1) The document discusses the Halsted and Fisher hypotheses regarding breast cancer treatment. The Halsted hypothesis viewed breast cancer as spreading in an orderly manner from the breast to lymph nodes to distant sites, supporting radical mastectomy. The Fisher hypothesis viewed breast cancer as a systemic disease at diagnosis.
2) Recent evidence from NSABP trials suggests local therapy and local recurrence may affect survival outcomes, challenging the Fisher hypothesis. Patients who experienced local recurrence had higher risks of distant disease and mortality. Improved local control with radiotherapy was associated with decreased breast cancer deaths.
3) The evidence indicates that both local and systemic factors play a role in breast cancer, supporting an approach that considers both.
This 100-month analysis of the ATAC trial showed that anastrozole provided significantly improved disease-free survival, time to recurrence, time to distant recurrence, and incidence of new contralateral breast cancer compared to tamoxifen for both the total population and hormone-receptor positive subpopulation. Fracture rates were higher with anastrozole during treatment but did not differ after treatment completion. There were no significant differences in overall survival or deaths after recurrence between the groups. These long-term results establish the efficacy of anastrozole compared to tamoxifen as initial adjuvant treatment for postmenopausal women with hormone-sensitive early breast cancer.
1) Numerous clinical trials have evaluated adjuvant systemic therapies like chemotherapy, vaccines, and interferon for melanoma but with minimal success except for interferon, which showed a benefit for relapse-free survival.
2) A recent meta-analysis found that interferon prolongs disease-free survival in 7% of patients and overall survival in 3% compared to observation alone. Regional differences exist in its use in Europe.
3) Two large randomized trials of pegylated interferon for stage III melanoma found a significant benefit for relapse-free survival but not for distant metastasis-free survival or overall survival. Benefits were greater for patients with microscopic lymph node involvement versus macroscopic involvement.
Austin Journal of Clinical & Diagnostic Research is a multidisciplinary, Rapid-Publication journal. Austin Journal of Clinical & Diagnostic Research Journal is open to scientists from all countries. The mission of the journal is to promote topics of Clinical & Diagnostic research, as well as stimulate international cooperation in these areas. The journal will consider articles from every legitimate specialty.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Robot-assisted versus open radical hysterectomy: A multi-institutional experi...flasco_org
This study compared outcomes of 491 early-stage cervical cancer patients who underwent either robot-assisted radical hysterectomy (RRH, n=259) or open radical hysterectomy (ORH, n=232) across three institutions. The study found that patients who received RRH had significantly less estimated blood loss, shorter hospital stays, and fewer intra-operative complications compared to ORH patients. Disease recurrence and survival rates were similar between the two groups. Overall, RRH resulted in improved clinical outcomes for early-stage cervical cancer patients compared to ORH.
1) This letter discusses two large randomized clinical trials (B-04 and B-06) that evaluated the effect of local control on overall survival in breast cancer patients.
2) While both trials found that improved local control reduced local recurrence rates, they did not find an improvement in overall survival.
3) The author argues this does not contradict the Fisher hypothesis, but rather that some local recurrences actually represent systemic disease already present. Therefore, improved local control alone would not impact overall survival.
4) In conclusion, the author believes these trials confirm rather than contradict the Fisher hypothesis when interpreted appropriately in the context of the clinical situation evaluated in each trial.
This document reviews rare types of breast cancer. It summarizes information on 16 epithelial subtypes classified by the World Health Organization, including histopathology descriptions and clinical parameters. While rare cancers cannot be studied through large randomized trials, this review aims to provide clinicians an understanding to help determine optimal treatment approaches. It discusses cancers such as tubular carcinoma and mucinous carcinoma, which typically have a good prognosis and are often estrogen receptor positive with low lymph node involvement.
The document discusses the history and evolution of surgical trials for colon cancer. It summarizes several key randomized controlled trials comparing laparoscopic versus open colectomy. The trials demonstrated that laparoscopic colectomy is associated with shorter hospital stays and faster recovery, without increased morbidity or affecting long-term oncologic outcomes. More recent studies also support the complete mesocolic excision technique with central vascular ligation over traditional Japanese D3 surgery for improved lymph node yield and potentially better survival. New technologies like robotic assistance and magnetic endoscopic probes aim to advance minimally invasive colon surgery and cancer screening.
This study aimed to predict the risk of malignancy in women with adnexal masses using preoperative factors. The researchers analyzed 395 patients and found:
1) Tumor morphology on ultrasound, elevated serum CA 125 levels, presence of ascites, and older age were associated with higher risk of malignancy.
2) Patients with solid or complex masses and CA 125 > 35 U/mL had a positive predictive value of 84.7% for malignancy.
3) Purely cystic masses had a 100% negative predictive value for ruling out malignancy.
4) The combination of complex/solid mass and elevated CA 125 best defined patients at high risk of ovarian cancer.
This 100-month analysis of the ATAC trial showed that anastrozole provided significantly improved disease-free survival, time to recurrence, time to distant recurrence, and incidence of new contralateral breast cancer compared to tamoxifen for both the total population and hormone-receptor positive subpopulation. Fracture rates were higher with anastrozole during treatment but did not differ after treatment completion. There were no significant differences in overall survival or deaths after recurrence between the groups. These long-term results establish the efficacy of anastrozole compared to tamoxifen as initial adjuvant treatment for postmenopausal women with hormone-sensitive early breast cancer.
1) Numerous clinical trials have evaluated adjuvant systemic therapies like chemotherapy, vaccines, and interferon for melanoma but with minimal success except for interferon, which showed a benefit for relapse-free survival.
2) A recent meta-analysis found that interferon prolongs disease-free survival in 7% of patients and overall survival in 3% compared to observation alone. Regional differences exist in its use in Europe.
3) Two large randomized trials of pegylated interferon for stage III melanoma found a significant benefit for relapse-free survival but not for distant metastasis-free survival or overall survival. Benefits were greater for patients with microscopic lymph node involvement versus macroscopic involvement.
Austin Journal of Clinical & Diagnostic Research is a multidisciplinary, Rapid-Publication journal. Austin Journal of Clinical & Diagnostic Research Journal is open to scientists from all countries. The mission of the journal is to promote topics of Clinical & Diagnostic research, as well as stimulate international cooperation in these areas. The journal will consider articles from every legitimate specialty.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Robot-assisted versus open radical hysterectomy: A multi-institutional experi...flasco_org
This study compared outcomes of 491 early-stage cervical cancer patients who underwent either robot-assisted radical hysterectomy (RRH, n=259) or open radical hysterectomy (ORH, n=232) across three institutions. The study found that patients who received RRH had significantly less estimated blood loss, shorter hospital stays, and fewer intra-operative complications compared to ORH patients. Disease recurrence and survival rates were similar between the two groups. Overall, RRH resulted in improved clinical outcomes for early-stage cervical cancer patients compared to ORH.
1) This letter discusses two large randomized clinical trials (B-04 and B-06) that evaluated the effect of local control on overall survival in breast cancer patients.
2) While both trials found that improved local control reduced local recurrence rates, they did not find an improvement in overall survival.
3) The author argues this does not contradict the Fisher hypothesis, but rather that some local recurrences actually represent systemic disease already present. Therefore, improved local control alone would not impact overall survival.
4) In conclusion, the author believes these trials confirm rather than contradict the Fisher hypothesis when interpreted appropriately in the context of the clinical situation evaluated in each trial.
This document reviews rare types of breast cancer. It summarizes information on 16 epithelial subtypes classified by the World Health Organization, including histopathology descriptions and clinical parameters. While rare cancers cannot be studied through large randomized trials, this review aims to provide clinicians an understanding to help determine optimal treatment approaches. It discusses cancers such as tubular carcinoma and mucinous carcinoma, which typically have a good prognosis and are often estrogen receptor positive with low lymph node involvement.
The document discusses the history and evolution of surgical trials for colon cancer. It summarizes several key randomized controlled trials comparing laparoscopic versus open colectomy. The trials demonstrated that laparoscopic colectomy is associated with shorter hospital stays and faster recovery, without increased morbidity or affecting long-term oncologic outcomes. More recent studies also support the complete mesocolic excision technique with central vascular ligation over traditional Japanese D3 surgery for improved lymph node yield and potentially better survival. New technologies like robotic assistance and magnetic endoscopic probes aim to advance minimally invasive colon surgery and cancer screening.
This study aimed to predict the risk of malignancy in women with adnexal masses using preoperative factors. The researchers analyzed 395 patients and found:
1) Tumor morphology on ultrasound, elevated serum CA 125 levels, presence of ascites, and older age were associated with higher risk of malignancy.
2) Patients with solid or complex masses and CA 125 > 35 U/mL had a positive predictive value of 84.7% for malignancy.
3) Purely cystic masses had a 100% negative predictive value for ruling out malignancy.
4) The combination of complex/solid mass and elevated CA 125 best defined patients at high risk of ovarian cancer.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Articulo observacion importantes carotid body tumorMaynor Lopez
This study analyzed 49 carotid body tumor (CBT) resections in 39 patients over 25 years to assess outcomes. A neck mass was the most common presenting symptom. Complications occurred in 27% of cases, predominantly temporary nerve palsies which were more likely with larger tumors. Malignant disease was present in 15% of cases. During long-term follow up (average 11 years), 6 patients developed new paragangliomas, all with familial disease. Early resection of CBTs is recommended while still small to minimize risks, and lifelong follow up is essential in familial cases to screen for new tumors.
This document summarizes a study comparing the morbidity of sentinel lymph node biopsy (SLNB) alone versus SLNB followed by completion axillary lymph node dissection for breast cancer. The study found that postoperative morbidity was significantly lower in the SLNB alone group, including less pain, numbness, range of motion issues, and lymphedema. However, intermediate and long-term complications like lymphedema and tumor recurrence rates were equivalent between the groups. The study concludes that while SLNB alone has lower initial morbidity, ALND significantly increases long-term issues like lymphedema and quality of life impacts.
1. Radiotherapy targeting only para-aortic nodes is insufficient for testicular seminoma patients with a history of pelvic or scrotal surgery, as the primary lymphatic drainage pattern may have been altered.
2. For these cases, the treatment plan should include ipsilateral iliac and inguinal nodes in classic dog-leg AP-PA fields.
3. Prophylactic irradiation of the contralateral iliac, inguinal, or scrotal region may also be indicated for prior maldescensus testis, inguinal or scrotal violation, or pT3/4 primary tumors.
This document discusses the terminology used for preinvasive cervical lesions. It begins with definitions of dysplasia and provides a historical review of terminology, including carcinoma in situ (CIS) and cervical intraepithelial neoplasia (CIN). It then describes the 2001 Bethesda System for cervical cytology reporting and the Lower Anogenital Squamous Terminology (LAST) project. The LAST project aimed to create a unified histopathological nomenclature for HPV-associated preinvasive lesions across anatomical sites, recommending a two-tiered system of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL).
The document summarizes several studies from the October 2010 issue of Radiology on various medical imaging techniques. It reports that digital tomosynthesis was found to have higher sensitivity than radiography in detecting lung lesions. It also discusses studies finding that some epidural hematomas may remain indolent without treatment, dual-energy CT can help differentiate contrast staining from hemorrhage, and screening CT may not be effective for early detection of ovarian cancer.
The document summarizes changes made in the WHO Classification of Tumours of the Central Nervous System fifth edition regarding brain tumor classification. Key changes include reclassifying some tumor types as distinct entities, incorporating molecular features into classifications, separating pediatric and adult tumor types, removing the term "anaplastic" in grading, and basing grading on both histological and molecular features. Molecular testing now plays an important role in diagnoses of several tumor types.
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
This document summarizes a study that evaluated imaging and histopathologic differences between benign and malignant breast lesions initially assessed as BI-RADS category 3 (probably benign) but later upgraded during imaging surveillance. Of the 1,017 lesions initially assessed as BI-RADS 3, 60 (5.9%) were upgraded after a mean follow-up of 54.1 months. Fifteen of the 60 upgraded lesions (25%) proved to be malignant. There was no significant difference in malignancy rates between different types of upgraded lesions (masses, asymmetries, calcifications). While calcifications made up most upgraded lesions, most proved benign, suggesting decreased surveillance of calcifications may be appropriate.
The diagnosis and management of the acute abdomen in pregnancy 2019mostafa hegazy
This chapter discusses the anatomical and physiological changes that occur in pregnancy to support fetal development. During pregnancy, the cardiovascular, respiratory, renal, and gastrointestinal systems undergo adaptations to increase blood volume, cardiac output, and kidney and liver function which benefit fetal growth. The hormonal changes that facilitate these adaptations, including high levels of progesterone, estrogen, human chorionic gonadotropin, and cortisol, can also cause discomforts for the mother like nausea, breast tenderness, and skin changes.
Sentinel node mapping in breast cancer controversiesRamin Sadeghi
In this presentation the most important controversies in breast cancer lymphatic mapping and sentinel node biopsy have been discussed based on NCCN guideline.
The document discusses pancreatic ductal adenocarcinoma (PDA) and different treatment approaches. It summarizes several key trials evaluating neoadjuvant therapy, adjuvant therapy, and chemotherapy for resectable, borderline resectable, locally advanced, and metastatic PDA. The take home message is that more randomized controlled trials are needed to determine the optimal treatment approach for different PDA stages, but neoadjuvant therapy appears beneficial for locally advanced and borderline resectable disease, while gemcitabine + nab-paclitaxel or FOLFIRINOX chemotherapy provide good outcomes for metastatic PDA.
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
Feature story from the Garvan Institute of Medical Research's April 2013 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
This document lists 20 honored guests who have provided comments and perspectives on published articles related to thoracic oncology. The honored guests include physicians, researchers, and professors from institutions around the world. They have written commentaries on recent clinical trials and studies covering a range of topics within thoracic oncology, including treatments for lung cancer, screening methods, management of side effects, and surgical outcomes. The document provides the names and academic affiliations of each guest contributor and identifies the article each comment is in response to.
Sentinel node in breast cancer: update of the previous presentationRamin Sadeghi
This is an update of the presentation:
Sentinel node 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.
This document provides an overview and introduction to the book "Surgery: Complications, Risks and Consequences" edited by Brendon J. Coventry. The book aims to provide comprehensive information on over 250 surgical procedures and their associated complications to help surgeons better inform patients and improve outcomes. It includes descriptions of procedures, estimated frequencies of complications, and discussions of major complications. The book is intended to be a resource for clinicians to gain a better understanding of risks and to assist in surgical risk management and the informed consent process.
Adjuvant Radiation Therapy in Early Cervical Cancer - EvidencesDr. Malhar Patel
Radiation therapy is one of the main line of management of carcinoma cervix.
This presentation is regarding evidences of adjuvant radiation therapy (post operative) in case of early carcinoma cervix.
Sentinel lymph node concept in early breast cancer by prof. r. wasikeKesho Conference
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.
Leidy Alvarado presents research using serum samples from breast cancer patients, including 20 with recurrent cancer, to identify potential biomarkers for early detection of recurrence. Various profiling methods identified eleven potential biomarkers. A model was developed that could detect the possibility of cancer recurrence. This new method allows for more accurate and effective early detection of recurrent breast cancer compared to existing techniques.
The document summarizes key landmark breast cancer trials that helped establish modern standards of care. The NSABP B-04 trial showed that modified radical mastectomy was as effective as radical mastectomy. The NSABP B-06 and Milan trials established breast-conserving surgery plus radiation as an equivalent alternative to mastectomy. The NSABP B-32 trial demonstrated sentinel node biopsy alone had similar outcomes as axillary dissection for node-negative cancer. Subsequent trials like ALMANAC and Z011 found sentinel node biopsy reduced arm morbidity without compromising survival. These trials provided critical evidence supporting less invasive surgical approaches for breast cancer.
1) The document discusses major shifts in the treatment of breast cancer over the past 100 years, moving away from Halsted's radical mastectomy approach.
2) Six randomized trials have shown that breast-conserving surgery plus radiation has equivalent survival rates to mastectomy, though local recurrence rates are sometimes higher with breast-conserving options.
3) Adjuvant chemotherapy was initially controversial but multiple studies have confirmed it improves disease-free and overall survival, providing evidence that systemic therapy is more important than local control alone.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Articulo observacion importantes carotid body tumorMaynor Lopez
This study analyzed 49 carotid body tumor (CBT) resections in 39 patients over 25 years to assess outcomes. A neck mass was the most common presenting symptom. Complications occurred in 27% of cases, predominantly temporary nerve palsies which were more likely with larger tumors. Malignant disease was present in 15% of cases. During long-term follow up (average 11 years), 6 patients developed new paragangliomas, all with familial disease. Early resection of CBTs is recommended while still small to minimize risks, and lifelong follow up is essential in familial cases to screen for new tumors.
This document summarizes a study comparing the morbidity of sentinel lymph node biopsy (SLNB) alone versus SLNB followed by completion axillary lymph node dissection for breast cancer. The study found that postoperative morbidity was significantly lower in the SLNB alone group, including less pain, numbness, range of motion issues, and lymphedema. However, intermediate and long-term complications like lymphedema and tumor recurrence rates were equivalent between the groups. The study concludes that while SLNB alone has lower initial morbidity, ALND significantly increases long-term issues like lymphedema and quality of life impacts.
1. Radiotherapy targeting only para-aortic nodes is insufficient for testicular seminoma patients with a history of pelvic or scrotal surgery, as the primary lymphatic drainage pattern may have been altered.
2. For these cases, the treatment plan should include ipsilateral iliac and inguinal nodes in classic dog-leg AP-PA fields.
3. Prophylactic irradiation of the contralateral iliac, inguinal, or scrotal region may also be indicated for prior maldescensus testis, inguinal or scrotal violation, or pT3/4 primary tumors.
This document discusses the terminology used for preinvasive cervical lesions. It begins with definitions of dysplasia and provides a historical review of terminology, including carcinoma in situ (CIS) and cervical intraepithelial neoplasia (CIN). It then describes the 2001 Bethesda System for cervical cytology reporting and the Lower Anogenital Squamous Terminology (LAST) project. The LAST project aimed to create a unified histopathological nomenclature for HPV-associated preinvasive lesions across anatomical sites, recommending a two-tiered system of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL).
The document summarizes several studies from the October 2010 issue of Radiology on various medical imaging techniques. It reports that digital tomosynthesis was found to have higher sensitivity than radiography in detecting lung lesions. It also discusses studies finding that some epidural hematomas may remain indolent without treatment, dual-energy CT can help differentiate contrast staining from hemorrhage, and screening CT may not be effective for early detection of ovarian cancer.
The document summarizes changes made in the WHO Classification of Tumours of the Central Nervous System fifth edition regarding brain tumor classification. Key changes include reclassifying some tumor types as distinct entities, incorporating molecular features into classifications, separating pediatric and adult tumor types, removing the term "anaplastic" in grading, and basing grading on both histological and molecular features. Molecular testing now plays an important role in diagnoses of several tumor types.
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
This document summarizes a study that evaluated imaging and histopathologic differences between benign and malignant breast lesions initially assessed as BI-RADS category 3 (probably benign) but later upgraded during imaging surveillance. Of the 1,017 lesions initially assessed as BI-RADS 3, 60 (5.9%) were upgraded after a mean follow-up of 54.1 months. Fifteen of the 60 upgraded lesions (25%) proved to be malignant. There was no significant difference in malignancy rates between different types of upgraded lesions (masses, asymmetries, calcifications). While calcifications made up most upgraded lesions, most proved benign, suggesting decreased surveillance of calcifications may be appropriate.
The diagnosis and management of the acute abdomen in pregnancy 2019mostafa hegazy
This chapter discusses the anatomical and physiological changes that occur in pregnancy to support fetal development. During pregnancy, the cardiovascular, respiratory, renal, and gastrointestinal systems undergo adaptations to increase blood volume, cardiac output, and kidney and liver function which benefit fetal growth. The hormonal changes that facilitate these adaptations, including high levels of progesterone, estrogen, human chorionic gonadotropin, and cortisol, can also cause discomforts for the mother like nausea, breast tenderness, and skin changes.
Sentinel node mapping in breast cancer controversiesRamin Sadeghi
In this presentation the most important controversies in breast cancer lymphatic mapping and sentinel node biopsy have been discussed based on NCCN guideline.
The document discusses pancreatic ductal adenocarcinoma (PDA) and different treatment approaches. It summarizes several key trials evaluating neoadjuvant therapy, adjuvant therapy, and chemotherapy for resectable, borderline resectable, locally advanced, and metastatic PDA. The take home message is that more randomized controlled trials are needed to determine the optimal treatment approach for different PDA stages, but neoadjuvant therapy appears beneficial for locally advanced and borderline resectable disease, while gemcitabine + nab-paclitaxel or FOLFIRINOX chemotherapy provide good outcomes for metastatic PDA.
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
Feature story from the Garvan Institute of Medical Research's April 2013 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
This document lists 20 honored guests who have provided comments and perspectives on published articles related to thoracic oncology. The honored guests include physicians, researchers, and professors from institutions around the world. They have written commentaries on recent clinical trials and studies covering a range of topics within thoracic oncology, including treatments for lung cancer, screening methods, management of side effects, and surgical outcomes. The document provides the names and academic affiliations of each guest contributor and identifies the article each comment is in response to.
Sentinel node in breast cancer: update of the previous presentationRamin Sadeghi
This is an update of the presentation:
Sentinel node 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.
This document provides an overview and introduction to the book "Surgery: Complications, Risks and Consequences" edited by Brendon J. Coventry. The book aims to provide comprehensive information on over 250 surgical procedures and their associated complications to help surgeons better inform patients and improve outcomes. It includes descriptions of procedures, estimated frequencies of complications, and discussions of major complications. The book is intended to be a resource for clinicians to gain a better understanding of risks and to assist in surgical risk management and the informed consent process.
Adjuvant Radiation Therapy in Early Cervical Cancer - EvidencesDr. Malhar Patel
Radiation therapy is one of the main line of management of carcinoma cervix.
This presentation is regarding evidences of adjuvant radiation therapy (post operative) in case of early carcinoma cervix.
Sentinel lymph node concept in early breast cancer by prof. r. wasikeKesho Conference
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.
Leidy Alvarado presents research using serum samples from breast cancer patients, including 20 with recurrent cancer, to identify potential biomarkers for early detection of recurrence. Various profiling methods identified eleven potential biomarkers. A model was developed that could detect the possibility of cancer recurrence. This new method allows for more accurate and effective early detection of recurrent breast cancer compared to existing techniques.
The document summarizes key landmark breast cancer trials that helped establish modern standards of care. The NSABP B-04 trial showed that modified radical mastectomy was as effective as radical mastectomy. The NSABP B-06 and Milan trials established breast-conserving surgery plus radiation as an equivalent alternative to mastectomy. The NSABP B-32 trial demonstrated sentinel node biopsy alone had similar outcomes as axillary dissection for node-negative cancer. Subsequent trials like ALMANAC and Z011 found sentinel node biopsy reduced arm morbidity without compromising survival. These trials provided critical evidence supporting less invasive surgical approaches for breast cancer.
1) The document discusses major shifts in the treatment of breast cancer over the past 100 years, moving away from Halsted's radical mastectomy approach.
2) Six randomized trials have shown that breast-conserving surgery plus radiation has equivalent survival rates to mastectomy, though local recurrence rates are sometimes higher with breast-conserving options.
3) Adjuvant chemotherapy was initially controversial but multiple studies have confirmed it improves disease-free and overall survival, providing evidence that systemic therapy is more important than local control alone.
Coexistence of carcinoma and tuberculosis in the breast: A rarity.KETAN VAGHOLKAR
Coexistence of carcinoma and tuberculosis in the same breast is extremely rare. The presence of two lesions in the same organ poses both a diagnostic as well as a therapeutic challenge to the surgeon. The case report highlights both the aspects of management.
Report for treatment of breast cancer mastectGil Lederman
The document summarizes a study comparing lumpectomy/radiation therapy to mastectomy in the treatment of breast cancer. The study found that disease-free and overall survival rates were equivalent between the two treatments at 10 years follow up. For women who had a local recurrence after lumpectomy/radiation, salvage mastectomy was often effective with a 67% disease-free survival rate. Factors like tumor stage and lymph node involvement were better predictors of cancer recurrence than the type of local therapy. The study demonstrates that lumpectomy/radiation is as effective as mastectomy for breast cancer treatment while preserving the breast.
Stroma Cells May Inhibit the Growth of Pancreatic Cancer TumorsBradley Jobling
A study by Drs. Oberstein and Olive found that certain stromal cells in pancreatic tumors may inhibit, rather than support, cancer growth in the earlier stages of pancreatic ductal adenocarcinoma. When mice with pancreatic cancer and reduced stromal cells were treated with long-term chemotherapy, their survival decreased similar to results seen in human clinical trials. Further research indicates some stromal cell types can restrain pancreatic tumor development, disproving the common belief that stromal cells mainly promote cancer.
Wavelength October 2015 Volume 19 No. 2Jerry Duncan
This article discusses the first clinical uses of Elekta's new Leksell Gamma Knife Icon system at University Hospital La Timone in Marseilles, France. The Icon allows for frameless Gamma Knife radiosurgery using a mask for head fixation rather than the traditional rigid frame. The first patient was treated on August 10th for a brain metastasis using this frameless approach. Additional patients were also treated for metastases. On August 17th, the first patient began a multi-session, hypofractionated treatment for a meningioma using the frameless approach. The Icon's advanced motion management and imaging capabilities enable these frameless treatments by precisely reproducing the patient's position over multiple sessions.
This document discusses the evolution of breast cancer surgery from radical mastectomy to breast-conserving surgery (BCS). It provides an overview of the key factors to consider when determining eligibility for BCS, including tumor characteristics, family history, genetic factors, and patient age/health status. Multiple studies have shown that BCS followed by radiation therapy provides equivalent survival outcomes to mastectomy for appropriately selected early-stage patients. Surgical challenges include achieving negative margins, maintaining cosmesis, and detecting local recurrence after BCS. Patient selection factors and techniques to help guide BCS are discussed.
Evidence for Cure by Adjuvant Therapy in Colon Cancer: Observations Based on ...alessandrolealmd
This document summarizes a study analyzing individual patient data from 20,898 patients in 18 randomized trials testing fluorouracil-based adjuvant therapy for stage II-III colon cancer. The key findings were:
1) Adjuvant chemotherapy provided a significant and consistent overall survival benefit over 8 years of follow-up, indicating chemotherapy cures some patients rather than just delaying recurrence.
2) Recurrence rates after 5 years were less than 1.5% per year, and after 8 years were less than 0.5% per year for patients treated in clinical trials, demonstrating low long-term recurrence risks.
3) Significant disease-free survival benefit from adjuvant chemotherapy was seen in the first 2 years
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
This document provides an overview of breast cancer therapy. It discusses that breast cancer treatment is multidisciplinary, involving surgery, radiation, and systemic therapy. For early-stage breast cancer, the majority of women are candidates for either breast-conserving surgery plus radiation or mastectomy, as the risks and survival outcomes are similar between the two approaches. Adjuvant systemic therapy is used based on proven survival benefits and molecular profiling to individualize treatment.
The newsletter provides information on upcoming conferences, recent literature on breast cancer and other topics, and a commentary on the use of a 21-gene recurrence score assay to guide treatment decisions for early-stage breast cancer. It also lists literature on topics like coffee consumption and breast cancer risk, neoadjuvant chemotherapy for triple-negative breast cancer, and a historical account of breast cancer surgery.
Primary small cell breast carcinoma represents less than 1% of breast cancers. Due to its rarity, there are no uniformly accepted guidelines for treatment. Its prognosis is varied being generally regarded as worse than that of most breast cancers and it poses unique diagnostic challenges. We present a case of primary small cell breast cancer, rationale for our management strategies with reference to the published literature to serve as a guide to the management of this rare cancer of the breast.
Alain Toledano : Small Breast Cancers Radiotherapy : Locoregional Treatments ...breastcancerupdatecongress
This document provides guidance on the use of accelerated partial breast irradiation (APBI) based on published evidence and expert consensus. It proposes three patient groups: 1) "suitable" patients for whom APBI outside of trials is acceptable, 2) "cautionary" patients for whom APBI should only be considered in trials, and 3) "unsuitable" patients for whom APBI is not recommended. While APBI may be an option for select patients, whole breast irradiation remains the established standard treatment with longer-term data demonstrating effectiveness and safety. Patients choosing APBI should understand it is not as established as whole breast irradiation.
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.
This document provides a case study analysis of an observational study on cervical cancer conducted in South Asia. The study aimed to identify what stages of cervical dysplasia would progress to cancer to help design cervical cancer screening guidelines. Over 1000 women participated over 12 years. However, midway another study found that all dysplasia requires treatment, and the researchers continued without treatment. Many women's cancers progressed or spread by the end without treatment provided. Questions are raised about ethics approval given facility limitations, informed consent without disclosing disease progression risk, and continuing the study after learning about treatment needs from another study.
PRIMARY SQUAMOUS CELL CANCER OF BREAST: A CASE REPORTKETAN VAGHOLKAR
Primary squamous cell cancer (SqCC) of the breast is a rather rare disease. These tumors are known to be
quite aggressive in nature and are usually found to be treatment-resistant. Currently, there is no standard treatment
guideline for the management of primary SqCC of the breast. In this case report, we present a case of primary SqCC of
the breast in 60-year old postmenopausal women presenting as pigmented lesion over the right breast (no lump). Initial
skin biopsy (core) done by dermatologist revealed squamous cell cancer in situ (Bowen’s disease); however surgical
resection of the lesion and subsequent histopathological examination revealed primary SqCC (no secondary sites were
found elsewhere in the body).
Cost-Effectiveness of Contralateral Prophylactic
Mastectomy Versus Routine Surveillance in Patients
With Unilateral Breast Cancer
Benjamin Zendejas, James P. Moriarty, Jamie O’Byrne, Amy C. Degnim, David R. Farley, and Judy C. Boughey
Cancer de mama
Clinica Ruber
Dr Juan Carlos Meneu
Downloadable slides highlighting key concepts in colorectal cancer screening and appropriate therapy selection and application in the adjuvant setting and beyond.
The document discusses guidelines for preventing and treating dermatologic toxicities caused by EGFR inhibitor therapies, noting that a rash occurs in the majority of patients and can impact quality of life. It recommends systemic minocycline or doxycycline during the first 1-6 weeks of EGFR inhibitor therapy to prevent acneiform rash based on level II evidence with a grade A recommendation. Topical hydrocortisone cream with sunscreen and moisturizer is also recommended to prevent and treat rash.
El documento habla sobre la nutrición de pacientes oncológicos. Explica que estos pacientes tienen mayores requerimientos nutricionales debido al catabolismo causado por la quimioterapia. El objetivo es cumplir con el aporte calórico necesario para cada paciente y evitar la pérdida de peso a través de una dieta hipercalórica. También se busca brindar una alimentación segura para pacientes inmunocomprometidos para prevenir enfermedades transmitidas por alimentos.
El documento proporciona instrucciones sobre los cuidados necesarios para pacientes que reciben radioterapia interna con fuentes selladas, incluyendo preparación del paciente, restricciones para el personal y visitas, y medidas de protección contra la radiación. Se requiere que el paciente permanezca aislado en una habitación privada y que el tiempo de exposición al paciente se limite estrictamente. El personal solo puede pasar 15 minutos por turno junto al paciente y debe trabajar detrás de blindajes para protegerse de la radiación.
El documento proporciona instrucciones sobre los cuidados necesarios para pacientes que reciben radioterapia con fuentes radiactivas no selladas, incluyendo informar al paciente sobre el procedimiento, asignar una habitación privada con puerta cerrada, limitar las visitas y actividades de la paciente, tomar precauciones con secreciones corporales usando guantes y utensilios desechables, cambiar la ropa de cama solo si está manchada, y dar de alta a la paciente cuando los isótopos radiactivos en su cuerpo sean seguros.
El documento resume los conceptos básicos de la nutrición como el proceso de asimilación de alimentos y líquidos para el funcionamiento y mantenimiento del organismo. Explica que la nutrición estudia el equilibrio homeostático a nivel molecular y de los macrosistemas, y cómo determinar dietas para personas sanas o enfermas. Además, clasifica los macronutrientes, micronutrientes y los principales grupos de alimentos, y menciona las consecuencias del exceso o déficit nutricional.
La radioterapia es un tratamiento para el cáncer que utiliza radiación de alta energía para destruir células cancerosas. Puede ser externa, usando una máquina para dirigir la radiación desde fuera del cuerpo, o interna, colocando las fuentes radiactivas dentro del cuerpo. La radioterapia se usa para tratar el cáncer, reducir los síntomas o como complemento de otras terapias como la cirugía o quimioterapia. Aunque destruye las células cancerosas, también puede afectar a las
El documento describe el linfoedema y su tratamiento a través de vendajes. Explica que el linfoedema es una acumulación de fluidos ricos en proteínas causada por un desequilibrio en el transporte de la linfa. Su tratamiento incluye drenaje linfático manual, presoterapia secuencial, ejercicios linfo-cinéticos y vendajes de contención o elastocompresión para facilitar la circulación linfática y reducir el volumen. Los vendajes pueden ser de diferentes grados de extensibilidad y compresión
La piel está compuesta de tres capas principales: la epidermis, la dermis y la hipodermis. La epidermis es la capa externa queratinizada que protege el cuerpo. Debajo se encuentra la dermis, formada por tejido conjuntivo que nutre a la epidermis y contiene anexos como folículos pilosos y glándulas. La capa más profunda es la hipodermis, que actúa como almohadilla aislante y almacén de energía. La piel cumple funciones vitales como protección, regulación térmica
El documento resume el rol de enfermería en la patología mamaria, incluyendo la educación sobre el cáncer de mama, el autoexamen, el apoyo durante el diagnóstico y tratamiento, y la rehabilitación. El cáncer de mama es la principal causa de muerte por cáncer en mujeres y se recomienda implementar programas de tamizaje. La enfermera desempeña un papel clave en la detección temprana, el tratamiento y la mejora de la calidad de vida de las pacientes.
El documento trata sobre el tratamiento del melanoma maligno (MM), incluyendo quimioterapia, inmunoterapia e intervenciones según el estadio. Se discuten genes asociados como BRAF, tratamientos como vemurafenib, y estudios sobre fármacos inmunomoduladores como interferón e ipilimumab.
El documento proporciona información sobre varias emergencias oncológicas, incluyendo el síndrome de vena cava superior, la compresión de la médula espinal, el taponamiento cardíaco y la meningitis neoplásica. Describe los síntomas, causas, diagnóstico y tratamiento de cada una de estas condiciones médicas de urgencia relacionadas con el cáncer. El objetivo general es mejorar la calidad de vida de los pacientes con cáncer y reducir la mortalidad en situaciones que ponen en riesgo la vida.
El documento habla sobre emergencias oncológicas. Menciona algunas situaciones urgentes como el síndrome de vena cava superior, taponamiento cardíaco, obstrucción intestinal, obstrucción urinaria, obstrucción biliar, compresión de la médula espinal, hipertensión endocraneana, meningitis neoplásica, convulsiones, leucocitostasis intracerebral, hemoptisis, obstrucción aérea, hipercalcemia, síndrome de secreción inapropiada de hormona antidiurética, acidosis láctica
El documento resume la epidemiología, factores de riesgo, manifestaciones clínicas, diagnóstico, estadificación y tratamiento del cáncer de cuello uterino y cáncer de endometrio. El cáncer de cuello uterino afecta a aproximadamente 500,000 mujeres por año y es causado principalmente por el virus del papiloma humano. El cáncer de endometrio es el segundo cáncer ginecológico más común y factores como la obesidad y la falta de hijos aumentan el riesgo. Ambos cán
El documento describe el cáncer de piel, incluyendo sus dos tipos principales (melanoma y no melanoma), factores de riesgo, síntomas, pronóstico y formas de prevención. El cáncer de piel no melanoma, que incluye el carcinoma basocelular y escamocelular, es el más común y suele presentarse en áreas expuestas al sol. El riesgo aumenta en personas de piel clara y con antecedentes de quemaduras solares. La exposición excesiva a los rayos UV es el principal factor de riesgo.
La quimioterapia es un tratamiento importante para el cáncer que usa medicamentos para destruir células cancerosas. Existen diferentes tipos de medicamentos quimioterapéuticos que actúan en diferentes puntos del ciclo celular. La quimioterapia se administra en ciclos para permitir que las células sanas se recuperen entre tratamientos y suele tener efectos secundarios como náuseas. El proceso de administración de quimioterapia requiere seguridad y monitoreo del paciente.
El documento habla sobre la prevención del cáncer. Explica que el cáncer se produce por la interacción entre factores genéticos y ambientales como carcinógenos físicos, químicos y biológicos. Detalla la importancia de la prevención primaria a través de estilos de vida saludables y la eliminación de factores de riesgo como el tabaco. También habla sobre la prevención secundaria mediante exámenes periódicos para detección temprana, lo que mejora los resultados del tratamiento.
El documento trata sobre genética y cáncer. Explica que el cáncer se produce por la acumulación de varias mutaciones genéticas que alteran el control del crecimiento celular. Algunos genes como los supresores tumorales y los protooncogenes juegan un papel clave. Existen algunos tipos de cáncer hereditarios asociados a mutaciones en genes específicos como el retinoblastoma.
Este documento describe los tipos y usos de catéteres para acceso venoso, así como los procedimientos para su colocación, habilitación y cuidados. Explica que los catéteres implantables se usan comúnmente para quimioterapia y nutrición parenteral en pacientes con cáncer. Detalla dos tipos principales de catéteres, los semi-implantables y los totalmente implantables, y sus ventajas e inconvenientes. Además, explica los pasos para habilitar un catéter de forma aséptica y los cuidados necesarios para
Las extravasaciones ocurren cuando un medicamento se escapa del vaso sanguíneo durante su administración. Pueden causar dolor, necrosis o formación de escaras en el tejido. El tratamiento consiste en detener la administración del fármaco, intentar eliminarlo de la zona, administrar corticoides localmente y enfriar o calentar la zona según el tipo de quimioterápico. Es importante prevenir las extravasaciones eligiendo buenas venas y formando al personal médico en el procedimiento correcto.
Este documento describe las tasas de incidencia y mortalidad de cáncer en diferentes partes del mundo. Los tipos de cáncer más comunes varían según el grado de desarrollo del país, y los factores de riesgo como el tabaquismo, la dieta, la obesidad y las infecciones crónicas contribuyen a las diferencias. Los estudios sugieren que los factores ambientales, más que la herencia, determinan el riesgo de distintos tipos de cáncer.