This document discusses the management of neck nodes in head and neck malignancies from a radiation oncologist's perspective. It provides details on:
1) Determining the appropriate nodal regions to treat based on primary site using evidence from anatomical studies and patterns of failure data.
2) Risk stratification approaches for elective nodal irradiation based on factors like primary site, stage, extracapsular extension.
3) Guidelines for target volumes and doses for different clinical scenarios including postoperative and metastatic neck nodes of unknown primary.
4) The importance of imaging, histology and other tests to accurately determine the primary and guide treatment planning.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Sino-nasal cancers are not uncommon. However, treatment is always challenging because of surrounding critical normal structures.
Skilled surgical procedure and high end radiation therapy (IMRT, IGRT, SBRT) can definitely treat these difficult cancers.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Sino-nasal cancers are not uncommon. However, treatment is always challenging because of surrounding critical normal structures.
Skilled surgical procedure and high end radiation therapy (IMRT, IGRT, SBRT) can definitely treat these difficult cancers.
At the end of the lecture the audience should:
1. Know the prevalence of HPV associated SCC of the H&N.
2. Be able to identify the high-risk serotypes of HPV associated with SCC of the head and neck.
3. Have a strong understanding of the prognostic significance of an HPV related SCC of the head and neck.
Nasopharyngeal carcinoma is a non lymphomatous squamous-cell carcinoma that occurs in the epithelial lining of the nasopharynx.
It frequently arises from the pharyngeal recess (fossa of Rosenmuller) posteromedial to the medial crura of the eustachian tube opening in the nasopharynx
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Management of neck: A radiation oncologist's perspective
1. Management of Neck Nodes in Head
and Neck Malignancies: A Radiation
Oncologist’s Perspective
Dr Suman Mallik
Radiation Oncologist
Westbank Cancer Centre
Westbank Health and Wellness Institute
11. Oral Cavity
3.5%
91%
3.9%
4.8%
Pantvaidya G 2013
698 Neck Dissection
566 oral cancer patient
434 unilateral, 132 bilateral
Tongue(255),
Buccal Mucosa(233)
698 Neck Dissection
566 oral cancer patient
434 unilateral, 132 bilateral
Tongue(255),
Buccal Mucosa(233)
Level I to III 91%
Skip metastasis to level III 13.8%
Skip Metastasis for tongue
primary 19%
Level I to III 91%
Skip metastasis to level III 13.8%
Skip Metastasis for tongue
primary 19%
12. Oral Cavity: determinants for nodal
irradiation
• Primary site
• T stage
• Depth (4 mm Vs 9mm)
• N stage
• Perinodal extension
• LVE, PNI
18. T1-T2 Tonsil, clinical N0 or N+ (N=228)
• Contralateral Neck failure 8/228 (3.5%)
• For a well lateralized tumor it is safe to
treat neck unilaterally
O’Sullivan B IJROBP 2001
30. Risk Stratification
Target Definitive RT PORT High
risk
PORT
intermediate
risk
CTV1 Gross Tumor, node
and adjacent nodal
region
70 Gy equivalent
Surgical bed with
soft tissue
involvement or
nodal region with
extracapsular
spread
56-60 Gy eqv
Surgical bed
without soft tissue
involvement or
nodal region
without
extracapsular
extension
56-60 Gy eqv
CTV2 Elective nodal
region.
50-60 Gy eqv
Elective nodal
region
50-54 Gy eqv
Elective nodal
region
50-54 Gy eqv
CTV3 Elective nodal
region
50-54 Gy eqv
Elective nodal
region
50 Gy eqv
Elective nodal
region
50 Gy eqv
33. Extent of ECE
• The mean and median extent
values of ECE were 1.8 and 1
mm
• ECE 5 mm in 97% and 3 mm in
91% of the 231 LN analyzed.
• The largest percentage of LN
had an ECE of 1 mm (58%)
• In 17 (17%) patients,
infiltration of the adjacent
• muscular fascia was observed,
with mean and median
extension values of 2.8 and
2.0 mm, respectively (range,
1–9 mm).
PIRUS GHADJAR IJROBP 2010
36. ECE
• For metastatic lymph node the risk of ECE is
associated with lymph node size.
• The extention of EC spread is not related to
lymph node size.
• In 96 % of all ECE, extension is less than 5 mm.
• 1 cm margin over node will cover >99% ECE
but also significantly increase the high dose
volume
37. Delineation of nodal stations
Harari et al 2004
Grégoire V et al Radiother
Oncol 2000;56:135–50.
Grégoire V et al, Radiother
Oncol 2003;69:227–36.
Grégoire V et al, Radiother
Oncol 2013.
RTOG contouring guideline
www.dahanca.dk
45. CUP
• The five-year estimates of neck control, disease-
specific survival and overall survival for radically
treated patients were 51%, 48% and 36%, respectively.
• Oropharynx, hypopharynx and oral cavity being the
most common sites.
• Emerging primaries outside the head and neck region
are primarily located in the lung and oesophagus .
• The most important factor for neck control is nodal
stage (5-year estimates 69% [N1], 58% [N2] and 30%
[N3]).
• Conflicting results on surgery and radiotherapy.
Grau 2000 Head and Neck
46. Post Neck Dissection
N1 disease ECE(-)
Level involved Target area
Level 1 only RT to oral cavity, Waldeyer’s
ring, oropharynx, bilateral neck
Level 2,3 RT to oropharynx and bilateral
neck
Level 4 only RT to Waldeyer’s ring, larynx,
hypopharynx, bilateral neck
Level 5 RT to npx, larynx,
hypopharynx, bilateral neck
OR
OBSERVATION
47. Post Neck Dissection
N2-3 disease ECE(-)
Level involved Target area
Level 1 only RT to oral cavity, Waldeyer’s
ring, oropharynx, bilateral neck
Level 2,3, upper 5 RT to nasopharynx,
oropharynx, hypopharynx,
larynx and bilateral neck
Level 4 only RT to Waldeyer’s ring, larynx,
hypopharynx, bilateral neck
Level 5 RT to npx, larynx,
hypopharynx, bilateral neck
+ Chemotherapy
48. Post Neck Dissection ECE(+)
Level involved Target area
Level 1 only RT to oral cavity, Waldeyer’s
ring, oropharynx, bilateral neck
Level 2,3, upper 5 RT to nasopharynx,
oropharynx, hypopharynx,
larynx and bilateral neck
Level 4 only RT to Waldeyer’s ring, larynx,
hypopharynx, bilateral neck
Level 5 RT to npx, larynx,
hypopharynx, bilateral neck
+ Chemotherapy
49.
50. Take home message
• Optimal clinical examn and imaging modality
• Evolution and evidences of nodal delineation
• Optimal treatment approach
• Multimodality approach