05.08.2014

Adjuvant treatment for gastric cancer

Bladder cancer is the ninth most common cancer worldwide, 11 and among the most expensive to manage.
About 90% of bladder cancers diagnosed in developed countries are urothelial or transitional cell carcinomas i.e. NMIBC usually appears as papillary tumors (small growths that look like mushrooms) confined to the mucosa or sub-mucosa, but also includes flat lesions (i.e. Bladder cancer is the ninth most common cancer diagnosis worldwide, with more than 330,000 new cases each year and more than 130,000 deaths per year. Although the incidence of bladder cancer is relatively high, the mortality is relatively low. Bladder cancer is one of the most expensive cancers to manage, accounting for around 7% of total cancer expenditure in the US and this burden is comparable in other developed countries.
Women are diagnosed less often than men, but tend to have more advanced disease at diagnosis as a result of the fact that bladder cancer is less often suspected. Increasing evidence suggests that genetic predisposition has a significant influence on bladder cancer incidence.
Blood in the urine (hematuria) is the most common finding in non-muscle invasive bladder cancer.
The diagram above shows the staging of bladder cancer, according to the current tumor, node, metastasis (TNM) classification. It is important that bladder cancer is staged accurately as different management strategies are employed for non-muscle invasive bladder cancer compared with muscle invasive bladder cancer. In 1998, a new classification of non-invasive urothelial tumors was proposed by the World Health Organization (WHO) and the International Society of Urological Pathology (ISUP) and published by WHO in 2004. The prognostic value of both grading systems (WHO 1973 and 2004) has been confirmed, but attempts to demonstrate better prognostic value of one system over another have yielded controversial results. As outlined in the overall classification section, accurate diagnosis between non-muscle invasive bladder cancer and muscle invasive bladder cancer is very important as they are treated differently. During initial assessment, use of voided urine cytology or urinary markers is advocated to predict high-grade tumor before TURBT. TURBT is the gold standard method to confirm diagnosis and treat non-muscle invasive bladder cancer with adjuvant chemotherapy or Bacillus Calmette-Guerin (BCG) in high-grade tumors. Early diagnosis of non-muscle invasive bladder cancer is essential to ensure timely treatment, which in turn minimizes the risk of recurrence or progression to muscle invasive disease. The prognosis for non-muscle invasive bladder cancer is excellent, providing the disease is diagnosed and managed early; 5-year survival rate of 97% for the earliest stage tumors.
The EAU guidelines include key recommendations for the diagnosis of non-muscle invasive bladder cancer. At the time of the initial diagnosis of bladder cancer, computed tomography (CT) urography or IVU should be performed only in selected cases (e.g. Table footnote Evidence grade A = Based on clinical studies of good quality and consistency that addressed the specific recommendations, including at least one randomized trial. Blue-light cystoscopy allows more sensitive fluorescence-guided biopsy and resection than conventional procedures leading to an additional detection rate of 20% for all tumors and 23% for CIS.
TURBT is both a diagnostic and therapeutic technique and any suspicion of bladder cancer warrants this procedure. The goal of TURBT in Ta or T1 bladder tumors is to make the correct diagnosis and remove all visible lesions. As a result of inadequate diagnosis, patients require repeat procedures (cystoscopy and resection, with local or general anesthesia) to manage recurrent disease, further increasing the risk of surgical complications 62 and increased costs. Compared to white light cystoscopy alone, Hexvix® blue-light cystoscopy improves detection of non-muscle invasive bladder cancer because more lesions are detected, and improves removal of tumors during resection due to better visualization.12, 13 This results in an improved surgical outcome, leading to fewer residual tumors, 13, 15 and fewer short- and long-term recurrences. Following TURBT, adjuvant treatment options include early instillation chemotherapy (defined as chemotherapy within 6 hours of TURBT), further instillation chemotherapy, instillation of BCG, and radical cystectomy.
Table footnote: Evidence grade A = Based on clinical studies of good quality and consistency that addressed the specific recommendations, including at least one randomized trial. Clinical experience with the use of opioids for chronic, severe, non–malignant pain which is neuropathic in character suggests that there may be a sub–population of chronic severe pain patients who may clearly benefit from maintenance with opioid analgesics.
Find health and lifestyle advices & Get answers!Share real-life experiences with more than 250,000 community members! Prostate cancer treatment side effects Prostate cancer treatment is a thing that is planned to the smallest details. Slide 1: After a screening mammogram demonstrated an abnormality, a woman underwent a unilateral diagnostic mammogram demonstrating a cluster of coarse and fine pleomorphic calcifications with a linear distribution in the right breast at 10 o’clock posterior depth. Slide 2a: A screening mammogram demonstrated a partially speculated lesion on the craniocaudal view of the left breast.


Slide 2b: A post-lumpectomy mammogram demonstrated a 10-cm area consistent with postoperative changes. Slide 3: An ultrasound image demonstrating the hypoechoic appearance of an infiltrating ductal carcinoma.
Slide 4a: A stereotactic guided biopsy was performed for a concerning area of clustered pleomorphic calcifications located in the right breast that was previously seen on diagnostic mammogram. Slide 4b: A stereotactic guided biopsy was performed for a concerning area of clustered pleomorphic calcifications located in the right breast that was previously seen on diagnostic mammogram. Slide 6: Standard breast tangents for the treatment of an early-stage right-sided breast cancer after a lumpectomy. Slide 7a: An early-stage breast cancer was removed with lumpectomy from an 82-year-old female. Slide 7b: An early-stage breast cancer was removed with lumpectomy from an 82-year-old female. Slide 7c: An early-stage breast cancer was removed with lumpectomy from an 82-year-old female. Slide 8: An x-ray image of a wire-localized lumpectomy specimen demonstrating the presence of a biopsy clip and the terminal end of the wire. Slide 9: Planning CT scan of a patient lying in the “prone” position that allows the breast to fall away from the chest wall and improves radiation dose homogeneity for large breasts. Slide 10b: Planning CT scan demonstrating chest wall excursion with the deep inspiratory breath hold technique for treatment of a left-sided breast tumor to avoid dose to the heart. Hormonal therapy for treatment of breast cancer is the oldest and safest procedure for all phases of this cancer.
The question here is, does aromatase inhibitors toxicity account for lack of improved survival?
The result of this meta-analysis was that AIs demonstrated an increase in heart disease and bone fractures but had lower rates of blood clots and cancer of the uterus.
Basically, this analysis is showing that when aromatase inhibitors are used first there is no overall survival benefit however when tamoxifen is used first followed by AIs there is a reduction in AIs toxicity.
The take home message is that post-menopausal patients with ER+ (estrogen receptor positive) metastatic breast cancer respond well with aromatase inhibitors at least as well as tamoxifen but perhaps a little better.
This systematic study of the medical literature has brought to light that aromatase inhibitors have better efficacy and better toxicity profiles when used in second-line treatment than tamoxifen alone.
ARE YOU UNDERGOING TREATMENT?Pay it forward with your experience to help other visitors..Click To Share Your Story With Us! These types of surgical stomach cancer treatment options are normally performed in the latter stages when cure is not possible and provides a way of helping your nutrition. Radiotherapy is normally used as a palliative care treatment when cure is not an option. About Me May 03, 16 10:00 AMHello I'm Dr Peter Thatcher, MBBS (the equivalent of MD in the US), gastroenterologist and author of this website dedicated to stomach cancer awareness and education.
Stomach Cancer Jan 15, 16 10:10 AMIf you need stomach cancer or gastric carcinoma advice including causes, diagnosis, surgery, chemotherapy, awareness & survival rates, qualified help is here!
So far so good Jan 11, 16 04:04 PMI was diagnosed with stage 4 gastric cancer 13 months ago.
10 The good news is that it has a relatively low mortality when compared with other cancers, particularly when it is detected and treated early. 11 It is more common in older people and affects approximately four times the number of men than women.
Because of long-term survival and the need for lifelong routine monitoring and treatment, the cost per patient of bladder cancer from diagnosis to death ranges from US$96,000 to US$187,000 (2001 values) in the USA.
It is the arylamines (mainly 4-aminobiphenyl and other heterocyclic amines) in cigarette smoke that are the responsible carcinogens.
Ta or T1 tumors do not cause bladder pain and rarely present with lower urinary tract symptoms.
Its major contribution is a detailed histological description of the various grades, which uses specific cytological and architectural criteria. The majority of clinical trials published to date on Ta or T1 bladder tumors have been performed using the 1973 WHO classification, and therefore the current European Association of Urology (EAU) guidelines are based on this scheme.
Cystoscopy is recommended in all patients with symptoms suggestive of bladder cancer and cannot be replaced by cytology or by any other non-invasive test.
Evidence grade B = Based on well-conducted clinical studies, but without randomized clinical trials. Therefore, the treatment for this medical condition usually includes some androgen deprivation therapy, which stops production of testosterone.


22, 2011) published a report on AIs stating that toxicities associated with this drug may explain the lack o f survival improvement as compared to tamoxifen. There are also risks of stomach cancer surgery as well as long term consequences as you will read on the after stomach cancer surgery page.
Getting to know about the options available, the experience you can provide is invaluable to anyone embarking on therapy, whether surgical, chemotherapy or radiotherapy. 44 It is important that bladder cancer is classified accurately as either non-muscle invasive or muscle invasive bladder cancer due to the fact that these stages of urothelial cancers are managed quite differently. 3 The US National Cancer Institute estimates that there will be 72,570 new cases of bladder cancer in the US in 2013 and 15,210 deaths. Overall, bladder cancer is the fifth most expensive cancer in terms of total medical care expenditures, accounting for almost US$3.7 billion (2001 values) in direct costs. The risk is related to the metabolism of these carcinogens and a NAT2 (N-acetyltransferase 2) slow-acetylation genotype has been associated with increased risk of bladder cancer. Until the prognostic role of WHO 2004 is validated by more prospective trials, both classifications are currently used in practice.
Radical cystectomy is warranted in muscle invasive disease and systemic chemotherapy where there is evidence of metastases.
The most important risk factor for understaging T1 tumors is absence of muscle in the tissue which occurs in 30–50% of submitted specimens. Without testosterone, cancer cells grow more slowly or die.Hormone therapy (also called androgen deprivation therapy) is used in early stages of prostate cancer to shrink tumors before the treatments with radiation and surgery. Durogesic DTrans, may relieve intractable non–cancer neuropathic pain by its intrinsic analgesic effect. It is also used in advanced prostate cancer cases to slow the growth of the tumors and shrink them.
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Serious adverse events are rare in TURBT, but can include occasional bleeding and perforation (greater than 5%). Most often, acute pain is nociceptive, whereas chronic severe pain can be nociceptive, neuropathic or mixed in origin. Additionally, some patients may be recommended to use hormone therapy after the surgery or radiation treatment, as adjuvant therapy, because it is known to slow the growth of cancer cells that may have been left behind the previous treatments.Hormone Medications for Prostate CancerTreatment for prostate cancer may include two different types of drugs, such as medications designed to stop production of testosterone in the body and medication which block testosterone to reach cancer cells (anti-androgens).
Surgical removal of the testicles (orchiectomy) is another option available for prostate cancer patients, but the procedure is permanent and irreversible.Luteinizing hormone releasing hormone (LHRH) agonists are common treatment for prostate cancer and these drugs work by stopping production of testosterone in testicles.
There are injections and implants of LHRH agonists available on the market and they can be used once per month or even once per year, depending on the every specific patient’s needs. Figure of WHO analgesic ladderThe WHO stepwise algorithm for analgesic therapy based on pain severity reserves the use of opioid therapy for moderate and severe pain. In most cases, these drugs are recommended to be used until the cancer gets under control and responda to the treatment. However, the use of opioids to treat patients with chronic non-cancer pain is controversial because of concerns about efficacy and safety, and the possibility of addiction or abuse.
These drugs come as tablets and your doctor may prescribe Bicalutamide (Casodex), Flutamide or Nilutamide (Nilandron).Potential Risks of Hormone Therapy for Prostate CancerAndrogen deprivation therapy has certain side effects, which may involve nausea, weight gain, breast growth, hot flashes and loss of muscle and bone mass. The oral route of drug administration is appropriate for patients receiving opioids, although the transdermal route is becoming more popular.
Men using hormone therapy to stop testosterone production may also experience fatigue, loss of sex drive, erectile dysfunction, some mood swings and memory difficulties as well as liver problems. For continuous chronic severe pain, opioids should be administered around-the-clock, and several long-acting formulations are available that require administration only once or twice daily.
Patients who have used hormone therapy for a long period of time may be exposed to greater risk of heart disease, heart attack or some other cardiovascular problems.
Opioid doses should be titrated according to agent-specific schedules to maximise pain relief and maintain tolerability. Adverse effects include constipation, nausea and vomiting, sedation, cognitive impairment and respiratory depression.
Tolerance to the analgesic and adverse effects, as well as physical dependence, which causes withdrawal symptoms upon discontinuance, may occur with opioid use. Successful pain treatment and symptom management is an attainable goal for the majority of patients with chronic severe pain.



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