This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
The document discusses the management of Wilms' tumor, a type of kidney cancer that typically affects children. It covers the history, epidemiology, pathogenesis, pathology, clinical features, workup, staging, and treatment approaches for Wilms' tumor. Treatment typically involves surgical removal of the tumor, followed by chemotherapy and sometimes radiation therapy, with the goal of eliminating both the primary tumor and any metastases in a multidisciplinary, stage-adapted approach.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
Wilms tumor, also known as nephroblastoma, is the most common malignant renal tumor of childhood. It develops from embryonic kidney tissue and accounts for 6-7% of childhood cancers. The tumor is usually diagnosed before age 5 and may be detected via abdominal mass or hematuria. Staging involves imaging like CT or MRI to determine extent. Prognosis depends on histology and stage. Treatment typically involves nephrectomy followed by chemotherapy, with radiation sometimes used. Late effects can include growth issues, infertility, and second cancers. Long term follow up is important after treatment ends.
Wilm's tumor is the most common renal malignancy in children. It typically presents as a painless abdominal mass in children around 3 years old. Imaging such as ultrasound and CT are used to evaluate the tumor extent and presence of metastases. The tumor is staged surgically, with higher stages indicating a worse prognosis. Histology is also important, as the presence of anaplasia predicts a poorer outcome. Genetic conditions like WAGR and Denys-Drash syndromes increase the risk of developing Wilm's tumor. Treatment involves surgery, chemotherapy, and sometimes radiation therapy.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document summarizes the management of testicular tumors. It begins by stating that testicular tumors are relatively rare but most curable solid neoplasms. It then describes the lymphatic drainage patterns and WHO classification of different tumor types. The staging system and general management approaches are outlined, including radical orchidectomy surgery, surveillance, radiotherapy using external beam radiation, and chemotherapy regimens. Radiotherapy is indicated as adjuvant therapy for early stages, while chemotherapy is used for advanced stages. Close follow up after initial treatment is recommended to monitor for recurrence or side effects.
The document discusses the management of Wilms' tumor, a type of kidney cancer that typically affects children. It covers the history, epidemiology, pathogenesis, pathology, clinical features, workup, staging, and treatment approaches for Wilms' tumor. Treatment typically involves surgical removal of the tumor, followed by chemotherapy and sometimes radiation therapy, with the goal of eliminating both the primary tumor and any metastases in a multidisciplinary, stage-adapted approach.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
Wilms tumor, also known as nephroblastoma, is the most common malignant renal tumor of childhood. It develops from embryonic kidney tissue and accounts for 6-7% of childhood cancers. The tumor is usually diagnosed before age 5 and may be detected via abdominal mass or hematuria. Staging involves imaging like CT or MRI to determine extent. Prognosis depends on histology and stage. Treatment typically involves nephrectomy followed by chemotherapy, with radiation sometimes used. Late effects can include growth issues, infertility, and second cancers. Long term follow up is important after treatment ends.
Wilm's tumor is the most common renal malignancy in children. It typically presents as a painless abdominal mass in children around 3 years old. Imaging such as ultrasound and CT are used to evaluate the tumor extent and presence of metastases. The tumor is staged surgically, with higher stages indicating a worse prognosis. Histology is also important, as the presence of anaplasia predicts a poorer outcome. Genetic conditions like WAGR and Denys-Drash syndromes increase the risk of developing Wilm's tumor. Treatment involves surgery, chemotherapy, and sometimes radiation therapy.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document summarizes the management of testicular tumors. It begins by stating that testicular tumors are relatively rare but most curable solid neoplasms. It then describes the lymphatic drainage patterns and WHO classification of different tumor types. The staging system and general management approaches are outlined, including radical orchidectomy surgery, surveillance, radiotherapy using external beam radiation, and chemotherapy regimens. Radiotherapy is indicated as adjuvant therapy for early stages, while chemotherapy is used for advanced stages. Close follow up after initial treatment is recommended to monitor for recurrence or side effects.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
Hepatoblastoma- Investigations and managementARJUN MANDADE
This document summarizes information about hepatoblastoma, a rare type of liver cancer that mostly affects young children. It discusses the history and terminology of hepatoblastoma. Key points include: hepatoblastoma typically affects children under 3 years old and accounts for about 1% of childhood cancers. Complete surgical resection is the main treatment when possible but less than 50% of patients are resectable at diagnosis. The addition of cisplatin-based chemotherapy has improved outcomes by increasing resectability. Prognosis remains suboptimal for patients with unresectable or metastatic disease after chemotherapy. Chemoembolization and liver transplantation are promising alternative treatments in these cases.
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
Bladder cancer is the 7th most common cancer in the US. In 2014, there were 74,690 new cases and 15,580 deaths. Bladder cancer is more common in men than women. Risk factors include smoking, family history, occupational chemical exposure, and bladder infections. Symptoms include blood in the urine, frequent urination, and pain during urination. Diagnosis involves cystoscopy and biopsy. Staging uses CT, MRI, and PET scans to determine if the cancer has invaded the bladder wall or spread. Higher stage and grade cancers have a worse prognosis. Treatment and survival depend on the stage, with 5-year survival rates ranging from 96% for stage 0 to 5.5% for stage IV cancer
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is the third most commonly diagnosed cancer worldwide. Risk factors include increasing age, family history, inflammatory bowel disease, lifestyle factors like obesity and smoking. Screening is recommended regularly beginning at age 50 to detect cancers early. Staging uses the TNM system and treatment depends on stage but commonly includes surgery along with chemotherapy and radiation for later stages. The document provides detailed information on epidemiology, risk factors, stages, diagnosis, treatment and screening guidelines for colorectal cancer.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
This document summarizes renal cell carcinoma (RCC), the most common type of kidney cancer. Key points include:
- RCC originates in the renal cortex and arises mostly from the upper pole of the kidney.
- Common subtypes include clear cell, papillary, and chromophobe carcinomas.
- Risk factors include male sex, older age, smoking, obesity, and genetic conditions like von Hippel-Lindau syndrome.
- Symptoms may include hematuria, flank pain, and palpable flank mass. Imaging like CT and MRI are used to diagnose and stage disease.
- Treatment depends on stage but typically involves surgical removal (radical or partial nephrectomy
This document discusses lobular carcinoma in situ (LCIS), a non-invasive breast cancer characterized by small, uniform cells that have expanded into the lobules of the breast but not beyond. It is classified into classic LCIS and pleomorphic LCIS subtypes based on pathology. Diagnosis involves diagnostic tests like mammography and biopsy. Management options according to NCCN guidelines include surgical excision, chemoprevention, and increased surveillance depending on risk factors and biopsy results. Large clinical trials on tamoxifen chemoprevention for LCIS are described.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Lymphomas originate from cells of the lymphoid tissue. They are divided into Hodgkin's and non-Hodgkin's lymphomas. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It commonly presents with peripheral lymphadenopathy and B symptoms. Diagnosis involves biopsy and imaging. Staging involves the Ann Arbor or Cotswolds classification. Treatment involves chemotherapy, radiation therapy or a combination based on prognostic factors. Complications can include pneumonitis, cardiomyopathy, secondary cancers and gonadal dysfunction.
1) Short term ADT added to radiation therapy improved outcomes for intermediate risk prostate cancer, while long term ADT showed benefits in high risk disease based on multiple trials.
2) The AFFIRM trial showed that enzalutamide improved median survival to 18.4 months compared to 13.6 months for placebo in metastatic CRPC patients after docetaxel failure.
3) The COU-AA-301 trial found that abiraterone acetate plus prednisone improved median survival to 15.8 months compared to 11.2 months for placebo in metastatic CRPC patients after docetaxel failure.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document provides an overview of carcinoma of the thyroid gland, including epidemiology, causes and risk factors, classification, clinical presentation, diagnosis, and management. Some key points include:
- Papillary carcinoma is the most common type, accounting for around 80% of cases.
- Risk factors include radiation exposure, family history, and chronic iodine deficiency.
- Clinical presentation varies depending on the type but commonly includes a neck mass or lymph node enlargement.
- Diagnosis involves laboratory tests, imaging like ultrasound, and fine needle aspiration biopsy.
- Treatment options include surgery, radioactive iodine therapy, chemotherapy, and radiation therapy. Surgical management depends on factors like tumor size and
Tumor lysis syndrome is an oncologic emergency caused by massive tumor cell lysis and release of potassium, phosphate, and nucleic acids into circulation. It often occurs after initiation of cytotoxic therapy in patients with high-grade lymphomas or ALL who have a large tumor burden or high proliferative rate. This can result in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and acute kidney injury due to uric acid precipitation in renal tubules. Aggressive hydration, allopurinol or rasburicase to reduce uric acid, phosphate binders, and renal replacement therapy if needed are used to treat and prevent tumor lysis syndrome.
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
The document discusses Superior Vena Cava Syndrome (SVCS), which results from obstruction of blood flow through the Superior Vena Cava (SVC). SVCS was first described in 1757 and was historically caused by non-malignant processes, but malignancy is now the most common cause. The obstruction causes venous congestion and symptoms like face/neck swelling, cough, and dilated chest veins. Treatment depends on symptom severity and the underlying cause, with stenting used for life-threatening cases and management of malignancy for non-emergency cases.
The document summarizes a randomized controlled trial that compared neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer. 368 patients were randomized to either neoadjuvant chemoradiotherapy consisting of carboplatin, paclitaxel and radiotherapy followed by surgery, or surgery alone. The primary outcome was overall survival, with secondary outcomes including progression-free survival and progression-free interval. After a minimum follow-up of 5 years, long-term results demonstrated improved overall and progression-free survival for patients who received neoadjuvant chemoradiotherapy prior to surgery compared to surgery alone.
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
Hepatoblastoma- Investigations and managementARJUN MANDADE
This document summarizes information about hepatoblastoma, a rare type of liver cancer that mostly affects young children. It discusses the history and terminology of hepatoblastoma. Key points include: hepatoblastoma typically affects children under 3 years old and accounts for about 1% of childhood cancers. Complete surgical resection is the main treatment when possible but less than 50% of patients are resectable at diagnosis. The addition of cisplatin-based chemotherapy has improved outcomes by increasing resectability. Prognosis remains suboptimal for patients with unresectable or metastatic disease after chemotherapy. Chemoembolization and liver transplantation are promising alternative treatments in these cases.
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
Bladder cancer is the 7th most common cancer in the US. In 2014, there were 74,690 new cases and 15,580 deaths. Bladder cancer is more common in men than women. Risk factors include smoking, family history, occupational chemical exposure, and bladder infections. Symptoms include blood in the urine, frequent urination, and pain during urination. Diagnosis involves cystoscopy and biopsy. Staging uses CT, MRI, and PET scans to determine if the cancer has invaded the bladder wall or spread. Higher stage and grade cancers have a worse prognosis. Treatment and survival depend on the stage, with 5-year survival rates ranging from 96% for stage 0 to 5.5% for stage IV cancer
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is the third most commonly diagnosed cancer worldwide. Risk factors include increasing age, family history, inflammatory bowel disease, lifestyle factors like obesity and smoking. Screening is recommended regularly beginning at age 50 to detect cancers early. Staging uses the TNM system and treatment depends on stage but commonly includes surgery along with chemotherapy and radiation for later stages. The document provides detailed information on epidemiology, risk factors, stages, diagnosis, treatment and screening guidelines for colorectal cancer.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
This document summarizes renal cell carcinoma (RCC), the most common type of kidney cancer. Key points include:
- RCC originates in the renal cortex and arises mostly from the upper pole of the kidney.
- Common subtypes include clear cell, papillary, and chromophobe carcinomas.
- Risk factors include male sex, older age, smoking, obesity, and genetic conditions like von Hippel-Lindau syndrome.
- Symptoms may include hematuria, flank pain, and palpable flank mass. Imaging like CT and MRI are used to diagnose and stage disease.
- Treatment depends on stage but typically involves surgical removal (radical or partial nephrectomy
This document discusses lobular carcinoma in situ (LCIS), a non-invasive breast cancer characterized by small, uniform cells that have expanded into the lobules of the breast but not beyond. It is classified into classic LCIS and pleomorphic LCIS subtypes based on pathology. Diagnosis involves diagnostic tests like mammography and biopsy. Management options according to NCCN guidelines include surgical excision, chemoprevention, and increased surveillance depending on risk factors and biopsy results. Large clinical trials on tamoxifen chemoprevention for LCIS are described.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Lymphomas originate from cells of the lymphoid tissue. They are divided into Hodgkin's and non-Hodgkin's lymphomas. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It commonly presents with peripheral lymphadenopathy and B symptoms. Diagnosis involves biopsy and imaging. Staging involves the Ann Arbor or Cotswolds classification. Treatment involves chemotherapy, radiation therapy or a combination based on prognostic factors. Complications can include pneumonitis, cardiomyopathy, secondary cancers and gonadal dysfunction.
1) Short term ADT added to radiation therapy improved outcomes for intermediate risk prostate cancer, while long term ADT showed benefits in high risk disease based on multiple trials.
2) The AFFIRM trial showed that enzalutamide improved median survival to 18.4 months compared to 13.6 months for placebo in metastatic CRPC patients after docetaxel failure.
3) The COU-AA-301 trial found that abiraterone acetate plus prednisone improved median survival to 15.8 months compared to 11.2 months for placebo in metastatic CRPC patients after docetaxel failure.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document provides an overview of carcinoma of the thyroid gland, including epidemiology, causes and risk factors, classification, clinical presentation, diagnosis, and management. Some key points include:
- Papillary carcinoma is the most common type, accounting for around 80% of cases.
- Risk factors include radiation exposure, family history, and chronic iodine deficiency.
- Clinical presentation varies depending on the type but commonly includes a neck mass or lymph node enlargement.
- Diagnosis involves laboratory tests, imaging like ultrasound, and fine needle aspiration biopsy.
- Treatment options include surgery, radioactive iodine therapy, chemotherapy, and radiation therapy. Surgical management depends on factors like tumor size and
Tumor lysis syndrome is an oncologic emergency caused by massive tumor cell lysis and release of potassium, phosphate, and nucleic acids into circulation. It often occurs after initiation of cytotoxic therapy in patients with high-grade lymphomas or ALL who have a large tumor burden or high proliferative rate. This can result in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and acute kidney injury due to uric acid precipitation in renal tubules. Aggressive hydration, allopurinol or rasburicase to reduce uric acid, phosphate binders, and renal replacement therapy if needed are used to treat and prevent tumor lysis syndrome.
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
The document discusses Superior Vena Cava Syndrome (SVCS), which results from obstruction of blood flow through the Superior Vena Cava (SVC). SVCS was first described in 1757 and was historically caused by non-malignant processes, but malignancy is now the most common cause. The obstruction causes venous congestion and symptoms like face/neck swelling, cough, and dilated chest veins. Treatment depends on symptom severity and the underlying cause, with stenting used for life-threatening cases and management of malignancy for non-emergency cases.
The document summarizes a randomized controlled trial that compared neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer. 368 patients were randomized to either neoadjuvant chemoradiotherapy consisting of carboplatin, paclitaxel and radiotherapy followed by surgery, or surgery alone. The primary outcome was overall survival, with secondary outcomes including progression-free survival and progression-free interval. After a minimum follow-up of 5 years, long-term results demonstrated improved overall and progression-free survival for patients who received neoadjuvant chemoradiotherapy prior to surgery compared to surgery alone.
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
1. Nephroblastoma, also known as Wilms tumor, is the most common renal malignancy in children. It typically presents as an abdominal mass and can metastasize to lungs, liver, and bone.
2. Treatment involves nephrectomy followed by chemotherapy based on stage and histology. Radiation therapy may be given for local control in certain high risk cases.
3. With multimodal therapy, the cure rate for Wilms tumor is now over 90%. Ongoing surveillance is important due to risk of recurrence or secondary tumors.
This document discusses the management of ovarian cancer. It covers risk-reducing salpingo-oophorectomy (RRSO) for high-risk patients, surgical staging techniques including open and minimally invasive approaches, management of early-stage disease including adjuvant chemotherapy and radiation, cytoreductive surgery and goals for advanced-stage disease, and the role of interval debulking surgery after neoadjuvant chemotherapy. Complete resection of all tumor is the optimal outcome for advanced ovarian cancer to improve survival outcomes.
Radiotherapy plays an important role in the management of urinary bladder cancers. It can be used as part of bladder-preserving protocols for muscle-invasive bladder cancer or as palliative treatment in elderly patients. Combined modality treatment with transurethral resection and concurrent chemoradiotherapy provides 5-year overall survival of 50-65% and bladder preservation in 38-43% of patients. External beam radiotherapy is typically delivered with a 4-field box technique to the whole pelvis at 45-50 Gy followed by a bladder boost to 60-65 Gy.
This document provides an overview of rectal carcinoma. It discusses the epidemiology, risk factors, clinical presentation, investigations, staging, and treatment options. Rectal carcinoma is the third most common cause of cancer deaths in the USA, with over 150,000 new cases diagnosed annually. Treatment may involve local excision, low anterior resection, abdominoperineal resection, or multivisceral resection depending on the stage, size, and location of the tumor. Total mesorectal excision and adjuvant chemoradiation are important to reduce local recurrence rates.
This document provides an overview of colorectal carcinoma, including its anatomy, genetics, risk factors, screening, diagnosis, staging, and treatment strategies. Some key points:
- Colorectal cancer is one of the most common cancers worldwide. Proximal colon cancer is usually related to microsatellite instability, while distal colon cancer is associated with chromosomal instability.
- Risk factors include diet, smoking, inflammation. Screening includes fecal occult blood tests and endoscopy starting at age 50.
- Staging involves examining tumor depth, lymph node involvement, and metastasis. Treatment depends on stage but generally involves surgical resection with or without chemotherapy or radiation. The goal is sphincter preservation for rectal cancers
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
The most common type of cancer arising in the kidney: Renal cell carcinoma(RCC)(also known as Hypernephroma or Grawitz tumor).
Renal cell carcinoma accounts for over 3% of all adult malignancies and has several histological subtypes.
Approximately 85% of kidney tumors are renal cell carcinoma, and approximately 70% of these have a Clear cell histology. Its diagnostic work-up, staging and management.
A 17-year-old male presents with a 3-month history of heaviness in his right scrotum without a history of trauma. On examination, he has a painless enlargement of the right testis and a palpable intra-abdominal mass. The clinical diagnosis is a painless solid testicular swelling, which is considered a testicular tumor unless proven otherwise. Further investigations including tumor markers, imaging, and staging are required to determine the appropriate multimodal treatment approach using surgery, chemotherapy, and/or radiotherapy.
This document provides information on the management of carcinoma of the stomach. It discusses the anatomy, epidemiology, risk factors, pathology, diagnostic workup including imaging and staging, prognostic factors, and treatment options including surgery, chemotherapy, and radiation therapy. The treatment strategies have evolved over time with various clinical trials investigating neoadjuvant and adjuvant approaches.
Small cell lung cancer (SCLC) accounts for 15-20% of lung cancers. It is an aggressive disease with rapid growth and early metastasis. The median survival is 2-4 months without treatment. Pathology shows dense sheets of small cells with scant cytoplasm and frequent mitoses. Immunohistochemistry markers include CD56, chromogranin, and synaptophysin. SCLC commonly causes paraneoplastic syndromes. Treatment involves chemotherapy with cisplatin and etoposide combined with early, accelerated thoracic radiotherapy to improve survival outcomes. Prognosis remains poor, especially in extensive stage disease.
The document discusses the anatomy and functions of the soft palate, including its role in separating the nasopharynx from the oropharynx and in speech, swallowing, and respiratory functions. It then provides statistics on the annual incidence of oral cancer worldwide and risk factors such as tobacco, alcohol, HPV infection, and poor oral hygiene. The stages of oral cancer are described based on tumor size and spread.
Saliva is composed primarily of water and electrolytes and is produced daily in quantities of 0.5-1 liters. There are 3 major salivary glands - parotid, submandibular, and sublingual glands. The parotid gland is the largest salivary gland and is located behind the ramus of the mandible. Treatment for salivary gland tumors involves surgical excision followed by radiation therapy depending on tumor stage, grade, margins, and lymph node involvement. Post-operative radiation improves local control for tumors with adverse features.
The document discusses breast-conserving treatment for early-stage breast cancer. Breast-conserving treatment, including wide local excision of the tumor, axillary lymph node dissection, and breast irradiation, is now the standard of care for most women with early-stage invasive breast cancer. Ideal candidates for breast-conserving treatment have unicentric primary tumors less than 4-5 cm in diameter. Contraindications include positive margins, advanced or multicentric disease, pregnancy, and prior radiation. The addition of a radiation boost to the tumor bed after whole breast irradiation reduces the risk of local recurrence. Hypofractionated regimens have been shown to be as effective as conventional fractionation with shorter treatment times.
1) The document discusses various techniques for radiation therapy treatment planning and delivery for breast cancer, including tangential field planning, supraclavicular field matching, electron boosts, and accelerated partial breast irradiation.
2) Techniques for accelerated partial breast irradiation discussed include multi-catheter interstitial brachytherapy, balloon-based brachytherapy using devices like Mammosite, and external beam radiation therapy.
3) Factors that determine suitability for accelerated partial breast irradiation include patient age, tumor size and characteristics, and nodal involvement. Dosage schedules and advantages and disadvantages of different techniques are also reviewed.
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Pre management of carcinoma urinary bladdervrinda singla
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2. Introduction
Also known as Nephroblastoma
Most common primary malignant renal tumor of
childhood
2nd most common malignant abdominal tumor in
childhood
Perez and Brady’s Principles and Practice of Radiation Oncology (sixth edition)
3. EPIDEMIOLOGY
6% of pediatric malignancies
More than 95% of kidney tumors in children
Incidence : 8 cases per 1 million children (<15 years)
Mean age : 3-4 yr of age
Bilateral WTs : 7%
Multifocal in single kidney : 12%
Perez and Brady’s Principles and Practice of Radiation Oncology (sixth edition)
4. Genetics and molecular biology
Chromosome 11p13 (WT-1 gene):
WAGR syndrome (gene deletions)
Denys Drash Syndrome (point mutations)
Chromosome 11q15(WT- 2 gene):
Beckwith -Wiedemann Syndrome (gene deletions)
Loss of heterozygosity (LOH) at 16q and 1p
Wilms tumor suppressor gene on the X chromosome, WTX
Perez and Brady’s Principles and Practice of Radiation Oncology (sixth edition)
8. Gross pathology
Large tumor compressing
the normal renal
parenchyma
Intact fibrous capsule with
prominent veins
Yellowish color with
heterogeneous appearance
– hemorrhagic/cystic areas.
9.
10. Anaplasia
3 cytological abnormalities:
o Hyperdiploid mitotic figures
o Nuclear enlargement (3x or more)
o Hyperchromasia
Diffuse or Focal : even in one or two foci is enough to impart a
markedly worse prognosis
These changes are associated with high rates of relapse and
death
11. Nephrogenic Rests
Foci of abnormally persistent embryonal tissue
Present in up to 36% of kidneys which develop
unilateral WT and almost 100% of kidneys
involved by bilateral WT.
Intralobar nephrogenic rests
Perilobar nephrogenic rests
12. Clinical Features
● Abdominal lump (60-70%) : smooth, firm, non
tender mass on one side of abdomen
● Other symptoms:
– Hematuria (25%)
– Hypertension
– Fever
13. Pretreatment Work Up (COG)
History : Record pre-existing conditions, family history of
cancer, or congenital defects
Physical examination :Blood pressure, weight, height, presence
of abdominal masses, congenital anomalies particularly
genitourinary, hemihypertrophy, and aniridia
Laboratory : Hemoglobin, white cell and differential counts,
platelets, urinalysis, serum blood urea nitrogen, creatinine,
protein and aspartate aminotransferases, alkaline
phosphatase, bilirubin
14. Pretreatment Work Up
Radiology : CT or MRI scan of the abdomen and pelvis,
abdominal ultrasonography, chest CT scan, chest x-ray
Bone scan and MRI of the brain (CCSK , RTK, and renal cell
carcinoma)
20. Comparison of diagnostic performance of CT and MRI
for abdominal staging of pediatric renal tumors: a
report from the Children's Oncology Group
Servaes et al
Feb 2015
CT and MRI have similar diagnostic performance for detection
of lymph node metastasis and capsular penetration. MR
detected more contralateral synchronous lesions; however
these were present in a very small number of cases. Either
modality can be used for initial loco–regional staging of
pediatric renal tumors.
21. Children’s Oncology Group Staging of Wilms’Tumor ,
Rhabdoid Tumor and Clear Cell Sarcoma of the Kidney
Stage I: Tumor limited to kidney, completely resected.
The renal capsule is intact.
The tumor was not ruptured or biopsied prior to
removal.
The vessels of the renal sinus are not involved.
There is no evidence of tumor at or beyond the
margins of resection.
22. Stage II:
The tumor is completely resected and there is no evidence of
tumor at or beyond the margins of resection.
The tumor extends beyond kidney, as is evidenced by any one
of the following criteria:
There is regional extension of the tumor (i.e., penetration of
the renal capsule or extensive invasion of the soft tissue of the
renal sinus)
Blood vessels within the nephrectomy specimen outside the
renal parenchyma, including those of the renal sinus, contain
tumor.
23. Stage III:
Residual non hematogenous tumor present following surgery and confined to
abdomen. Any one of the following may occur:
Lymph nodes within the abdomen or pelvis are involved by tumor.
The tumor has penetrated through the peritoneal surface
Gross or microscopic tumor remains postoperatively
The tumor is not completely resectable because of local infiltration into
vital structures
Tumor spillage occurring either before or during surgery
The tumor was biopsied before removal
24. Stage IV :Haematogenous metastases (i.e., lung, liver,
bone, brain) or lymph node metastases outside the
abdomino pelvic region
Stage V: Bilateral renal involvement by tumor is
present at diagnosis.
25. Multimodality Management
● Wilms Tumors are highly chemo and radiosensitive
● Tumor stage and histology are the main prognostic indicators that
determine the treatment regimen
● Surgery and chemotherapy comprise the main therapy for Wilms
tumors, with the addition of radiation for metastatic or histologically
aggressive tumors.
26. Surgery
● Primary method for achieving local control
● Transverse transabdominal, transperitoneal incision
● The standard procedure includes:
– Unilateral radical nephrectomy
– Selective sampling of nodes : para-aortic, celiac, and iliac areas
– Renal vein and IVC should be palpated to exclude intravascular tumor
extension
– Routine exploration of the contralateral kidney is not necessary if
imaging is satisfactory and does not suggest a bilateral process.
● The use of titanium clips to identify residual tumor and margins of
resection is also recommended
27. Role of nephron-sparing surgery
– Indicated in bilateral Wilms tumor
– WT in patients with genetic predisposition
– WT in solitary functional kidney / renal failure
– Very young infants < 6 months age
DeVita, Hellman, and Rosenberg’s Cancer Principles & Practice of Oncology
10th edition
28. Neoadjuvant Chemotherapy
● Solitary kidney
● Bilateral renal tumors
● Tumor in a horseshoe kidney
● Tumor thrombus in the inferior vena cava above the
level of the hepatic veins
● Respiratory distress as a result of extensive metastatic
disease
DeVita, Hellman, and Rosenberg’s Cancer Principles & Practice of Oncology 10th edition
29. Stage I
Overall Survival : 92 -95%
Patients in this stage group can be spared radiation
therapy and given adjuvant chemotherapy
EE4A regimen -18 week course of Vincristine &
Actinomycin D
Rhabdoid tumors - RTK regimen ( Carboplatin,
Etoposide, Cyclophosphamide, MESNA with GCSF
support)
30. Stage II
Overall Survival : 89-92%
FH & FA : EE4A regimen and radiation can be avoided.
UH : Regimen I (Vincristine, Doxorubicin,
Cyclophosphamide, MESNA, Etoposide)
Radiation therapy : DA, CCSK, RTK
Patients with Rhabdoid histology are treated with
Regimen RTK
31. Stage III
Overall Survival : 70 – 88%
DD4A regimen : Dactinomycin, Vincristine,
Doxorubicin over 24 weeks
All patients irrespective of histology should receive
flank radiation in this stage (Dose recommended is
10.8 Gy in 1.8 Gy per fraction with optional boost of
10.5 Gy)
32. Stage IV
Primary surgery even in the setting of metastatic disease if the disease is
operable with the provision that chemotherapy is started at week 0.
Alternative approach is to go for neoadjuvant chemotherapy
In patients with FH/ FA the DD4A regimen is used while the regimen I is
used in presence of CSSK / DA.
In patients with RTK – RTK regimen is used.
Radiation therapy is to be delivered as per the local stage but a minimum
dose of 10.8 Gy to the flank is given.
RT is also indicated in other metastatic sites
33. Bilateral Wilms Tumor
● Account for 7% of all WT
● Both sides staged separately
● Metachronous tumors are worse than synchronous
● Overall survival rates 78%.
Initial open biopsy / Trucut
biopsy and staging
Downstaging with
Chemotherapy
Bench Surgery
Partial nephrectomy
NWTS-3 , NWTS -4
34. Radiation Timing
● Important information from the NWTS 3 / 4 trial
● Showed that radiation therapy delay by more than
10 days may result in increased risk of recurrence.
● NWTS 1 showed that if RT was initiated after 10 days
there was a 10% risk of local relapse especially in
patients with UFH
35. Flank Radiation
● Parallel opposed field
● Supine
● Planning target volume : Tumor bed (outline of the kidney and
associated tumor on the initial CT or MRI) with a 1-cm margin
● The medial border must cross the midline to include the entire
width of the vertebrae
● Beam energy: 4-6 MV
● Dose : 10.8 Gy in 1.8 Gy per fraction over 6 fractions.
36. Flank Radiation: Manual
● Superior border: 1 cm above the line between
the lower border of body of sternum and
transpyloric plane
● Inferior border: Kept along a line passing
through the transtubercular plane
● Medial border: Kept 1.5 - 2 cm across the
midline to encompass the vertebral bodies
● Lateral border: Kept open
37. Flank radiation
● Anteroposterior flank irradiation
portal showing inclusion of the
entire width of the vertebral body in
the irradiated volume.
● The outline of the right kidney (RK)
and the WT from the preoperative
computed tomography scan is
shown
38. Whole Abdomen Radiation
● Indications:
– Peritoneal implants
– Tumor spillage during surgery
– Preoperative tumor rupture
● Dose prescribed is 10.8 Gy in 1.5 Gy / # - this can be
followed by a selected boost of 10.5 Gy to the Tumor
bed.
● Energy : 4-6 MV photons
39. WAR Manual Marking
● Superior border:
– At the upper border of the
nipples
● Inferior border:
– Superior border of the
symphysis pubis
● Shielding of acetabulum and
femoral heads
40. WAR: Simulator markings
● Superior border:
– Extend to the level of dome of
diaphragm
● Inferior border:
– To the level of inferior border of the
obturator foramen.
● Lateral border:
– Extends to the lateral peritoneal
reflection
● Acetabular head and the femoral head
shielded to prevent slipped femoral
epiphyses
41. Lung Bath: Manual
● Superior border:
– 3cm above the clavicle
● Inferior border:
– Below the xiphisternum
● Lateral borders:
– Lateral border of nipples
42. Lung bath: Simulator marking
● Superior border:
– Extends above the superior
border of the lateral edge of
clavicle
● Inferior border:
– Below extends to level of L1
(transpyloric plane)
– Field border is kept 1 cm
below the costophrenic
angles
● Shielding for humeral head
necessary.
43. Other recommended doses
● Lung Mets : 12Gy WLI in 8#
● Brain Mets : 30.6 Gy whole brain in 17 fractions Or 21.6
Gy to whole brain followed by 10.8Gy IMRT/ stereotactic
boost
● Liver mets : 19.8Gy whole liver in 11#
● Bone Mets :25.2 Gy to the lesion plus 3-cm margin
● Unresected Nodal Mets : 19.8 Gy
Children’s Oncology Group Renal Tumor Protocol Radiation Therapy Gui delines
44. Relapsed / Refractory WT
● The most frequent site of relapse overall is the lungs
● Good prognosis in relapse:
– Tumors with favourable histology
– Recurred only in the lungs
– Relapse in the abdomen where radiotherapy had not been
included in the primary treatment
– Relapse that occurred more than 12 months from diagnosis.
45. RT for Recurrent Abdominal
Tumors
● 12.6–18 Gy (<12 months)
● 21.6 Gy (older children, previous RT ≤10.8
Gy)
● Boost dose of 9 Gy to gross residual tumor
Children’s Oncology Group Renal Tumor Protocol Radiation Therapy Gui delines
46. First National Wilms Tumor Study
(1969–1974)
Postoperative RT was not necessary for children younger than
2 years of age with group I tumors
Combined dactinomycin and vincristine for irradiated patients
with group II and III tumors was better than therapy with
either agent alone.
The RFS with and without RT among patients with group I
tumors younger than 2 years of age was 90% and 88%,
respectively
47. Second National Wilms Tumor Study
(1974–1979)
In patients with group I tumors there was no survival
difference between 6 months or 15 months of dactinomycin
plus vincristine.
Patients with groups II to IV tumors had a superior 2-year RFS
of 77% with doxorubicin, dactinomycin, and vincristine
compared with 63% with dactinomycin and vincristine alone.
48. Third National Wilms Tumor Study
(1979–1985)
RT and doxorubicin could be eliminated in children with
stage II FH tumors.
Patients with stage III FH tumors who received
doxorubicin or 20 Gy had fewer abdominal relapses than
those receiving 10 Gy without doxorubicin
The addition of cyclophosphamide in high-risk patients
did not improve outcomes
49. Fourth National Wilms Tumor
Study (1986–1994)
The results proved that the survival was similar
among patients who received standard-course (5
days) or single-dose, pulse-intensive dactinomycin
chemotherapy.
Further, pulse intensive therapy was associated with
less hematologic toxicity and marked reduction of
treatment costs.
50. Fifth National Wilms Tumor Study
(1995–2001)
It was a non randomized study to evaluate the prognostic
factors involved in WT
LOH at Chr 1p and 16q were significant in determining an
adverse prognosis.
51. Differential Diagnosis of Lump
Abdomen in a child
Benign
Hydronephrosis
Polycystic disease
Splenomegaly (left
sided tumors)
Malignant
Neuroblastoma
NHL
Rhabdomyosarcoma
Germ Cell Tumor
Hepatoblastoma
Symptoms
* Large newborn (LGA, large for gestational age)
* Large tongue, prominent eyes
* Creases in ear lobes
* External ear (pinna) abnormalities and low-set ears
* Abdominal wall defect: umbilical hernia or omphalocele
* Separated abdominal muscles (diastasis recti)
* Undescended testicles (cryptorchidism)
* Low blood sugar (hypoglycemia)
* Poor feeding, Lethargy. Seizures
* Enlargement of some organs and tissues : Kidney Liver and Spleen
Special Points:
The overall risk of childhood malignancy in BWS has been estimated to be 4–21%.
Wilms tumour is the most frequently reported tumour, affecting 1–8% of individuals.
Bilateral Wilms tumour (17%) and perilobar nephrogenic rests (60%) occur at increased frequency compared with unselected series of Wilms tumour patients (5% and 15%, respectively)
Large soft tissue opacity displacing bowel
Cystic v/s solid mass, doppler
Heterogeneous soft tissue density masses with infrequent areas of calcification and fat dense regions