injecting radioactive tracing agents and blue dye to identify the first draining lymph node from the tumor, which is then biopsied to detect any cancer metastases. The sentinel lymph node biopsy procedure provides accurate assessment of axillary node status while avoiding unnecessary full axillary lymph node dissection for most early-stage breast cancer patients.
Carcinoma cervix management : 2022 nccn guidelines
1) Management of carcinoma of the cervix involves accurate staging using imaging and pathology to guide treatment. Locally advanced disease is treated with chemoradiation while early stage disease may be treated surgically.
2) Surgical options range from conization for stage IA1 to radical hysterectomy for stage IB2. Adjuvant chemoradiation is given for intermediate and high risk features.
3) Radiation techniques have advanced from 4-field to 3D conformal and IMRT to reduce toxicity while adequately treating the tumor and draining lymph nodes.
Small cell ca lung
Small cell lung cancer (SCLC) accounts for 15-20% of lung cancers. It is an aggressive disease with rapid growth and early metastasis. The median survival is 2-4 months without treatment. Pathology shows dense sheets of small cells with scant cytoplasm and frequent mitoses. Immunohistochemistry markers include CD56, chromogranin, and synaptophysin. SCLC commonly causes paraneoplastic syndromes. Treatment involves chemotherapy with cisplatin and etoposide combined with early, accelerated thoracic radiotherapy to improve survival outcomes. Prognosis remains poor, especially in extensive stage disease.
Sentinel node biopsy in oral cancer
This document discusses sentinel node biopsy (SNB) for oral cancers. The study evaluated 480 patients with oral squamous cell carcinoma (SCC) of size 0.5-4cm without neck node involvement on imaging. SNB using radiocolloid and blue dye identified occult cervical lymph node metastases in 23% of patients. SNB had a sensitivity of 86% and negative predictive value of 95% for detecting occult disease. While SNB failed to detect occult metastases in 14% of patients, it also identified unexpected contralateral lymphatic drainage in 12% of cases. The results support SNB as a safe and effective technique for staging the neck in early oral cancers, while also sparing over 70% of patients unnecessary neck
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...Dr.Bhavin Vadodariya
1) The document summarizes key landmark trials in breast cancer surgery including the Halsted theory, Fisher theory, and results from NSABP B04, B06, and B17 trials which established breast conservation as a standard of care for early stage breast cancer.
2) It also discusses a trial evaluating cryoablation as a non-surgical option for small breast cancers and results showing 92% successful ablation with no residual disease after surgical resection.
3) Going forward, the document envisions more individualized and targeted breast cancer treatment based on genomic profiling of each tumor to identify markers and select the most appropriate targeted therapies or ablative procedures.Importance of margins in breast conserving surgery
1) A positive surgical margin after breast-conserving surgery is associated with at least a two-fold increase in risk of local recurrence, even with additional radiation or systemic therapy.
2) While a radiation boost can help reduce recurrence risk for patients with positive margins, the absolute benefit is small and does not lower the risk to the level of patients with negative margins.
3) In a study of over 12,000 patients, having clear margins of 1mm or greater did not provide any additional reduction in risk of recurrence compared to margins of 1mm or less.
Sentinel lymph node breast ca
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
PENILE CONSERVATION BY RADIOTHERAPY
This document discusses penile conservation for squamous cell carcinoma of the penis. It provides evidence that radiotherapy can successfully preserve the penis in over 50% of cases, with 5-year survival rates comparable to surgery. Brachytherapy is highlighted as an effective non-surgical approach, allowing for homogenous dose distribution and sparing of surrounding tissue. Complications are mostly mild to moderate, with urethral stenosis occurring in under 15% of cases. With close follow-up, radiotherapy can offer local control and penile preservation similar to surgery while maintaining patient quality of life and sexuality.
Antimicrotubules kiran
Antimicrotubule agents such as paclitaxel and docetaxel are microtubule-stabilizing drugs that directly bind to tubulin. They profoundly alter microtubule dynamics and suppress microtubule depolymerization, leading to mitotic arrest. Peripheral neuropathy is a common side effect due to their effects on microtubules in neurons. Paclitaxel and docetaxel are effective in treating several types of cancer but require premedication to reduce hypersensitivity reactions and have dose-limiting toxicities of neutropenia and neuropathy.
Management of axilla in breast cancer : Recent updates
A comprehensive approach to the management of axillary disease in breast cancer and the latest updates.
Can the laparoscopic approach to D2 gastrectomy be justified?
Laparoscopic gastrectomy is being compared to open gastrectomy for gastric cancer treatment. Several studies show that laparoscopic and open approaches have comparable short-term surgical outcomes in terms of complication rates. Regarding long-term oncologic outcomes, multiple studies found no differences in the number of retrieved lymph nodes or disease-free and overall survival rates between the two approaches. While the laparoscopic approach has a learning curve of around 20 cases, it provides better post-operative quality of life measures like less pain and earlier return of bowel function.
Ovary 2
This document discusses several topics related to the treatment of ovarian cancer including adjuvant chemotherapy, assessment of treatment response, and management of recurrent/resistant disease. It summarizes several key studies comparing different chemotherapy regimens for advanced ovarian cancer, including the use of carboplatin versus cisplatin, dose-dense versus conventional schedules, intraperitoneal versus intravenous administration, and the addition of bevacizumab. It also reviews options for recurrent platinum-sensitive and platinum-resistant disease, secondary cytoreduction surgery, and the potential role of targeted therapies, immunotherapy and radiation.
Mangment of recurent sarcoma
- Recurrent retroperitoneal sarcoma is common, occurring in 50% of patients within 5 years of primary resection. Late recurrences beyond 5 years are also possible, requiring long-term follow-up.
- Patterns of recurrence vary depending on histological subtype. Well-differentiated liposarcoma often recurs locally, which can sometimes be managed with additional surgery. Leiomyosarcoma commonly spreads to distant sites, with 50% of patients experiencing metastases.
- Complete surgical resection remains the main treatment for recurrent retroperitoneal sarcoma when possible. Management decisions must consider the likelihood and implications of local versus distant failure based on histological factors.
Non small cell ca
This document discusses the management of non-small cell lung carcinoma. It begins by outlining the lymph node staging system for NSCLC. It then discusses the main treatment modalities of surgery, radiation, and chemotherapy. For early stage disease, surgery is the primary treatment discussed. The document outlines criteria for determining operability and details on surgical procedures. It also discusses the role of radiation and chemoradiation for various stages. Post-operative radiation is discussed for high risk patients. The document provides guidance on chemotherapy regimens and timing for different stages.
Adjuvant radiotherapy of regional lymph nodes in breast
Regional radiotherapy to lymph nodes in breast cancer patients improves overall survival according to a meta-analysis of randomized trials. The analysis found that comprehensive radiotherapy to the internal mammary and medial supraclavicular lymph nodes resulted in a statistically significant 15% reduction in mortality risk and improved disease-free and distant metastasis-free survival rates. The absolute benefits to overall survival ranged from 1.6-3.3% depending on the trial. Some increased risks of minor toxicities from additional radiation were also observed.
Debjyoti locally advanced breast carcinoma
This document discusses treatment pathways for stage IIIA and IIIB breast cancer. It describes the tumor and node characteristics of these stages. Neoadjuvant chemotherapy is recommended to downsize tumors before surgery. Surgery options include breast conservation or mastectomy. Post-operative radiation and chemotherapy are also used. Hormone therapy may be given depending on receptor status. Receptor status helps determine prognosis and additional targeted therapies. Molecular subtyping further classifies breast cancers to help guide treatment approaches. Axillary lymph node dissection is discussed as an important part of staging and treatment.
Sentinel node mapping in breast cancer controversies
In this presentation the most important controversies in breast cancer lymphatic mapping and sentinel node biopsy have been discussed based on NCCN guideline.
Regional lymph node management in breast cancer
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Primary Breast...
This slideshow discusses new points for sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients
EARLY BREAST CARCINOMA AND DCIS.pptx
This document provides an overview of early breast carcinoma and ductal carcinoma in situ (DCIS). It discusses the management of lobular carcinoma in situ (LCIS) and DCIS, including surgical and radiation treatment options. It also covers the surgical management and adjuvant therapies for invasive breast cancer, such as the use of lumpectomy, lymph node dissection and radiation to lymph nodes. Emerging techniques for accelerated partial breast irradiation are also mentioned.
Surgical margins in_breast_conservation_therapy_.16
The document discusses surgical margins in breast conservation therapy for early stage breast cancer and ductal carcinoma in situ (DCIS).
- There is no consensus on what constitutes a safe surgical margin width, but margins of 10 mm are generally considered low risk for local recurrence, while margins of 2 mm or less are often considered inadequate.
- Positive margins are associated with increased risk of local recurrence, but the significance of close margins (within 1 mm) remains controversial.
- The surgeon must balance the risks of local recurrence and cosmesis when planning breast conservation therapy to avoid compromising patient prognosis.
More Related Content
What's hot
sentinel lymph node post neoadjuvant
sentinel lymph node post chemo therapy
what about residual disease ,the FNR of sentinel lymph node .
Sentinel lymph node concept in early breast cancer by prof. r. wasike
This document discusses the sentinel lymph node concept in early breast cancer. It presents three case studies of patients who underwent segmentectomy or breast-conserving therapy along with sentinel lymph node biopsy for early-stage breast cancer tumors. The sentinel lymph node biopsy procedure involves injecting radioactive tracing agents and blue dye to identify the first draining lymph node from the tumor, which is then biopsied to detect any cancer metastases. The sentinel lymph node biopsy procedure provides accurate assessment of axillary node status while avoiding unnecessary full axillary lymph node dissection for most early-stage breast cancer patients.
Carcinoma cervix management : 2022 nccn guidelines
1) Management of carcinoma of the cervix involves accurate staging using imaging and pathology to guide treatment. Locally advanced disease is treated with chemoradiation while early stage disease may be treated surgically.
2) Surgical options range from conization for stage IA1 to radical hysterectomy for stage IB2. Adjuvant chemoradiation is given for intermediate and high risk features.
3) Radiation techniques have advanced from 4-field to 3D conformal and IMRT to reduce toxicity while adequately treating the tumor and draining lymph nodes.
Small cell ca lung
Small cell lung cancer (SCLC) accounts for 15-20% of lung cancers. It is an aggressive disease with rapid growth and early metastasis. The median survival is 2-4 months without treatment. Pathology shows dense sheets of small cells with scant cytoplasm and frequent mitoses. Immunohistochemistry markers include CD56, chromogranin, and synaptophysin. SCLC commonly causes paraneoplastic syndromes. Treatment involves chemotherapy with cisplatin and etoposide combined with early, accelerated thoracic radiotherapy to improve survival outcomes. Prognosis remains poor, especially in extensive stage disease.
Sentinel node biopsy in oral cancer
This document discusses sentinel node biopsy (SNB) for oral cancers. The study evaluated 480 patients with oral squamous cell carcinoma (SCC) of size 0.5-4cm without neck node involvement on imaging. SNB using radiocolloid and blue dye identified occult cervical lymph node metastases in 23% of patients. SNB had a sensitivity of 86% and negative predictive value of 95% for detecting occult disease. While SNB failed to detect occult metastases in 14% of patients, it also identified unexpected contralateral lymphatic drainage in 12% of cases. The results support SNB as a safe and effective technique for staging the neck in early oral cancers, while also sparing over 70% of patients unnecessary neck
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...Dr.Bhavin Vadodariya
1) The document summarizes key landmark trials in breast cancer surgery including the Halsted theory, Fisher theory, and results from NSABP B04, B06, and B17 trials which established breast conservation as a standard of care for early stage breast cancer.
2) It also discusses a trial evaluating cryoablation as a non-surgical option for small breast cancers and results showing 92% successful ablation with no residual disease after surgical resection.
3) Going forward, the document envisions more individualized and targeted breast cancer treatment based on genomic profiling of each tumor to identify markers and select the most appropriate targeted therapies or ablative procedures.Importance of margins in breast conserving surgery
1) A positive surgical margin after breast-conserving surgery is associated with at least a two-fold increase in risk of local recurrence, even with additional radiation or systemic therapy.
2) While a radiation boost can help reduce recurrence risk for patients with positive margins, the absolute benefit is small and does not lower the risk to the level of patients with negative margins.
3) In a study of over 12,000 patients, having clear margins of 1mm or greater did not provide any additional reduction in risk of recurrence compared to margins of 1mm or less.
Sentinel lymph node breast ca
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
PENILE CONSERVATION BY RADIOTHERAPY
This document discusses penile conservation for squamous cell carcinoma of the penis. It provides evidence that radiotherapy can successfully preserve the penis in over 50% of cases, with 5-year survival rates comparable to surgery. Brachytherapy is highlighted as an effective non-surgical approach, allowing for homogenous dose distribution and sparing of surrounding tissue. Complications are mostly mild to moderate, with urethral stenosis occurring in under 15% of cases. With close follow-up, radiotherapy can offer local control and penile preservation similar to surgery while maintaining patient quality of life and sexuality.
Antimicrotubules kiran
Antimicrotubule agents such as paclitaxel and docetaxel are microtubule-stabilizing drugs that directly bind to tubulin. They profoundly alter microtubule dynamics and suppress microtubule depolymerization, leading to mitotic arrest. Peripheral neuropathy is a common side effect due to their effects on microtubules in neurons. Paclitaxel and docetaxel are effective in treating several types of cancer but require premedication to reduce hypersensitivity reactions and have dose-limiting toxicities of neutropenia and neuropathy.
Management of axilla in breast cancer : Recent updates
A comprehensive approach to the management of axillary disease in breast cancer and the latest updates.
Can the laparoscopic approach to D2 gastrectomy be justified?
Laparoscopic gastrectomy is being compared to open gastrectomy for gastric cancer treatment. Several studies show that laparoscopic and open approaches have comparable short-term surgical outcomes in terms of complication rates. Regarding long-term oncologic outcomes, multiple studies found no differences in the number of retrieved lymph nodes or disease-free and overall survival rates between the two approaches. While the laparoscopic approach has a learning curve of around 20 cases, it provides better post-operative quality of life measures like less pain and earlier return of bowel function.
Ovary 2
This document discusses several topics related to the treatment of ovarian cancer including adjuvant chemotherapy, assessment of treatment response, and management of recurrent/resistant disease. It summarizes several key studies comparing different chemotherapy regimens for advanced ovarian cancer, including the use of carboplatin versus cisplatin, dose-dense versus conventional schedules, intraperitoneal versus intravenous administration, and the addition of bevacizumab. It also reviews options for recurrent platinum-sensitive and platinum-resistant disease, secondary cytoreduction surgery, and the potential role of targeted therapies, immunotherapy and radiation.
Mangment of recurent sarcoma
- Recurrent retroperitoneal sarcoma is common, occurring in 50% of patients within 5 years of primary resection. Late recurrences beyond 5 years are also possible, requiring long-term follow-up.
- Patterns of recurrence vary depending on histological subtype. Well-differentiated liposarcoma often recurs locally, which can sometimes be managed with additional surgery. Leiomyosarcoma commonly spreads to distant sites, with 50% of patients experiencing metastases.
- Complete surgical resection remains the main treatment for recurrent retroperitoneal sarcoma when possible. Management decisions must consider the likelihood and implications of local versus distant failure based on histological factors.
Non small cell ca
This document discusses the management of non-small cell lung carcinoma. It begins by outlining the lymph node staging system for NSCLC. It then discusses the main treatment modalities of surgery, radiation, and chemotherapy. For early stage disease, surgery is the primary treatment discussed. The document outlines criteria for determining operability and details on surgical procedures. It also discusses the role of radiation and chemoradiation for various stages. Post-operative radiation is discussed for high risk patients. The document provides guidance on chemotherapy regimens and timing for different stages.
Adjuvant radiotherapy of regional lymph nodes in breast
Regional radiotherapy to lymph nodes in breast cancer patients improves overall survival according to a meta-analysis of randomized trials. The analysis found that comprehensive radiotherapy to the internal mammary and medial supraclavicular lymph nodes resulted in a statistically significant 15% reduction in mortality risk and improved disease-free and distant metastasis-free survival rates. The absolute benefits to overall survival ranged from 1.6-3.3% depending on the trial. Some increased risks of minor toxicities from additional radiation were also observed.
Debjyoti locally advanced breast carcinoma
This document discusses treatment pathways for stage IIIA and IIIB breast cancer. It describes the tumor and node characteristics of these stages. Neoadjuvant chemotherapy is recommended to downsize tumors before surgery. Surgery options include breast conservation or mastectomy. Post-operative radiation and chemotherapy are also used. Hormone therapy may be given depending on receptor status. Receptor status helps determine prognosis and additional targeted therapies. Molecular subtyping further classifies breast cancers to help guide treatment approaches. Axillary lymph node dissection is discussed as an important part of staging and treatment.
Sentinel node mapping in breast cancer controversies
In this presentation the most important controversies in breast cancer lymphatic mapping and sentinel node biopsy have been discussed based on NCCN guideline.
Regional lymph node management in breast cancer
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Primary Breast...
This slideshow discusses new points for sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients
What's hot (20)
Sentinel lymph node concept in early breast cancer by prof. r. wasike
Sentinel lymph node concept in early breast cancer by prof. r. wasike
Carcinoma cervix management : 2022 nccn guidelines
Carcinoma cervix management : 2022 nccn guidelines
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...
Importance of margins in breast conserving surgery
Importance of margins in breast conserving surgery
Management of axilla in breast cancer : Recent updates
Management of axilla in breast cancer : Recent updates
Can the laparoscopic approach to D2 gastrectomy be justified?
Can the laparoscopic approach to D2 gastrectomy be justified?
Adjuvant radiotherapy of regional lymph nodes in breast
Adjuvant radiotherapy of regional lymph nodes in breast
Sentinel node mapping in breast cancer controversies
Sentinel node mapping in breast cancer controversies
Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Primary Breast...
Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Primary Breast...
Similar to DCIS Margins
EARLY BREAST CARCINOMA AND DCIS.pptx
This document provides an overview of early breast carcinoma and ductal carcinoma in situ (DCIS). It discusses the management of lobular carcinoma in situ (LCIS) and DCIS, including surgical and radiation treatment options. It also covers the surgical management and adjuvant therapies for invasive breast cancer, such as the use of lumpectomy, lymph node dissection and radiation to lymph nodes. Emerging techniques for accelerated partial breast irradiation are also mentioned.
Surgical margins in_breast_conservation_therapy_.16
The document discusses surgical margins in breast conservation therapy for early stage breast cancer and ductal carcinoma in situ (DCIS).
- There is no consensus on what constitutes a safe surgical margin width, but margins of 10 mm are generally considered low risk for local recurrence, while margins of 2 mm or less are often considered inadequate.
- Positive margins are associated with increased risk of local recurrence, but the significance of close margins (within 1 mm) remains controversial.
- The surgeon must balance the risks of local recurrence and cosmesis when planning breast conservation therapy to avoid compromising patient prognosis.
Journal club
This study examined predictors of contralateral breast cancer in unilateral breast cancer patients undergoing contralateral prophylactic mastectomy (CPM). The study analyzed 542 patients who underwent CPM at one cancer center between 2000-2007. Univariate analysis found that younger age, Gail risk score >1.67%, ipsilateral invasive lobular histology, additional ipsilateral moderate-high risk pathology, and multicentric ipsilateral tumor predicted higher risk of contralateral breast cancer. However, multivariate analysis identified only younger age and ipsilateral invasive lobular histology as independent predictors of contralateral breast cancer. The study aimed to help identify which unilateral breast cancer patients might most benefit from CPM.
ADJUTANT RADIOTHERAPY IN BREAST CANCER
This document discusses the evidence for adjuvant radiotherapy in breast cancer treatment. It finds that radiotherapy after breast-conserving surgery or mastectomy significantly reduces the risk of local recurrence and improves overall survival. For patients undergoing breast-conserving surgery, radiotherapy reduces the 10-year cumulative incidence of recurrence in the ipsilateral breast from 39.2% to 14.3%. Post-mastectomy radiotherapy is recommended for patients with ≥4 positive lymph nodes or 1-3 positive lymph nodes with high-risk features, as it lowers the risk of locoregional recurrence and improves overall survival. The timing, techniques, target volumes, and indications for radiotherapy are also outlined based on clinical evidence and guidelines.
Margin of Breast Conservative Surgery - How much is enough_.pptx
Margin width is an important factor influencing local recurrence risk for both ductal carcinoma in situ (DCIS) and invasive breast cancer treated with breast-conserving surgery. For DCIS treated with excision alone, a margin width of at least 2mm minimizes local recurrence risk. For DCIS treated with excision and radiation therapy, margins of 2mm or more are associated with reduced risk compared to narrower margins, but wider margins do not provide additional benefit. For invasive breast cancer, obtaining a negative margin, defined as no tumor cells on the inked edge, is associated with low recurrence rates and is recommended. Larger margins do not lower the risk further. Special cases may require individualized treatment plans including re-exc
management of carcinoma cervix- 2021
This document provides guidelines for the management and treatment of carcinoma of the cervix. It discusses staging of the disease using imaging and pathology. Locally advanced cervical cancer is defined. The document outlines the standard surgical and radiotherapy approaches based on disease stage. It also discusses the indications for and types of adjuvant chemoradiation therapy based on risk factors. Techniques for radiotherapy including 3D conformal radiation and IMRT are covered.
Landmark trials in carcinoma breast
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.
RT in early breast.pptx
- Young age is a risk factor for local recurrence after breast-conserving therapy, and adding a boost dose reduces the 5-year local recurrence rate from 26% to 8.5% for patients aged 35 or younger, compared to from 3.9% to 2.1% for patients older than 60.
- Post-mastectomy radiotherapy reduces locoregional recurrences by 70% and prevents one breast cancer death within 15 years for every four recurrences prevented at 5 years. PMRT is generally recommended for stage pT3/pN2a or higher.
- While radiotherapy decreases in-field recurrences, significant excess non-breast cancer mortality from heart disease and lung cancer was
Evolution of Hypofractionated Radiotherapy in Breast Cancer
Hypofractionated radiotherapy in breast cancer is one of the major evolution. It started few decades back. We have to know its history and radiobiological perspective. In this presentation I have tried to cover as much as possible. It would be helpful for all Radiation Oncologist specially the trainees.
LAND MARK TRIALS - KIRAN.pptx
This document summarizes several landmark trials in breast cancer treatment. It describes trials evaluating chemoprevention using tamoxifen and raloxifene, surgery including lumpectomy versus mastectomy, sentinel node biopsy versus axillary dissection, and the role of radiation therapy. Key findings include that lumpectomy with radiation was found to have similar survival as mastectomy, sentinel node biopsy reduced arm morbidity compared to axillary dissection, and radiation therapy after lumpectomy lowered the risk of recurrence in early-stage breast cancer patients.
TMT IN BLADDER CANCER.pptx
Trimodal therapy (TMT) involving chemotherapy, radiation, and TURBT is an alternative to radical cystectomy for muscle-invasive bladder cancer. This study analyzed 105 patients treated with TMT to identify optimal candidates. Tumor diameter prior to TURBT was found to be the best predictor of outcomes from TMT. Patients with a tumor diameter ≤3 cm who were eligible for cisplatin chemotherapy had a 79.2% 5-year disease-specific survival rate with TMT, comparable to radical cystectomy. Conversely, patients with a tumor diameter >5 cm had a poor 28.2% 5-year survival rate with TMT regardless of other factors.
Adjuvant chemotherapy of breast cancer
This document summarizes adjuvant chemotherapy for breast cancer. It discusses the rationale for adjuvant chemotherapy based on the Fisher hypothesis that breast cancer is a systemic disease at diagnosis. Evidence from large meta-analyses shows that adjuvant chemotherapy improves outcomes compared to no treatment or CMF chemotherapy alone. The addition of anthracyclines or taxanes to chemotherapy regimens provides further benefits. Molecular profiling tools can help select patients who will most benefit from chemotherapy based on tumor biology. Guidelines recommend chemotherapy for higher risk patient subgroups based on tumor characteristics and gene expression profiles.
EARLY BREAST CANCER MANAGEMENT.pptx
This document summarizes the management of early breast cancer. It discusses that early breast cancer has not spread beyond the breast or lymph nodes. Management is based on clinical factors and can include lumpectomy or mastectomy for local treatment, followed by radiation and/or systemic therapies like chemotherapy. Breast conservation therapy with lumpectomy and radiation is equivalent to mastectomy in terms of survival. Sentinel lymph node biopsy can accurately stage lymph nodes and reduce morbidity compared to full axillary lymph node dissection for early breast cancer patients.
Combined 18 clinical training--rectal surgical principles
This document discusses surgical treatment options for rectal cancer, including radical resection and local excision procedures. It emphasizes that total mesorectal excision during radical resection is optimal for most rectal cancers as it facilitates nerve preservation and complete resection, improving local control rates to less than 10%. Local excision may be adequate for early stage cancers, with local failure rates of around 20% when strict selection criteria are followed. Adjuvant chemotherapy and radiation are recommended to improve outcomes after conventional surgery for advanced cancers.
Bladder preservation in carcinoma of bladder
Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. However, bladder preservation strategies can be considered for select patients to maintain quality of life. Bladder preservation involves either single modality treatment like chemotherapy or radiotherapy, or trimodal therapy using transurethral resection, chemotherapy and radiotherapy. Trimodal therapy provides oncological outcomes equivalent to cystectomy for early stage tumors if strict criteria are met. Close surveillance is needed after bladder preservation due to risk of recurrence. Salvage cystectomy may be required for muscle-invasive recurrences.
fertililty sparing surgeries in gynecological cancers
- Fertility preservation is important for cancer patients of childbearing age to maintain their quality of life. Advances in cancer treatment like chemotherapy and radiation can impact fertility.
- For early stage cervical cancers like stage 1A1, 1A2, and 1B1, fertility sparing surgeries like conization or radical trachelectomy combined with lymph node dissection may be options to preserve fertility while treating the cancer.
- For early stage ovarian and endometrial cancers, fertility sparing surgeries like cystectomy or tumor resection with lymph node sampling can be considered to treat the cancer and spare fertility in select cases.
Surgical mgmt of axilla in Breast ca patients with negative SLN biopsy.pptx
1) A study evaluated a surgical approach aimed at reducing the false negative rate of sentinel lymph node dissection in breast cancer patients with negative sentinel lymph nodes.
2) 312 patients underwent sentinel lymph node dissection followed by axillary lymph node dissection, with sentinel lymph nodes visualized using dual tracers and fluorescence. Non-visualized lymph nodes near the sentinel lymph nodes were also examined.
3) The false negative rate was found to decrease with removal of more lymph nodes, with a median of 6 lymph nodes removed per patient in this study. Removing more first echelon lymph nodes improved staging accuracy.
bladder preservation - Bladder Cancer .pptx
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer. It describes trimodality therapy (TMT) involving maximal transurethral resection of bladder tumor (TURBT), radiation therapy with concurrent chemotherapy. Observational studies have found no significant difference in survival outcomes between TMT and radical cystectomy. Patient selection factors for TMT include clinical T2-T3a disease, absence of hydronephrosis or extensive carcinoma in situ. Concurrent chemoradiation typically involves cisplatin-based chemotherapy with 40-45Gy radiation to the bladder and pelvis, followed by a boost to the bladder. Follow up involves frequent cystoscopy and urine cytology.
Should triple negative breast cancer (tnbc) subtype
Triple-negative breast cancer (TNBC) is an aggressive subtype without targets for hormonal or HER2-directed therapy. While some studies found higher local recurrence rates with breast conservation for TNBC, other large studies found equivalent survival compared to mastectomy. Genetic testing is recommended for TNBC patients to guide risk-reducing interventions. For a patient with early-stage TNBC treated with lumpectomy, conventional whole-breast radiotherapy with boost is recommended to reduce the risk of local recurrence due to the aggressive nature of TNBC.
Mgmt vulva and vagina cancers
This document summarizes the management of vulvar and vaginal cancers. It discusses the typical sites of vulvar carcinoma involvement, risk factors, staging, treatment approaches including radical surgery and lymph node dissection historically and more recent less morbid surgical approaches. It covers the types of vulvar cancer, risk factors like HPV, signs and symptoms, and indicators of poor prognosis. Modern treatment approaches including radiation and chemotherapy are summarized. Neoadjuvant chemotherapy with radiation to reduce the extent of necessary surgery is discussed.
Similar to DCIS Margins (20)
Surgical margins in_breast_conservation_therapy_.16
Surgical margins in_breast_conservation_therapy_.16
Margin of Breast Conservative Surgery - How much is enough_.pptx
Margin of Breast Conservative Surgery - How much is enough_.pptx
Evolution of Hypofractionated Radiotherapy in Breast Cancer
Evolution of Hypofractionated Radiotherapy in Breast Cancer
Combined 18 clinical training--rectal surgical principles
Combined 18 clinical training--rectal surgical principles
fertililty sparing surgeries in gynecological cancers
fertililty sparing surgeries in gynecological cancers
Surgical mgmt of axilla in Breast ca patients with negative SLN biopsy.pptx
Surgical mgmt of axilla in Breast ca patients with negative SLN biopsy.pptx
Should triple negative breast cancer (tnbc) subtype
Should triple negative breast cancer (tnbc) subtype
More from Yana Puckett, MD, MPH, MS
Management of pleomorphic lcis
Pleomorphic lobular carcinoma in situ (PLCIS) is a recently characterized entity distinguished from classic LCIS by its more dyshesive, pleomorphic cells and association with markers of poorer prognosis. [PLCIS exhibits loss of E-cadherin and beta-catenin expression as well as genomic alterations linked to aggressiveness.] While long-term outcomes are unknown, available evidence suggests PLCIS may have higher recurrence rates than classic LCIS if margins are positive after excision. Current recommendations include surgical excision of PLCIS lesions with negative margins of 2mm or more and consideration of adjuvant hormonal or radiation therapy based on tumor biomarkers.
What is the proportion of patients that go on to surgery after nt in pdac (1)
What is the proportion of patients that go on to surgery after nt in pdac (1)Yana Puckett, MD, MPH, MS
Neoadjuvant treatment (NT) in resectable pancreatic cancer can increase resection rates and survival outcomes. Meta-analyses show 65% of patients with borderline resectable pancreatic cancer receiving NT went on to resection, with a median survival of 25.9 months for resected patients versus 11.9 months for unresected patients. In the US, around 25% of patients with resectable pancreatic cancer receive NT, though this percentage has been increasing over time. Early phase II trials showed resection rates between 39-85% for patients receiving NT prior to surgery. Larger trials have shown resection rates over 80% for NT arms.Indications for slnb in patients undergoing nac with clinically positive axil...
Indications for slnb in patients undergoing nac with clinically positive axil...Yana Puckett, MD, MPH, MS
This document discusses the use of neoadjuvant chemotherapy (NAC) in breast cancer patients and the impact of clinically positive lymph nodes (LNs) after NAC. It summarizes a clinical trial that found 41% of patients with initially clinically positive LNs converted to pathologically node-negative after NAC. The trial also found that sentinel lymph node biopsy (SLNB) after NAC for these patients resulted in a false negative rate of 12.6%, which was reduced to 6.8% when the initially positive clipped node was identified as a sentinel node. Current guidelines recommend SLNB after NAC for patients with a good clinical response and initially positive LNs, removing the clipped node and all sentinel nodes found.SWOG Trial Update
The document summarizes two clinical trials testing different chemotherapy regimens for pancreatic cancer. The S1505 trial compared mFOLFIRINOX vs gemcitabine/nab-paclitaxel as pre- and post-operative therapy and reported results at the 2019 and 2020 ASCO conferences. The PRODIGE 24 trial compared adjuvant mFOLFIRINOX vs gemcitabine alone in over 490 patients with resected pancreatic cancer and found that mFOLFIRINOX significantly increased disease-free and overall survival, though it had greater toxicity.
Does flat epithelial atypia always need excision
Flat epithelial atypia (FEA) is a benign breast lesion found on imaging as calcifications. Several studies examined the risk of FEA upgrading to malignancy after surgical excision. Meta-analyses found an 11.1% upgrade rate to cancer and 17.9% to atypical ductal hyperplasia. A retrospective study of 271 FEA cases found a 15% overall upgrade rate. However, a study of 69 FEA cases biopsied with vacuum-assisted biopsy found no upgrades after obtaining numerous core samples and ensuring complete calcification removal. Another study of 48 similar FEA cases found a low 2% upgrade rate with surveillance including annual mammograms. Therefore, the author's practice will be surveillance of qualifying
Cspine clearance
This document discusses guidelines for cervical spine immobilization and imaging in trauma patients. It describes the NEXUS criteria, a clinical decision tool that can safely rule out cervical spine fractures without imaging in alert, stable trauma patients. Validation studies found the NEXUS criteria have a sensitivity of 99.6% in adults and 83-100% in pediatric patients older than 8. While it can reduce unnecessary imaging by 12.6%, caution is advised in older adults and children under 8, where sensitivity may be lower. The document provides indications for when cervical spine imaging is recommended in pediatric trauma based on mechanism of injury and clinical findings.
Age-Associated Financial Vulnerability: An Emerging Public Health Issue
This article discusses the concept of age-associated financial vulnerability (AAFV) in older adults and its implications. It notes that even cognitively intact older adults can experience functional changes that increase financial vulnerability. The article cites research finding that 4.7% of older adults reported financial exploitation. It argues that AAFV poses substantial risks to older adults' financial security and that more research is needed on risk factors and potential screening and policy solutions to address this emerging problem.
Effect of primary care intervention on breastfeeding duration and intensity
Effect of primary care intervention on breastfeeding duration and intensityYana Puckett, MD, MPH, MS
This document summarizes two randomized controlled trials that studied the effect of primary care interventions on breastfeeding duration and intensity. The studies found that:
1. Lactation consultant support alone or combined with electronic prompts from prenatal care providers increased the intensity of breastfeeding at 3 months postpartum compared to usual care.
2. In one study, the intervention groups that received both lactation consultant support and electronic prompts, or lactation consultant support alone, had higher breastfeeding intensity at 3 months than the usual care group.
3. Both studies found that interventions integrating lactation consultants into routine prenatal and postnatal care can increase breastfeeding intensity at 3 months.Pediatric Head Trauma
1) Pediatric head trauma is a leading cause of death and disability in children, with over 650,000 evaluated per year. The causes vary by age, from abuse and falls in infants/toddlers to motor vehicle crashes and assaults in adolescents.
2) Management involves stabilizing the ABCs, preventing secondary brain injury, and obtaining a CT scan if indicated based on decision rules. For severe injuries, intensive care is needed for ICP monitoring, seizure prophylaxis, and treating complications like hypo/hyperglycemia.
3) While outcomes have improved with specialized pediatric trauma care, severe traumatic brain injury continues to carry high mortality rates around 40% and most survivors have long-term impairments.
Key disaster response preparedness agencies
This document discusses several key US agencies involved in disaster preparedness and response. It outlines the roles of the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, the Department of Homeland Security Office of Health Affairs, the Centers for Disease Control and Prevention, and the Federal Emergency Management Agency. These agencies work at the federal, state, and local levels to strengthen national response capabilities through funding, surveillance, research, and organized coordination during public health emergencies and disasters.
IRB Constrans CBPR
The current Institutional Review Board (IRB) system that oversees research involving human subjects can constrain Community-Based Participatory Research (CBPR). IRB guidelines are often too restrictive for CBPR, which requires community involvement. There is also tension between protecting individual participants versus entire communities. The document recommends three changes: 1) Provide more effective training for IRBs in CBPR methods and goals, 2) Require that each IRB have at least one member fluent in CBPR, and 3) Improve communication between IRBs and CBPR researchers to develop healthier relationships and better understand each approach. The overall goal is to balance IRB oversight with supporting successful CBPR projects.
Organic food 4 (1).pptx
This document discusses whether eating organic food is necessary for public health. It examines the regulations and certification processes for organic foods. While organic foods may have higher nutritional values due to lower pesticide residues, the document notes there is variability between studies. Organic farming eliminates the use of chemical pesticides and fertilizers. The future of organic food may include more community gardens and vertical farming in urban areas. The document provides references to support its examination of these issues.
Patient Satisfaction, Patient Reported Outcomes, Safety, and Quality of Care
Patient Satisfaction, Patient Reported Outcomes, Safety, and Quality of CareYana Puckett, MD, MPH, MS
This document discusses patient safety and medical errors. It notes that while human error is inevitable in healthcare, medical errors result in significant deaths and costs each year. To improve patient safety, the document advocates evaluating health systems, promoting a culture of reporting errors without blame, learning from mistakes, and designing systems to prevent errors and mitigate their effects if they do occur. The use of electronic health records and other technologies can help monitor patients and avoid some errors, but overreliance on computers also risks new types of mistakes, so limitations must be considered. Overall patient safety is improved when healthcare systems focus on evaluation, open communication, and making changes based on lessons learned over time.Week 3 educational product puckett
This document discusses various topics related to outcomes research, including comparative effectiveness research, multilevel data analysis, investigating change over time, and estimating treatment effects from observational data. Comparative effectiveness research directly compares existing healthcare interventions to determine their benefits and harms. Multilevel analysis is helpful for comparing patient outcomes across hospitals while accounting for risk factors. Propensity score adjustment and other statistical techniques can be used to estimate causal treatment effects from observational data and reduce selection bias. Bayesian statistics are increasingly being used in areas like early-phase cancer trials.
AHRQ Review
Here are the key points I gathered from reviewing the references:
1. AHRQ.gov is the official website of the Agency for Healthcare Research and Quality (AHRQ), one of the agencies within the US Department of Health and Human Services. It provides information about AHRQ's mission, research focus areas, and resources.
2. The textbook "Novick & Morrow’s Public Health Administration" discusses principles of public health administration and population-based management. It likely contains information relevant to AHRQ's role in conducting health services research and improving healthcare quality, access, and outcomes for the US population.
3. Both references provide authoritative background information about AHRQ as an organization and its work in health
Bsh 500 this is public health
Environmental and occupational factors play a large role in cardiovascular disease risk. Particulate matter, an occupational toxin, increases CVD risk. Diet is also a major risk factor, as saturated and trans fats, sodium, and sugars can contribute to heart disease. Smoking significantly increases cardiovascular risks, as does secondhand smoke exposure. Various occupational risks like stress, shift work, heavy lifting and toxin exposures are linked to higher heart disease rates. Public health aims to monitor these environmental and workplace factors, educate the public, and enforce regulations to reduce cardiovascular risks in both settings.
Breast cancer research
Breast cancer is the most common cancer in women. Rates are higher in Black women than White women due to disparities in screening and treatment. Genetic and lifestyle factors affect risk, and regular screening is recommended starting at age 40. However, some groups face barriers to screening like lack of access to care, knowledge, and cultural beliefs. Researchers are working to better understand risk factors and improve prevention and individualized treatment through studies on genetics, screening methods, and high-risk populations.
Environmental Health Notes
This document discusses various topics related to water treatment and solid waste management. It provides information on different water sources and their compositions, as well as water treatment processes like primary and secondary wastewater treatment. It also discusses solid waste disposal methods such as landfilling, incineration, recycling and their advantages and disadvantages. Key pollutants are described, as well as various environmental regulations around air and water quality.
Organic Food
This document discusses issues related to organic food versus conventional food. It provides definitions of organic food according to regulations. It explores costs of organic farming and whether it is worth the higher price. The document examines research on potential health benefits of organic food including higher nutritional content and lower pesticide residues. It also discusses labeling issues, genetically modified foods, and new approaches like vertical farming.
Pediatric abdominal trauma
Grand rounds presentation on pediatric abdominal trauma with the latest recommendations in literature reviewed.
More from Yana Puckett, MD, MPH, MS (20)
What is the proportion of patients that go on to surgery after nt in pdac (1)
What is the proportion of patients that go on to surgery after nt in pdac (1)
Indications for slnb in patients undergoing nac with clinically positive axil...
Indications for slnb in patients undergoing nac with clinically positive axil...
Age-Associated Financial Vulnerability: An Emerging Public Health Issue
Age-Associated Financial Vulnerability: An Emerging Public Health Issue
Effect of primary care intervention on breastfeeding duration and intensity
Effect of primary care intervention on breastfeeding duration and intensity
Patient Satisfaction, Patient Reported Outcomes, Safety, and Quality of Care
Patient Satisfaction, Patient Reported Outcomes, Safety, and Quality of Care
Recently uploaded
The Nervous and Chemical Regulation of Respiration
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
vonoprazan A novel drug for GERD presentation
Vonoprazan, a new potassium acid channel blocker used in the conditions of GERD and gastric ulcer, duodenal ulcer ....
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Fallopian tube blockage may cause female infertility. For treatment, herbal medicine Fuyan Pill can be a solution.
10 Benefits an EPCR Software should Bring to EMS Organizations
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Ageing, the Elderly, Gerontology and Public Health
Challenges associated with ageing from a public health perspective
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Dr. ZANAB FARHEEN FAYAZ ,MDS(ORTHODONTICS & DENTOFACIAL ORTHOPEDICS ).
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Do you have abnormal smell after periods? It may be vaginitis. Do not worry, herbal medicine Fuyan Pill can help you get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
How to choose the best dermatologists in Indore.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Acute Gout Care & Urate Lowering Therapy .pdf
In this document , the management of acute gout attacks and a description of urate lowering therapy is mentioned.
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...Kosmoderma Academy Of Aesthetic Medicine
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Recently uploaded (20)
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations
Ageing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public Health
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
DCIS Margins
- 1. DCIS Margins Yana Puckett, MD, MBA, MPH, MSc
- 2. Background ● Pre-invasive breast cancer. ● Incidence 33 per 100,000 women. ● Majority asymptomatic and non-palpable. ● Adequate margins for DCIS controversial topic. ● No ink on tumor only applies to invasive cancer.
- 3. DCIS on Pathologic Sectioning ● Studies of mastectomy specimens using whole organ sectioning and radiologic-pathologic correlation have demonstrated that while most cases of DCIS are unicentric. ● May be multifocal, with “gaps” of uninvolved tissue between foci of DCIS. ● Given this, a “negative margin” does not guarantee the absence of residual DCIS in the breast.
- 4. Margin Status ● Rate of recurrence low grade DCIS ~ 4%; high grade DCIS ~ 15% ● 25-50% of recurrences present with invasive disease ● Margin status x3 power of tumor grade predicting local recurrence ● Subject of much debate on what margins are enough for DCIS ● NSABP-B17, and EORTC clinical trials reveal clear margins significantly decrease recurrence ● No trial to examine optimum excision width.
- 5. NSABP-B17 ● The annual hazard rate for ipsilateral breast recurrence after lumpectomy alone was 8.1% for those with positive margins compared with 3.3% for patients with negative margin ● Reduced by WBRT to 2.7% and 1.2%, respectively.
- 6. EORTC 10853 trial ● At 15 years, almost one in three non-irradiated women developed an LR after Lumpectomy for DCIS. RT reduced this risk by a factor of 2. ● Positive margins were significantly associated with IBTR in a multivariate analysis of the long-term results
- 7. Consensus Guidelines 2016 ● Meta-analysis: 20 studies including 7883 patients as evidence base for consensus. ○ 2 mm margin standard for adequate margin for DCIS with WBRT (associated with low rates of recurrence and decreased re-excision rates, improve cosmetic outcome, and decrease healthcare costs). ○ Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.