Christopher Azzoli, M.D., Assistant Member, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center: Current Modalities in the Treatment of Lung Cancer
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
Management of Lung Cancer
By Dr Parneet Singh
1. Lung cancer is most commonly diagnosed at late stages. NSCLC stages at presentation range from 10% at stage I to 40% at stage IV.
2. Prognostic factors include patient performance status, weight loss, age, pulmonary function tests, tumor stage and molecular markers, completeness of resection, addition of chemotherapy and radiotherapy.
3. Treatment depends on stage - surgery or SBRT for stage I-II, chemotherapy and radiotherapy for stage III, chemotherapy and radiotherapy for consolidation or palliation in stage IV. Surgery provides the best chance for cure in early stages.
This document provides a case presentation and question regarding the next appropriate step in management for a patient. The case involves a 56-year-old man evaluated for weakness, dry eyes/mouth, and erectile dysfunction following treatment for limited-stage small cell lung cancer 3 months prior. On examination, the patient has ptosis, proximal weakness, absent reflexes that improve after brief exercise. The most likely diagnosis is myasthenia gravis.
This document discusses lung cancer, including risk factors, types, staging, diagnosis, and treatment options. It notes that smoking is the primary risk factor, greatly increasing lifetime risk. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer. Staging involves determining the size and spread of the tumor using imaging and lymph node involvement. Treatment depends on stage but commonly includes surgery for early stages and chemotherapy with or without radiation for later stages. Outcomes remain poor, especially for metastatic disease, but improved understanding of lung cancer has led to personalized treatment approaches.
REVIEW OF METHODS FOR DIAGNOSIS OF LUNG CANCERswankyshahir
This document discusses the diagnosis of lung cancer. It covers risk factors for lung cancer like smoking and air pollution. Screening methods are discussed, including low-dose CT screening which has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. Diagnostic tools covered include sputum cytology, chest x-rays, CT scans, PET scans, bronchoscopy, biopsy and gene mutations associated with lung cancer like EGFR and KRAS. Early detection through low-dose CT screening and use of various diagnostic imaging and biopsy methods is key to improving outcomes for lung cancer patients.
This document discusses lung cancer, including its anatomy, staging, diagnostic imaging, and treatment options. It provides details on the lobes of the lungs, lymph node stations, and the importance of lymph node involvement in staging. Imaging techniques like CT, PET, and PET/CT are described. Treatment depends on cancer type and stage, and may involve surgery, chemotherapy, radiation therapy, or a combination. Side effects of radiation treatment are also outlined.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for around 85% of cases. The three main subtypes are squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Treatment depends on the cancer stage and patient's health, and may involve surgery, chemotherapy, radiation therapy, targeted therapy, or immunotherapy. For early stages, surgery is usually the primary treatment, while later stages involve combinations of treatments to control symptoms and prolong life when cure is not possible. Clinical trials play an important role in advancing new treatments.
the upcoming 8th edition of TNM staging in lung cancer will be published soon. what we need to know about TNM , how it was developed and why? how we can improve our practice for suspected lung cancer patients
- A 60 year old smoker presented for a routine physical and was found to have an abnormality on chest x-ray
- The next appropriate test would be a CT scan of the chest with IV contrast to further characterize any lung lesions found on CXR
- A CT-guided biopsy would not be the next test, as further imaging is needed first to identify and stage any potential lung cancer before invasive testing
The best answer is A) CT chest with IV contrast to further evaluate and characterize any lung abnormalities found on CXR before considering an invasive biopsy.
Management of Lung Cancer
By Dr Parneet Singh
1. Lung cancer is most commonly diagnosed at late stages. NSCLC stages at presentation range from 10% at stage I to 40% at stage IV.
2. Prognostic factors include patient performance status, weight loss, age, pulmonary function tests, tumor stage and molecular markers, completeness of resection, addition of chemotherapy and radiotherapy.
3. Treatment depends on stage - surgery or SBRT for stage I-II, chemotherapy and radiotherapy for stage III, chemotherapy and radiotherapy for consolidation or palliation in stage IV. Surgery provides the best chance for cure in early stages.
This document provides a case presentation and question regarding the next appropriate step in management for a patient. The case involves a 56-year-old man evaluated for weakness, dry eyes/mouth, and erectile dysfunction following treatment for limited-stage small cell lung cancer 3 months prior. On examination, the patient has ptosis, proximal weakness, absent reflexes that improve after brief exercise. The most likely diagnosis is myasthenia gravis.
This document discusses lung cancer, including risk factors, types, staging, diagnosis, and treatment options. It notes that smoking is the primary risk factor, greatly increasing lifetime risk. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer. Staging involves determining the size and spread of the tumor using imaging and lymph node involvement. Treatment depends on stage but commonly includes surgery for early stages and chemotherapy with or without radiation for later stages. Outcomes remain poor, especially for metastatic disease, but improved understanding of lung cancer has led to personalized treatment approaches.
REVIEW OF METHODS FOR DIAGNOSIS OF LUNG CANCERswankyshahir
This document discusses the diagnosis of lung cancer. It covers risk factors for lung cancer like smoking and air pollution. Screening methods are discussed, including low-dose CT screening which has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. Diagnostic tools covered include sputum cytology, chest x-rays, CT scans, PET scans, bronchoscopy, biopsy and gene mutations associated with lung cancer like EGFR and KRAS. Early detection through low-dose CT screening and use of various diagnostic imaging and biopsy methods is key to improving outcomes for lung cancer patients.
This document discusses lung cancer, including its anatomy, staging, diagnostic imaging, and treatment options. It provides details on the lobes of the lungs, lymph node stations, and the importance of lymph node involvement in staging. Imaging techniques like CT, PET, and PET/CT are described. Treatment depends on cancer type and stage, and may involve surgery, chemotherapy, radiation therapy, or a combination. Side effects of radiation treatment are also outlined.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for around 85% of cases. The three main subtypes are squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Treatment depends on the cancer stage and patient's health, and may involve surgery, chemotherapy, radiation therapy, targeted therapy, or immunotherapy. For early stages, surgery is usually the primary treatment, while later stages involve combinations of treatments to control symptoms and prolong life when cure is not possible. Clinical trials play an important role in advancing new treatments.
the upcoming 8th edition of TNM staging in lung cancer will be published soon. what we need to know about TNM , how it was developed and why? how we can improve our practice for suspected lung cancer patients
- A 60 year old smoker presented for a routine physical and was found to have an abnormality on chest x-ray
- The next appropriate test would be a CT scan of the chest with IV contrast to further characterize any lung lesions found on CXR
- A CT-guided biopsy would not be the next test, as further imaging is needed first to identify and stage any potential lung cancer before invasive testing
The best answer is A) CT chest with IV contrast to further evaluate and characterize any lung abnormalities found on CXR before considering an invasive biopsy.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Lung cancer is a leading cause of cancer death worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85% of lung cancer cases. Treatment for NSCLC depends on the stage - surgery is recommended for early stage disease, while later stages may involve chemotherapy, radiation therapy, or a combination. New targeted therapies and immunotherapy agents are improving survival rates for advanced NSCLC.
This document discusses lung cancer treatment and recent advances. It begins with an introduction on lung cancer being the most common malignancy worldwide and a leading cause of cancer death. It then covers topics like incidence and prevalence rates, classification and pathology of lung cancer types (non-small cell vs. small cell), staging systems, risk factors, investigations, imaging, surgery, chemotherapy regimens for different stages, and prognosis factors. Key points emphasized are the rising rates of adenocarcinoma, importance of imaging and staging for determining treatment options, and multimodality therapy for locally advanced stages.
LUNG CANCER remains the leading cause of cancer-related mortality in men and women in the United States, accounting for over 157,000 deaths annually.Despite advances in imaging, lung cancer is often detected when the disease has spread from the primary tumour to regional lymph nodes or distant sites. Appropriate therapy is dependent on accurate staging to identify those patients who are surgical candidates and those patients for whom chemotherapy and radiation therapy is indicated.
In this review, the current staging system for lung cancer is discussed, along with practical imaging approaches.
Small Cell Lung Cancer Management by Dr.Tinku JosephDr.Tinku Joseph
Small cell lung cancer (SCLC) typically presents with widespread metastases. SCLC is classified as limited stage or extensive stage disease. Treatment for limited stage SCLC involves chemotherapy with cisplatin and etoposide plus concurrent thoracic radiation. Prophylactic cranial irradiation is also recommended. Extensive stage SCLC is treated with chemotherapy alone. The standard regimen is cisplatin and etoposide, though carboplatin-based regimens are also used. Local radiation may provide additional benefit for responsive extensive stage patients. Median survival for SCLC depends on stage but typically ranges from 10 to 24 months with treatment.
1) Lung cancer is a malignant lung tumor characterized by uncontrolled cell growth in lung tissues that can spread to other organs. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
2) NSCLC accounts for about 80-85% of cases and includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC grows and spreads more rapidly than NSCLC.
3) Treatment for lung cancer depends on the type and stage of cancer, and may include surgery, chemotherapy, radiation therapy, targeted therapies, and supportive care. The goal of treatment is to cure early-stage cancer or prolong survival and palliate symptoms of advanced cancer
This document provides an overview of lung cancer, including:
- The four most common causes of lung masses are benign lesions, primary lung cancer, metastatic disease, and lung abscess.
- There are two main types of lung cancer - small cell lung cancer and non-small cell lung cancer, which is most common.
- Symptoms of lung cancer can include cough, breathing problems, weight loss, chest pain, and fatigue, though early-stage cancers may be asymptomatic.
- Diagnostic tests include chest x-rays, CT scans, sputum cytology, bronchoscopy, and biopsies. Staging helps determine prognosis and treatment.
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...MedicineAndHealthCancer
- Lung cancer is one of the leading causes of cancer death worldwide, with over 1.5 million new cases and 1.5 million deaths per year globally. In the US there are over 164,000 new cases and 156,900 deaths per year.
- The main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC makes up 80% of cases and SCLC 20%. NSCLC subtypes include squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and bronchioloalveolar carcinoma.
- Treatment depends on the cancer type and stage. For early stage NSCLC, surgery is usually recommended. Later stage NSCLC may
Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.
This document discusses non-small cell lung cancer (NSCLC), including its diagnosis, staging, types, and risk factors. It begins by describing lung anatomy and function. It then covers how NSCLC starts and spreads, the TNM staging system, the three main types of NSCLC (squamous cell carcinoma, adenocarcinoma, large cell carcinoma), and risk factors such as smoking, radon, asbestos, genetics, and other workplace exposures.
This document summarizes recent advances in the management of lung cancer. It covers staging of non-small cell lung cancer (NSCLC) and small cell lung cancer using various imaging techniques like CT, PET, and MRI. It discusses treatment options for early and locally advanced NSCLC including surgery, chemotherapy, and radiation. For metastatic NSCLC, platinum-based chemotherapy is the standard first-line treatment. Second-line options include docetaxel, pemetrexed, erlotinib, and ramucirumab plus docetaxel. Maintenance therapy and anti-angiogenic agents like bevacizumab are also discussed.
This document provides information about small cell lung cancer (SCLC). It discusses that tobacco consumption is the primary cause of SCLC and accounts for 80-90% of lung cancer cases. It also notes that SCLC accounts for 13% of lung cancer worldwide. The natural history of untreated SCLC is rapid progression with a median survival of 2-4 months if extensive stage disease is present at diagnosis in approximately two thirds of patients. Diagnostic workup involves imaging like CT scans and PET scans to stage the cancer as well as biopsies to confirm the diagnosis. Prognostic factors like limited versus extensive stage disease and performance status impact survival outcomes.
This document provides information about lung cancer including:
1. It defines lung cancer as the uncontrolled growth of malignant cells in the lungs or tracheobronchial tree caused by repeated carcinogenic irritation.
2. The main risk factors for lung cancer are smoking, radiation exposure, and environmental/occupational exposures like asbestos and radon. Smoking is the leading cause of lung cancer.
3. Treatment for lung cancer depends on the stage and type but may include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination. Lung cancer staging helps determine prognosis and appropriate treatment.
The document discusses lung cancer, including:
1) Lung cancer incidence and mortality rates have increased in China since 1990, becoming the leading cause of cancer death.
2) Risk factors for lung cancer include cigarette smoking, air pollution, certain occupations, and genetic factors.
3) Diagnosis involves imaging like chest X-rays and CT scans, as well as procedures like bronchoscopy to obtain tissue samples.
4) Treatment depends on cancer type and stage, and may involve surgery, chemotherapy, radiation therapy, targeted therapy, and other approaches. Adjuvant chemotherapy provides a limited survival benefit for non-small cell lung cancer.
The document provides an overview of lung neoplasms (tumors), including risk factors, classification, clinical features, diagnosis, and management. Some key points include:
- Lung cancer is the leading cause of cancer death in the US, with most patients diagnosed at an advanced stage. Survival depends on several factors like sex, age, and race.
- Major risk factors include smoking, age, industrial compounds, pre-existing lung diseases, family history, and viruses. Lung cancers are broadly classified into non-small cell carcinomas and neuroendocrine carcinomas.
- Clinical features vary depending on tumor type and location. Diagnosis involves imaging like CT scans, biopsies, and
Lung cancer treatment depends on the type and stage of cancer. The most common types are small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). For early-stage NSCLC, surgery such as lobectomy or pneumonectomy is the standard treatment and can be curative. Adjuvant chemotherapy may be given after surgery. Later stage NSCLC is typically treated with chemotherapy, radiation therapy, or a combination. SCLC is usually treated with chemotherapy and radiation therapy since it often cannot be completely surgically removed. The 5-year survival rate after treatment ranges from 75% for stage 1 to less than 30% for stage 3 lung cancer.
Geoffrey Oxnard, MD, discusses the latest research in targeted therapies and molecular testing to treat lung cancer.
This presentation was originally given as part of "Living with Lung Cancer: A Forum for Patients and Caregivers" on Nov. 14, 2015 at Dana-Farber Cancer Institute in Boston, Mass.
Audio and slides for this presentation are available on YouTube: http://youtu.be/rt_O7m2eTYA
David Barbie, MD, of the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute, discusses the stages of lung cancer, how the disease is treated, and new targeted therapies for patients. This presentation was originally given at Dana-Farber's "Living with Lung Cancer" forum on Nov. 2, 2013.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Lung cancer is a leading cause of cancer death worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85% of lung cancer cases. Treatment for NSCLC depends on the stage - surgery is recommended for early stage disease, while later stages may involve chemotherapy, radiation therapy, or a combination. New targeted therapies and immunotherapy agents are improving survival rates for advanced NSCLC.
This document discusses lung cancer treatment and recent advances. It begins with an introduction on lung cancer being the most common malignancy worldwide and a leading cause of cancer death. It then covers topics like incidence and prevalence rates, classification and pathology of lung cancer types (non-small cell vs. small cell), staging systems, risk factors, investigations, imaging, surgery, chemotherapy regimens for different stages, and prognosis factors. Key points emphasized are the rising rates of adenocarcinoma, importance of imaging and staging for determining treatment options, and multimodality therapy for locally advanced stages.
LUNG CANCER remains the leading cause of cancer-related mortality in men and women in the United States, accounting for over 157,000 deaths annually.Despite advances in imaging, lung cancer is often detected when the disease has spread from the primary tumour to regional lymph nodes or distant sites. Appropriate therapy is dependent on accurate staging to identify those patients who are surgical candidates and those patients for whom chemotherapy and radiation therapy is indicated.
In this review, the current staging system for lung cancer is discussed, along with practical imaging approaches.
Small Cell Lung Cancer Management by Dr.Tinku JosephDr.Tinku Joseph
Small cell lung cancer (SCLC) typically presents with widespread metastases. SCLC is classified as limited stage or extensive stage disease. Treatment for limited stage SCLC involves chemotherapy with cisplatin and etoposide plus concurrent thoracic radiation. Prophylactic cranial irradiation is also recommended. Extensive stage SCLC is treated with chemotherapy alone. The standard regimen is cisplatin and etoposide, though carboplatin-based regimens are also used. Local radiation may provide additional benefit for responsive extensive stage patients. Median survival for SCLC depends on stage but typically ranges from 10 to 24 months with treatment.
1) Lung cancer is a malignant lung tumor characterized by uncontrolled cell growth in lung tissues that can spread to other organs. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
2) NSCLC accounts for about 80-85% of cases and includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC grows and spreads more rapidly than NSCLC.
3) Treatment for lung cancer depends on the type and stage of cancer, and may include surgery, chemotherapy, radiation therapy, targeted therapies, and supportive care. The goal of treatment is to cure early-stage cancer or prolong survival and palliate symptoms of advanced cancer
This document provides an overview of lung cancer, including:
- The four most common causes of lung masses are benign lesions, primary lung cancer, metastatic disease, and lung abscess.
- There are two main types of lung cancer - small cell lung cancer and non-small cell lung cancer, which is most common.
- Symptoms of lung cancer can include cough, breathing problems, weight loss, chest pain, and fatigue, though early-stage cancers may be asymptomatic.
- Diagnostic tests include chest x-rays, CT scans, sputum cytology, bronchoscopy, and biopsies. Staging helps determine prognosis and treatment.
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...MedicineAndHealthCancer
- Lung cancer is one of the leading causes of cancer death worldwide, with over 1.5 million new cases and 1.5 million deaths per year globally. In the US there are over 164,000 new cases and 156,900 deaths per year.
- The main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC makes up 80% of cases and SCLC 20%. NSCLC subtypes include squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and bronchioloalveolar carcinoma.
- Treatment depends on the cancer type and stage. For early stage NSCLC, surgery is usually recommended. Later stage NSCLC may
Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.
This document discusses non-small cell lung cancer (NSCLC), including its diagnosis, staging, types, and risk factors. It begins by describing lung anatomy and function. It then covers how NSCLC starts and spreads, the TNM staging system, the three main types of NSCLC (squamous cell carcinoma, adenocarcinoma, large cell carcinoma), and risk factors such as smoking, radon, asbestos, genetics, and other workplace exposures.
This document summarizes recent advances in the management of lung cancer. It covers staging of non-small cell lung cancer (NSCLC) and small cell lung cancer using various imaging techniques like CT, PET, and MRI. It discusses treatment options for early and locally advanced NSCLC including surgery, chemotherapy, and radiation. For metastatic NSCLC, platinum-based chemotherapy is the standard first-line treatment. Second-line options include docetaxel, pemetrexed, erlotinib, and ramucirumab plus docetaxel. Maintenance therapy and anti-angiogenic agents like bevacizumab are also discussed.
This document provides information about small cell lung cancer (SCLC). It discusses that tobacco consumption is the primary cause of SCLC and accounts for 80-90% of lung cancer cases. It also notes that SCLC accounts for 13% of lung cancer worldwide. The natural history of untreated SCLC is rapid progression with a median survival of 2-4 months if extensive stage disease is present at diagnosis in approximately two thirds of patients. Diagnostic workup involves imaging like CT scans and PET scans to stage the cancer as well as biopsies to confirm the diagnosis. Prognostic factors like limited versus extensive stage disease and performance status impact survival outcomes.
This document provides information about lung cancer including:
1. It defines lung cancer as the uncontrolled growth of malignant cells in the lungs or tracheobronchial tree caused by repeated carcinogenic irritation.
2. The main risk factors for lung cancer are smoking, radiation exposure, and environmental/occupational exposures like asbestos and radon. Smoking is the leading cause of lung cancer.
3. Treatment for lung cancer depends on the stage and type but may include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination. Lung cancer staging helps determine prognosis and appropriate treatment.
The document discusses lung cancer, including:
1) Lung cancer incidence and mortality rates have increased in China since 1990, becoming the leading cause of cancer death.
2) Risk factors for lung cancer include cigarette smoking, air pollution, certain occupations, and genetic factors.
3) Diagnosis involves imaging like chest X-rays and CT scans, as well as procedures like bronchoscopy to obtain tissue samples.
4) Treatment depends on cancer type and stage, and may involve surgery, chemotherapy, radiation therapy, targeted therapy, and other approaches. Adjuvant chemotherapy provides a limited survival benefit for non-small cell lung cancer.
The document provides an overview of lung neoplasms (tumors), including risk factors, classification, clinical features, diagnosis, and management. Some key points include:
- Lung cancer is the leading cause of cancer death in the US, with most patients diagnosed at an advanced stage. Survival depends on several factors like sex, age, and race.
- Major risk factors include smoking, age, industrial compounds, pre-existing lung diseases, family history, and viruses. Lung cancers are broadly classified into non-small cell carcinomas and neuroendocrine carcinomas.
- Clinical features vary depending on tumor type and location. Diagnosis involves imaging like CT scans, biopsies, and
Lung cancer treatment depends on the type and stage of cancer. The most common types are small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). For early-stage NSCLC, surgery such as lobectomy or pneumonectomy is the standard treatment and can be curative. Adjuvant chemotherapy may be given after surgery. Later stage NSCLC is typically treated with chemotherapy, radiation therapy, or a combination. SCLC is usually treated with chemotherapy and radiation therapy since it often cannot be completely surgically removed. The 5-year survival rate after treatment ranges from 75% for stage 1 to less than 30% for stage 3 lung cancer.
Geoffrey Oxnard, MD, discusses the latest research in targeted therapies and molecular testing to treat lung cancer.
This presentation was originally given as part of "Living with Lung Cancer: A Forum for Patients and Caregivers" on Nov. 14, 2015 at Dana-Farber Cancer Institute in Boston, Mass.
Audio and slides for this presentation are available on YouTube: http://youtu.be/rt_O7m2eTYA
David Barbie, MD, of the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute, discusses the stages of lung cancer, how the disease is treated, and new targeted therapies for patients. This presentation was originally given at Dana-Farber's "Living with Lung Cancer" forum on Nov. 2, 2013.
Gastric cancer is a significant problem in some countries. A 40-year-old man presented with locally advanced gastric cancer and underwent neoadjuvant chemotherapy followed by surgery, resulting in a complete pathological response. A 69-year-old woman presented with stage IV gastric cancer and received palliative chemotherapy to control her symptoms. Multidisciplinary treatment and consideration of prognostic factors are important for managing both localized and advanced gastric cancer.
Diagnosis is defined as utilization of scientific knowledge for identifying a diseased process and to differentiate from other disease process
Literal meaning of diagnosis is determination and judgment of variations from the normal .
Get the facts on Lung Cancer Symptoms, Treatments, Types, Stages, Signs, etc. Get tips on Lung Cancer. For detail information about lung cancer visit us. - Lung Cancer Symptoms, Signs, Treatment & Causes
The document provides guidance on orthodontic diagnosis and treatment planning. It outlines the key steps in the diagnostic process, which include obtaining a patient history, performing a clinical examination, analyzing diagnostic records, classifying the malocclusion, developing a problem list, and formulating a treatment plan. The clinical examination involves assessing both extraoral and intraoral structures to identify abnormalities. The goals of orthodontic treatment are discussed as functional efficiency, structural balance, and esthetic harmony. An accurate diagnosis is emphasized as the foundation for providing appropriate orthodontic care.
Orthodontics terms /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
This document from the Indian Dental Academy provides summaries of key concepts in orthodontics and dentistry. It lists names associated with malocclusion, arch forms, facial indices, cephalic indices, extraction techniques, and landmarks used in cephalometric analysis. It also defines orthodontic appliances and procedures like headgear design, palatal vault indices, and stages of cervical vertebrae maturation.
The document discusses diagnosis and treatment planning for patients requiring removable partial dentures. It outlines the importance of a thorough patient interview and clinical examination, including diagnostic casts and jaw relation records, to understand the patient's needs and dental condition. A comprehensive analysis of all diagnostic findings is necessary to develop an appropriate treatment plan that meets the objectives of eliminating disease, preserving oral tissues, and restoring function and esthetics. The treatment plan for an edentulous patient is simple, but a complex case requires assembling all diagnostic criteria to ensure success.
Lung cancer was rare prior to 1900 but became a leading cause of cancer death in the mid-20th century due to tobacco consumption. Tobacco smoking remains the primary cause of lung cancer worldwide, though 60% of new lung cancers in the US occur in former or never smokers. There are two main types of lung cancer - non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, and small cell lung cancer. Molecular profiling of mutations has identified subsets of NSCLC and helped develop targeted therapies, though transformation between cancer types can occur. Aberrant miRNA and methylation expression are also involved in lung cancer pathogenesis and have potential as biomarkers.
Immune checkpoint inhibitors work by releasing brakes on the immune system called checkpoints that normally limit anti-tumor immune responses. In clinical trials, checkpoint inhibitors have demonstrated the ability to induce long-lasting responses in a subset of patients with various cancers including melanoma. Combining checkpoint inhibitors with other immunotherapies, targeted therapies, or cell-based therapies may help generate anti-tumor immune responses in patients whose tumors do not respond to checkpoint inhibitors alone. Managing cancer in the era of checkpoint inhibitors will likely involve complex combinations of different treatment approaches.
This document provides an overview of molecular genetics and cancer biology concepts. It begins with an introduction to basic molecular genetics topics like DNA, genes, chromosomes, and gene expression. It then discusses how normal cells can become cancerous through genetic mutations that disrupt processes like tumor suppressor genes, oncogenes, the cell cycle, and DNA repair. The document emphasizes how understanding molecular genetics advances has helped improve diagnosis and treatment of cancers like prostate and bladder cancer, but also highlights ongoing challenges. It provides context on cancer rates and the need for continued research.
This document discusses the importance of developing a thorough treatment plan for patients. It outlines the key steps in treatment planning which include taking a dental and medical history, performing a clinical examination, taking radiographs and diagnostic impressions, creating diagnostic casts and wax-ups. The treatment plan should be developed in phases to address disease control, restorative work, and long-term maintenance. Factors like the patient's needs, expectations, and medical conditions must be considered when formulating the optimal treatment.
The document discusses diagnostic procedures used in dentistry. It outlines various tests like thermal tests, electric pulp tests, mobility tests, and radiographs that are used to diagnose dental issues like pulp vitality, periapical lesions, and periodontal disease. The goal of diagnosis is to accurately identify the disease through signs, symptoms, and test results to determine the appropriate treatment.
This document outlines a treatment plan for periodontal disease. It includes 5 phases: emergency, etiotropic (non-surgical), surgical, restorative, and maintenance. The etiotropic phase involves nonsurgical therapies like scaling, root planing, and oral hygiene instruction. The surgical phase uses various periodontal surgeries to further treat pockets and furcations. The restorative phase focuses on final restorations. Lastly, the maintenance phase provides periodic recall visits to monitor the patient's condition. The overall goal is to resolve inflammation and reduce pocket depths through a coordinated approach involving multiple dental specialists.
This document discusses lung cancer epidemiology, risk factors, pathology, and smoking cessation. It notes that lung cancer is largely caused by tobacco consumption and was rare before the 20th century. While smoking is the primary risk factor, some people who develop lung cancer have never smoked. The four main histological types are small cell lung cancer, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Stopping smoking can avoid over 90% of lung cancer risk from tobacco. Occupational exposures like asbestos and radiation also increase lung cancer risk.
Renal Cell Carcinoma A New Standard Of Carefondas vakalis
This document summarizes the current standard of care for renal cell carcinoma (RCC), focusing on targeted therapies such as anti-angiogenesis agents. It reviews the biology and risk factors for RCC, the clinical efficacy and safety profiles of drugs like sorafenib and sunitinib, and phase III trial results demonstrating improved progression-free and overall survival compared to interferon-alpha. It concludes that anti-angiogenic therapies such as sorafenib, sunitinib, and temsirolimus have become the new standard first-line treatment for metastatic RCC based on superior clinical outcomes over existing immunotherapy options.
1) The document discusses a masterclass on non-small cell lung cancer (NSCLC) surgery.
2) It presents a case study of a 59-year-old female with an incidental chest X-ray finding and questions regarding her diagnosis, staging, and treatment options.
3) The document reviews NSCLC staging statistics, survival rates based on stage, and concepts in personalized and integrated therapy for NSCLC.
These slides are from versions of a talk I gave at ESTRO in 2014 and again in Lille in 2015.
The talk aims to explain the importance of correctly defining the CTV with respect to nodes in curative radiotherapy planning.
The lecture makes some important points about the function of lymph glands and their potential to act as stem cell 'rests' for malignant cells: this fact might explain whilst lymph node failure rates don't necessarily equate to disease failure rates.
The lecture then goes on to emphasise the utility of the best imaging technologies may more accurately identify involved nodes.
Shrinking fields with confidence may be the best way to reduce radiation toxicity.
This document provides an overview of non-small cell lung cancer (NSCLC). It discusses that lung cancer is the leading cause of cancer death. The majority of cases are late-stage at diagnosis and have a poor prognosis. Smoking is responsible for 90% of lung cancers. Advances in screening and targeted therapies have improved outcomes for some patients. Molecular testing is important to identify drivers and direct treatment, such as EGFR mutations that predict response to tyrosine kinase inhibitors.
This document summarizes a presentation on breast cancer management. It includes information on lactational breast abscess, abscess drainage procedures, names mentioned in breast surgery history, types of breast cancer, age and cancer risk, sensitivity of mammography by age, hormones affecting the breast, age distribution of breast cancer patients at a hospital from 2009-2010, incidence and mortality rates of breast cancer in the UK, hormonal therapy options, neoadjuvant vs adjuvant treatment, management of the axilla, sentinel lymph node biopsy procedure, heart irradiation from treatment, lumpectomy vs mastectomy, 20-year follow up data from a randomized breast cancer treatment trial, factors considered in treatment planning, tumor grading, immunohistochemistry markers, educating health
Robert Sinha, M.D., Radiation Oncologist .Western Radiation Oncology - Dorothy Schneider Cancer Center - 2013 Mills-Peninsula Health Services Cancer Symposium
This document discusses the use of multiparametric MRI in characterizing and evaluating brain tumors. It describes how conventional MRI sequences like T1, T2, FLAIR along with functional techniques like diffusion weighted imaging, perfusion weighted imaging, and magnetic resonance spectroscopy can be used together to characterize tissues and evaluate neoangiogenesis. Examples are provided of how different tumors appear on various MRI sequences as well as how multiparametric MRI can help differentiate tumor types and serve as an imaging biomarker of treatment response.
LUNG CANCER MANAGEMENT IN LOW RESOURCE SETTINGSKanhu Charan
The document provides information on lung cancer management in low resource settings. It discusses limited resources for setup, equipment, manpower, money and management. It also discusses potential sources of support including government, NGOs, donations and volunteers. Statistics on lung cancer prevalence and mortality are presented. The epidemiology, risk factors, diagnosis, staging and treatment of lung cancer are summarized.
5-Year Survival of Non-Small Cell Lung Cancer Patients after Radical Surgery Significantly Depended on Phase Transition “Early-Invasive Cancer”, Lymph Node Metastases and Cell Ratio Factors
The document discusses immunotherapy options for nonmetastatic non-small cell lung cancer (NSCLC). It summarizes results from several clinical trials evaluating the addition of immunotherapy to standard chemotherapy and radiation therapy regimens. A key trial, CheckMate 816, found that neoadjuvant nivolumab plus chemotherapy significantly improved pathologic complete response rates and event-free survival compared to chemotherapy alone in patients with resectable stage IB-IIIA NSCLC. Based on these results, nivolumab was approved by the FDA in combination with chemotherapy in the neoadjuvant setting for resectable NSCLC tumors. The document provides an overview of evolving treatment approaches incorporating immunotherapy to improve outcomes for nonmetastatic NSCLC
This document summarizes evidence on the use of radiation therapy in the management of ductal carcinoma in situ (DCIS) of the breast. It reviews data from four randomized controlled trials showing that the addition of radiation therapy after breast-conserving surgery significantly reduces rates of local recurrence compared to surgery alone, including reductions in both invasive and non-invasive recurrences. It also discusses several non-randomized studies exploring selective use of radiation therapy in patients with favorable tumor characteristics, and ongoing questions about the need for radiation therapy in all patients with DCIS.
1. Restaging lung cancer patients after induction therapy is difficult to interpret based on radiographic methods alone due to their poor predictive value in assessing tumor response and mediastinal involvement.
2. While PET/CT may help predict tumor response, timing is important as optimal accuracy occurs around 26 days after therapy.
3. Surgical exploration remains important for confirming radiographic findings and assessing resectability given imaging limitations in evaluating response to induction therapies.
This document summarizes advances in the management of breast cancer over the last 30 years. It discusses trends towards increased use of breast-conserving surgery rather than total mastectomy, as randomized trials have shown equivalent survival outcomes. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for nodal staging due to lower morbidity. While bilateral mastectomy rates have increased, studies find local recurrence rates remain low with breast-conserving surgery and radiation. Overall, management of breast cancer has shifted to less invasive surgical options due to long-term data demonstrating equivalent survival.
The document discusses methods for diagnosing and staging non-small cell lung cancer (NSCLC), including physical exams, imaging tests, biopsies and laboratory tests. It then describes the TNM staging system for NSCLC and outlines treatment options based on cancer stage, including surgery, radiation, chemotherapy and targeted therapy. Later sections provide details on studies evaluating the benefits of postoperative radiation therapy and chemoradiation for locally advanced NSCLC.
Controversies in Surgical Approach to Breast Cancerspa718
This document discusses several controversies in surgical approaches to breast cancer:
1. Detecting small lesions in women with dense breast tissue using mammography alone may be inadequate, and supplemental tests like ultrasound or MRI may improve detection rates.
2. For patients with early-stage breast cancer and positive sentinel lymph nodes, axillary lymph node dissection may not always be necessary, especially for those receiving breast-conserving surgery and radiation based on studies like ACOSOG Z0011 and AMAROS.
3. The use of intraoperative radiation therapy (IORT) following breast-conserving surgery remains controversial, as some studies have found higher local recurrence rates compared to whole breast radiation, though recurrence risks may
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
This document summarizes a spine conference discussing a 78-year-old woman with metastatic squamous lung carcinoma to her spine. She presented with numbness, weakness, and inability to walk due to a lesion at her T12 vertebra. Biopsies and imaging revealed metastatic squamous cell carcinoma from a primary lung cancer diagnosed in 2012. She underwent a T12-L1 tumor excision and posterior instrumentation. Her postoperative course was complicated by an ileus and pulmonary embolism. The conference covered topics such as spinal metastasis, diagnosis, treatment with surgery versus radiation, and prognostic factors.
CES2018-02: Cáncer de pulmón (clases 1 y 2)Mauricio Lema
The document discusses staging of lung cancer using the TNM system. It provides details on the T, N, and M descriptors for lung cancer staging. For the T descriptor, it notes changes in the 8th edition where tumor size cut-offs are more granular. For the N descriptor, it discusses exploratory subgroupings to classify single versus multiple lymph node metastases. For the M descriptor, it proposes subclassifying M1 metastases by single versus multiple organ involvement. Overall, the document reviews the TNM staging system for lung cancer and proposes some revisions for the 8th edition.
Similar to Current Modalities in the Treatment of Lung Cancer (20)
This document discusses white foods and their nutritional value. It summarizes that while colorful foods contain many nutrients, white foods should not be avoided and contain important nutrition as well. Examples of healthy white foods provided are potatoes, cauliflower, beans, mushrooms, and onions. The document then provides recipes for a potato soup, white bean spread, and kasha pilaf with mushrooms to showcase nutritious white food options.
This document summarizes a nutrition discussion and cooking demonstration that featured three healthy appetizer recipes: Cranberry Chicken Salad Cups made with wonton skins, Mini Spanakopitas which are low-fat Greek spinach pies, and Garbanzo Guacamole which combines beans and avocado. The demonstration emphasized making party foods that are both tasty and healthy by using ingredients like egg whites instead of whole eggs, baking wonton skins instead of frying, and reducing fat and calories in the recipes. Detailed instructions and nutrition information are provided for each of the three appetizer recipes.
This document provides recipes for two savory side dishes - a Savory Bread Pudding with Swiss Chard and a Wild Rice Pilaf with Cranberries and Pecans. The bread pudding uses stale bread, Swiss chard, cheese, herbs and eggs baked into a creamy dish. The pilaf combines wild rice, stock, shallots, dried fruits and toasted pecans for a flavorful grain side. Instructions for preparing both dishes are included.
A chef from Whole Foods Market demonstrated how to use various whole grains like brown rice, wheat berries, and pearled barley in meals. She shared recipes for breakfast porridge made with brown rice, a wheat berry and apricot salad, and a barley pilaf. Whole grains provide more fiber and nutrients than processed grains and have a nutty taste and chewy texture. The chef provided tips for incorporating more whole grains into meals easily.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document provides recipes for Southwest Stew, Babaganoush, and Chocolate Haystacks to serve at a Super Bowl party. The Southwest Stew is a hearty vegetarian chili-like dish made with tomatoes, vegetables, chickpeas and spinach. Babaganoush is a roasted eggplant dip made with tahini, lemon juice and olive oil. Chocolate Haystacks are a fiber-rich dessert made by coating a high-fiber cereal with dark chocolate and peanut butter, then adding dried fruit. The recipes allow for preparations in advance so the host is not busy during the game.
Evelyn Margolin from Whole Foods Market in Ridgewood visited a cooking studio to demonstrate how to make traditional Passover Seder menu items vegan. She used recipes from Vegan Holiday Kitchen to modify dishes like matzo ball soup, vegetable kugel, and coconut almond macaroons to eliminate animal products and comply with Kosher for Passover restrictions. The matzo balls were made with quinoa flakes instead of eggs. The vegetable kugel contained mushrooms for texture and potato starch instead of eggs. Coconut almond macaroons used potato starch instead of egg whites for leavening. The dishes were flavorful and satisfying for the vegan Passover Seder.
This document provides a recipe for Irish soda bread along with context about the cultural history and variations of Irish soda bread. It discusses how there is no single authentic recipe as versions vary between Ireland and America. The winner of a soda bread baking contest was John Napoli's entry using his great-grandmother's recipe passed down to him. The document also provides the full recipe for Great-Grandma Henrehan's Irish soda bread and a strawberry rhubarb compote recipe to serve alongside.
This document provides recipes for two immune-boosting soups - Greek Avgolemono Soup and Shiitake Hot and Sour Soup - that can help protect against colds and flu. It discusses how foods like vitamin C, zinc, garlic and ginger have immune-boosting properties. The soups contain ingredients like chicken broth, eggs, tofu and vegetables that are nourishing and may help ease symptoms. Directions are included for making both easy and flavorful soup recipes.
This document announces an interactive evening event about multiple myeloma featuring speaker Dr. David H. Vesole. The event will be held on February 28, 2013 from 6-7:30 PM at Gilda's Club Northern New Jersey and will include a presentation on myeloma disease management and treatment options, followed by a question and answer session and stories from myeloma survivors. Pre-registration is required by February 26th.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
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.
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.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Current Modalities in the Treatment of Lung Cancer
1. Hackensack University Medical Center
John Theurer Cancer Center
New Frontiers in the Management of Solid and
Liquid Tumors
Lung Cancer Update
2011
Harry Harper, M.D.
Christopher Azzoli, M.D.
November 4, 2011
2. Lung Cancer Update, 2011
OVERVIEW
• Lung cancer facts and figures
• Screening smokers for lung cancer
• NSCLC:
– Surgery
– Chemotherapy + XRT
– Chemotherapy
• SCLC:
– Chemotherapy
– Chemotherapy + XRT
– Prophylactic cranial irradiation
3. Cancer in the United States, 2011
New Cases Deaths
Prostate 240,890 Lung 156,940
Breast 230,480 Colorectal 49,380
Lung 221,130 Breast 39,520
Colorectal 141,210 Prostate 33,720
Jemal, Cancer Facts & Figures 2011, CA, 2011
4. Stage at Diagnosis: Females
100
Breast Cancer 100
Lung Cancer
90 All Races 90
80 White 80
Percent (%)
70 African American 70
60 61 59
60 60 55 55
51
50 50
39
40 33 32 40
30 30 22 22 22
20 20 15 15 12
10 5 4 8 10
0 0
Localized Regional Distant Localized Regional Distant
Jemal A et al. CA Cancer J Clin. 2010;60:227-300.
5. September, 2002 – February, 2004
50,000 participants randomized
Monitor through 2009
Low-dose fast spiral CT
Current, or
former heavy 0 1 2
cigarette smoker
(>1ppd x 30 years) Randomized
Age 55-74
CXR
Primary endpoint: 0 1 2
Mortality due to lung cancer Years
6. National Lung Screening Trial
24% CT scans “abnormal” (>4mm solid nodule or enlarged nodes)
7% of CXR were “abnormal”
Lung Lung Lung Lung Total Lung Cancer
cancers cancers cancers cancer deaths Deaths Avoided
detected detected detected deaths
Scan 1 Scan 2 Scan 3
CT 270 168 211 427 1877 1 for every
Total: 320 screened
649
CXR 136 65 78 503 1998 Mammogram:
Total: 1 for every
279 HR HR 570 from
0.80 0.93 age 50
NLST, NEJM 2011
7. Estimated American Smokers at Risk
CDC sponsored National Health and Nutrition Examination Survey (NHANES)
9,762 Americans polled in 2007-08
Criteria Total Smokers Current Former
55-74, ≥30 pack
7,425,000 4,027,000 3,398,000
years
50-79, ≥20 pack
years
13,500,000 9,114,000 4,386,000
55-74, any
26,627,000 7,738,000 18,889,000
smoking history
≥50, any smoking
history
46,481,000 14,729,000 31,752,000
≥21, ≥10 years of
smoking any 77,005,000 39,883,000 37,122,000
amount
Data Courtesy of Peter Bach
12. Best Treatment for NSCLC: SURGERY
Surgically resected patients, 1990 – 2000
Overall Survival with Surgery
Overall Survival
8988 / 15952 : TOTAL
1 3 5 7 9
Goldstraw, et al. J Thorac Oncol. 2007;2:706-714
14. Benefit of Adjuvant Cisplatin+Vinorelbine
LACE, N=4584 Number Needed to Treat
Pignon , JCO 2008;26
to Save 1 Life
1 / absolute risk reduction
Stage IB HR 0.92
N=1371 5Y risk 36% 1 / 3% = 33 patients
HR 0.83
Stage II
N=1616 5Y risk 61% 1 / 10% = 10 patients
Stage III
N=1247
HR 0.83
5Y risk 74%
1 / 13% = 8 patients
15. Best Treatment for Unresectable/Inoperable NSCLC:
RADIATION THERAPY
Unresectable Stage III (N2-N3) NSCLC:
MST 3YS Febrile G3-4
(mos) (%) Illness Esophagitis
XRT only (>6000 rads) 11 m < 10% 3% 3%
Cisplatin-based chemo, then XRT 15 m 10-20 8% 5%
“SEQUENTIAL”
Cisplatin-based chemo plus XRT 17 m 20-30 15% 30%
“CONCURRENT”
REFERENCES:
1. Dillman, NEJM 1990
2. RTOG 94-10, Curran, JNCI, 2011
3. Chemo before chemo+RT (induction) is toxic, does not improve overall survival (CALGB 39801)
4. Docetaxel after chemo+RT (consolidation) is toxic, does not improve overall survival (HOG 01-24)
16. Important clinical trials in unresectable stage
IIIB NSCLC
Cisplatin + Pemetrexed x 3
R Pemetrexed x 4
A Concurrent XRT to 6600cGy
N
D
N=600 O
M Dealer’s choice x 4:
I Cisplatin + Etoposide x 3 Etoposide
Z
E Concurrent XRT to 6600cGy Vinorelbine
Paclitaxel
US NIH, 2011.
17. Best treatment for stage IV NSCLC:
DRUG THERAPY
Survival No Cytotoxic Chemo + Target
Chemo chemo anti- EGFR
angio mutation
genesis
MST (mo) 4 8 12 30
1-year (%) 10 20 50 90
2-year (%) 0 3 10 30
• Improving length of life
• Improving quality of life
18. “Cytotoxic” Chemotherapy
for Stage IV NSCLC
n=1725 Cisplatin 75 mg/m2 Day 1 plus Pemetrexed
500 mg/m2 Day 1
Stage IV
NSCLC R One cycle = 3 weeks, stop at 6 cycles
Record
Cisplatin 75 mg/m2 Day 1 plus
histology
Gemcitabine 1,250 mg/m2 Days 1, 8
Results Pem/Cis Gem/Cis HR
No. patients 862 863
Median survival (mos) 10.3 10.3 0.94
Adenocarcinoma (847) 12.6 10.9
Large cell (153) 10.4 6.7
SqCC (473) 9.4 10.8 1.23
Scagliotti et al, 2008.
19. “Continuation Maintenance” Chemotherapy
Four cycles of pemetrexed (500 mg/m2, Day 1) +
cisplatin (75 mg/m2, Day 1)* n=900
CR, PR, or SD and ECOG PS of 0 or 1
Pemetrexed 500 mg/m2 Placebo + BSC*
+ BSC* (D1, q21d) (D1, q21d)
until disease 2:1
until disease
progression randomization progression
N=372 pts N=186 pts
PFS HR=.62, OS results pending
Paz-Ares et al, 2011
Paz-Ares et al, 2011.
20. Biologic/Molecular Targets for New Drugs
Tumor cell bevacizumab
VEGF Endothelial cell
MetMab cetuximab figitumumab
VEGF
PDGF
IGFR VEGFR
EGFR PDGFR
MET
Sorafenib
Gefitinib CC CC Sunitinib
P P Erlotinib P P Axitinib
P P Sorafenib
ARQ197 P P Vandetanib P P
Pazopanib Sunitinib
XL-184 EML4-ALK Axitinib
Crizotinib Motesanib
Crizotinib Vandetanib Pazopanib
P P XL-184 Motesanib
Pi3K Pi3K
Raf Raf
Akt Akt
MEK MEK
mTOR mTOR
ERK ERK
Gene Transcription Gene Transcription
Angiogenesis Proliferation Metastasis Adhesion Angiogenesis Survival
21. Target Angiogenesis: Bevacizumab
SQUAMOUS HISTOLOGY EXCLUDED
(for squamous histology, rate of hemoptysis 30% in phase 2 testing
PFS OS
100 CbP 100 CbP
CbP + Bevacizumab CbP + Bevacizumab
Patients Surviving (%)
Patients With PFS (%)
80 80
p < .001; HR = 0.66 p = .003; HR = 0.79
Median PFS: 6.2 mos vs. Median OS: 12.3 mos vs.
60 4.5 mos 60 10.3 mos
6-Mos PFS: 55% vs. 33% 1-Yr OS: 51% vs. 44%
1-Yr PFS: 15% vs. 6% 2-Yr OS: 23% vs. 15%
40 40
20
20
0 0
0 6 12 18 24 30 36 0 6 12 18 24 30 36
Time (mos) Time (mos)
RR: 15% for CbP Vs. 35% for CbP + Bevacizumab
Sandler et al, NEJM 2006.
22. Bevacizumab with other Drugs
SQUAMOUS HISTOLOGY EXCLUDED
1.0 PFS 1.0 PFS
Possibility of PFS (%)
0.8 CG + Placebo 0.8 CG + Placebo
CG + Bevacizumab CG + Bevacizumab
7.5 mg/kg 15 mg/kg
0.6 0.6
0.4 0.4
0.2 0.2
0.0 0.0
0 3 6 9 12 15 18 0 3 6 9 12 15 18
Time (mos) Time (mos)
End Point CG + Placebo CG + Bev (7.5 mg/kg) CG + Bev (15 mg/kg)
0.75 (0.62–0.91); 0.82 (0.68–0.98);
PFS, HR (95% CI) NA
p = .0026 p = .0301
Median PFS (mos) 6.1 6.7 6.5
RR (%) 20 34 (p < .0001) 30 (p < .017)
Median Survival (mos) 13.6 13.4
HR, p value 13.1 (0.92, p = .3664) (1.02, p = .8420)
Reck et al, 2010, 2009.
23. Ongoing BevacizumabTrials
Determination of Eligibility
Primary Endpoint: OS
Arm A - 450 Patients Arm B - 450 Patients
Pemetrexed Paclitaxel
500 mg/m2 iv q21d 200 mg/m2 iv q21d
Induction Therapy: Carboplatin Carboplatin
up to four 21-day cycles AUC 6 iv q21d AUC 6 iv q21d
Bevacizumab Bevacizumab
Patients with CR, PR, or SD 15 mg/kg iv q21d 15 mg/kg iv q21d
After induction therapy
Continue on to maintenance therapy
Pemetrexed Bevacizumab
Maintenance Therapy:
until PD or treatment discontinuation
500 mg/m2 iv q21d 15 mg/kg iv q21d
Bevacizumab
Patients with PD: 15 mg/kg iv q21d
follow up q90d until death
Patients without PD:
follow up q6w until PD;
thereafter, follow up q90d until death Post discontinuation follow up
Patel et al, 2009.
24. Testing Bevacizumab for
Early-stage NSCLC: ECOG 1505
Eligibility
• Resected IB (>4cm) – IIIA R Chemotherapy* x 4 cycles
• ≥ lobectomy A
• Adequate MLND sampling N
• All pts: level 7 D
O
• Left: level 5 or 6 M
• Right: level 4 I Chemotherapy* x 4 cycles +
• No previous chemotherapy Z bevacizumab x 1 year
• No planned XRT E
• No CVA / TIA / ATE
N = 1500 Primary endpoint: overall survival
• Cisplatin and vinorelbine
• Cisplatin and docetaxel Secondary endpoints: disease-free survival, safety
• Cisplatin and gemcitabine [bleeding and arterial thromboembolic events]
• Cisplatin and pemetrexed
No molecular markers being studied prospectively
Accrual has been slow. Results anticipated in 2016.
25. Angiogenesis: Targeted Agents on the Horizon
Agent Description Reference
Sorafenib Multi-kinase inhibitor including VEGFR Spigel et al, 2010
Sunitinib Multi-kinase inhibitor including VEGFR Govindan et al, 2010
Axitinib Multi-kinase inhibitor including VEGFR Kelly et al, 2010
BIBF 1120 Multi-kinase inhibitor including VEGFR, PDGFR, FGFR Reck, 2010
(intedanib)
Cediranib Multi-kinase inhibitor including VEGFR Mitchell et al, 2010
Vandetanib Multi-kinase inhibitor including EGFR and VEGFR Morabito et al, 2010
HuMV833 Antibody to VEGF-A Jayson et al, 2002
IMCL 1121b Antibody to VEGFR2 Spratlin et al, 2010
(ramucirumab)
IMC-18F1 Antibody to VEGFR1 Schwartz et al, 2010
VEGF Trap Antibody to VEGF-A Leighl et al, 2010
(aflibercept)
VEGFR = vascular endothelial growth factor receptor; PDGFR = platelet-derived growth factor receptor;
FGFR = fibroblast growth factor receptor.
26. Target EGFR: Cetuximab
R
Stage IV NSCLC A
CT + cetuximab
N
EGFR expression D cetuximab until PD
O
by IHC M
I CT
N=1,688 Z Median 1-year
ITT (n=1125)
E OS survival
▬ CT +
cetuximab 11.3 mo 47%
(n=557)
Overall survival (%)
RETROSPECTIVE SUBGROUP ▬ CT 10.1 mo 42%
ANALYSIS: (n=568)
• HR = 0.80 in the 354 patients HR=0.871, p=0.044
with the highest EGFR IHC
score
• HR = 1.05 in patients with
lower EGFR IHC score
Months
Pirker et al, 2009, and 2011
28. Stage IV 1st-line EGFR TKI for EGFR mutation
Study Drugs ORR PFS OS
IPASS gefitinib 71% N=261 HR 1.00
Yang, ESMO vs. HR 0.48 P=0.990
2010 carbo + paclitaxel 47% P<.0001
First-SIGNAL gefitinib 85% N=42 HR 0.82
Lee, IASLC vs. HR 0.62 P=.648
2009 cis + gemcitabine 37% P=.084
WJTOG 3405 gefitinib 62% N=172
Tsurutani vs. HR 0.49 Not reported
ESMO 2009 cis + docetaxel 32% P<.001
NEJ 002 gefitinib 74% N=228 HR NS
Maemondo vs. HR 0.30 P=0.31
NEJM 2010 carbo + paclitaxel 31% P<.001
OPTIMAL erlotinib 83% N=154
Zhou, ESMO vs. HR 0.16 Not reported
2010 carbo + gemcitabine 36% P<.0001
29. EGFR mutation is Prognostic of Survival in
Early-stage NSCLC
1.0
Probability of OS
0.8
0.6
0.4
No EGFR mutation: Median OS = 6.3yr (95%CI: 5.6 - 7.8)
EGFR mutation: Median OS = 6.9yr (95%CI: 6.3 - NA)
0.2
p (adj for stage) < 0.001
No EGFR mutation
0.0
EGFR mutation
Data
courtesy
0 1 2 3 4 5 6 7 8
Years After Surgery Sandra
No. At Risk D’Angelo
No EGFR mutation
896 778 517 293 160 104 65 26 10 MSKCC
EGFR mutation
222 204 133 91 55 33 18 7 4
30. Testing erlotinib for early-stage
NSCLC with EGFR mutation
NCI Personalized Adjuvant Trial “PAT”
Resected NSCLC R Erlotinib for 2 years
A
Tested positive for N
D
EGFR activating/ O
M
sensitizing mutation I
Z Placebo for 2 years
N=400 E
US NIH, 2011.
31. ALK gene translocation drives 3% of NSCLC
Vysis LSI ALK dual color break apart probe
Break-apart FISH assay of
tumor cells from a patient with
rearrangement of the gene
encoding ALK
Kwak et al, 2010.
32. Phase II studies of crizotinib for patients with
stage IV NSCLC and ALK translocation
• Study A (N = 136 patients), ORR 50%, median duration 10
months
• Study B (N = 119 patients), ORR 61%, median duration 12
months
• 94% had received prior systemic treatment for NSCLC
• No differences in ORR by performance status, the number of prior
chemotherapeutic regimens, or the percentage of cells found to
have the ALK gene rearrangement were noted.
FDA Approval Announcement, 8/26/2011
33. First-line crizotinib for patients with ALK Translocation
Randomized Study of Crizotinib vs Pem/Cis or Pem/Carbo in Untreated
Patients with Non-squamous Carcinoma of the Lung With EML4-ALK Mutation
Crizotinib 250 mg PO BID
Pemetrexed 500 mg/m2 + cisplatin 75 mg/m2 or carboplatin AUC 5, q 21 days
1º endpoint: To demonstrate that crizotinib is superior
to first-line chemotherapy
2º endpoint: ORR, OS, Duration of Response Safety
US NIH, 2011.
34. Novel Agents Under Phase III Investigation:
Currently Recruiting Trials
Agent Mechanism of Action Study ID Primary Completion Date
Tivantinib (ARQ c-Met inhibitor NCT01244191 May 2013
197)
Tivantinib (ARQ c-Met inhibitor NCT01395758 June 2012
197)
Iniparib PARP inhibitor NCT01082549 (ECLIPSE) March 2013
PF-02341066 ALK inhibitor NCT00932893 June 2012
Afatinib EGFR/HER2 inhibitor NCT01121393 (LUX-Lung 6) May 2012
Afatinib EGFR/HER2 inhibitor NCT01085136 (LUX-Lung 5) March 2012
Talactoferrin Immunostimulant NCT00706862 (FORTIS-C) March 2013
Ipilimumab Anti-CTLA4 Antibody NCT01285609 August 2014
Ramucirumab VEGFR-2 inhibitor NCT01168973 June 2014
Necitumumab EGFR inhibitor NCT00981058 (SQUIRE) May 2013
Vargatef Multikinase inhibitor NCT00806819 (LUME-Lung 2) May 2013
MetMab Met inhibitor Recruitment will begin later this year (2011)
US NIH, 2011.
35. Problem: With so many new drugs, and
targets, how do we know we are giving
the right drug to the right patient?
Solution: Test! Don’t guess!
36. Lung Cancer Mutation Consortium
Incidence of Single Driver Mutations
At least 1 mutation was found in 54% (280/516)
of tumors completely tested (CI 50%–59%)
97% of Mutations Mutually Exclusive
Kris et al, ASCO 2011.
37. Lung Cancer Mutation Consortium Targeted
Clinical Trials
Target Agent(s)
EGFR Erlotinib + OSI 906
Erlotinib + MM 121
KRAS Tivantinib + Erlotinib
GSK1120212
MET Amplification MetMAB
EML4-ALK Crizotinib
NRAS GSK1120212
MEK1 GSK1120212
BRAF (V600E) GSK2118434
BRAF (not V600E) GSK1120212
HER2 Afatinib
PIK3CA BKM120
Kris et al, ASCO 2011.
38. Real progress for patients with stage
IV NSCLC
Survival No Cytotoxic Chemo+ EGFR
Chemo chemo bev TKI for
EGFR
mutant
MST (mo) 4 8 12 30
1-year (%) 10 20 50 90
2-year (%) 0 3 10 30
• Improving length of life
• Improving quality of life
39. SMALL CELL
LUNG CANCER
Limited Extensive
Stage Stage
Surgery rarely an option.
No molecular markers discovered yet.
No new drugs for 20 years!
40. Twice Daily Thoracic Radiotherapy for
Limited Stage SCLC
Turrisi et al, NEJM, 1999
• 417 patients with limited stage SCLC
• 4 cycles etoposide + cisplatin with concurrent once vs.
twice daily RT to 45 Gy starting with first cycle
2-year survival
41 vs. 47%
5-year survival
16 vs. 26%
p = 0.04
41. Prophylactic Cranial Irradiation
Auperin et al, NEJM, 1999
Death Brain Mets
• 7 randomized trials, 987 pts
with CR
• 5% increase in survival at 3 yrs
• Higher dose improved local
recurrence but no effect on
survival
16% ↓ risk 54% ↓ risk
42. PCI in Extensive SCLC
286 patients with extensive SCLC and response after 4-6 cycles of chemotherapy
were randomized to PCI or no PCI
Median survival: 6.7 vs 5.4 mo
1 yr survival: 27% vs 13%
Slotman et al,
NEJM 2007
43. For Extensive Stage: Cisplatin + Etoposide
1.0
0.9
Irinotecan + cis (n = 221)
0.8
Etoposide + cis (n = 110)
0.7
Probability
0.6
0.5
P = 0.6226
0.4
0.3
0.2
0.1
0
0 10 20 30 40
Months
IP: median 9.3 mo (0.1-32.6) 1yr 35.4%, 2yr 8.0%
EP: median 10.2 mo (0.3-44.6) 1yr 36.7%, 2yr 7.9%
Hanna, J Clin Oncol 24:2038, 2006
44. “2nd-line” Chemo for Extensive SCLC
Topotecan CAV
Response Rate 24% 18%
Med Survival 6 mo 6 mo
Grade 4 (% pts)
Neutropenia 70% 72%
Anemia 3% 2%
Platelets 29% 5%
Transfusions
RBCs 52% 27%
Plts 20% 2%
Greater proportion had improved dyspnea, anorexia, hoarseness and
fatigue with topotecan
von Pawel, JCO, 17:658, 1999
45. “2nd-line” Chemo for Extensive SCLC:
• Rechallenge with 1st regimen if time to
relapse > 6 months
• Topotecan n=637
• CAV amrubicin 40 mg/m2 IV on days 1-3
vs.
• Irinotecan topotecan 1.5 mg/m2 IV on days 1-5
• Paclitaxel
HR 0.82, p=NS
• Docetaxel primary refractory subgroup, HR 0.77, p=.047
• Gemcitabine
• Vinorelbine
• Amrubicin: active, but failed to
significantly improve survival vs.
topotecan in phase 3 study
Jotte R, J Clin Oncol 29: 2011;29(15s):(abstract 7000),453s
46. Lung Cancer Update, 2011
REVIEW
• Lung cancer facts and figures
• Screening smokers for lung cancer Newest stories:
• NSCLC: Screening saves lives !
– Surgery
– Chemotherapy + XRT The era of personalized
– Chemotherapy medicine has arrived !
• SCLC: EGFR, ALK …
– Chemotherapy
– Chemotherapy + XRT
– Prophylactic cranial irradiation