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 summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
1) The PORTEC-1 and PORTEC-2 trials compared pelvic radiotherapy to no additional treatment or vaginal brachytherapy for patients with endometrial carcinoma. PORTEC-1 found pelvic radiotherapy reduced vaginal recurrence while PORTEC-2 found vaginal brachytherapy achieved excellent vaginal control with fewer side effects compared to pelvic radiotherapy.
2) The PORTEC-3 trial randomized 686 patients with high risk endometrial cancer to chemoradiotherapy or radiotherapy alone. It found chemoradiotherapy improved failure-free survival compared to radiotherapy alone, especially for stage III patients, but with increased toxicity.
3)
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.
Join Dr. Kara Long Roche, Associate Director of the Gynecologic Oncology Fellowship Program at Memorial Sloan Kettering Cancer Center, as she breaks down new advancements in ovarian cancer research and treatment.
The document discusses adjuvant treatment strategies for endometrial cancer based on risk stratification into low, intermediate, and high risk groups. For intermediate risk early-stage disease, vaginal brachytherapy is preferred over pelvic radiotherapy due to lesser toxicities. Ongoing trials are evaluating whether chemotherapy improves survival outcomes for high-risk early-stage cancer. For locally advanced or metastatic disease, platinum-based chemotherapy is standard and combined chemoradiation shows promise based on improved progression-free and overall survival in early studies.
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 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 summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
1) The PORTEC-1 and PORTEC-2 trials compared pelvic radiotherapy to no additional treatment or vaginal brachytherapy for patients with endometrial carcinoma. PORTEC-1 found pelvic radiotherapy reduced vaginal recurrence while PORTEC-2 found vaginal brachytherapy achieved excellent vaginal control with fewer side effects compared to pelvic radiotherapy.
2) The PORTEC-3 trial randomized 686 patients with high risk endometrial cancer to chemoradiotherapy or radiotherapy alone. It found chemoradiotherapy improved failure-free survival compared to radiotherapy alone, especially for stage III patients, but with increased toxicity.
3)
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.
Join Dr. Kara Long Roche, Associate Director of the Gynecologic Oncology Fellowship Program at Memorial Sloan Kettering Cancer Center, as she breaks down new advancements in ovarian cancer research and treatment.
The document discusses adjuvant treatment strategies for endometrial cancer based on risk stratification into low, intermediate, and high risk groups. For intermediate risk early-stage disease, vaginal brachytherapy is preferred over pelvic radiotherapy due to lesser toxicities. Ongoing trials are evaluating whether chemotherapy improves survival outcomes for high-risk early-stage cancer. For locally advanced or metastatic disease, platinum-based chemotherapy is standard and combined chemoradiation shows promise based on improved progression-free and overall survival in early studies.
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.
The document provides biographical information about Dr. Narendra Malhotra, an obstetrician gynecologist from Agra, India. It notes that he has served as the president of FOGSI, dean of ICMU, and director of Ian Donald School of Ultrasound. It also lists his accomplishments, publications, areas of special interest, and contact information for his practice.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
This document discusses radiotherapy for stomach cancer. It begins with the anatomy of the stomach and risk factors for stomach cancer like H. pylori infection and diet low in fruits and vegetables. It then discusses diagnostic workup including endoscopy, CT, PET scans. Treatment options include surgery, radiation, chemoradiation, or best supportive care. Post-op radiotherapy improves survival compared to surgery alone for high-risk patients. Pre-op chemoradiation improves local control compared to chemotherapy alone. Adding oxaliplatin and radiotherapy to S-1 chemotherapy after surgery improves disease-free survival compared to S-1 alone.
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
HPV Vaccination Update in 2021 Dr Sharda Jain Lifecare Centre
This document discusses the importance of prioritizing HPV vaccination in India. It notes that cervical cancer is a major problem in India, with over 60,000 deaths per year. However, HPV vaccination rates in India are less than 1%. The document advocates scaling up HPV vaccination programs for adolescent girls according to WHO guidelines. Vaccinating girls before age 15 is key to eliminating cervical cancer as a public health problem. It also discusses opportunities for catch-up vaccination by OBGYNs and nurses when women visit for other women's health issues. The overall message is that HPV vaccination should be a top priority for the Indian government to substantially reduce the cervical cancer burden.
Radiation therapy can enhance anti-tumor immunity through several mechanisms like increasing antigen visibility and activating the cGAS-STING pathway. However, it can also induce immunosuppressive effects by modifying the tumor microenvironment. The combination of radiation therapy with immunotherapy may provide synergistic effects by stimulating both local and systemic tumor control. Some challenges in combining these approaches include optimizing the timing and dose of radiation therapy to maximize its immune stimulatory effects while minimizing direct effects on T cells. Further studies are still needed to determine the best approaches.
The document discusses HPV vaccination, including:
1) Cervical cancer is a major disease burden in India, with India accounting for about 25% of cervical cancer deaths worldwide. HPV is the cause of nearly all cervical cancers.
2) HPV vaccination aims to prevent cervical cancer by vaccinating against HPV types 16 and 18, which cause about 70% of cervical cancers. Vaccination is recommended for girls and women between ages 9-45 before sexual debut or exposure to HPV.
3) Real-world effectiveness data from Australia's HPV vaccination program shows decreases in HPV vaccine-type infections and high-grade cervical abnormalities in young women following the program.
This document provides summaries of recent oncology research studies presented between June 16th and July 4th 2023. The studies covered topics including brain tumors, lymphomas, melanoma, bladder cancer, breast cancer, lung cancer, gallbladder cancer, endometrial cancer, and toxicity. Highlights include positive results from trials of targeted therapies for brain tumors and lymphomas, as well as improvements in outcomes with neoadjuvant and adjuvant immunotherapy in lung and breast cancers. Safety and efficacy findings are also reported from studies of chemotherapy regimens and radiotherapy techniques.
Report Back from SGO: What’s the Latest in Cervical Cancer? - 2022bkling
We invite you to join Dr. Kristina Butler, Gynecologic Oncologist at Mayo Clinic Arizona, as she shares her biggest takeaways from the latest cervical cancer research presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Butler will break down what the research presented at the conference means for you and answer your questions about the new developments.
1. The patient presented with a 1.5 x 1.5 cm cancerous growth on their uvula. A biopsy confirmed it was a moderately differentiated squamous cell carcinoma.
2. A mould was prepared using alginate impression material and dental stone to create an intraoral prosthesis for brachytherapy treatment planning and delivery.
3. Brachytherapy treatment was planned using CT imaging and catheter reconstruction to deliver 60Gy in 13/14 fractions twice daily to adequately cover the clinical target volume while sparing nearby organs at risk.
Latest update on cervical cancer & hpv vaccine 2013Lifecare Centre
Cervical cancer is a major cause of cancer deaths among women globally, with over 270,000 deaths per year. India has a high burden with over 100,000 new cases annually. Human papillomavirus (HPV) infection is the primary cause, with HPV types 16 and 18 causing over 70% of cervical cancers. Two HPV vaccines, a bivalent and quadrivalent vaccine, provide protection against HPV 16 and 18 and have demonstrated efficacy of over 90% in clinical trials. Ongoing monitoring in Nordic countries has found the quadrivalent vaccine continues to provide protection against HPV 16/18 infection for up to 9 years. Guidelines recommend routine HPV vaccination for girls and boys at age 11-12 to be
AN OPPORTUNITY FOR HPV VACCINATION , Dr. Sharda Jain Lifecare Centre Lifecare Centre
This document discusses strategies for cervical cancer prevention in India through HPV vaccination. It notes that cervical cancer is almost entirely preventable but prevention efforts in India have been inadequate. HPV vaccination provides strong protection, especially if received before sexual debut. However, vaccination rates in India are very low. The document argues that the postpartum period provides an opportunity for catch-up HPV vaccination that can improve coverage. Several studies show high HPV prevalence in postpartum women, demonstrating the potential benefit. Other evidence suggests postpartum women are receptive to vaccination and compliance with the 3 dose schedule can be high with proper counseling. The document advocates that healthcare providers should recommend HPV vaccination to women in the postpartum period to help control cervical cancer in India
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Sentinel lymph node biopsy is a minimally invasive technique used to examine the primary draining lymph nodes in clinically node-negative necks. It involves injecting a radioactive tracer and blue dye around the primary tumor site, then using a gamma probe both preoperatively and intraoperatively to identify the sentinel lymph nodes, which are the first to receive lymphatic drainage from the tumor. The located sentinel lymph nodes are then surgically excised and sent for pathological analysis, with further treatment depending on whether metastases are found.
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
The best way to treat locally advanced rectal cancerMohamed Abdulla
This document discusses treatment approaches for locally advanced rectal cancer. It begins with basic facts about colorectal cancer incidence and risk factors. It then outlines the principles of surgery as the cornerstone treatment but notes the high rates of local recurrence without adjuvant radiation therapy. The document reviews evidence demonstrating the benefits of total mesorectal excision surgery and chemoradiation in reducing recurrence rates. It examines neoadjuvant and adjuvant chemotherapy approaches, noting some trials found no benefit to adjuvant therapy especially for those who received preoperative chemoradiation. The document discusses moving towards a total neoadjuvant paradigm with upfront chemotherapy and chemoradiation to achieve pathologic complete responses when possible.
Cervical cancer is the second most common cancer in women worldwide. The document discusses opportunities and challenges for cervical cancer prevention including new HPV vaccines and screening assays. It provides an overview of HPV vaccines, countries that have introduced them, and challenges to introduction. Monitoring vaccine coverage and impact is also discussed.
Recent advances in targeted therapy for metastatic lung cancerAlok Gupta
This document discusses recent advances in targeted therapy for metastatic lung cancer. It summarizes key findings from several clinical trials evaluating third-generation EGFR TKIs like osimertinib for patients with EGFR mutation-positive NSCLC. The document highlights that osimertinib provides significantly longer progression-free survival compared to earlier generation EGFR TKIs, with a median PFS of 18.9 months versus 10.2 months. Osimertinib also demonstrated a higher objective response rate and longer duration of response. Benefits were consistent across patient subgroups.
Addressing the counseling challenges in HPV vaccinationLifecare Centre
The document discusses the challenges of HPV vaccination in India. It notes that India accounts for a large proportion of the global cervical cancer burden, with over 96,000 new cases and 60,078 deaths annually. While screening is important for prevention, current screening coverage in India is only 3.1%. The document then outlines several common barriers to HPV vaccination among healthcare providers and patients. It seeks to address these barriers by providing concise responses and emphasizing that vaccination provides the highest protection when received before sexual debut or HPV exposure. It argues that OBGYNs are well-positioned to provide catch-up vaccination opportunities.
Standard Treatment Guidelines
serve as an important vehicle in assisting the doctor in decision making & providing the best treatment options for her patients.
The document provides biographical information about Dr. Narendra Malhotra, an obstetrician gynecologist from Agra, India. It notes that he has served as the president of FOGSI, dean of ICMU, and director of Ian Donald School of Ultrasound. It also lists his accomplishments, publications, areas of special interest, and contact information for his practice.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
This document discusses radiotherapy for stomach cancer. It begins with the anatomy of the stomach and risk factors for stomach cancer like H. pylori infection and diet low in fruits and vegetables. It then discusses diagnostic workup including endoscopy, CT, PET scans. Treatment options include surgery, radiation, chemoradiation, or best supportive care. Post-op radiotherapy improves survival compared to surgery alone for high-risk patients. Pre-op chemoradiation improves local control compared to chemotherapy alone. Adding oxaliplatin and radiotherapy to S-1 chemotherapy after surgery improves disease-free survival compared to S-1 alone.
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
HPV Vaccination Update in 2021 Dr Sharda Jain Lifecare Centre
This document discusses the importance of prioritizing HPV vaccination in India. It notes that cervical cancer is a major problem in India, with over 60,000 deaths per year. However, HPV vaccination rates in India are less than 1%. The document advocates scaling up HPV vaccination programs for adolescent girls according to WHO guidelines. Vaccinating girls before age 15 is key to eliminating cervical cancer as a public health problem. It also discusses opportunities for catch-up vaccination by OBGYNs and nurses when women visit for other women's health issues. The overall message is that HPV vaccination should be a top priority for the Indian government to substantially reduce the cervical cancer burden.
Radiation therapy can enhance anti-tumor immunity through several mechanisms like increasing antigen visibility and activating the cGAS-STING pathway. However, it can also induce immunosuppressive effects by modifying the tumor microenvironment. The combination of radiation therapy with immunotherapy may provide synergistic effects by stimulating both local and systemic tumor control. Some challenges in combining these approaches include optimizing the timing and dose of radiation therapy to maximize its immune stimulatory effects while minimizing direct effects on T cells. Further studies are still needed to determine the best approaches.
The document discusses HPV vaccination, including:
1) Cervical cancer is a major disease burden in India, with India accounting for about 25% of cervical cancer deaths worldwide. HPV is the cause of nearly all cervical cancers.
2) HPV vaccination aims to prevent cervical cancer by vaccinating against HPV types 16 and 18, which cause about 70% of cervical cancers. Vaccination is recommended for girls and women between ages 9-45 before sexual debut or exposure to HPV.
3) Real-world effectiveness data from Australia's HPV vaccination program shows decreases in HPV vaccine-type infections and high-grade cervical abnormalities in young women following the program.
This document provides summaries of recent oncology research studies presented between June 16th and July 4th 2023. The studies covered topics including brain tumors, lymphomas, melanoma, bladder cancer, breast cancer, lung cancer, gallbladder cancer, endometrial cancer, and toxicity. Highlights include positive results from trials of targeted therapies for brain tumors and lymphomas, as well as improvements in outcomes with neoadjuvant and adjuvant immunotherapy in lung and breast cancers. Safety and efficacy findings are also reported from studies of chemotherapy regimens and radiotherapy techniques.
Report Back from SGO: What’s the Latest in Cervical Cancer? - 2022bkling
We invite you to join Dr. Kristina Butler, Gynecologic Oncologist at Mayo Clinic Arizona, as she shares her biggest takeaways from the latest cervical cancer research presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Butler will break down what the research presented at the conference means for you and answer your questions about the new developments.
1. The patient presented with a 1.5 x 1.5 cm cancerous growth on their uvula. A biopsy confirmed it was a moderately differentiated squamous cell carcinoma.
2. A mould was prepared using alginate impression material and dental stone to create an intraoral prosthesis for brachytherapy treatment planning and delivery.
3. Brachytherapy treatment was planned using CT imaging and catheter reconstruction to deliver 60Gy in 13/14 fractions twice daily to adequately cover the clinical target volume while sparing nearby organs at risk.
Latest update on cervical cancer & hpv vaccine 2013Lifecare Centre
Cervical cancer is a major cause of cancer deaths among women globally, with over 270,000 deaths per year. India has a high burden with over 100,000 new cases annually. Human papillomavirus (HPV) infection is the primary cause, with HPV types 16 and 18 causing over 70% of cervical cancers. Two HPV vaccines, a bivalent and quadrivalent vaccine, provide protection against HPV 16 and 18 and have demonstrated efficacy of over 90% in clinical trials. Ongoing monitoring in Nordic countries has found the quadrivalent vaccine continues to provide protection against HPV 16/18 infection for up to 9 years. Guidelines recommend routine HPV vaccination for girls and boys at age 11-12 to be
AN OPPORTUNITY FOR HPV VACCINATION , Dr. Sharda Jain Lifecare Centre Lifecare Centre
This document discusses strategies for cervical cancer prevention in India through HPV vaccination. It notes that cervical cancer is almost entirely preventable but prevention efforts in India have been inadequate. HPV vaccination provides strong protection, especially if received before sexual debut. However, vaccination rates in India are very low. The document argues that the postpartum period provides an opportunity for catch-up HPV vaccination that can improve coverage. Several studies show high HPV prevalence in postpartum women, demonstrating the potential benefit. Other evidence suggests postpartum women are receptive to vaccination and compliance with the 3 dose schedule can be high with proper counseling. The document advocates that healthcare providers should recommend HPV vaccination to women in the postpartum period to help control cervical cancer in India
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Sentinel lymph node biopsy is a minimally invasive technique used to examine the primary draining lymph nodes in clinically node-negative necks. It involves injecting a radioactive tracer and blue dye around the primary tumor site, then using a gamma probe both preoperatively and intraoperatively to identify the sentinel lymph nodes, which are the first to receive lymphatic drainage from the tumor. The located sentinel lymph nodes are then surgically excised and sent for pathological analysis, with further treatment depending on whether metastases are found.
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
The best way to treat locally advanced rectal cancerMohamed Abdulla
This document discusses treatment approaches for locally advanced rectal cancer. It begins with basic facts about colorectal cancer incidence and risk factors. It then outlines the principles of surgery as the cornerstone treatment but notes the high rates of local recurrence without adjuvant radiation therapy. The document reviews evidence demonstrating the benefits of total mesorectal excision surgery and chemoradiation in reducing recurrence rates. It examines neoadjuvant and adjuvant chemotherapy approaches, noting some trials found no benefit to adjuvant therapy especially for those who received preoperative chemoradiation. The document discusses moving towards a total neoadjuvant paradigm with upfront chemotherapy and chemoradiation to achieve pathologic complete responses when possible.
Cervical cancer is the second most common cancer in women worldwide. The document discusses opportunities and challenges for cervical cancer prevention including new HPV vaccines and screening assays. It provides an overview of HPV vaccines, countries that have introduced them, and challenges to introduction. Monitoring vaccine coverage and impact is also discussed.
Recent advances in targeted therapy for metastatic lung cancerAlok Gupta
This document discusses recent advances in targeted therapy for metastatic lung cancer. It summarizes key findings from several clinical trials evaluating third-generation EGFR TKIs like osimertinib for patients with EGFR mutation-positive NSCLC. The document highlights that osimertinib provides significantly longer progression-free survival compared to earlier generation EGFR TKIs, with a median PFS of 18.9 months versus 10.2 months. Osimertinib also demonstrated a higher objective response rate and longer duration of response. Benefits were consistent across patient subgroups.
Addressing the counseling challenges in HPV vaccinationLifecare Centre
The document discusses the challenges of HPV vaccination in India. It notes that India accounts for a large proportion of the global cervical cancer burden, with over 96,000 new cases and 60,078 deaths annually. While screening is important for prevention, current screening coverage in India is only 3.1%. The document then outlines several common barriers to HPV vaccination among healthcare providers and patients. It seeks to address these barriers by providing concise responses and emphasizing that vaccination provides the highest protection when received before sexual debut or HPV exposure. It argues that OBGYNs are well-positioned to provide catch-up vaccination opportunities.
Standard Treatment Guidelines
serve as an important vehicle in assisting the doctor in decision making & providing the best treatment options for her patients.
Protection from a single dose of HPV Vaccine : Dr Sharda Jain Lifecare Centre
- A single dose of the HPV vaccine is expected to improve access and coverage by making vaccination programs less expensive and complex while still providing comparable efficacy to two or three dose schedules.
- The WHO now recommends a single dose schedule for HPV vaccination of adolescents ages 9-14 based on evidence that it provides solid protection against HPV types 16 and 18, which cause the majority of cervical cancers, for at least 10 years.
- Wider adoption of a single dose schedule could help reach the WHO's goal of vaccinating 90% of girls globally by age 15 by 2030 and help eliminate cervical cancer as a public health problem.
- The document discusses recommendations for HPV vaccination from international health organizations. It notes that nearly all cervical cancer cases are caused by HPV and cervical cancer disproportionately impacts women in low and middle income countries.
- Recent evidence from trials shows that a single dose of HPV vaccine can provide similar efficacy to 2-3 doses in preventing cervical precancer and cancer. A single dose schedule could make vaccination programs more affordable and scalable.
- India recently launched its first indigenous HPV vaccine. Experts argue that a national single-dose HPV vaccination program for adolescents in India could substantially reduce cervical cancer rates and help eliminate the disease in the country.
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
HPV INFECTIONS WITH RECENT ADVANCES IN CARCINOMA CERVIX.pptxakshatsahni425
1) Cervical cancer is a major public health problem in India, which accounts for about 27% of new cervical cancer cases and deaths worldwide.
2) Screening through tests like visual inspection with acetic acid (VIA) and treatment of pre-cancerous lesions can prevent the majority of cervical cancers. Vaccination against HPV also provides protection.
3) Effective treatments for pre-cancerous lesions include cryotherapy, loop electrosurgical excision procedure (LEEP), and laser ablation, while early invasive cancers can be treated with surgery, radiotherapy, or chemotherapy.
Evidence Based Guide of Screening for Prevention of Cervical Cancer Lifecare Centre
This document discusses cervical cancer prevention in India. It notes that India accounts for about 23-25% of new cervical cancer cases and deaths worldwide despite having only about 16% of the world's female population. Human papillomavirus (HPV) infection, especially types 16 and 18, is responsible for nearly all cervical cancer cases. The document recommends primary prevention through HPV vaccination and secondary prevention via cervical cancer screening to detect and treat precancerous lesions. However, it notes that current cervical cancer screening coverage in India is very low at only about 2.6% of the female population, highlighting the need to scale up screening efforts.
Cervical cancer is a major problem worldwide and in India. HPV is the primary cause, with types 16 and 18 responsible for about 80% of cases globally. A large Swedish study found HPV vaccination reduced cervical cancer risk by 63% compared to unvaccinated women. WHO guidelines recommend girls-only HPV vaccination before age 9 along with twice-lifetime screening to accelerate global cervical cancer elimination between 2059 to 2102 and prevent an additional 12.1 million cases.
HPV Vaccine: A Breakthrough In Prevention of Cervical CancerApollo Hospitals
Cervical cancer is one of the commonest cancers in women. As it affects young women it has grave
personal, social and economic consequences. It is unfortunate that despite cancer cervix being a preventable
disease, we have failed to reduce the number of deaths related to it. Recent developments in the understanding of the disease process and its link to the oncogenic strains of Human Papilloma Virus (HPV) has opened new avenues in
the way of prevention of cervical cancer.
HPV Vaccination & Ca. Cervix Screening Update Dr. Sharda Jain Dr. Jyoti A...Lifecare Centre
The document discusses the disease burden of cervical cancer in India, providing statistics showing that India accounts for approximately 25-27% of new cervical cancer cases and deaths worldwide despite having a smaller population than other parts of the world. It then discusses the role of HPV in causing cervical cancer, noting that HPV types 16 and 18 cause over 70% of cases. The document recommends HPV vaccination between ages 9-13 when immune response is strongest, and suggests it can provide benefits even for some sexually active women who have not been exposed to all HPV types covered by the vaccine. Long-term follow-up studies show the vaccine continues to provide nearly 100% effectiveness against HPV 16/18-related cervical diseases for many years.
Post Partum Vaccination Dr. Jyoti Agarwal, Dr. Sharda jain Lifecare Centre
The document discusses postpartum period as an opportunity for HPV vaccination. A study in Brazil found HPV prevalence of 58.5% in young primiparous women, with 17.3% and 13.3% positive for HPV types 16 and 18. This suggests the majority could benefit from catch-up vaccination. Another study in the US found high acceptance of postpartum HPV vaccination, though only 30.7% completed the three dose series. The author's own experience vaccinating over 200 women postpartum found 99% compliance, with women feeling it was convenient and recommending it to others. Postpartum period provides an opportunity for expanding HPV vaccination efforts.
Mission SAY No to Cervical Cancer With HPV Vaccination DR. SHARDA JAIN S...Lifecare Centre
1. Cervical cancer is a major health issue in India, accounting for 23% of new cervical cancer cases and 25% of cervical cancer deaths worldwide.
2. Human papillomavirus (HPV) infection causes cervical cancer, with vaccination providing 98-100% efficacy against HPV types.
3. Screening and vaccination can help prevent cervical cancer, but coverage in India remains low due to cost and lack of national programs.
Dr. Nisrin Anfinan discusses challenges related to cervical cancer in Saudi Arabia. The incidence of cervical cancer in Saudi Arabia is very low at 1.9 cases per 100,000 women, accounting for only 2.6% of cancers in women. However, challenges exist in understanding the prevalence of HPV infections and abnormal pap smears in the population. Implementing an effective screening program will also be difficult without understanding sexual practices and managing sexually transmitted infections. Determining the most appropriate screening method and triaging patients will also be challenges.
Dr. Nisrin discusses the challenges of addressing cervical cancer in Saudi Arabia. Key challenges include understanding the prevalence of HPV infections and abnormal pap smears in the population. It will also be important to understand sexual practices across different regions and groups. Implementing screening programs will be difficult without addressing sexually transmitted infections. Additionally, the cost-effectiveness of vaccination programs requires consideration given the low cervical cancer rates in Saudi Arabia. Quality assurance for screening and colposcopy procedures also needs to be introduced.
Dr. Nisrin discusses the challenges of addressing cervical cancer in Saudi Arabia. Key challenges include understanding the prevalence of HPV infections and abnormal pap smears in the population. It will also be important to understand sexual practices across different regions and groups. Implementing screening programs will be difficult without addressing sexually transmitted infections. Additionally, the cost-effectiveness of vaccination programs requires consideration given the low cervical cancer rates in Saudi Arabia. Quality assurance for screening and colposcopy procedures also needs to be introduced.
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1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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Why HPV Vaccination for Preventing Cervical Cancer in India Should Become a Part of Immunization Programme
1. Why HPVVaccination for Preventing
Cervical Cancer in India Should Become
a Part of Immunization Programme
Dr Anil Gupta
Senior Resident
Department of Radiation Oncology
AIIMS, New Delhi
Presenter
Dr D N Sharma
Prof and Head
Department of Radiation Oncology
AIIMS, New Delhi and NCI, Jhajjar
Moderator
2. Incidence of Cancer in Females in India
Cervical cancer is a public health problem in India.
Only cancer which can be prevented, detected and treatable
3. Estimated number of new cases from
2020 to 2040
GLOBOCAN 2020
One-fifth of the global burden of this
cancer
about 73 000 women die of
the disease annually in India
4. How HPVVaccine works?
CIN of grade 2 (CIN2), CIN3 and adenocarcinoma in situ (AIS) are considered as high-risk
HPV (hrHPV) infection
Cervical cancer is etiologically linked with persistent high-risk HPV infection.
Approx. 85% are caused by HPV, 70% are caused by HPV strain 16 and 18.
Prophylactic HPV vaccines contain virus-like-particles (VLPs) consisting of the major L1
protein of the capsid.
Administration by i.m injection triggers production of antibodies that are believed to
prevent new type-specific infections and subsequent development of CIN
5. What HPV vaccines are available?
All three vaccines areWHO prequalified, which means thatWHO has
determined that they meet global standards of quality, safety and efficacy
6.
7. Safety
Some concerns of AEFI
• Syncope, Dizziness, and Nausea
• Neurological events
• VenousThromboembolic Events
• Premature ovarian failure/infertility
• Deaths
No causal association is established
Lot of negative publicity without any scientific grounds
8. Cochrane metanalysis
26 trials (73,428 participants)
Most trials were at low risk of bias
Certainty of evidence for protection against cervical precancer CIN 2, CIN 3 and
adenocarcinoma‐in‐situ [AIS]
Adverse events and Pregnancy outcomes analysed
Cochrane Database of Systematic Reviews 09 May 2018
9. Adverse events
Relative risk (Vaccinated vs non
vaccinated)
CI (95%)
Short-term local adverse
events
1.18 to 1.73
Overall systemic events 1.02 0.98–1.07
Serious adverse events 0.98 0.92 to 1.05
Mortality ratio 1.29 0.85–1.98
Young women 0.98 0.59-
Mid-adult women 2.36 1.10–5.03
Miscarriage 0.88 0.68–1.14
Termination of pregnancy 0.9 0.80–1.02
Stillbirths 1.12 0.68–1.83
Congenital abnormalities 1.22 0.88–1.69
15. Key points
Bivalent and quadrivalent HPV vaccines induce excellent protection against persistent
HPV16/18 infection and associated precursor lesions in young who are not infected with
high-risk HPV.
Vaccine efficacy decreases by age. No protection against any CIN2+/AIS was found in the
group of older women (aged 24 or older) unselected by HPV DNA status at enrolment.
Similar rates of serious adverse events were observed in the experimental and control
arms of randomized trials.
INFERENCE
Young females (less than 25 year old) should be the primary target of vaccination
campaign.
16. HPV vaccine reduces incidence of cervical
cancer?
N Engl J Med 2020;383:1340-8.
DOI: 10.1056/NEJMoa1917338
1,672,983 girls
and women 10
to 30 years of
age included in
the study
18. Present Status in India
FOGSI and the IndianAcademy of Paediatrics,Association ofGynaecologicOncologists of
India (AGOI) recommend its use
Presently not a part of Universal Immunization Programme but NationalTechnical
Advisory Group on Immunisation advised its inclusion.
2 dose vs 3 dose trial suspended in between follow up continuedimmunogenicity
following two doses of HPV vaccination was non-inferior to that following three doses, and
one-dose recipients showed a robust and sustained immune response
19. Cost-effectiveness analysis
Cost of vaccinating 11-year-old girls in Punjab is around 135 million INR
lifetime cost of treating cervical cancer cases in vaccinated is INR 52 million
In Unvaccinated is INR 149 million
The net cancer treatment costs is around 38 million INR
incremental cost per cervical case prevented and death averted found to be INR 51,808 and INR
52,330
o If the cost per vaccinated girl is less than $10, vaccination is likely to be extremely cost-effective in
India
o Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with
vaccination alone, and 21–33% with screening 3 times per lifetime
o
Prinja S et al Cancer 2017
Diaz M, et al Br J Cancer 2008
21. Punjab Model of HPVVaccination
• Phase I
Bathinda and Mansa districts-high annual incidences
Training targeting officials, teachers, district immunisation officers, medical officers, cold
chain handlers, auxiliary nurse midwives, and accredited social health activist workers was
provided by Department of Health and FamilyWelfare Punjab in collaboration withWHO.
Education of the parents of class 6 girls was done through the Punjab Edusat Society
Administration of the vaccine initiated in 2016, through community health centres, and
sub-district and district hospitals.
98% targeted girls completing the prescribed two doses, less than 1% ofvaccine being
wasted. Minor adverse events were documented in 28 girls
• Phase II
Started in 2017
99% targeted girls completed treatment
22. What about other countries
Denmark
Initially vaccine uptake was 80-90% (started in 2009)
From 2014, the uptake dropped to below 40% due to negative publicity
No link between adverse effects found
“Stop HPV, Stop Cervical Cancer” campaign started
Vaccination picked up from 27% in 2016 to 76% in 2018
• Similar case with Ireland
23. Can it Prevent other HPV related diseases?
Gardasil 9 is licensed for
prevention of HPV-related
cervical, vaginal and vulvar
cancers in females and HPV-
related anogenital lesions and
anal cancers in males and females
24. Conclusion
• Vaccination is the most practical solution.
• Although Misinformation and confusion surround the safety, duration of immunity, validity,
effectiveness, and cost-effectiveness exists even after so much evidence.
• Worldwide and nation studies have refuted the doubts over safety and efficacy again and again.
• State-wise introduction of HPV vaccination in Sikkim, Punjab and opportunistic vaccination in
Delhi are encouraging signs of government engagement
• Leading international (UICC/GACVS/FDA) and national health organisations continue to
recommend their use.
• It’s apt time to put all doubts to rest and introduce vaccination in Universal Immunization
Programme.
The five deaths in Andhra Pradesh were determined to be due to poisoning (n=2), drowning (n=1), malaria (n=1), and pyrexia of unknown origin (n=1); fever started 96 days after the third dose of the vaccine in the last case. In Gujarat, one girl died due to malaria and another due to a snake bite