This document provides updates made in Version 1.2023 of the National Comprehensive Cancer Network (NCCN) Guidelines for Testicular Cancer. Key updates include:
- Adding consideration of abdomen/pelvis CT with contrast to the primary treatment workup.
- Modifying footnotes regarding mildly elevated tumor marker levels and sperm banking recommendations.
- Adding links to the AJCC TNM Staging Classification and modifying footnotes on tumor marker levels and staging.
- Adding new headers for sections addressing recurrence across various clinical stages and treatment pathways.
- Adding a footnote on treatment options for recurrence in patients previously on surveillance.
This document discusses the management of early breast cancer. It covers breast management including breast-conserving surgery and mastectomy. It discusses axillary management including axillary lymph node dissection and sentinel lymph node biopsy. It also discusses the roles of pre-operative systemic therapy, adjuvant therapy including anti-HER2 therapy, chemotherapy, and hormonal therapy based on breast cancer subtypes. The document provides guidelines on treatment options based on breast cancer stage and molecular profiles.
This document summarizes recent advances in treating triple negative breast cancer (TNBC). TNBC accounts for 15-20% of breast cancers and has a poorer prognosis than other subtypes. New classifications identify basal-like and other subtypes. Standard chemotherapy remains the first-line treatment for early and advanced TNBC, but adding platinum agents or nab-paclitaxel to neoadjuvant chemotherapy improves outcomes. PARP inhibitors such as olaparib and talazoparib improve progression-free survival in BRCA-mutated metastatic TNBC. Immunotherapy with atezolizumab, pembrolizumab or combinations improves progression-free and overall survival in PD-L1 positive advanced
This document discusses treatment approaches for metastatic triple negative breast cancer. It notes that chemotherapy is currently the standard treatment but that the disease is heterogeneous. Several new targeted treatment approaches are discussed that are being explored in clinical trials, including PARP inhibitors targeting DNA repair, platinum agents, anti-androgens targeting the androgen receptor, immune checkpoint inhibitors, and antibody-drug conjugates. Ongoing research aims to improve outcomes by identifying biomarkers to match patients to effective targeted therapies.
Management of lower Gastrointestinal malignanciesAnimesh Agrawal
This document discusses the management of lower gastrointestinal malignancies involving the colon, rectum, and anal canal. It provides details on:
1. Staging criteria for colon cancer according to the TNM system and AJCC guidelines.
2. Treatment options including surgery, chemotherapy, and radiotherapy depending on the cancer stage, location, and patient factors. The primary treatment is surgery to completely remove the tumor.
3. Adjuvant chemotherapy regimens including FOLFOX, CapeOx, and 5-FU based therapies are recommended for stage III disease and sometimes for high-risk stage II based on trial evidence showing improved survival outcomes.
4. The FOLFOX regimen of
Update on Management of Triple Negative Breast Cancerspa718
This document provides an update on the management of triple negative breast cancer from Dr. Banu Arun at MD Anderson Cancer Center. It discusses that triple negative breast cancer is a heterogeneous disease comprised of several molecular subtypes with different characteristics and potential treatment targets. Clinical trials exploring chemotherapy regimens, platinum agents, PARP inhibitors, anti-angiogenic drugs, and immunotherapies are summarized. Ongoing research aims to better define the subtypes in order to personalize treatment for triple negative breast cancer patients.
The document summarizes several clinical trials related to prostate cancer treatment. It provides details on trials such as PIVOT, ProtecT, TAX327 which compared radical prostatectomy vs observation, active monitoring vs surgery or radiation, and docetaxel vs mitoxantrone for advanced prostate cancer. It also summarizes larger ongoing trials like STAMPEDE and LATITUDE that are evaluating multiple treatment strategies for high risk or metastatic prostate cancer.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
This document discusses the management of early breast cancer. It covers breast management including breast-conserving surgery and mastectomy. It discusses axillary management including axillary lymph node dissection and sentinel lymph node biopsy. It also discusses the roles of pre-operative systemic therapy, adjuvant therapy including anti-HER2 therapy, chemotherapy, and hormonal therapy based on breast cancer subtypes. The document provides guidelines on treatment options based on breast cancer stage and molecular profiles.
This document summarizes recent advances in treating triple negative breast cancer (TNBC). TNBC accounts for 15-20% of breast cancers and has a poorer prognosis than other subtypes. New classifications identify basal-like and other subtypes. Standard chemotherapy remains the first-line treatment for early and advanced TNBC, but adding platinum agents or nab-paclitaxel to neoadjuvant chemotherapy improves outcomes. PARP inhibitors such as olaparib and talazoparib improve progression-free survival in BRCA-mutated metastatic TNBC. Immunotherapy with atezolizumab, pembrolizumab or combinations improves progression-free and overall survival in PD-L1 positive advanced
This document discusses treatment approaches for metastatic triple negative breast cancer. It notes that chemotherapy is currently the standard treatment but that the disease is heterogeneous. Several new targeted treatment approaches are discussed that are being explored in clinical trials, including PARP inhibitors targeting DNA repair, platinum agents, anti-androgens targeting the androgen receptor, immune checkpoint inhibitors, and antibody-drug conjugates. Ongoing research aims to improve outcomes by identifying biomarkers to match patients to effective targeted therapies.
Management of lower Gastrointestinal malignanciesAnimesh Agrawal
This document discusses the management of lower gastrointestinal malignancies involving the colon, rectum, and anal canal. It provides details on:
1. Staging criteria for colon cancer according to the TNM system and AJCC guidelines.
2. Treatment options including surgery, chemotherapy, and radiotherapy depending on the cancer stage, location, and patient factors. The primary treatment is surgery to completely remove the tumor.
3. Adjuvant chemotherapy regimens including FOLFOX, CapeOx, and 5-FU based therapies are recommended for stage III disease and sometimes for high-risk stage II based on trial evidence showing improved survival outcomes.
4. The FOLFOX regimen of
Update on Management of Triple Negative Breast Cancerspa718
This document provides an update on the management of triple negative breast cancer from Dr. Banu Arun at MD Anderson Cancer Center. It discusses that triple negative breast cancer is a heterogeneous disease comprised of several molecular subtypes with different characteristics and potential treatment targets. Clinical trials exploring chemotherapy regimens, platinum agents, PARP inhibitors, anti-angiogenic drugs, and immunotherapies are summarized. Ongoing research aims to better define the subtypes in order to personalize treatment for triple negative breast cancer patients.
The document summarizes several clinical trials related to prostate cancer treatment. It provides details on trials such as PIVOT, ProtecT, TAX327 which compared radical prostatectomy vs observation, active monitoring vs surgery or radiation, and docetaxel vs mitoxantrone for advanced prostate cancer. It also summarizes larger ongoing trials like STAMPEDE and LATITUDE that are evaluating multiple treatment strategies for high risk or metastatic prostate cancer.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
The document summarizes revisions to the FIGO staging system for endometrial cancer in 2023. Key changes include distinguishing aggressive from non-aggressive histological subtypes and assessing lymphovascular space invasion. The revised system incorporates prognostic molecular markers like POLE mutations and p53 abnormalities. Stage I is now restricted to non-invasive tumors. Stage IA3 includes some ovarian involvement by low-grade endometrial cancer. The revisions aim to better stratify patients by risk to guide treatment decisions.
This document discusses the potential "double trouble" of receiving radiation therapy after prostate cancer surgery due to increased toxicity. It notes that most post-operative prostate patients receive radiation and questions why surgery would be chosen over a shorter course of hypofractionated radiation therapy, which has equal results. While surgery is an option, careful patient selection is important to avoid double toxicity from combined treatments. A hypofractionated radiation regimen is recommended to minimize side effects and avoid inviting double trouble that may be difficult to troubleshoot.
This document discusses the management of locally advanced prostate cancer. It defines locally advanced prostate cancer as regional or lymph node involvement without distant metastasis. For imaging, endorectal MRI is useful for staging but has limitations. Treatment options discussed include radical prostatectomy with pelvic lymph node dissection, radiation therapy with long-term androgen deprivation therapy, and newer developments like focal ablation and intermittent androgen deprivation. Guidelines recommend multimodal therapy like surgery followed by radiation for locally advanced prostate cancer.
This document discusses treatment approaches for locally advanced breast cancer (LABC). It describes inflammatory breast cancer (IBC) as an aggressive variant of LABC. Nearly all cases of LABC warrant neoadjuvant chemotherapy followed by surgery. For some patients, breast-conserving surgery may be an option after chemotherapy reduces the tumor size. Mastectomy remains the standard surgical treatment for LABC. Axillary lymph node assessment involves sentinel lymph node biopsy or axillary lymph node dissection depending on clinical response to neoadjuvant therapy. The residual cancer burden score provides a standardized way to report tumor response after neoadjuvant treatment and correlate with patient outcomes.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
This document discusses the management of triple negative breast cancer (TNBC). It begins with an overview of the three main subtypes of breast cancer and their associated treatments. It then focuses on the characteristics and treatment challenges of TNBC, including its aggressiveness, younger patient population, and lack of targeted therapies. Current treatment options for metastatic TNBC are discussed, including various chemotherapy regimens. The document also touches on neoadjuvant and adjuvant systemic therapy approaches as well as ongoing research into better understanding the biology of TNBC to revolutionize outcomes.
Dr. Michael Davies presents the latest information on targeted melanoma therapies at the MRF's Patient Symposium at MD Anderson Cancer Center on January 31, 2015.
Hypofractionated radiotherapy regimens are being re-explored for their potential logistical benefits compared to conventionally fractionated radiotherapy. Several studies have evaluated hypofractionation for prostate cancer, finding comparable rates of tumor control and acceptable toxicity profiles. The CHHiP trial directly compared 57Gy in 19 fractions to 74Gy in 37 fractions for prostate cancer, finding no significant differences in patient-reported bowel symptoms up to 2 years post-treatment.
Debjyoti locally advanced breast carcinomaArkaprovo Roy
This document discusses treatment pathways for stage IIIA and IIIB breast cancer. It describes the tumor and node characteristics of these stages. Neoadjuvant chemotherapy is recommended to downsize tumors before surgery. Surgery options include breast conservation or mastectomy. Post-operative radiation and chemotherapy are also used. Hormone therapy may be given depending on receptor status. Receptor status helps determine prognosis and additional targeted therapies. Molecular subtyping further classifies breast cancers to help guide treatment approaches. Axillary lymph node dissection is discussed as an important part of staging and treatment.
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.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
MANAGEMENT OF EARLY STAGE NON SMALL CELL LUNG CARCINOMAIsha Jaiswal
1. The document discusses management guidelines for early stage non-small cell lung cancer (NSCLC), including treatment options for operable versus inoperable patients such as surgery, chemotherapy, and radiation therapy.
2. Key findings from studies on lymphadenectomy, sublobar resection versus lobectomy, and video-assisted thoracoscopic surgery (VATS) versus open surgery are summarized, finding no clear survival benefits to more extensive procedures in early stage disease.
3. The roles of postoperative radiotherapy and chemotherapy are examined based on clinical trials, with chemoradiation found potentially beneficial in stage III disease but not stage I/II, and cisplatin-based chemotherapy improving survival in stage II/III
Complete Mesocolic Excision (CME) is a surgical technique for colon cancer based on Total Mesorectal Excision principles for rectal cancer. CME involves sharp dissection along embryonic planes between the visceral and parietal fascia to remove the colon and intact mesocolon lymphovascular package. Central ligation of supplying vessels also aims to maximize lymph node harvest. A study of over 1,300 colon cancer patients who underwent CME found improved 5-year cancer survival rates and reduced local recurrence compared to previous techniques, correlated with higher lymph node counts. CME principles include producing an intact specimen and maximizing lymph node dissection for improved oncologic outcomes.
This document discusses the management of localized and locally advanced prostate cancer. It covers risk stratification methods including D'Amico, NCCN and EAU classifications. Treatment options for localized prostate cancer include active surveillance, radical prostatectomy, external beam radiotherapy and brachytherapy. Patient selection factors, follow-up protocols and potential complications are reviewed for different treatment modalities. Risk assessment tools like Partin tables, Kattan and Briganti nomograms are also described to guide treatment decisions in localized prostate cancer.
Management of the axilla after neoadjuvant chemotherapyDr. Haytham Fayed
This document discusses surgical management of the axilla after neoadjuvant chemotherapy for breast cancer. It provides background on how axillary lymph node dissection was previously the standard approach but is now being reevaluated. Sentinel lymph node biopsy after neoadjuvant chemotherapy may accurately stage the axilla and spare some patients from axillary lymph node dissection if the sentinel nodes are negative, though identification rates are slightly lower than without chemotherapy. The document concludes that current evidence suggests an algorithm involving axillary ultrasound before and sentinel lymph node biopsy after neoadjuvant chemotherapy to guide need for further axillary lymph node dissection.
ROLE OF NEOADJUVANT CHEMORADIATION IN LOCALLY ADVANCED BREAST CANCERKanhu Charan
This retrospective study analyzed 187 breast cancer patients treated with neoadjuvant chemoradiation followed by mastectomy from 1970-1984. It found that the 10-year locoregional control, disease-free survival, and overall survival rates were 91%, 47%, and 55% respectively. Only pathological nodal involvement was an independent negative prognostic factor for disease-free and overall survival. The study demonstrates comparable long-term locoregional control with this approach compared to other trials, suggesting neoadjuvant chemoradiation followed by mastectomy can achieve good outcomes.
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). It outlines the trimodality approach of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation. Studies have shown 5-year bladder intact survival rates ranging from 36-66% with this approach. Complete response to induction chemoradiation may allow bladder preservation. Radical cystectomy is associated with significant morbidity while bladder preservation maintains quality of life. Long-term outcomes depend on patient selection and a multidisciplinary approach can maximize organ preservation while achieving high cure rates.
The document provides updated guidelines for biliary tract cancers from the National Comprehensive Cancer Network. Key updates include reorganizing the guidelines to separate biliary tract cancers from hepatocellular carcinoma. Additional molecular testing recommendations were revised for gallbladder, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. Guidelines for principles of molecular testing and systemic therapy were also added.
The document summarizes updates made in Version 1.2018 of the NCCN Guidelines for Testicular Cancer from Version 2.2017. Key updates include:
- Revisions to postdiagnostic workup, staging, and treatment recommendations for pure seminoma and nonseminoma across various clinical stages.
- Addition of AJCC 8th edition cancer staging tables and revisions to some footnotes to reference the 7th edition for subclassifying and making treatment decisions about stage I tumors.
- New pathways and treatment options added for patients with incomplete response to chemotherapy, recurrence after second-line therapy, and recommendations for third-line therapy.
- Revisions to follow-up recommendations and tables for seminoma and
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
The document summarizes revisions to the FIGO staging system for endometrial cancer in 2023. Key changes include distinguishing aggressive from non-aggressive histological subtypes and assessing lymphovascular space invasion. The revised system incorporates prognostic molecular markers like POLE mutations and p53 abnormalities. Stage I is now restricted to non-invasive tumors. Stage IA3 includes some ovarian involvement by low-grade endometrial cancer. The revisions aim to better stratify patients by risk to guide treatment decisions.
This document discusses the potential "double trouble" of receiving radiation therapy after prostate cancer surgery due to increased toxicity. It notes that most post-operative prostate patients receive radiation and questions why surgery would be chosen over a shorter course of hypofractionated radiation therapy, which has equal results. While surgery is an option, careful patient selection is important to avoid double toxicity from combined treatments. A hypofractionated radiation regimen is recommended to minimize side effects and avoid inviting double trouble that may be difficult to troubleshoot.
This document discusses the management of locally advanced prostate cancer. It defines locally advanced prostate cancer as regional or lymph node involvement without distant metastasis. For imaging, endorectal MRI is useful for staging but has limitations. Treatment options discussed include radical prostatectomy with pelvic lymph node dissection, radiation therapy with long-term androgen deprivation therapy, and newer developments like focal ablation and intermittent androgen deprivation. Guidelines recommend multimodal therapy like surgery followed by radiation for locally advanced prostate cancer.
This document discusses treatment approaches for locally advanced breast cancer (LABC). It describes inflammatory breast cancer (IBC) as an aggressive variant of LABC. Nearly all cases of LABC warrant neoadjuvant chemotherapy followed by surgery. For some patients, breast-conserving surgery may be an option after chemotherapy reduces the tumor size. Mastectomy remains the standard surgical treatment for LABC. Axillary lymph node assessment involves sentinel lymph node biopsy or axillary lymph node dissection depending on clinical response to neoadjuvant therapy. The residual cancer burden score provides a standardized way to report tumor response after neoadjuvant treatment and correlate with patient outcomes.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
This document discusses the management of triple negative breast cancer (TNBC). It begins with an overview of the three main subtypes of breast cancer and their associated treatments. It then focuses on the characteristics and treatment challenges of TNBC, including its aggressiveness, younger patient population, and lack of targeted therapies. Current treatment options for metastatic TNBC are discussed, including various chemotherapy regimens. The document also touches on neoadjuvant and adjuvant systemic therapy approaches as well as ongoing research into better understanding the biology of TNBC to revolutionize outcomes.
Dr. Michael Davies presents the latest information on targeted melanoma therapies at the MRF's Patient Symposium at MD Anderson Cancer Center on January 31, 2015.
Hypofractionated radiotherapy regimens are being re-explored for their potential logistical benefits compared to conventionally fractionated radiotherapy. Several studies have evaluated hypofractionation for prostate cancer, finding comparable rates of tumor control and acceptable toxicity profiles. The CHHiP trial directly compared 57Gy in 19 fractions to 74Gy in 37 fractions for prostate cancer, finding no significant differences in patient-reported bowel symptoms up to 2 years post-treatment.
Debjyoti locally advanced breast carcinomaArkaprovo Roy
This document discusses treatment pathways for stage IIIA and IIIB breast cancer. It describes the tumor and node characteristics of these stages. Neoadjuvant chemotherapy is recommended to downsize tumors before surgery. Surgery options include breast conservation or mastectomy. Post-operative radiation and chemotherapy are also used. Hormone therapy may be given depending on receptor status. Receptor status helps determine prognosis and additional targeted therapies. Molecular subtyping further classifies breast cancers to help guide treatment approaches. Axillary lymph node dissection is discussed as an important part of staging and treatment.
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.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
MANAGEMENT OF EARLY STAGE NON SMALL CELL LUNG CARCINOMAIsha Jaiswal
1. The document discusses management guidelines for early stage non-small cell lung cancer (NSCLC), including treatment options for operable versus inoperable patients such as surgery, chemotherapy, and radiation therapy.
2. Key findings from studies on lymphadenectomy, sublobar resection versus lobectomy, and video-assisted thoracoscopic surgery (VATS) versus open surgery are summarized, finding no clear survival benefits to more extensive procedures in early stage disease.
3. The roles of postoperative radiotherapy and chemotherapy are examined based on clinical trials, with chemoradiation found potentially beneficial in stage III disease but not stage I/II, and cisplatin-based chemotherapy improving survival in stage II/III
Complete Mesocolic Excision (CME) is a surgical technique for colon cancer based on Total Mesorectal Excision principles for rectal cancer. CME involves sharp dissection along embryonic planes between the visceral and parietal fascia to remove the colon and intact mesocolon lymphovascular package. Central ligation of supplying vessels also aims to maximize lymph node harvest. A study of over 1,300 colon cancer patients who underwent CME found improved 5-year cancer survival rates and reduced local recurrence compared to previous techniques, correlated with higher lymph node counts. CME principles include producing an intact specimen and maximizing lymph node dissection for improved oncologic outcomes.
This document discusses the management of localized and locally advanced prostate cancer. It covers risk stratification methods including D'Amico, NCCN and EAU classifications. Treatment options for localized prostate cancer include active surveillance, radical prostatectomy, external beam radiotherapy and brachytherapy. Patient selection factors, follow-up protocols and potential complications are reviewed for different treatment modalities. Risk assessment tools like Partin tables, Kattan and Briganti nomograms are also described to guide treatment decisions in localized prostate cancer.
Management of the axilla after neoadjuvant chemotherapyDr. Haytham Fayed
This document discusses surgical management of the axilla after neoadjuvant chemotherapy for breast cancer. It provides background on how axillary lymph node dissection was previously the standard approach but is now being reevaluated. Sentinel lymph node biopsy after neoadjuvant chemotherapy may accurately stage the axilla and spare some patients from axillary lymph node dissection if the sentinel nodes are negative, though identification rates are slightly lower than without chemotherapy. The document concludes that current evidence suggests an algorithm involving axillary ultrasound before and sentinel lymph node biopsy after neoadjuvant chemotherapy to guide need for further axillary lymph node dissection.
ROLE OF NEOADJUVANT CHEMORADIATION IN LOCALLY ADVANCED BREAST CANCERKanhu Charan
This retrospective study analyzed 187 breast cancer patients treated with neoadjuvant chemoradiation followed by mastectomy from 1970-1984. It found that the 10-year locoregional control, disease-free survival, and overall survival rates were 91%, 47%, and 55% respectively. Only pathological nodal involvement was an independent negative prognostic factor for disease-free and overall survival. The study demonstrates comparable long-term locoregional control with this approach compared to other trials, suggesting neoadjuvant chemoradiation followed by mastectomy can achieve good outcomes.
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). It outlines the trimodality approach of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation. Studies have shown 5-year bladder intact survival rates ranging from 36-66% with this approach. Complete response to induction chemoradiation may allow bladder preservation. Radical cystectomy is associated with significant morbidity while bladder preservation maintains quality of life. Long-term outcomes depend on patient selection and a multidisciplinary approach can maximize organ preservation while achieving high cure rates.
The document provides updated guidelines for biliary tract cancers from the National Comprehensive Cancer Network. Key updates include reorganizing the guidelines to separate biliary tract cancers from hepatocellular carcinoma. Additional molecular testing recommendations were revised for gallbladder, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. Guidelines for principles of molecular testing and systemic therapy were also added.
The document summarizes updates made in Version 1.2018 of the NCCN Guidelines for Testicular Cancer from Version 2.2017. Key updates include:
- Revisions to postdiagnostic workup, staging, and treatment recommendations for pure seminoma and nonseminoma across various clinical stages.
- Addition of AJCC 8th edition cancer staging tables and revisions to some footnotes to reference the 7th edition for subclassifying and making treatment decisions about stage I tumors.
- New pathways and treatment options added for patients with incomplete response to chemotherapy, recurrence after second-line therapy, and recommendations for third-line therapy.
- Revisions to follow-up recommendations and tables for seminoma and
The document provides updated guidelines for the treatment of biliary tract cancers from the National Comprehensive Cancer Network (NCCN). Key updates include: revised recommendations for molecular testing in gallbladder, intrahepatic, and extrahepatic cholangiocarcinoma; changing the recommendation for fluoropyrimidine-based chemoradiation after surgery from category 2A to 2B; and the addition of a new section on principles of molecular testing. The guidelines are intended for use by oncology clinicians in determining treatment approaches for patients with biliary tract cancers.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Head and Neck Cancers. It includes updates made in Version 3.2021, which add a footnote regarding biosimilar substitutes for trastuzumab. The guidelines provide evidence-based recommendations for multidisciplinary treatment of various head and neck cancers, including cancer of the oral cavity, oropharynx, hypopharynx, larynx, paranasal sinuses, and salivary glands. Recommendations cover evaluation, staging, surgery, radiation, systemic therapies, follow-up, and management of advanced or recurrent cancers.
The document provides guidelines for the treatment of penile cancer from the National Comprehensive Cancer Network. It includes recommendations for evaluating suspicious penile lesions, determining the clinical diagnosis and pathologic diagnosis, and recommendations for primary treatment based on tumor stage and grade. It also provides recommendations for managing non-palpable and palpable inguinal lymph nodes, surveillance schedules, and treatment of recurrent or metastatic disease. The guidelines are regularly updated based on the latest evidence and consensus of the expert panel.
The document provides updates to the NCCN Guidelines for Hepatocellular Carcinoma from Version 5.2022 to Version 1.2023. Key updates include: separating the Guidelines for Biliary Tract Cancers from Hepatocellular Carcinoma; emphasizing patient-centered language; changing external beam radiation therapy to radiation therapy; revising treatment pathways and footnotes for potentially resectable or transplantable disease; revising screening and surveillance recommendations; and adding a recommendation to consider biopsy for patients with more advanced disease being considered for systemic therapy.
The document summarizes updates made in March 2023 to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Gastric Cancer. Key updates include revised recommendations for workup, follow-up surveillance, endoscopic staging principles, pathologic review and biomarker testing principles. The guidelines continue to emphasize the importance of multidisciplinary care and participation in clinical trials for optimal management of gastric cancer.
This document provides the panel members, guidelines updates, and table of contents for the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Thyroid Carcinoma. The panel members are experts in fields related to thyroid cancer from NCCN member institutions. The guidelines were updated in November 2022 to include additional treatment options for recurrent and metastatic thyroid cancer. The table of contents provides an outline of the guidelines contents covering diagnosis and treatment of the main thyroid cancer types.
The document summarizes updates made in Version 5.2021 of the National Comprehensive Cancer Network (NCCN) Guidelines for Hepatobiliary Cancers. Key updates include adding dostarlimab-gxly as a treatment option for patients with mismatch repair deficient tumors across hepatocellular carcinoma and biliary tract cancer guidelines. Reference sections were also updated to include studies on dostarlimab. Guidelines for hepatocellular carcinoma screening criteria and surgical assessment were revised.
This document provides guidelines for the treatment of hepatobiliary cancers from the National Comprehensive Cancer Network (NCCN). It was last updated on October 14, 2022. The guidelines include the latest recommendations for screening, diagnosing, and treating hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. New recommendations include durvalumab plus chemotherapy as a preferred regimen for unresectable biliary tract cancer, and selpercatinib for RET fusion-positive hepatobiliary tumors.
This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Esophageal and Esophagogastric Junction Cancers Version 2.2023. It lists the panel members and provides an overview of the guideline updates. The guidelines provide recommendations on screening, diagnosis, staging, treatment and surveillance for squamous cell carcinoma and adenocarcinoma of the esophagus and esophagogastric junction.
This document provides guidelines for the treatment of gastric cancer from the National Comprehensive Cancer Network (NCCN). It was updated in January 2022 and includes:
1) Revisions to the recommended workup, including universal testing for microsatellite instability by PCR, next-generation sequencing, or mismatch repair immunohistochemistry for all newly diagnosed patients.
2) A recommendation for perioperative chemotherapy as the preferred primary treatment for medically fit patients with locoregional cT2 or higher gastric cancer.
3) Revisions to the principles of pathologic biomarker testing, including consideration of next-generation sequencing if sufficient tissue is available after initial testing.
The document provides guidelines for the treatment of ovarian cancer from the National Comprehensive Cancer Network (NCCN). It includes algorithms and treatment recommendations for various types and stages of ovarian cancer, including epithelial ovarian cancer, less common histologies like clear cell carcinoma, and recurrent or persistent disease. The guidelines were last updated in September 2022 and are developed by an expert panel to aid in clinical decision making.
- This document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Thyroid Carcinoma.
- Version 3.2022 was published on November 1st, 2022 and includes updates to systemic therapy recommendations for papillary, follicular, and Hürthle cell carcinomas.
- The guidelines provide evidence-based recommendations for the evaluation, diagnosis and treatment of the main types of thyroid carcinoma.
- The document presents updated guidelines from the National Comprehensive Cancer Network (NCCN) for the treatment of anal carcinoma.
- Key updates include revising treatment recommendations for metastatic disease and surveillance, capping the mitomycin dose for concurrent chemoradiation regimens, and revising target volume definitions and quality assurance procedures for radiation therapy.
- The guidelines are intended to help clinicians determine the best evidence-based approaches for treating patients with this cancer.
The document summarizes updates made in Version 1.2019 of the NCCN Guidelines for Anal Carcinoma from Version 2.2018. Key updates include:
1) Addition of PET/CT or PET/MRI to the workup for anal canal and perianal cancer.
2) Addition of FOLFCIS ± RT as a treatment option for metastatic disease.
3) Revision of surveillance recommendations to include abdominal/pelvic CT or MRI annually for 3 years.
4) Significant revisions to the principles of radiation therapy.
This document provides guidelines for the diagnosis and treatment of neuroendocrine tumors. It was created by the National Comprehensive Cancer Network (NCCN) and outlines their expert panel members and recommendations. The guidelines cover topics such as neuroendocrine tumors of the gastrointestinal tract, pancreas, unknown primary site, and multiple endocrine neoplasia. It provides information on evaluation, staging, treatment including surgery and systemic therapy, and surveillance.
The document summarizes the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Breast Cancer. It lists the panel members and provides updates to version 4.2023 of the guidelines, including revisions to recommendations for adjuvant endocrine therapy and biomarker testing. The guidelines cover workup, treatment, surveillance, and management of recurrent or metastatic breast cancer. Sections address issues such as locoregional treatment, systemic adjuvant therapy, preoperative systemic therapy, surveillance, and treatment of recurrent or stage IV disease.
Testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle.
Urological emergency; early diagnosis and treatment are vital.
Mainly disease of Neonates, Adolescents.
The rate of testicular viability decreases significantly after 6 hours from onset of symptoms.
The document summarizes the histology of the female reproductive system. It describes the layers of the ovary including the cortex containing ovarian follicles and stroma, and the medulla containing blood vessels, connective tissue, and hilus cells. It also describes the layers of the uterus (perimetrium, myometrium, endometrium), uterine tubes (mucous membrane, muscle coat, serosa), and vagina (mucous membrane with stratified squamous epithelium, muscle coat, adventitia).
There are marked variations in the incidence of gastric cancer worldwide.
The UK it is approximately 15 per 100000 per year
The USA 10 per 100000 per year
Eastern Europe 40 per 100 000 per year.
It is more common in Japan—70 per 1,00,000 population.
Common in males 2:1.
Decrease incidence in western world (Western Europe and US)—last four decades.
Urethral stricture is an abnormal narrowing or loss of distensibility of any part of the urethra as a result of fibrosis at the site of injury or inflammation.
The document discusses the histology of lymphoid organs including the thymus, lymphatic nodules, spleen, palatine tonsils, and lymph nodes. These organs play important roles in the immune system through the development, storage, and activation of lymphocytes that help the body fight infections and diseases.
The male reproductive system consists of the testes, conducting tubules and ducts (epididymis, vas deferens, ejaculatory ducts), accessory sex glands (seminal vesicles, prostate, and bulbourethral glands), and the penis.
Evaluating Tools for Characterizing Anterior Urethral Stricture Disease A Com...Dr Abdul Qayyum Khan
We evaluated if scores generated by the LSE classification system and
the Urethral Stricture Score system are associated with intraoperative surgical
complexity and stricture recurrence risk.
The document discusses electrohydraulic lithotripsy (EHL), a technique that uses electric sparks delivered in pulses between electrodes at the tip of a fiber to create shock waves. These shock waves oscillate and generate sufficient pressure to fragment stones by inducing the immediate expansion of surrounding liquid from the electric sparks. Modifications to the acoustic lens of an electromagnetic lithotripter produced a broader focal zone and improved pressure waveform, demonstrating better stone fragmentation in vitro.
Amputation is surgery to remove all or part of a limb or extremity. You may need an amputation if you’ve undergone a severe injury or infection or have a health condition like peripheral arterial disease (PAD). Many people live a healthy, active lifestyle after an amputation, but it may take time to get used to life without a limb.
The term basal nuclei is applied to a collection of masses of gray matter situated within each cerebral hemisphere.
They are the
corpus striatum,
amygdaloid nucleus,
claustrum.
The subthalamic nuclei, the substantia nigra, and the red nucleus are functionally closely related to the basal nuclei.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
1.Detect presence of liver disease.
2.Distinguish among different types of liver diseases.
3.Estimate the extent of known liver damage.
4.Follow the response of treatment
Rabies causes an estimated 31,000 deaths annually in Asia, with 20,000 deaths in India and 2,000-5,000 deaths in Pakistan. The virus has an incubation period of 2 weeks to 6 months after a bite, and once symptoms appear the disease is fatal. Symptoms can include fever, headache, hydrophobia, aerophobia, and ascending paralysis. Diagnosis is usually clinical but rabies virus can be detected by PCR or antibodies measured by ELISA. For bite victims, the wound should be thoroughly washed and rinsed, rabies immunoglobulin and vaccine administered based on wound category, and a vaccine series given. Modern cell culture vaccines have replaced nerve tissue vaccines globally and include purified vero cell, chick
Disorders that perturb cardiovascular, renal, or hepatic function are often marked by the accumulation of fluid in tissues (edema) or body cavities (effusions).
Transmission Based Precautions are a set of infection control guidelines used to prevent the spread of diseases that are spread by contact or airborne methods. They include using gloves and gowns for contact precautions when in close contact with patients, as well as using masks for airborne precautions when treating patients with illnesses like tuberculosis. Hospitals implement Transmission Based Precautions with certain patients to stop the spread of infections to others.
This document outlines learning objectives for understanding the thoracic cage and diaphragm. The key points are:
- Describe the boundaries of the thoracic cage, openings of the thorax, and components of the diaphragm including its origin, direction of fibers, blood supply and nerve supply.
- List the structures that pass through openings in the thorax and diaphragm.
- Explain the functions of the diaphragm in respiration and other acts.
- Enumerate conditions related to damage of the phrenic nerve including diaphragmatic paralysis and hernias.
Autoimmunity disorders occur when the immune system mounts an attack against the body's own tissues and organs. They are difficult to diagnose due to nonspecific initial symptoms, fluctuating symptoms, and the potential for multiple autoimmune conditions. Diagnostic methods include initial laboratory tests of inflammatory markers and autoantibodies, immunological studies, flow cytometry to analyze immune cells, cytokine studies, and examination of major histocompatibility complex genes associated with autoimmunity. A variety of autoantibodies against nuclear, cytoplasmic, and other cellular components can indicate autoimmune disease patterns and targets.
Negative pressure pulmonary edema (NPPE) or postobstruction pulmonary edema (POPE) is a clinical entity of great relevance in anesthesiology and intensive care. The presentation of NPPE can be immediate or delayed, which therefore necessitates immediate recognition and treatment by anyone directly involved in the perioperative care of a patient.
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.
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
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.
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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.