The document discusses testicular seminoma, including:
- It is the most common solid tumor in men aged 15-35 and has increasing incidence. Risk factors include cryptorchidism, family history, and genetic factors.
- Presentation is usually a unilateral testicular mass. Staging involves imaging and tumor markers. Pathology shows seminoma cells that are typically PLAP positive.
- Treatment depends on stage. Stage I options include surveillance, chemotherapy, or radiotherapy. Advanced stages receive chemotherapy. Outcomes are generally excellent even for advanced disease.
This document discusses a trial investigating the role of local radiation therapy for metastatic prostate cancer. The main findings were:
1. No overall survival benefit was seen with radiation therapy, but survival improved in patients with low metastatic burden.
2. Failure-free survival improved with radiation therapy overall and in the low metastatic burden group.
3. Adverse effects from radiation therapy were modest.
The trial provides evidence that radiation therapy to the prostate improves outcomes for men with metastatic prostate cancer who have a low metastatic burden and does not negatively impact side effects.
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
This document discusses bladder cancer. Some key points:
1. Bladder cancer is the most common tumor of the urinary tract and the second most common cause of cancer death.
2. Bladder cancer presents at a muscle-invasive stage in 20-40% of cases.
3. Diagnosis involves cystoscopy, urine cytology, imaging like CT/MRI, and biopsy.
4. Treatment depends on stage - non-muscle invasive cancers receive transurethral resection and intravesical therapy while muscle-invasive cancers require radical cystectomy and urinary diversion.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is emerging as a new standard treatment for peritoneal surface malignancies. Traditionally, peritoneal carcinomatosis was considered incurable and treated only with palliative chemotherapy. However, CRS-HIPEC aims to remove all visible tumor deposits surgically and then uses heated chemotherapy in the abdominal cavity to target any remaining microscopic disease. Studies show CRS-HIPEC provides significantly longer survival times compared to intravenous chemotherapy alone, with median overall survivals of 16-36 months. Experts indicate CRS-HIPEC should now be considered the standard of care for select patients with peritoneal metastases from conditions like ovarian
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
Cervix cancer is the fourth most common gynecologic cancer in women. Screening through regular pap smears can lower the risk of cervix cancer by 80%. Treatment depends on the stage - early stages may be treated with surgery or radiation while more advanced stages involve radiation with chemotherapy. Radiation uses external beam radiation to the pelvis and internal radiation through brachytherapy applicators in the cervix and vagina. Side effects result from radiation to nearby organs like the bowel, bladder, and ovaries.
This document discusses a trial investigating the role of local radiation therapy for metastatic prostate cancer. The main findings were:
1. No overall survival benefit was seen with radiation therapy, but survival improved in patients with low metastatic burden.
2. Failure-free survival improved with radiation therapy overall and in the low metastatic burden group.
3. Adverse effects from radiation therapy were modest.
The trial provides evidence that radiation therapy to the prostate improves outcomes for men with metastatic prostate cancer who have a low metastatic burden and does not negatively impact side effects.
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
This document discusses bladder cancer. Some key points:
1. Bladder cancer is the most common tumor of the urinary tract and the second most common cause of cancer death.
2. Bladder cancer presents at a muscle-invasive stage in 20-40% of cases.
3. Diagnosis involves cystoscopy, urine cytology, imaging like CT/MRI, and biopsy.
4. Treatment depends on stage - non-muscle invasive cancers receive transurethral resection and intravesical therapy while muscle-invasive cancers require radical cystectomy and urinary diversion.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is emerging as a new standard treatment for peritoneal surface malignancies. Traditionally, peritoneal carcinomatosis was considered incurable and treated only with palliative chemotherapy. However, CRS-HIPEC aims to remove all visible tumor deposits surgically and then uses heated chemotherapy in the abdominal cavity to target any remaining microscopic disease. Studies show CRS-HIPEC provides significantly longer survival times compared to intravenous chemotherapy alone, with median overall survivals of 16-36 months. Experts indicate CRS-HIPEC should now be considered the standard of care for select patients with peritoneal metastases from conditions like ovarian
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
Cervix cancer is the fourth most common gynecologic cancer in women. Screening through regular pap smears can lower the risk of cervix cancer by 80%. Treatment depends on the stage - early stages may be treated with surgery or radiation while more advanced stages involve radiation with chemotherapy. Radiation uses external beam radiation to the pelvis and internal radiation through brachytherapy applicators in the cervix and vagina. Side effects result from radiation to nearby organs like the bowel, bladder, and ovaries.
Adjuvant radiotherapy in cancer breast pptxGopa Ghosh
1) Adjuvant radiotherapy is established as curative for breast cancer and indications are evolving based on ongoing trials.
2) For early stage disease after breast conserving surgery or mastectomy, radiotherapy reduces the risk of recurrence by 50% and is the standard of care. Hypofractionated schedules have shown similar outcomes with improved cosmesis.
3) For early node-positive disease, radiotherapy to the breast and regional nodes decreases the risk of locoregional recurrence by an absolute 10% and may improve overall survival marginally. Post-mastectomy radiotherapy is routinely recommended for residual disease after neoadjuvant chemotherapy in locally advanced disease.
This document summarizes the management of early breast cancer and carcinoma in situ. It discusses the stages included in early breast cancer and factors that influence treatment decisions such as stage, nodal status, tumor characteristics, age, and patient preference. The main treatment options for the primary tumor and axilla are discussed, including surgery, radiotherapy, chemotherapy, hormonal therapy, and targeted therapy. Breast conservation therapy with lumpectomy or quadrantectomy followed by radiotherapy is an acceptable alternative to mastectomy for early stage breast cancer based on evidence from multiple clinical trials showing equivalent survival outcomes.
HIPEC, or hyperthermic intraperitoneal chemotherapy, is a treatment for advanced cancers that have spread to the peritoneum. It involves delivering heated chemotherapy directly into the peritoneal cavity during cytoreductive surgery to remove any visible tumors. HIPEC aims to treat any remaining microscopic disease. Heating the chemotherapy to 41-42°C allows it to penetrate deeper tissues and more effectively kill cancer cells compared to normal intraperitoneal or intravenous chemotherapy alone. While HIPEC is effective, it is also associated with increased risks of complications due to the combined effects of surgery, chemotherapy, and localized hyperthermia.
The CROSS trial found that neoadjuvant chemoradiotherapy followed by surgery significantly improved long-term overall and progression-free survival compared to surgery alone for patients with resectable esophageal or esophagogastric junction cancer. At a minimum follow-up of 5 years, median overall survival was 48.6 months for chemoradiotherapy plus surgery versus 24 months for surgery alone. Both squamous cell carcinoma and adenocarcinoma subtypes benefited. Neoadjuvant chemoradiotherapy using carboplatin and paclitaxel is now considered the standard of care for these patients.
1) Endometrial cancer is the most common gynecologic cancer in developed countries, with a lifetime risk of 1 in 35 women. It occurs most often in postmenopausal women.
2) Diagnosis involves endometrial biopsy or dilation and curettage to obtain tissue samples. Staging involves total abdominal hysterectomy and bilateral salpingo-oophorectomy.
3) For low-risk early-stage disease, no additional treatment is typically needed. For high-risk early-stage disease, adjuvant pelvic radiation with or without chemotherapy is recommended based on trials such as PORTEC-3.
1) Radiotherapy plays an important role in managing carcinoma of the cervix by delivering high doses through a combination of external beam radiotherapy and brachytherapy.
2) The disease has central and peripheral components - the central component confined to the cervix is best treated with brachytherapy, while the peripheral component involving surrounding tissues is treated with both external beam radiotherapy and brachytherapy.
3) External beam radiotherapy techniques include 3D conformal radiotherapy and IMRT to improve dose distribution and spare surrounding organs-at-risk.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
MRI is useful for staging rectal cancer and assessing tumor involvement of surrounding structures. It can determine the depth of tumor invasion beyond the muscularis propria (T stage), evaluate the circumferential resection margin (CRM) distance between the tumor and mesorectal fascia, and identify suspicious lymph nodes. A tumor-mesorectal fascia distance of less than 1mm on MRI indicates a positive CRM, which is associated with higher rates of local recurrence. MRI is also used to assess nodal metastases based on node size, borders, and signal intensity. Accurate pre-treatment staging with MRI allows for optimal surgical planning and identification of patients who may benefit from neoadjuvant chemoradiation.
This document summarizes the management of carcinoma of the cervix according to the 2018 FIGO staging system and various medical textbooks. It discusses treatment options for preinvasive disease and early stage cervical cancer (Stage IA-IIA), including conization, loop electrosurgical excision, hysterectomy, and radiotherapy. For more advanced stages (IB3-IVA), the standard of care is described as concurrent chemoradiotherapy with cisplatin. Several landmark clinical trials are summarized that demonstrated improved survival outcomes with the addition of chemotherapy to radiotherapy.
1) A landmark randomized clinical trial published in 1999 found that concurrent weekly cisplatin chemotherapy during pelvic radiation improved progression-free survival and overall survival rates for patients with bulky stage IB cervical cancer compared to radiation alone. The study demonstrated a 79% 5-year progression-free survival rate and 85% 5-year overall survival rate for patients receiving concurrent chemoradiation versus 74% and 63% respectively for radiation alone.
2) Another 1999 randomized clinical trial found that for high-risk cervical cancer patients, pelvic radiation with concurrent cisplatin and fluorouracil chemotherapy resulted in improved overall survival compared to pelvic and para-aortic radiation alone, establishing concurrent chemoradiation as the new standard
This document provides information about a case of carcinoma cervix. It begins with an overview of epidemiology, risk factors, pathogenesis, diagnosis, staging, treatment and prevention of carcinoma cervix. It then presents the history and examination findings of a 45-year-old female patient with complaints of irregular bleeding and discharge. Investigations revealed stage 2B carcinoma cervix. She was treated conservatively with antibiotics and blood transfusion to improve her general health prior to definitive treatment. The document concludes with an open discussion and review of the case.
Fight Colorectal Cancer’s Medical Advisory Board Member, Axel Grothey, MD, focused this webinar to stage III colon cancer patients. Dr. Grothey, medical oncologist at Mayo Clinic, will spend the hour discussing current treatment options and exciting new research that pertains to stage III colon cancer patients.
This randomized controlled trial compared neoadjuvant chemoradiotherapy plus surgery to surgery alone in 368 patients with resectable esophageal or junctional cancer. Patients receiving neoadjuvant treatment had significantly improved overall survival (48.6 vs 24 months) and progression-free survival (37.7 vs 16.2 months). R0 resection rates were also higher in the neoadjuvant group (92% vs 69%). The trial demonstrated that preoperative chemoradiotherapy improves long-term outcomes for esophageal cancer patients.
The document discusses triple negative breast cancer (TNBC) and early stage disease. It covers molecular subtypes of breast cancer, challenges in treating TNBC due to lack of targeted therapies, and evidence that neoadjuvant chemotherapy can improve outcomes for TNBC patients who achieve a pathological complete response. Ongoing research aims to better predict which patients will respond to neoadjuvant treatment and identify new targeted therapies for TNBC subtypes.
The document discusses several trials evaluating preoperative chemoradiotherapy versus postoperative chemoradiotherapy or radiotherapy alone for rectal cancer. Some key trials found that preoperative therapy improved local recurrence rates and survival compared to postoperative or no adjuvant therapy. Longer intervals between preoperative radiotherapy and surgery were associated with higher rates of tumor downstaging. Adding oxaliplatin or chemotherapy without radiation improved survival outcomes in some trials. Ongoing studies are exploring chemotherapy alone and targeted agents in rectal cancer.
This document summarizes information about seminoma, a type of testicular cancer. It discusses the anatomy and epidemiology of testicular tumors. It describes risk factors, pathology, pathways of spread, clinical features, diagnostic workup and staging of seminoma. It provides details about management including surgery, radiation therapy and chemotherapy for different stages. It discusses follow-up protocols and results of therapy.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
Adjuvant radiotherapy in cancer breast pptxGopa Ghosh
1) Adjuvant radiotherapy is established as curative for breast cancer and indications are evolving based on ongoing trials.
2) For early stage disease after breast conserving surgery or mastectomy, radiotherapy reduces the risk of recurrence by 50% and is the standard of care. Hypofractionated schedules have shown similar outcomes with improved cosmesis.
3) For early node-positive disease, radiotherapy to the breast and regional nodes decreases the risk of locoregional recurrence by an absolute 10% and may improve overall survival marginally. Post-mastectomy radiotherapy is routinely recommended for residual disease after neoadjuvant chemotherapy in locally advanced disease.
This document summarizes the management of early breast cancer and carcinoma in situ. It discusses the stages included in early breast cancer and factors that influence treatment decisions such as stage, nodal status, tumor characteristics, age, and patient preference. The main treatment options for the primary tumor and axilla are discussed, including surgery, radiotherapy, chemotherapy, hormonal therapy, and targeted therapy. Breast conservation therapy with lumpectomy or quadrantectomy followed by radiotherapy is an acceptable alternative to mastectomy for early stage breast cancer based on evidence from multiple clinical trials showing equivalent survival outcomes.
HIPEC, or hyperthermic intraperitoneal chemotherapy, is a treatment for advanced cancers that have spread to the peritoneum. It involves delivering heated chemotherapy directly into the peritoneal cavity during cytoreductive surgery to remove any visible tumors. HIPEC aims to treat any remaining microscopic disease. Heating the chemotherapy to 41-42°C allows it to penetrate deeper tissues and more effectively kill cancer cells compared to normal intraperitoneal or intravenous chemotherapy alone. While HIPEC is effective, it is also associated with increased risks of complications due to the combined effects of surgery, chemotherapy, and localized hyperthermia.
The CROSS trial found that neoadjuvant chemoradiotherapy followed by surgery significantly improved long-term overall and progression-free survival compared to surgery alone for patients with resectable esophageal or esophagogastric junction cancer. At a minimum follow-up of 5 years, median overall survival was 48.6 months for chemoradiotherapy plus surgery versus 24 months for surgery alone. Both squamous cell carcinoma and adenocarcinoma subtypes benefited. Neoadjuvant chemoradiotherapy using carboplatin and paclitaxel is now considered the standard of care for these patients.
1) Endometrial cancer is the most common gynecologic cancer in developed countries, with a lifetime risk of 1 in 35 women. It occurs most often in postmenopausal women.
2) Diagnosis involves endometrial biopsy or dilation and curettage to obtain tissue samples. Staging involves total abdominal hysterectomy and bilateral salpingo-oophorectomy.
3) For low-risk early-stage disease, no additional treatment is typically needed. For high-risk early-stage disease, adjuvant pelvic radiation with or without chemotherapy is recommended based on trials such as PORTEC-3.
1) Radiotherapy plays an important role in managing carcinoma of the cervix by delivering high doses through a combination of external beam radiotherapy and brachytherapy.
2) The disease has central and peripheral components - the central component confined to the cervix is best treated with brachytherapy, while the peripheral component involving surrounding tissues is treated with both external beam radiotherapy and brachytherapy.
3) External beam radiotherapy techniques include 3D conformal radiotherapy and IMRT to improve dose distribution and spare surrounding organs-at-risk.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
MRI is useful for staging rectal cancer and assessing tumor involvement of surrounding structures. It can determine the depth of tumor invasion beyond the muscularis propria (T stage), evaluate the circumferential resection margin (CRM) distance between the tumor and mesorectal fascia, and identify suspicious lymph nodes. A tumor-mesorectal fascia distance of less than 1mm on MRI indicates a positive CRM, which is associated with higher rates of local recurrence. MRI is also used to assess nodal metastases based on node size, borders, and signal intensity. Accurate pre-treatment staging with MRI allows for optimal surgical planning and identification of patients who may benefit from neoadjuvant chemoradiation.
This document summarizes the management of carcinoma of the cervix according to the 2018 FIGO staging system and various medical textbooks. It discusses treatment options for preinvasive disease and early stage cervical cancer (Stage IA-IIA), including conization, loop electrosurgical excision, hysterectomy, and radiotherapy. For more advanced stages (IB3-IVA), the standard of care is described as concurrent chemoradiotherapy with cisplatin. Several landmark clinical trials are summarized that demonstrated improved survival outcomes with the addition of chemotherapy to radiotherapy.
1) A landmark randomized clinical trial published in 1999 found that concurrent weekly cisplatin chemotherapy during pelvic radiation improved progression-free survival and overall survival rates for patients with bulky stage IB cervical cancer compared to radiation alone. The study demonstrated a 79% 5-year progression-free survival rate and 85% 5-year overall survival rate for patients receiving concurrent chemoradiation versus 74% and 63% respectively for radiation alone.
2) Another 1999 randomized clinical trial found that for high-risk cervical cancer patients, pelvic radiation with concurrent cisplatin and fluorouracil chemotherapy resulted in improved overall survival compared to pelvic and para-aortic radiation alone, establishing concurrent chemoradiation as the new standard
This document provides information about a case of carcinoma cervix. It begins with an overview of epidemiology, risk factors, pathogenesis, diagnosis, staging, treatment and prevention of carcinoma cervix. It then presents the history and examination findings of a 45-year-old female patient with complaints of irregular bleeding and discharge. Investigations revealed stage 2B carcinoma cervix. She was treated conservatively with antibiotics and blood transfusion to improve her general health prior to definitive treatment. The document concludes with an open discussion and review of the case.
Fight Colorectal Cancer’s Medical Advisory Board Member, Axel Grothey, MD, focused this webinar to stage III colon cancer patients. Dr. Grothey, medical oncologist at Mayo Clinic, will spend the hour discussing current treatment options and exciting new research that pertains to stage III colon cancer patients.
This randomized controlled trial compared neoadjuvant chemoradiotherapy plus surgery to surgery alone in 368 patients with resectable esophageal or junctional cancer. Patients receiving neoadjuvant treatment had significantly improved overall survival (48.6 vs 24 months) and progression-free survival (37.7 vs 16.2 months). R0 resection rates were also higher in the neoadjuvant group (92% vs 69%). The trial demonstrated that preoperative chemoradiotherapy improves long-term outcomes for esophageal cancer patients.
The document discusses triple negative breast cancer (TNBC) and early stage disease. It covers molecular subtypes of breast cancer, challenges in treating TNBC due to lack of targeted therapies, and evidence that neoadjuvant chemotherapy can improve outcomes for TNBC patients who achieve a pathological complete response. Ongoing research aims to better predict which patients will respond to neoadjuvant treatment and identify new targeted therapies for TNBC subtypes.
The document discusses several trials evaluating preoperative chemoradiotherapy versus postoperative chemoradiotherapy or radiotherapy alone for rectal cancer. Some key trials found that preoperative therapy improved local recurrence rates and survival compared to postoperative or no adjuvant therapy. Longer intervals between preoperative radiotherapy and surgery were associated with higher rates of tumor downstaging. Adding oxaliplatin or chemotherapy without radiation improved survival outcomes in some trials. Ongoing studies are exploring chemotherapy alone and targeted agents in rectal cancer.
This document summarizes information about seminoma, a type of testicular cancer. It discusses the anatomy and epidemiology of testicular tumors. It describes risk factors, pathology, pathways of spread, clinical features, diagnostic workup and staging of seminoma. It provides details about management including surgery, radiation therapy and chemotherapy for different stages. It discusses follow-up protocols and results of therapy.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
This document provides information on testicular tumors, including their classification, presentation, histopathology, and immunohistochemistry. It discusses the most common types of germ cell tumors - seminoma, spermatocytic seminoma, embryonal carcinoma, yolk sac tumor, and teratoma. It also covers sex cord stromal tumors such as Leydig cell tumor and Sertoli cell tumor. Key points include that seminoma is the most common germ cell tumor in adults. Embryonal carcinoma and yolk sac tumor often occur as components of mixed germ cell tumors. Teratomas contain mature somatic tissues. Immunohistochemistry aids in distinguishing tumor types.
1) O câncer de testículo é o tipo mais comum de tumor maligno em homens entre 15-35 anos, com taxas de incidência de 1% de todos os cânceres.
2) O seminoma é o tipo histológico mais comum de câncer de testículo, representando cerca de 50% dos casos. Ele geralmente ocorre na quarta década de vida.
3) O tratamento para seminoma depende do estádio da doença. Estádio I pode ser tratado com vigilância, radioterapia ou quimioterapia
Los seminomas testiculares son los tumores testiculares más comunes,
representando aproximadamente el 45% de los tumores testiculares primarios.
Se originan en el epitelio germinal de los túbulos seminíferos y afectan con más
frecuencia a hombres entre los 15-35 años. El diagnóstico se realiza mediante
ecografía, TAC, RNM y análisis de marcadores tumorales en sangre, y el
tratamiento depende del estadio del tumor, incluyendo cirugía, radioter
O documento discute o câncer de testículo, incluindo sua incidência, classificação histológica, fatores de risco, estágios e tratamentos. O câncer de testículo é mais comum em homens abaixo dos 45 anos e compõe cerca de 1% dos tumores masculinos. Existem vários tipos histológicos, sendo o seminoma o mais comum. O tratamento varia de acordo com o estágio e tipo histológico, incluindo vigilância ativa, radioterapia e quimioterapia.
This document provides information on testicular cancer, including its incidence, histology, lymph node drainage patterns, staging classifications, workup, and management guidelines. Some key points:
- Testicular cancers constitute 1% of all cancers and germ cell tumors are the most common solid tumors in men aged 15-35.
- Lymph node drainage patterns differ for right and left testes, with retroperitoneal lymph nodes being the most common site of spread.
- Germ cell tumors are the most common type and are classified based on their histologic components.
- Staging involves the TNM classification and serum tumor marker levels. Workup includes imaging, tumor marker tests, and radical orchi
This document discusses testicular tumours and their anatomy, etiology, classification, clinical features, diagnosis, staging, and treatment. Some key points:
- Testicular tumours most commonly occur in men ages 20-35 and risk factors include cryptorchidism, Klinefelter syndrome, and history of mumps orchitis.
- Germ cell tumours make up 90-95% of cases and include seminomas, teratomas, embryonal carcinomas, and others. Staging involves clinical exam, imaging, and tumour markers.
- Diagnosis involves ultrasound and biopsy of solid intratesticular masses. Treatment depends on tumour type, stage, and involves surgery, radiation,
This document provides an overview of reproductive embryology and urogenital development from weeks 5-8 of gestation. It discusses the key structures and events in bladder, genital, and gonadal development in both males and females. It also reviews common disorders of sex development and the genetic basis for differences in male versus female development. Case examples are presented and analyzed.
El documento contrasta el hecho educativo, que es el proceso permanente de adquirir conocimientos a través de la interacción social, con el acto pedagógico, que se refiere a las acciones intencionales de los docentes para enseñar a los estudiantes mediante estrategias de aprendizaje y generar una internalización de conocimientos. Ambos procesos son fundamentales para que los seres humanos aprendan y formen parte de la sociedad.
1. El documento describe la anatomía y contenido del mediastino, así como los tumores más comunes que pueden presentarse en sus diferentes regiones. 2. Explica los métodos diagnósticos como la radiografía de tórax, la tomografía computarizada y la biopsia para diferenciar tumores primarios de secundarios. 3. Resalta tumores frecuentes como los timomas, teratomas y linfomas, e indica su ubicación, edad de presentación, diagnóstico y tratamiento.
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
This document discusses testicular tumors, including:
- Germ cell tumors are the most common type, comprising 95% of cases. Seminomas and non-seminomatous germ cell tumors are the main subtypes.
- Important biomarkers for testicular cancer include AFP, HCG, LDH, and PLAP. Elevated levels can indicate the presence of a non-seminoma.
- Staging is important and is based on whether the cancer is confined to the testis or has spread to lymph nodes or other organs. Spread beyond the retroperitoneum is considered stage III.
- Diagnostic workup involves imaging like ultrasound, CT, MRI and PET scans
Spermatocele is a benign cystic accumulation of sperm that arises from the head of the epididymis. It typically presents as an asymptomatic mobile swelling near the testicle. Ultrasound shows a hypoechoic cystic lesion connected to the epididymis. Treatment involves observation for small asymptomatic cases or spermatocelectomy via scrotal surgery to remove the cyst. Sclerotherapy is sometimes used as an alternative but has a higher recurrence rate.
This document provides information on testicular tumors, including their epidemiology, risk factors, classification, types, clinical features, investigations, staging, and spread. Some key points:
- Testicular tumors comprise 1-2% of all malignancies and 95% are germ cell tumors (GCTs), which predominantly affect young males.
- Risk factors include cryptorchidism, family history, prior testicular cancer, intratubular germ cell neoplasia, and environmental exposures.
- The main types of GCTs are seminoma, embryonal carcinoma, choriocarcinoma, yolk sac tumor, and teratoma.
- Clinical features depend on whether the
Cleft lip and palate are congenital anomalies that require a multidisciplinary team for treatment. They can involve the lip, alveolus, hard and soft palates. Treatment involves a coordinated approach between multiple specialties and begins with surgery to repair the cleft, followed by ongoing dental, orthodontic and reconstructive procedures over many years.
The document discusses various types of local flaps used in head and neck reconstruction. Local flaps involve moving tissue from one site to another to repair defects. There are several types of local flaps classified based on how the tissue moves (advancement, pivotal, interpolation) and what tissues are included (skin, muscle, fat). Common examples used to repair facial defects include buccal fat pad flaps, tongue flaps, and various types of advancement and pivotal flaps. Proper planning and design of local flaps is necessary to close wounds and defects with adequate tissue while avoiding dog ears or tension.
This document discusses different methods for classifying flap procedures. It describes classification based on composition, proximity to the defect, method of movement, and vascular anatomy. Specific flap types are also outlined, including fascio/cutaneous flaps classified by pedicle type and musculocutaneous flaps classified by their vascular supply patterns. Common examples of specific flap procedures are provided.
Cleft lip and palate are common birth defects that affect speech, hearing, breathing, and appearance. They require a team-based approach involving multiple specialists like otolaryngologists. The document discusses the management of cleft lip and palate, including the roles of different specialists in examining, diagnosing, and treating issues related to feeding, airway, speech, hearing, and surgery. Surgical techniques aim to restore normal anatomy and function through procedures on the lip and palate.
Pierre Robin sequence involves micrognathia, a cleft palate, and airway obstruction. Cleft lip and palate can be caused by genetic and environmental factors. Feeding difficulties are common in infants with clefts due to issues creating suction and maintaining nipple contact. A multidisciplinary team supports families throughout treatment including surgery, speech therapy, and orthodontics from infancy through adulthood.
Rectal Prolapse - Cedars Sinai Medical Center - Medicine Resident TalkTheSurgeryGroupofLA
Presentation by Yossef Nasseri, M.D.
Yosef Nasseri, M.D., is a founding member of The Surgery Group of Los Angeles, a Los Angeles based physician group providing a comprehensive approach to surgical care through advanced technology, long-term patient follow-up, and direct physician access. Dr. Nasseri is double board-certified in general and colorectal surgery and specializes in cutting-edge robotic and minimally invasive techniques for the treatment of colon and rectal cancers, inflammatory bowel disease, benign anorectal diseases, a variety of hernias, and general surgery.
Laryngeal cancer most commonly presents as squamous cell carcinoma of the larynx. For early stage disease, options include laser surgery or radiation therapy, which have similar effectiveness. For advanced stages, concurrent chemotherapy and radiation allows better larynx preservation compared to induction chemotherapy and radiation or radiation alone, though overall survival is similar. Organ preservation is prioritized when selecting treatment options for advanced laryngeal cancer.
- Renal tumours include renal cell tumours, mesenchymal tumours, and neuroendocrine tumours in both children and adults. Renal cell carcinoma, specifically clear cell RCC, accounts for around 70% of kidney cancers.
- Treatment depends on tumour stage and grade. Organ-confined tumours may be managed with active surveillance, partial or radical nephrectomy. Advanced or metastatic disease may receive chemotherapy, radiotherapy, or targeted drug therapies. Nephrectomy can improve outcomes for metastatic disease.
- Minimally invasive techniques like cryotherapy, radiofrequency ablation, and high-intensity focused ultrasound are alternatives to surgery for select patients. However, long-term outcomes are still best
- Renal tumours include renal cell tumours, mesenchymal tumours, and neuroendocrine tumours in both children and adults. Renal cell carcinoma, specifically clear cell RCC, accounts for around 70% of kidney cancers.
- Treatment depends on tumour stage and grade. Organ-confined tumours may be managed with active surveillance, partial or radical nephrectomy. Advanced or metastatic disease may receive radiation, immunotherapy, targeted drug therapy or palliative care.
- Nephron-sparing surgery aims to preserve renal function when possible for small, low-stage tumours. Complications include bleeding and impaired kidney function.
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdfadhilaamariyil
1) Seminoma is the most common germ cell tumor in young males. The standard treatment for stage I seminoma is either surveillance, radiotherapy, or chemotherapy.
2) For stage IIA/B seminoma, treatment options are radiotherapy or 3-4 cycles of chemotherapy. Radiotherapy provides better outcomes for stage IIA.
3) Advanced or metastatic seminoma (stage IIC/III) is treated with chemotherapy, with 5-year survival rates of 95% for good prognosis patients and 87% for intermediate prognosis.
Ovarian cancer is the 8th most common cancer in women and the 5th leading cause of cancer death. It has a median age of diagnosis of 60 years old and 68% of cases are metastatic at diagnosis. Risk factors include family history, personal history of breast cancer, infertility, and lack of pregnancy. Genetic mutations like BRCA1/2 account for 10-15% of cases. Symptoms are often vague. Treatment involves surgical staging and debulking followed by platinum-based chemotherapy, with the goal of optimal cytoreduction to ≤1cm residual disease.
This document provides information on gastric cancer including:
1. Symptoms, signs, diagnosis and staging using endoscopy, CT scans, laparoscopy and more.
2. Treatment options depending on stage including surgery (D1, D2 lymphadenectomy), chemotherapy, and chemoradiation.
3. Adjuvant therapy recommendations after surgery including S-1 chemotherapy or chemoradiation based on clinical trials.
4. Guidelines for radiation therapy planning and target volumes.
5. Systemic therapy options for advanced or metastatic disease including single agent versus multi-agent chemotherapy.
This document summarizes epidemiology, staging, and management of testicular cancer. It covers the following key points:
- Testicular cancer most commonly affects white males aged 15-35. Risk factors include cryptorchidism and family history.
- Staging involves physical exam, tumor markers, CT scans, and classification based on tumor size and spread. Seminomas are more common in stage I and radiosensitive. Non-seminomas have higher stages and marker levels.
- Treatment depends on stage and risk factors but may include surveillance, radiation, chemotherapy, and surgery. Chemotherapy regimens like BEP are effective while carrying risks like lung toxicity from bleomycin.
This document summarizes the management of testicular tumors. It discusses that testicular cancer is relatively rare but most curable solid neoplasm. It mainly affects young men aged 20-34. Most cases are germ cell tumors, either seminoma or non-seminoma. Stage and tumor markers guide treatment, which may include surveillance, surgery, radiotherapy, and multi-drug chemotherapy. Treatment outcomes have improved significantly with 5-year survival now over 90% due to advances in diagnosis, surgery, radiotherapy, and chemotherapy. Management involves a multidisciplinary approach and lifelong follow-up due to risk of recurrence or second cancers.
This document discusses treatment options for locally advanced breast cancer (LABC). It notes that LABC is a heterogeneous disease and standard primary chemotherapy includes anthracyclines and taxanes. Neoadjuvant chemotherapy is now the standard of care as it allows for breast conservation in some cases and those who achieve a pathological complete response have improved survival rates. The response to neoadjuvant therapy and molecular subtypes (e.g. triple negative, HER2-positive) can help determine the most effective adjuvant treatment strategy. Targeted therapies like trastuzumab improve outcomes for HER2-positive breast cancer when given with chemotherapy in the neoadjuvant setting.
The document summarizes current standards and next steps in treating gastric cancer. It discusses how adjuvant chemotherapy and neoadjuvant/perioperative chemotherapy have been shown to improve survival rates compared to surgery alone, increasing 5-year survival by 5-10% and 18% risk reduction respectively. However, tolerance of adjuvant treatments is often poor with high rates of delays, reductions and early termination. Neoadjuvant chemotherapy is better tolerated and may improve R0 resection rates and survival, as supported by several randomized clinical trials.
The document summarizes current standards and next steps in treating gastric cancer. It discusses trends showing falling incidence of distal gastric cancer but rising incidence of proximal gastric cancer. It reviews primary staging procedures and treatments for gastric cancer including surgery, adjuvant treatments, and treatments for advanced cases. It provides evidence that adjuvant chemotherapy and perioperative chemotherapy can increase overall survival rates compared to surgery alone.
Radiotherapy plays an important role in the management of urinary bladder cancers. It can be used as part of bladder-preserving protocols for muscle-invasive bladder cancer or as palliative treatment in elderly patients. Combined modality treatment with transurethral resection and concurrent chemoradiotherapy provides 5-year overall survival of 50-65% and bladder preservation in 38-43% of patients. External beam radiotherapy is typically delivered with a 4-field box technique to the whole pelvis at 45-50 Gy followed by a bladder boost to 60-65 Gy.
The document discusses carcinoma of the colon and its management. It provides details on epidemiology, risk factors, staging, diagnostic workup, surgery, adjuvant therapy including chemotherapy and radiation therapy. Surgery is the primary treatment but adjuvant therapy with chemotherapy improves survival outcomes, especially in stage III disease. Chemotherapy regimens like FOLFOX and 5-FU plus leucovorin are commonly used in the adjuvant and metastatic settings.
This document discusses esophageal cancer, including:
- Risk factors like tobacco, alcohol, nutritional deficiencies are common in developing countries.
- Diagnosis involves endoscopy, biopsy, imaging like CT, EUS to determine stage. Advanced stages present with dysphagia, weight loss.
- Treatment depends on stage but may include surgery, chemotherapy, radiation. Surgery involves resection and lymph node dissection.
- Palliative treatments like stenting can relieve dysphagia from obstruction.
- Prognostic factors include stage, tumor markers, lymph node involvement. Early detection and treatment improve outcomes.
Positron emission tomography (PET) provides functional imaging of the body with high sensitivity and specificity. Common PET radiotracers include [F-18] FDG for glucose metabolism and tumor imaging. PET is useful for diagnosing cancer, staging and re-staging, detecting treatment response, and localizing unknown primary tumors. It has applications in lung cancer, colorectal cancer, lymphoma, and other cancers. PET imaging improves over other modalities in detecting metastatic disease and is useful for treatment planning and monitoring.
This document provides an overview of epithelial ovarian cancer including epidemiology, risk factors, pathology, clinical presentation, diagnosis, staging, treatment options, and outcomes. It discusses that ovarian cancer is the second most common gynecologic malignancy in Western countries. Seventy percent of patients present with advanced stage disease. Treatment depends on stage but typically involves surgery and platinum-based chemotherapy. Outcomes have improved over time but remain poor for advanced and recurrent disease.
This document provides information on the management of small cell lung cancer (SCLC). It begins with defining SCLC and describing its typical clinical presentation and features. It then discusses the epidemiology and etiology of SCLC, noting that it is caused primarily by tobacco smoking. The document outlines the recommended workup, staging, and prognostic factors for SCLC. It provides details on the evidence-based management of limited-stage and extensive-stage SCLC, including the use of chemotherapy, radiotherapy, surgery, and protocols for concurrent and sequential chemo-radiotherapy treatment.
Selective Use Of Postoperative Radiotherapy AftEr MastectOmyfondas vakalis
The SUPREMO trial aims to determine whether postmastectomy radiotherapy (PMRT) improves outcomes for women with early-stage breast cancer with 1-3 positive lymph nodes. The trial will randomize approximately 3,500 patients to receive either chest wall irradiation or no chest wall irradiation after mastectomy and systemic therapy. The primary outcome is overall survival, with secondary outcomes including disease-free survival, acute/late morbidity, quality of life, and cost-effectiveness. Results from previous trials suggest PMRT may reduce locoregional recurrence and improve survival, especially for those with more positive nodes, but more evidence is still needed.
C:\Documents And Settings\User\Desktop\Head And NeckGamal Abdul Hamid
This document summarizes recent advances in the treatment of head and neck cancer. It discusses the incidence, risk factors, staging, and historical treatment approaches including chemotherapy and chemoradiation. Recent randomized trials show improved outcomes with induction taxane-based chemotherapy followed by chemoradiation compared to chemotherapy and radiation alone. Ongoing trials are further exploring the benefits of induction chemotherapy prior to definitive treatment.
2012_Breast Cancer and Coronary Artery DiseaseJohn Lucas
This document discusses radiation therapy for breast cancer and its potential effects on the heart and coronary arteries. It provides an overview of the pathophysiology of radiation-induced cardiac toxicity, including microangiopathy of small vessels, macroangiopathy of coronary arteries, and fibrosis. It also summarizes several studies that found increased risks of ischemic heart disease, pericarditis, and valvular disease in patients receiving left-sided breast radiation compared to right-sided radiation. Newer radiation techniques using methods like deep inspiration breath hold and intensity-modulated radiation therapy can help reduce radiation doses to the heart.
The document discusses combining chemotherapy and radiation for non-small cell lung cancer (NSCLC). It summarizes several studies that show combined treatment improves median survival compared to radiation alone by 9-12 months versus 12-14 months. Concurrent chemotherapy and radiation is also shown to improve overall survival compared to sequential chemotherapy and radiation based on meta-analyses. However, concurrent treatment increases acute esophagitis toxicity. Induction chemotherapy before concurrent chemoradiation may improve outcomes compared to historical controls, but studies are limited. Omitting elective nodal irradiation may allow dose escalation while minimizing toxicity without increasing failures in untreated regions.
The document discusses the treatment of medulloblastoma, a type of brain tumor. It provides details on the role of radiotherapy in treatment, including:
1) Radiotherapy has historically been the most effective treatment when combined with surgery, improving survival rates from 1 in 61 to 25% at 10 years with craniospinal irradiation.
2) Several studies evaluated reducing craniospinal irradiation doses and adding chemotherapy, finding equivalent survival but reduced side effects.
3) Current standard treatment involves 23.4Gy craniospinal irradiation with chemotherapy, followed by a posterior fossa boost to 55.8Gy.
Radiosensitivity and the Cell Cycle - Chapter 4 jtlJohn Lucas
1. Cells are most radiosensitive during mitosis (M) and G2 phases and most resistant during late S phase of the cell cycle.
2. Following radiation exposure, cells lacking functional p53 are most likely to arrest in G2 phase through the G2 cell cycle checkpoint.
3. Techniques such as tritiated thymidine labeling and flow cytometry can be used to analyze the cell cycle and determine the fraction of cells in each phase.
Chapter 5 -repair or radiation damage and dose-rate effect - jtlJohn Lucas
The document summarizes various pathways for repairing DNA damage from radiation: base excision repair removes inappropriate bases; nucleotide excision repair removes bulky adducts like pyrimidine dimers. Mismatch repair fixes base-base mismatches. Non-homologous end joining and homologous recombination repair double-strand breaks, with the former being error-prone and active in G1, and the latter being error-free using a sister chromatid template and most active in G2 phase. Certain syndromes like ataxia-telangiectasia and LIG4 syndrome result from defects in these pathways and cause radiation sensitivity.
This document discusses treatment options for early stage lung cancer, including surgery, stereotactic body radiotherapy (SBRT), and other ablative modalities. It provides details on the types of surgical resection, factors affecting operability, and morbidity and quality of life outcomes following surgery. It also describes the historical use of radiotherapy, development of SBRT, studies investigating SBRT dose and fractionation schedules, and outcomes from SBRT clinical trials including local control and toxicity rates.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Have at least 1 X & Y chromosome, implying that transformation occurs in a germ cell prior to meiotic anaphase. A: i(12p) B: normal chromosome and i(12p) Testicular GCTs are the neoplastic counterpart of primordial germ cells/gonocytes. Primordial germ cells (PGCs) are derived from the epiblast and migrate to the genital ridge as early as the 6th week of the embryonic development. PGCs are positive for OCT-4, which is thought to regulate pluripotency. Once in the genital ridge, PGCs are called gonocytes and will differentiate into oocytes (ovary) or prespermatogonia (testis). This migration is accompanied by proliferation and is controlled by the KIT stem-cell signaling pathway. During normal maturation of germ cells, OCT-4, PLAP, and c-KIT immunoexpression disappear. Nevertheless, the corresponding genes are later reprogrammed during oncogenesis, and these proteins are detected in germ cell neoplasms, including seminomas.[8] KIT gene mutations are implicated in extragonadal survival of PGCs. In view of its presence in bilateral tumors, the mutation must take place in PGCs before their arrival in the gonadal ridges.[28] The initial event in the origin of seminoma is the malignant transformation of an intratubular germ cell. This process is analogous to intraepithelial or carcinoma in situ in other organs, but as gonocytes are not epithelial cells, the accurate terminology is intratubular germ cell neoplasia, unclassified (ITGCNU). Seminomas show relative overrepresentation of 12p chromosome sequences, but no consistent gain of 12p is detected in ITGCNU. These data indicate that overrepresentation of 12p is required for progression from preinvasive to invasive behavior. Candidate genes on 12p includeKRAS,CCND2, and NANOG.[29] All GCTs are aneuploid most likely because of early establishment of polyploidy. Polyploidy causes genomic instability with consequent genetic heterogeneity.
Hydroceles/Spermatoceles/Varicocele/Persistent processus vaginalis : transilluminate Hernia – loop of bowel – would be peristaltic Hematoma would be transilluminating and would be associated w/recent trauma Torsion would be painful US shows marginated hypoechoic vascularized mass
SHOULD BE COLLECTED BEFORE AND AFTER ORCHIECTOMY Half life of AFP? 5-7 days Half life of HCG? 18-36 hours Half life of PLAP? 24 hours How often is LDH found in seminoma? 80% of advanced seminoma bHCG can be mildly elevated but usually indicative of NSGCT.
AFP NEVER present with pure seminoma Alpha feto protein (AFP)- Never produced by Seminoma. T1/2 = 5-7 days. in 50% of metastatic non-S GCT. Nonspecific production (Hepatocellular CA, infection, drug or alcohol induced, pancreas, stomach, lung, embryonal, teratocarcinoma, & yolk sac CA). bHCG: 'd in 10% of Seminomas overall and 50% of Choriocarcinomas. T1/2 =18-24hrs. ’ d with advanced tumors in 50% of non-S GCT & 15-20% seminomas. (antibody directed at B subunit: cross reacts with LH can lead to false positive) LDH: prognostic in advanced disease. Frequently elevated. Non-specific.
Images: Mediastinal and hilar, Retroperitoneal LN Abd CT- most effective to identify RP LAD, but it has limitations in thin pts. Approx. 25% of pts with (-) CT scan will still have (+) LNs. 70% of 1-2cm RP LNs contain mets. Lymphangiogram detects abnormal paraaortic LN in 15-20% of Seminoma pts with (-) CT's. Generally only get if suspect retrograde flow or if considering observation . CT vs LAG – Marks - Urol Sept 91:264-266 54 pts In all cases where CT was positive (LN>1.0cm) Lag was also positive. 22% of pts had positive LAG's in face of negative CT scans and all were due to abnormal intranodal Architecture. A paper by Dosmann argues that although upstaging may be present, there is no diff in OS in Pts staged by CT alone. Upstaging by LAG is therefore approx.=15-20% and is usefull for delineating treatment portals and enables boosts to be delivered to nodal abnormalities not seen on CT scan. MRI or CT of brain indicated based on clinical presentation. Are seminomas FDG avid? Yes Optimal use of PET for seminomas? Pts w/ residual mass after tx
Should sperm banking be advised? YES How long not to attempt conception after RT? 6 months
Scrotal violation changes drainage. Moves LN to inguinal canal. What is done during radical inguinal orchiectomy? Testis removed,spermatic cord dissected hi into abd w/ ligation of the spermatic cord at the internal ring is required for all suspected testicular tumors Most common postoperative complication? Wound hemorrhage When is retroperitoneal dissection indicated ? Controversial Who likely does not need retroperitoneal dissection? Stage I Is retroperitoneal nodal dissection considered therapeutic? Yes, even in situation of +nodes Likelihood of in-field recurrence after nodal dissection? <1% Major morbidity of retroperitoneal dissection? Ejaculatory disfunction ( damage to sympathetics)
Scrotal violation changes drainage. Moves LN to inguinal canal. How does scrotal violation affect local recurrence rate? 2.9% (scrotal violation) vs 0.4% (control)
Seminoma: (is 1/2 of all testicular GCTs; must be pure without AFP elevation) Classic (Typical): 85% of all seminomas & occurs most commonly in the fourth decade. Synctiotrophoblastic elements are noted in 10-15%, thus the frequency of bHCG production Spermatocytic: Extremely favorable prognosis. Rarely metastasizes. Occurs in men > 50. Rx with radical orchiectomy alone. Not assoc with Cis. True relation to seminoma unknown. Anaplasic: 10%. Has a mitotic rate. Noteworthy because up to 35% of pts who die have this subtype. “ Aggressive&quot;, usually presents at a later stage, but stage for stage do the same as other histologies. Pure Seminoma histology does not change treatment except in Spermatocytic where RT is not offered Immmunoperoxidase stain positive for Placental alkaline phosphatase NonSeminoma: (usually tumor has multiple cell types – treated as Non-Seminomatous b/c more aggressive) Embryonal: Highly aggressive tumors. Assoc with ’d AFP &/or B-HCG. Most undifferentiated. Endodermal Sinus tumor (Yolk Sac): Generally produces AFP. Pure ones frequently found in mediastinum. Teratoma: >1 germ cell layer (ecto-, meso-, endoderm). Mature, immature, and teratoma with malignant transformation. Choriocarcinoma: Ususally widely metastatic. Can present with B-HCG. Consists of Cytotrophoblasts and Syncytiotrophoblasts. Other testicular neoplasms include Sex-cord-stromal tumors (Sertoli or Leydig cell tumors), gonadoblastoma (mixed GCT & stomal tumors), lymphomas, etc.
Seminomas originate from the germinal epithelium of seminiferous tubules The initial event in the origin of seminoma is the malignant transformation of an intratubular germ cell. This process is analogous to intraepithelial or carcinoma in situ in other organs, but as gonocytes are not epithelial cells, the accurate terminology is intratubular germ cell neoplasia, unclassified (ITGCNU).
IHC to diffx spermatocytic vs classic? Classic + for PLAP, spermatocytic neg for PLAP Placental Alk Phos + Seminoma Low molecular weight Keratins- Produced by non-S GCT. Seminomas don’t produce Radiation sensitivity Type A spermatogonia: presumed stem cells of spermatogenesis, considered relatively radioresistant. Possibly due to long cell cycle Type B spermatogonia: relatively radiosensitive
Seminiferous tubules? Finely coiled tubes w/i testis where meiosis occurs Seminiferous tubules lined with? Stem cells Other cell type within seminiferous tubules? Sertoli cells Sertoli cells? Support development of spermatogonia Tunica albuginea? Fibrous capsule that encases testis Tunica vaginalis? membrane covers albuginea derived from peritoneum Layers of testis beyond tunica vaginalis? int spermatic/cremasteric/ext spermatic fascia What is beyond external spermatic fascia? Dartos muscle and skin Rete testis? Network of seminal channels thru hilum of testis Where do efferent ducts from rete testis go?Epididymis Epididymis? Connect efferent ducts from testis to vas deferens Function of epididymis? Reservoir for sperm Physiologic ejaculation requires what steps? Bladder neck closure,seminal emission,ejaculation Which symp fibers mediate seminal emission? T12-L3 Which symp fibers mediate ejaculation? Sacral and lumbar
4-8 lymphatic trunks drain hilum of the testis, and run along spermatic cord up to the internal inguinal ring Drain into retroperitoneal LNs between T11-L4, with majority between L1-L3 Then upward via thoracic duct through mediastinum and to supraclavicular fossae, and occasionally to axillary LNs
Serum Markers for Seminoma WNL >70% 15-30% mild elevations of hCG
Lymphatics- primary drainage is to the retroperitoneal lymph nodes below renal vessels; Ep ididymis drains to ipsilateral pelvic nodes Left testicular tumors drain to nodes lateral to the aorta (para-aortic) to renal vein & then PA. Right testicular tumors usually metastasize to nodes between the aorta and the inferior vena cava (interaortocaval nodes),. BOTH: cysterna chyli retrocural or post. mediastinal LA L. SCV L SCV LA or pulmonary nodules may be present in the absence of RP LA. Lymphatic cross-over is at L4-5. Blood Vessels- follow similar course. Non-pulm mets (liver, bone, brain) very rare at presentation . Which laterality is associated w/ contralat spread? R-sided tumors Why are R-sided tumors assoc w/ contralat spread? Nodal drainage crosses over from R L,but not L R Do seminomas drain to inguinal nodes? Not unless surg disrupts lymph drainage collaterals
AUC= 7 x (GFR + 25) mg
German Testicular Study, 2003 (1998-2001) PMID 12644817 - &quot;Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group.&quot; (Classen J, Br J Cancer. 2003 Mar 24;88(6):828-31.) Prospective. Step-wise dose reduction starting at 18/9 Gy in 2 Gy steps. Results verified by biopsies Dose level 14 Gy aborted after a similar Danish trial (below) experienced a failure at 14 Gy. Cohort 16 Gy was expanded for more statistical power Interim resuls show that 16 Gy is not sufficient to control TIN (there were also viable spermatogonia present). Recommend considering different fractionation schedules. Endocrinology data not yet mature Copenhagen, 2002 (Denmark) PMID 11896102 -- &quot;Effect of graded testicular doses of radiotherapy in patients treated for carcinoma-in-situ in the testis.&quot; (Petersen PM, J Clin Oncol. 2002 Mar 15;20(6):1537-43.) Prospective. Dose reduction starting at 20/10 in 2 Gy steps. Results verified by biopsies Remission in all patients at 20, 18, and 16 Gy. One relapse at 14 Gy after 20 months Toxicity: Leydig cell function - testosterone decrease for >5 years after RT. Need for androgen substitution similar at all RT dose levels Conclusion: 20/10 safe, 14/7 might result in relapse. Hormone production impaired even at 14 Gy
Patients who are good candidates for observation? Horseshoe kidney,IBD,prior RT,committed to f/u Stage I pts that may be appropriate for active surveillance? <3cm pure seminoma,neg postop markers/scans Warde – JCO 2002 – pooled analysis of 638 patients to identify prognostic factors for relapse in stage I seminoma managed by surveillance. 7yr FU - Patient data from four cohorts - Single and multivariate Analyses - Royal Marsden Hospital (110 pts.), Danish Testicular Cancer Study Group (258 pts.), Princess Margaret Hospital (226 pts.), Royal London Hospital (44 pts.) recommended schedule of radiographic and clinical surveillance is as follows: Every four months for three to four years Every 6 months for years four to seven Every 12 months for years eight to ten 2nd Spanish Germ Cell CCG (1999-2003) PMID 16260698 -- &quot;Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study.&quot; (Aparicio J, J Clin Oncol. 2005 Dec 1;23(34):8717-23.) Prospective. 314 patients. 100 with no risk factors treated with surveillance. 214 patients with risk factors (tumor >4 cm, rete testis involvement) had carboplatin x2. Median F/U 34 months 5-year DFS: surveillance 94%, chemo 96%. Relapses: surveillance 6%, chemo 3% (1% if tumor >4cm, 9% if rete testis, 6% if both). All but one in retroperitoneum. Median time to relapse 9 months (4-28 months) Conclusion: risk-adapted strategy safe and feasible 3rd Spanish Germ Cell CCG (2004-8) PMID 22042940 -- &quot;Risk-Adapted Treatment in Clinical Stage I Testicular Seminoma: The Third Spanish Germ Cell Cancer Group Study.&quot; (Aparicio J, J Clin Oncol. 2011 Oct 31. [Epub ahead of print]) Prospective. 227 pts. 84 pts (37%) with no risk factors treated with surveillance. 44 pts (19%) had tumor > 4 cm, 25 (11%) with rete testis, 74 (33%) had both. Only the latter group (both risk factors) received treatment w/ carboplatin x 2. All others received surveillance only. Median f/u 34 mo. 16 relapses (7%) for pts on surveillance; 1 relapse (1.4%) for pts on surveillance. 3 yr DFS 88% (surveillance group), 98% (adjuvant carboplatin group). OS 100%. All relapses in retroperitoneal LNs except 1 pt w/ pelvic nodes. Median time to recurrence 14 mos; median node size 2.5 cm. All pts w/ relapse were made NED with chemotherapy. Conclusion: risk-adapted strategy is effective for stage I seminoma. For 2 risk factors: carboplatin. For 0-1 risk factors: observation. *****Close f/u required - Must have a reliable Patient. Which is more cost efficient, surveillance vs upfront RT? Upfront RT
Urology. 2002 Aug;60(2):324-8. Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study. OBJECTIVES: To evaluate the long-term oncologic efficacy and morbidity of carboplatin monotherapy , which was introduced at our department 11 years ago for the treatment of Stage I seminoma. Radiotherapy is the standard treatment of patients with clinical Stage I seminoma. Carboplatin has been advocated as a treatment alternative to avoid the late side effects of radiotherapy and the high recurrence rate of surveillance strategies. METHODS: From February 1990 until August 2001, 108 patients received two adjuvant cycles of single-agent carboplatin (400 mg/m2 body surface on days 1 and 22) 2 weeks after high inguinal orchiectomy . To assess for myelosuppression, complete blood counts were performed at least once a week until the nadir occurred after the second treatment cycle. RESULTS: During a mean follow-up period of 59.8 months (range 6 to 134), 2 patients (1.85%) developed a recurrence (retroperitoneal tumor) within the first year . Both patients received cisplatin-based salvage chemotherapy . At last follow-up, all patients were alive without any evidence of disease. Carboplatin treatment was well tolerated by all patients and was associated with only mild gastrointestinal side effects. Leukopenia was noted in 32 patients (29.6%); 21 (19.4%) of these patients had World Health Organization (WHO) grade 1, 8 (7.4%) had grade 2, 3 (2.8%) had grade 3, and none had grade 4. No patient developed neutropenic fever. Thrombocytopenia was observed in 48 patients (44.4%); of these patients, 38 (35.2%) had WHO grade 1 , 5 (4.6%) had grade 2, 2 (1.9%) had grade 3, and 3 (2.8%) had grade 4. CONCLUSIONS: From an oncologic standpoint, two cycles of carboplatin monotherapy was highly effective and very well tolerated by all patients.
MRC Trial TE 18 (1995-98) 2005 PMID 15718317 -- &quot;Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328)&quot;. (Jones WG et al.J Clin Oncol. 2005 Feb 20;23(6):1200-8.) Randomized. 625 pts. Paraaortic radiation (dogleg for patients with prior inguinal surgery). 20Gy/10 vs 30Gy/15 after orchiectomy Relapse: 30 Gy 10 relapses vs. 20 Gy 11 relapses (NS), 2-year relapse rate of 3-4%. 1 death (allocated to 20 Gy) Toxicity: At 4 weeks, 20 Gy significantly better ( moderate/severe lethargy 5% vs. 20%); at 12 weeks no difference Side effects of RT: Acute: fatigue nausea, vomiting, increased stool frequency, and rapid gastric emptying, have been described, especially in men with right-sided seminoma Myelosuppression treated skin Late: None in majority, impaired fertility, second malignancies, and possibly cardiac disease Conclusion: 20 Gy/10 sufficient, with faster return to work Severity of azospermia after 15-20 cGy? Minimal effect Severity of azospermia after 20-50 cGy? 30-50% azospermia, returns to baseline in 6-8 mo’s Severity of azospermia after 50-100 cGy? 50-80% azospermia, returns to baseline in 8-14 mo’s Severity of azospermia after 100-200 cGy? >90% azospermia, returns to baseline in 1-2 yrs Severity of azospermia after >200 cGy? Permanent azospermia
MRC Trial TE 10 (1989-1993) 1999 PMID 10561173 -- &quot;Optimal planning target volume for stage I testicular seminoma: A MRC randomized trial. Medical Research Council Testicular Tumor Working Group.&quot; (Fossa SD, JCO. 1999 Apr;17(4):1146.) Randomized. 478 men with Stage I to PA or Dog-Leg. RT 30 Gy. Median F/U 4.5 years Fields: PA (sup T10/T11 ( origin of thoracic duct ), inf L5/S1 ( top of obturator foramen/internal inguinal ring ), lat inclusion of ipsilateral renal hilum usually 10-12cm width); Dog-Leg (sup T10/T11; inf mid-obturator foramen; ipsilateral inclusion of renal hilum vertically down to L5/S1, then diagonal to lateral edge of acetabulum, then vertically down to mid-obturator foramen; contralateral transverse process vertically to L5/S1, then diagonal parallel with ipsilateral and vertically down to mid-obturator foramen) - Give 2cm Margin to (+)LNs. Outcomes: No difference in 3yr overall survival between DL 97% and PA 99% 3yr pelvic RFS was 100% with DL and 98% with PA 2% Pelvic relapse risk in PA only arm PA had : less nausea and vomiting Lower azospermia (11% vs 35%) More rapid recovery of sperm count Relapse: 9 in each group (NS), but pelvic recurrences 0 DL vs. 4 PA Toxicity: Acute toxicity less frequent & less pronounced in PA arm; sperm counts significantly higher in PA arm (median time to recovery 13 months vs. 20 months if normal, 24 vs. 37 months if abnormal pre-RT) Conclusion was that you can omit DL field if patient followed regularly due to high salvage rates. MD Anderson recommend using DL for Stage I if epididymal invasion or prior inguinal scrotal surgery Where are relapses seminoma treated w/ RT? Virtually all outside of tx port
How to protect the testes? Scrotal shield (clam shell) Scrotal shield can decrease dose to opposite testicle to? 1-2% prescribed dose How to minimize dose to contralat testis if scrotal violation? Contralat testis retracted towards inguinal canal When is tx of ipsi hemi-scrotum definitely indicated? Massive tumor invading scrotum
(Oliver et al) MRC TE19 1447 Stage I seminoma patients randomized: 904 patients received XRT Para-aortic (87%) or dogleg (13%) field XRT 20Gy/10fx or 30Gy/15fx 573 patients received 1 cycle of carboplatin: 4 year follow up Relapse free rate at 3years 95.9% rad vs. 94.8% carbo Relapse sites RT: 9% PA, 28% Pelvic Carboplatin: 74% PA, 0% Pelvic Physician recorded toxicity during treatment Patient recorded diary of symptoms for 12 weeks Carboplatin pts took less time off from work (-) in 2 nd testicular Ca thought to be due to tx of contralateral Tis 2008 Update Fewer rate of new GCTs with Chemo (2pt on chemo vs. 15pt on RT) Late toxicity of chemotherapy not yet known
(Oliver et al) MRC TE19 1447 Stage I seminoma patients randomized: 904 patients received XRT Para-aortic (87%) or dogleg (13%) field XRT 20Gy/10fx or 30Gy/15fx 573 patients received 1 cycle of carboplatin: 4 year follow up Relapse free rate at 3years 95.9% rad vs. 94.8% carbo Relapse sites RT: 9% PA, 28% Pelvic Carboplatin: 74% PA, 0% Pelvic Physician recorded toxicity during treatment Patient recorded diary of symptoms for 12 weeks Carboplatin pts took less time off from work (-) in 2 nd testicular Ca thought to be due to tx of contralateral Tis 2008 Update Fewer rate of new GCTs with Chemo (2pt on chemo vs. 15pt on RT) Late toxicity of chemotherapy not yet known
Study that got rid of mediastinal RT for stage I seminoma? Princess Margaret Study (Red Journal 1982) Relapse rate in mediastinum for Princess Margaret? <1%
Radiotherapy for stages IIA/B testicular seminoma: final report of a Phase 2: prospective multicenter clinical trial 94pts. 66 Stage IIA, 21 Stage IIB Reduced Portals RT to PA and ipsilateral iliac LN (Low PA) Dose stage IIA 30Gy and Stage IIB 36Gy F/U 5.8yrs Conclusion: RT for Stage IIA-B seminoma, with reduced portals, yields excellent tumor control and no late toxicity
Bleomycin, etoposide, cisplatin Phase 2 : Prospective, non-randomized. 72 pts (18-Stage IIA, 54-Stage IIB). Treatment with 4 cycles of cisplatin + etoposide or 3 cycles of BEP (bleomycin, etoposide, cisplatin). 83% achieved CR 17% PR 5yr PFS 100% and 87% for Stage IIa and IIB respectively 5yr OS 95% Conclusion: Chemotherapy is highly effective and well-tolerated treatment for Stage IIA and IIB - - Alternative that could avoid some of serious late effects associated with RT
Do orchiectomy in cases of advanced disease? Yes, b/c likelihood of residual disease in testis When to do orchiectomy in case of advanced disease? Generally pre-chemotherapy (b/c testis privileged) Tx mediastinal seminoma w/45-50 Gy to mediastinum Most common sitea of relapse after RT for stage II- Supraclav fossa and mediastinum Supraclav/mediastinal relapse after RT -<10% Site of relapse if single agent carboplatin for stage II- Retroperitoneum Primary RT be used for IIC dz when doesn’t overlap most of 1kidney/too much liver Is primary RT first line option for IIC dz? No, combination chemo is first line Relapse rate for primary RT if nodal dz >10 cm? >40% Role for adjuvant RT for dz tx’d w/ primary chemo- Consolidative tx for residual dz Rate of residual dz after primary chemo for stage II/III - 80% at 1 month Most residual dz after 1 month- Most tends to regress over subsequent months What pts w/ residual mass is observation sufficient <3cm Tx for pts w/ residual mass >3cm = consolidative surg or RT Likelihood of residual dz if >3cm residual mass? 30-50% Characteristics of residual mass that likelihood of dz there? Well defined on CT Which masses should not be resected-Ill defined mass (even if >3cm b/c risk of injury) Role of PET in evaluating residual masses- High specificity , good sensitivity in German series BOMP/EPI intensive alternating chemotherapy for IGCCC poor-prognosis germ-cell tumors: the Spanish Germ-Cell Cancer Group experience (GG) BACKGROUND: Patients with poor-prognosis germ-cell tumors according to the IGCCC have a poor long-term survival. This study evaluates the efficacy and toxicity of the intensive alternating chemotherapy regimen BOMP/EPI in these patients. PATIENTS AND METHODS: Patients with IGCCC poor-prognosis germ-cell tumors treated at 13 centres were studied. Treatment consisted of bleomycin 30 mg, vincristine 2 mg, methotrexate 300 mg/m2 and cisplatin 100 mg/m2 (BOMP), alternating after a 14-day interval with etoposide 120 mg/m2 day 1-4, ifosfamide 1.3 g/m2 day 1-4 and cisplatin 25 mg/m2 day 1-4 (EPI). BOMP was administered 21 days after the EPI. Bleomycin was administered weekly per 12 weeks. RESULTS: Thirty-eight patients were treated. The median number of cycles administered was 7 (1-10 cycles). Eighteen patients achieved complete responses with chemotherapy alone (12 had necrosis and 2 mature teratoma at postchemotherapy resection), and four achieved complete responses with chemotherapy and surgical resection of viable cancer. Thus, an overall favorable response was achieved in 22 patients (60%). Four additional patients had marker-negative non-resected residual masses. Eleven patients were considered treatment failures, including one who died early and another who succumbed to granulocytopenic sepsis and renal failure. Hematologic toxicity was the most common, with 26 patients (70%) having grade 4 granulocytopenia. After a median follow-up of 41 months, the actuarial two-year overall survival and progression-free survival were 64% and 58%, respectively. CONCLUSION: BOMP/EPI is active in poor-prognosis germ-cell tumors according to the IGCCC criteria. The results obtained compare favorably with those expected with conventional chemotherapy, and justify further studies.
XRT- pericardits, mycardial fibrosis, conduction defects, valv decfts, well documented from hodgkins and breast cacncer.
Zagars G, et al (2004) JCO 22(4) 641-8. N=453 stage I and II seminoma MD Anderson 1949-1999 Mean F/U was 13.3 years Observed vs. expected mortality for those receiving XRT. Multiple field designs All patient (453) received Dog Leg 31 (6.8 %) received whole abdominal XRT 71 (15.7 %) received prophylactic mediastinal XRT (PMI) 127 (28 %)received > 25 Gy Fig 1. 453 patients survival rates. Age and race adjusted surgival curves are shown. No difference in standard mortality ratio in the first 15 years. PMI was only factor that was found to have significant impact on mortality. 1st- the decrease in survival vs. expected 2nd- impact of PMI which was routinely done before 1971 regardless of stage. Finally, table of increased cardiac deaths Standardized Mortality Ratio (SMR) for first 15yrs 1.30 Beyond 15yrs SMR increased to 1.85 Cardiac SMR elevated only after 15yrs Cancer specific SMR only elevated after 15yrs 11 men died from seminoma relapse, 38 men died from excess nonseminoma mortality Increased cardiac and cancer mortality was significant after 15 yrs (P< .01) Elevated mortality seen regardless of PMI after 15 years recommendations: Surveillance for Stage I If XRT dose reduction from 25Gy/15fx to 20Gy/10Fx Field borders: Top of T10 questionable. T12 to bottom of L5 ?2 cycles of Carboplatin Men sucessfully treated with orchietomy and XRT have increased mortality as a result of causes other than their orignial tumor. XRT- pericardits, mycardial fibrosis, conduction defects, valv decfts, well documented from hodgkins and breast cacncer. Fig 2. Actuarial survival curves – only differed w/respect to whether or not PMI was delivered.
Types of 2ndry Malignancy: ALL, AML, melanoma, NHL, GI, sarcoma, renal, bladder Travis et al. 2005 40,576 testicular cancer survivors in 14 population registries in Europe and North America If dx by 35 years of age, cumulative risk of solid cancer 40yrs later 36% Seminoma 31% Nonseminoma 23% General Population Significant increase of cancers of the pleura and esophagus. Also GI, renal, stomach, bladder, and pancreas Increased relative risk of solid cancers for RT (RR=2.0), chemo alone (RR=1.8) and both (RR=2.9)
Types of 2ndry Malignancy: ALL, AML, melanoma, NHL, GI, sarcoma, renal, bladder Travis et al. 2005 40,576 testicular cancer survivors in 14 population registries in Europe and North America If dx by 35 years of age, cumulative risk of solid cancer 40yrs later 36% Seminoma 31% Nonseminoma 23% General Population Significant increase of cancers of the pleura and esophagus. Also GI, renal, stomach, bladder, and pancreas Increased relative risk of solid cancers for RT (RR=2.0), chemo alone (RR=1.8) and both (RR=2.9)
Still not perfectly clear if or how to treat seminoma Risk of Heart Attack if treated surgery alone vs. if given chemo
Still not perfectly clear if or how to treat seminoma Risk of Heart Attack if treated surgery alone vs. if given chemo