Gray areas in the management of colorectal cancer
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This document discusses several gray areas in the management of colorectal cancer. It covers topics such as imaging techniques, surgical approaches, use of pre-operative and post-operative radiation, factors determining need for adjuvant therapy, chemotherapy regimens, addition of biologics, and molecular testing. A panel of experts debated issues like circumferential resection margins, short vs long course pre-op radiation, omitting radiation or surgery in select cases, laparoscopy vs open surgery, number of lymph nodes to examine, and sequencing of FOLFOX and FOLFIRI chemotherapy. Neoadjuvant therapy was noted to potentially improve outcomes with similar post-op morbidities compared to upfront surgery.
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Past, Present and Future of Oncology
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Penis carcinoma- premalignant and management algorithm
This document outlines pre-malignant conditions and management algorithms for cancer of the penis. It discusses various premalignant lesions like Bowen's disease, erythroplasia of Queyrat, lichen sclerosis, and their treatment options including topical therapies, ablation, excision and Mohs micrographic surgery. It also discusses staging and treatment options for primary penile cancer including organ-sparing surgeries and algorithms for managing inguinal lymph nodes depending on tumor characteristics and pathological findings. Radiation therapy has a role for small early-stage lesions or in patients who cannot undergo surgery. The goal of management is eradication of disease while preserving organ function.
Rectal MRI .pptx
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Management of Cancer larynx
1. Laryngeal cancer is a complex disease that requires multidisciplinary management to cure the disease while preserving laryngeal function. Treatment must be personalized based on evidence-based guidelines.
2. Early glottic cancers that do not spread to lymph nodes can be treated effectively with either radiation therapy or surgery alone, with the goal of curing the disease while preserving voice quality and function.
3. More advanced supraglottic cancers that can spread to lymph nodes are generally treated with radiation therapy alone, as it is less morbid than surgery, though patient factors also influence treatment choice.
RAPIDO Trial
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
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Non muscle invasive bladder carcinoma - management
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Soft tissue sarcoma
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Penis carcinoma- surgical managementof primary lesion
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salivary gland cancers management updates
This document presents a case presentation on salivary gland tumors. It outlines the investigations, staging, management, and prognosis of salivary gland tumors. The key investigations discussed are history and physical exam, ultrasound with fine needle aspiration, MRI, and histological diagnosis. Surgical management is the primary treatment and may include parotidectomy or neck dissection. Adjuvant radiation therapy can improve outcomes for high-grade or advanced tumors. Definitive radiation is an option for unresectable tumors. Prognosis depends on factors like tumor site, grade, and stage. Sequelae of treatment include facial nerve damage and xerostomia.
Similar to Gray areas in the management of colorectal cancer (20)
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Carcinoma of unknown primary
This document discusses carcinoma of unknown primary (CUP). Key points:
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- The cancer is often aggressive and may have disseminated before the primary is detectable. Major histologies are adenocarcinoma (60-90%) and squamous cell carcinoma (5%).
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Keynote 48
The document summarizes results from a study comparing pembrolizumab (Pem), a drug that enhances the immune system, to extreme chemotherapy (Extreme) in treating recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). It found that Pem combined with chemotherapy increased overall survival compared to Extreme, with a hazard ratio of 0.77 and median survival of 13.0 months versus 10.7 months. For PD-L1 positive tumors, Pem monotherapy also increased overall survival compared to Extreme. The authors concluded that Pem combined with chemotherapy or Pem monotherapy for PD-L1 positive tumors are appropriate first-line treatments for recurrent or metastatic HNSCC.
Venous thrombolembolism in cancer patients
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Pharmacokinetics & pharmacodynamics of anticancer agents
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This document discusses prostate cancer screening, diagnosis, staging, and treatment options. It covers PSA testing and digital rectal exams for screening. Biopsies and PSMA PET scans are used for diagnosis and staging. Risk stratification helps determine treatment, which may include radical prostatectomy, radiotherapy, hormone therapy drugs like abiraterone acetate and enzalutamide, chemotherapy like docetaxel, or bone-directed drugs for metastases. Complications of prostatectomy include blood transfusions, infections, incontinence, and erectile dysfunction. Radiotherapy and hormone therapies can cause side effects like fatigue, fluid retention, and liver enzyme changes.
Challenges in management of oral cavity cancers
This document discusses many of the challenges faced in managing oral cavity cancers. It outlines challenges for primary physicians in conducting thorough examinations and determining the appropriate imaging studies. It also discusses challenges for surgeons regarding factors that make tumors difficult to resect as well as different neck dissection techniques. For pathologists, it notes challenges with biopsy samples and determining extracapsular extension. It reviews treatment options and challenges regarding the management of the neck, use of induction chemotherapy, comparing radiation and surgery, use of brachytherapy and determining optimal cisplatin scheduling. It also discusses salvage treatments and challenges faced by patients.
Basic considerations of chemotherapy
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Small molecule targeted therapy
The document discusses various targeted therapies used in oncology including monoclonal antibodies, small molecule inhibitors, and tyrosine kinase inhibitors. It provides information on drug indications, mechanisms of action, FDA approvals, and common adverse effects for several targeted agents such as palbociclib, bortezomib, imatinib, crizotinib, ceritinib, osimertinib, and vemurafenib. The document is intended to educate medical practitioners on modern targeted therapies for cancer treatment.
Immunotherapy in head and neck malignancy
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A prospective study comparing induction chemotherapy followed by
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Usefulness of denosumab to non squamous non small
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This document discusses indolent non-Hodgkin lymphomas, including their classification, most common subtypes, presentation, workup, staging, histopathological examination, treatment approaches, and follow up. It focuses on follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma/chronic lymphocytic leukemia. Key points include the most common NHL subtypes by incidence, presentations involving lymph nodes or extranodal sites, investigations including imaging and biopsy, and stage-based and subtype-based treatment options such as chemotherapy, immunotherapy, radiation, surgery, and clinical trial approaches.
Treatment of ewing’s sarcoma
This document discusses the treatment of Ewing's sarcoma. It begins with an introduction to Ewing's sarcoma, describing its identification in 1921 and its characteristics. It then discusses the pathology, genetics, clinical presentation, routes of spread, diagnostic workup, staging, and prognostic factors. The bulk of the document focuses on treatment options, including induction chemotherapy, local therapy options of surgery or radiation, maintenance chemotherapy, and surveillance. It also covers treatment of metastatic and recurrent disease. The document provides detailed information on chemotherapy regimens, radiation techniques, and ongoing research directions.
Rt in lymphoma
This document discusses radiation therapy (RT) for various types of non-Hodgkin's lymphoma. It covers RT dose recommendations when used alone or as part of combined modality therapy for different lymphoma stages and histologies. It discusses techniques for total body irradiation and strategies for treating primary extranodal lymphomas in different anatomical sites. Overall, the document provides guidance on using RT to effectively treat various lymphomas based on stage, histology, and other clinical factors.
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- 1. Gray areas in the management of colorectal cancer Panelists Prof. Bitan Chatterjee Prof. Sourav Ghosh Prof. Aloke Ghoshdastidar Dr. Suman Mallick Dr. Ranojay Ghosh Dr. Koushik Chatterjee Moderator – Dr. Rajib Bhattacharjee
- 3. IMAGING? • EUS • CT Scan • MRI • PET Scan
- 5. SURGICAL APPROACHS LOCAL PROCEDURES • Polypectomy • Transanal excision • Trans-anal endoscopic microsurgery EXTENSIVESIVE PROCEDURES • LAR • Proctectomy with TME • APR
- 6. Approaches
- 9. Pre-op vs Post-op Radiation Pre op RT – Advantage • Sphincter preservation • Pre op tissues more radiosensitive • No risk of trapped small bowel injury • Healthy tissue anastomosis Post op RT used in clinical stage 1 tumor turned stage 2 or 3
- 13. Low risk factors in pT3 N0 tumors •Low grade •Less than 2mm invasion into mesorectum •LVSI •Negative margines
- 14. Pre-op RT – Long course vs Short course
- 16. Can RT be omitted? MSKCC - PROSPECT
- 17. Can surgery be omitted ?
- 19. Radical Surgery • Colectomy or Complete Mesocolic Excision (CME)?
- 21. PATHOLOGY • Points of reporting • Margin assessment • Lymph nodes • Tumor deposits/ Satellite nodules
- 22. No of lymph nodes
- 23. Adjuvant therapy Stage II • Indications? • Oxaliplatin?
- 27. MOSAIC TRIAL
- 28. MOSAIC TRIAL
- 29. Stage III (T1-4 N1-2 M0) • Regimen ? • Duration ? • Issues with oxaliplatin toxicity
- 38. CONCLUSION - with Neoadjuvant therapy there is considerable downstaging and post op morbidities are similar F O X T R O T
- 39. Cytoreductive surgery & HIPEC
- 40. FOLFOX->FOLFIRI FOLFIRI->FOLFOX n 111 109 OS 20.6 21.5 RR 54% 56% PFS 1 8.0 8.5 PFS 2 10.9 14.2 G 3-4 Toxicity Neutropenia Neurotoxicity Mucositis Nausea, Vomiting
- 41. FOLFOX or CAPOX
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