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Search Results: 1 - 10 of 17175 matches for " Advanced cancer "
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Advanced Bladder Cancer in Senegal: Epidemiological and Clinical Aspects  [PDF]
R. Kane, L. Niang, Y. Diallo, M. Jalloh, A. Ndiaye, S. M. Gueye
Open Journal of Urology (OJU) , 2014, DOI: 10.4236/oju.2014.411022
Abstract:

Advanced bladder cancer remains particularly frequent in our practice. Aim: To evaluate the proportion of advanced bladder cancer at diagnosis and to describe the characterisitics at diagnosis. Materials and methods: We conducted a descriptive and retrospective study assessing 97 cases of advanced bladder cancer over a period of 10 years (January 2002 to January 2012) at the department of Urology of H?pital Principal de Dakar and H?pital Général de Grand Yoff. We included the records of all patients with a pathologic confirmation of locally advanced bladder cancer (T3, T4) and/or a visceral or lymph node metastasis. Results: Mean age was 47 years (Range: 25 - 80 years). The cohort comprised 69 men and 28 women with a sex ratio of 2.46. The reasons for referral were a hematuria (60.82%), pelvic mass (19.2%), irritative urinary symptoms (8.2%). Reported medical histories were: urinary schistosomiasis (13 patients), tobaccoo(10 patients), recurrent cystitis (8 patients). Indications of local extention were: inguinal lymph nodes (6 patients), tumoral hepatomegaly (5 patients), bone pain (15 patients). A cystoscopy was performed in 64.95% of patients in a mean time of 2.5 months. A Trans Urethral Resection of Bladder Tumour (TURBT) was performed in 77 patients with a mean time from referral of 4 months. Pathologic examination showed squamous cell carcinoma (42%), urothelial carcinoma (28%) and adenocarcinoma (9%). Thoraco-abdomino pelvic CT scan showed a loco regional extension in 18 patients, extension to the peri vesical fat in 3 patients and metastasis in 25 patients. Conclusion: Delayed diagnosis of bladder cancer is still common in Africa with a high mortality rate. A better management requires an improvement of the equipment in the hospital with an emphasis on the access to endoscopy allowing for an early diagnosis.

Upper mediastinal and paratracheal node dissection in total (pharyngo) laryngectomy, it is really indicated?  [PDF]
Didier Dequanter, M. Shahla, P. Paulus, P. Lothaire
Open Journal of Stomatology (OJST) , 2011, DOI: 10.4236/ojst.2011.14028
Abstract: Introduction: Advanced laryngeal and hypopharyn- geal cancers are aggressive tumors with a poor prog- nosis. Multiple lymph node metastases often occur in the neck as well as in the upper mediastinum and thus upper mediastinal dissection is crucial to im- proving the cure rate. However, excessive mediastinal dissection can increase postoperative morbidity and mortality making it important to employ the proper technique and appropriate extent of dissection. In the present study, we aimed to determine the need and the prognostic importance of mediastinal dissection in patients with advanced carcinoma of the upper aerodigestive tract. Methods: A retrospective review of the records of 30 patients who underwent (phar- ynxgo) laryngectomy for advanced squamous cell carcinomas was done. 17 patients had laryngeal car- cinomas, 13 had hypopharyngeal carcinomas. The mediastinal dissection was designed to remove mainly the paratracheal and retrooesophageal lymph nodes. Results: 60 neck dissections and 30 mediastinal dis- section were performed in 30 patients and yielded positive nodes were found in 20/30 patients. Neck nodes were positive in 9/17 of the patients with la-ryngeal cancer and 11/13 of the patients with hypo- pharyngeal cancers respectively. Positive nodes were detected in the neck regardless of T stage. The medi- astinal nodes were positive in 0% of the patients with laryngeal cancer. Upper mediastinal metastases were detected positive in 6/13 of the hypopharyngeal pa-tients. In these patients, mediastinal metastases were associated with tumors greater than 35 mm. The ma- jority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. 0% of the patients had positive paratracheal nodes alone in a histologically negative cervical neck dissec-tion Regarding the appropriate extent of dissection, no major complications were observed. Conclusions: There is little controversy about neck dissection in advanced tumors of the (pharyngo) larynx. Laryn- geal carcinomas showed no positive mediastinal no- des in this series. The study highlighted the propen- sity of advanced hypopharyngeal cancers to involve the paratracheal nodes.
Salvage surgery after failure of non surgical therapy for advanced head and neck cancer  [PDF]
Didier Dequanter, N. Vercruysse, M. Shahla, P. Paulus, Ph. Lothaire
Open Journal of Stomatology (OJST) , 2011, DOI: 10.4236/ojst.2011.14029
Abstract: Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, re- serveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advan- ced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evalu- ated in 27 patients undergoing salvage surgery for re- current tumor (larynx n = 13; oral cavity n = 9; hypo- pharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 - 136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbi- dity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.
The Role of Everolimus in the Treatment of Breast Cancer  [PDF]
José Pablo Leone, Ricardo H. álvarez
Journal of Cancer Therapy (JCT) , 2013, DOI: 10.4236/jct.2013.47136
Abstract: The development of resistance to chemotherapy, endocrine therapy and anti HER2 agents in breast cancer is an important and common problem that impacts in the management of patients, particularly in the metastatic setting. This resistance has been explained in part by the activation of signal transduction pathways, including the PI3K/AKT/mTOR. The blockade with mTOR inhibitors such as everolimus is a new target agent for therapy that attempts to enhance treatment efficacy and restore tumor sensitivity. In this review article, we present the data about the use of everolimus for the treatment of breast cancer in all tumor phenotypes. Future studies that evaluate biomarkers for treatment response are needed to identify the specific populations that have the highest benefit of this new targeted therapy.

Partial Nephrectomy as Treatment of an Atypical Metastasis from Prostate Cancer—A Case Report and Review of Literature  [PDF]
Ulisses Lopes Guerra Pereira Sobrinho, André Luiz Lima Diniz, Rodrigo Galves Mesquita Martins, Diogo Eugenio Abreu Da Silva, Tomás Accioly De Souza, José Anacleto Dutra De Resende Júnior
Open Journal of Urology (OJU) , 2018, DOI: 10.4236/oju.2018.81002
Abstract: Background: Prostate cancer is the second most common type of cancer in man and the second in cancer-specific deaths in this population in the world. Most of the causes of death related to prostate cancer are due to its distant metastases, with the most common sites being: skeleton, distant lymph nodes, liver and lung. Renal metastasis is rare, and studies suggest infiltration due to arterial microembolization of the tumor. A key point in this scenario is the clinical suspicion of differential diagnoses, to offer the patient an effective therapy in such a specific case. Aim: To report a case of a patient with prostate cancer undergoing partial nephrectomy whose histopathological report revealed a metastatic lesion of that primary site. Case Presentation: 74 years old man, referred in May 2015 due to high PSA level and lumbago. PSA 323.11 ng/dl, rectal examination cT3a; biopsy was performed and histopathological study reported bilateral prostate adenocarcinoma, Gleason’s score 8 (4 + 4). Patient’s staging showed multiple secondary implants on skeletal scintigraphy. Tomography revealed solid exophytic lesion in the lower pole of the right kidney (4.7 × 3.6 cm); prostate without cleavage planes with seminal vesicles and pelvic node enlargement. Hormone therapy was initiated, PSA levels dropped to 9.51 ng/dl and total testosterone < 50 ng/dl. Partial nephrectomy was planned, initially by laparoscopy, but converted to laparotomy in December 2015. Procedure lasting 3 hours, minimal blood loss, no perioperative complications, discharged on the 3rd postoperative day. Histopathological report described undifferentiated malignant neoplasm, requiring immunohistochemistry that confirmed prostate adenocarcinoma. Patient remains hormone therapy, with no progression of the disease so far. Conclusion: Given the rarity of these cases, it is not possible to presume that nephrectomy enhances the survival rates. However, we observed that partial nephrectomy was a good choice for our patient, being the first case described in the literature. More reports should be available and studies with higher levels of evidence should be conducted to assist us in patient orientation and decision making.
Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer  [PDF]
Amen Hamdy Zaky, Adel Gabr, Doaa Wadie Maximous, Ahmed A. S. Salem, Amr Farouk Mourad, Haisam Atta, Marwa Ismail
Journal of Cancer Therapy (JCT) , 2018, DOI: 10.4236/jct.2018.92015
Abstract: Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of
Prognostic Factors and Treatment Outcome in 178 Locally Advanced Cervical Cancer Patients  [PDF]
Ozlem Yetmen Dogan, Makbule Dogan Eren, Sedef Ozdemir Dag, Alparsalan Mayada?li
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.85055
Abstract: Background: To evaluate local control, survival, radiation side effects and treatment outcome in locally advanced cervical cancer patients. Materials and Methods: Among 2006-2011, 178 patients with locally advanced cervical cancer were treated with chemoradiotherapy +/-?radiotherapy and high dose rate (HDR) brachytherapy. Follow-up was complete for all patients. Concomitant chemotherapy was not administered in 44 patients due to renal impairments and ECOG of 2 - 3. Results: The median follow-up period was 34.5 months (range, 5 to 93) and 42 months (range, 14 to 93 months) for alive patients. Five years local-regional control, progression-free survival and overall survival rates were 87.8%, 58.9% and 67.3% in all patients, respectively. In this retrospective study young age, tumor diameter, stage, presence of residual tumor and administration of chemotherapy were effected in survival analysis. The parameters which affected the complete response of patients were defined as presence of concomitant chemotherapy and number of courses <5. Central region recurrence rate was defined higher in the group with treatment duration of 9 weeks and higher (p
Diagnostic and therapy of locally advanced rectal cancer
Breberina M.,Petrovi? T.,Radovanovi? Z.,Bokorov B.
Acta Chirurgica Iugoslavica , 2006, DOI: 10.2298/aci0602121b
Abstract: The aim of the study was to check the results of the protocol with neoadjuvant chemoirradiation for the treatment of locally advanced rectal cancer. The value of preoperative methods for staging of rectal cancer was also studied. In the period 1st 0f June 2000 - 31st of December 2005, 116 patients were included into the study, all with histologically proven rectal cancer up to 12 cm from anal verge and all with T3/T4 No-2 M0 stage. Median follow up was 48 months. Operability rate was 90,1%, local recurrence 12%, and survival 78%, though only 66% without sign of local or distant recurrence.
Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand
Bisht Manisha,Bist S,Dhasmana D,Saini Sunil
Indian Journal of Palliative Care , 2008,
Abstract: Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE). The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE) drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.
Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma?  [PDF]
Didier Dequanter, Delphine Geukens, Jean-Marie Bailly, Mohammad Shahla, Pascal Paulus, Philippe Lothaire
Journal of Cancer Therapy (JCT) , 2011, DOI: 10.4236/jct.2011.23044
Abstract: Objectives: Elective neck treatment of clinically N0 patients in patients with head and neck carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T4 staged head and neck carcinomas required bilateral neck dissection in the management clinically No necks especially CT negative cervical nodes. Methods: We performed a retrospective analysis of patients with advanced head and neck disease who received bilateral neck dissection. All the patients had curative surgery as their initial treatment for the primary tumor and the neck. Results: All the 28 consecutive patients had T4 staged primary laryngeal cancer. Patients with clinically and radiologically N+ disease had invaded lymph node metastases in all cases. Patients staged clinically and radiologically N0 had no invaded cervical lymph nodes found by pathologic examination. Patients staged clinically N0 and radiologically N+ had invaded cervical lymph nodes in 8/12 cases and in 50% (4/8) of the cases bilaterally. Conclusion: This study showed the importance on adequate clinical and radiological staging. By patients with advanced disease clinically and radiologically N0, bilateral neck dissection should not be necessary. But in patients radiologically N+, routine bilateral neck dissection is beneficial.
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