Carsinoma Doctor

Posts Tagged ‘Chemotherapy’

At the time of filing, over 50% of patients with esophageal cancer have metastatic disease. The use of chemotherapy for this group of patients is increasing, with the intention of gaining control of local and distant tumor, improvement of quality of life and prolonging survival.
Evaluate the effectiveness of a) chemotherapy versus best supportive care or b) different chemotherapy regimens with each other in metastatic carcinoma of the esophagus.
Only two RCTs with 42 participants compared chemotherapy with best supportive care for metastatic cancer of the esophagus. In these RCTs, showed no survival benefit for chemotherapy. Five RCTs with 1 242 participants compared different chemotherapy regimens. Because of the variation in the population of patients and chemotherapy regimens, it was not possible to make a formal pooled analysis. There was no consistent benefit of any specific chemotherapy regimen.
Authors’ conclusions

Trials are needed well-designed phase III, and adequately powered, comparing chemotherapy versus best supportive care in patients with metastatic cancer of the esophagus. Chemotherapy agents with encouraging response rates and tolerable toxicity are cisplatin, 5-fluorouracil (5-FU), paclitaxel and anthracyclines. Future trials comparing palliative treatment modalities should assess the quality of life with quality of life measures validated.

Tumor involving the urothelium and is more prevalent in men than in women (9 and 4% of the tumors, respectively). In some cases, may result from exposure to naphthylamine and other aromatic amines, and cyclophosphamide treatment, and smokers are at greater risk than nonsmokers. Only 1-3%, it is a squamous cancer, and then you typically associated with schistosomiasis, and exceptionally adenocarcinoma (1%). Regarding diagnosis, hematuria princeps is the sign as it appears in 85% of cases, then perform a cystoscopy.

Although histologically tumor is of the same nature, from the standpoint of diagnostic and therapeutic, are divided into two groups: superficial and deep. The first affect the bladder mucosa and the latter to the muscle of the bladder. The surface is treated by transurethral endoscopic resection and occasionally endocavitary chemotherapy is added to chemotherapy (thiotepa, Adriamycin, Mitomycin C) or BCG. Supportive treatment is aimed at reducing recurrence and progression. Superficial tumors must be carefully followed by endoscopic control, by its tendency to relapse (in 40-70% of patients so happens) and progression (in 20-40% of cases progress to deep). The standard treatment is radical cystectomy deep (removal of the bladder, prostate and seminal vesicles) associated with treatment with chemotherapy or radiotherapy, in order to improve local control, facilitate surgery and improve overall survival. The deep treatment had a survival rate of 50% in five years.

Treatment is always surgical excision or tumor. Depending on the size and status of the patient, intervention may be required under general anesthesia, although most can be operated with local anesthesia on an outpatient basis without admission to hospital. If the tumor affects sensitive areas of the face such as eyes or nose, you may need a reconstruction of the area through plastic surgery techniques.

Tumors difficult to operate because of its size, location, or the patient’s condition. In some of these cases may opt for radiation therapy, which also gets cures in most cases. At present, the possibility of treating these tumors completely is 95%.

Some very superficial basal cell carcinomas or small can be treated with medication in cream, such as 5-fluorouracil or imiquimod, with excellent results. It also can be destroyed with an electric knife or by freezing with cryotherapy devices. Actinic keratoses can be treated similarly.

For cases of advanced squamous cell carcinoma has spread and has caused metastasis, the options are surgery, radiotherapy or chemotherapy depending on the case.

There infiltrating type BCC with many extensions or “roots” that can not be seen when operating. Often, the tumor recurrence over the scar if it is properly operated, because tumor cells are no longer continue to reproduce. For these cases there is a technique called Mohs micrographic surgery in which the tumor is analyzed under the microscope by removing stages as you go. This type of surgery ensures complete recovery of virtually 100% of infiltrative basal cell carcinomas.