scholarly journals Colorectal Cancer – Management of Metastatic Disease

2013 ◽  
Vol 09 (02) ◽  
pp. 100
Author(s):  
Paul H Sugarbaker ◽  
Keyword(s):  
Metastatic Disease ◽  
Systemic Chemotherapy ◽  
High Standard ◽  
Standard Of Care ◽  
Management Plan ◽  
Anatomical Site ◽  
Regional Lymph Nodes ◽  
Cancer Management ◽  
Metastatic Process

Metastases from colon cancer occur to the regional lymph nodes, the liver and the peritoneal surfaces. Rectal cancer may disseminate to these sites and also to the lungs. These metastases may occur synchronously with the detection of primary disease or metachronously in follow-up. The timing of the metastatic process is important in terms of treatment possibilities. Each anatomical site for metastatic disease has the potential for an individualised management strategy. Systemic chemotherapy as an adequate management plan for all sites of colorectal metastatic disease is not compatible with a high standard of care. Formulation of an optimal plan combining surgery with regional and systemic chemotherapy is a necessary function of the multidisciplinary team.

Colorectal Cancer—Management of Metastatic Disease

2014 ◽  
Vol 10 (01) ◽  
pp. 37
Author(s):  
Paul H Sugarbaker ◽  
Keyword(s):  
Metastatic Disease ◽  
Systemic Chemotherapy ◽  
High Standard ◽  
Standard Of Care ◽  
Management Plan ◽  
Anatomical Site ◽  
Regional Lymph Nodes ◽  
Cancer Management ◽  
Metastatic Process ◽  
Individualized Management

Metastases from colon cancer occur to the regional lymph nodes, the liver, and the peritoneal surfaces. Rectal cancer may disseminate to these sites and also to the lungs. These metastases may occur synchronously with the detection of primary disease or metachronously in follow-up. The timing of the metastatic process is important in terms of treatment possibilities. Each anatomical site for metastatic disease has the potential for an individualized management strategy. Systemic chemotherapy as an adequate management plan for all sites of colorectal metastatic disease is not compatible with a high standard of care. Formulation of an optimal plan combining surgery with regional and systemic chemotherapy is a necessary function of the multidisciplinary team.

scholarly journals P094 CPAP Service Patient Experience Survey

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A51-A52
Author(s):  
R Mihai ◽  
K Ellis ◽  
N Verginis ◽  
M Davey ◽  
G Nixon
Keyword(s):  
Support Groups ◽  
Online Survey ◽  
Positive Airway Pressure ◽  
High Standard ◽  
Standard Of Care ◽  
Sleep Apnoea ◽  
Information Support ◽  
Obstructive Sleep ◽  
Experience Survey

Abstract Introduction Increasing numbers of children with obstructive sleep apnoea require continuous positive airway pressure (CPAP) treatment. We aimed to collect feedback from parents/carers about our CPAP education and follow-up programme. Methods An online survey link was texted to families of children starting outpatient CPAP from Jan 2019 -Feb 2021. Questions assessed satisfaction with the CPAP initiation process, including education by our nurse educator (NE), mask fitting, using equipment, accessing help, confidence using CPAP and follow up. Open-ended feedback was invited. Results 17/55 (31%) of eligible families responded. “Very satisfied” responses regarding CPAP education ranged from 76% (discussion of costs) to 94% (machine use and maintenance). All families felt confident starting CPAP at home. Two reported issues starting CPAP, but reported feeling fully supported by staff remotely to troubleshoot. All families were “somewhat” or “very satisfied” with NE follow-up, with 2 families more neutral about physician follow-up. Two families reported lower satisfaction (“somewhat dissatisfied” or neutral) with the range of paediatric masks, rather than with the mask fitting process itself. Of 14 general comments, 64% were positive (most common theme was high standard of care from the NE); 21% negative (lack of mask choices, location of consulting suites); and 15% neutral. Suggestions for improvement included financial support information, support groups and online consumable ordering. Discussion Families feel confident and well supported to commence outpatient CPAP, highlighting the care, knowledge and support provided by our team. Findings emphasize the importance of a dedicated NE. Suggestions provided will inform future service improvements.

scholarly journals Surgical Approach to Recurrent Cholangiocarcinoma

2020 ◽  
pp. 1-6
Author(s):  
Hauke Lang
Keyword(s):  
Survival Benefit ◽  
Systemic Chemotherapy ◽  
Tumor Biology ◽  
Standard Of Care ◽  
Distal Cholangiocarcinoma ◽  
Careful Patient ◽  
Repeated Surgery ◽  
Biological Heterogeneity ◽  
Patterns Of Recurrence

<b><i>Background:</i></b> For recurrent cholangiocarcinoma, systemic chemotherapy is the standard of care. Repeated resection is a potential curative treatment, but data are scarce and outcomes are not well defined so far. <b><i>Summary:</i></b> In the last decade there has been an increasing number of reports suggesting a survival benefit and even cure after repeated surgery. This is particularly true for intrahepatic cholangiocarcinoma, where repeated resections offer similar or even better results than the first resection. In selected cases even a third liver resection is possible. In contrast, in perihilar and distal cholangiocarcinoma, repeated resection is only rarely possible. Although the improved outcome might be attributed to a careful patient selection and a favorable tumor biology, repeated surgical treatment should be attempted whenever possible. This necessitates a structured follow-up after resection. <b><i>Key Message:</i></b> Surgical resection offers the chance for prolonged survival and even for cure in recurrent cholangiocarcinoma. Hence, it is of the utmost importance to better understand the routes of metastases and to define factors qualifying for resection. Whether different patterns of recurrence reflect biological heterogeneity requires further investigation.

scholarly journals Sending NHS Patients for Operations Abroad: Is the Holiday Over?

2009 ◽  
Vol 91 (2) ◽  
pp. 128-130 ◽  
Author(s):  
Sammy A Hanna ◽  
Joyti Saksena ◽  
Stella Legge ◽  
Howard E Ware
Keyword(s):  
Total Joint Replacement ◽  
Oxford Knee Score ◽  
High Standard ◽  
Standard Of Care ◽  
Functional Results ◽  
Number Of Patients ◽  
Significant Difference ◽  
Set Up ◽  
The Uk

INTRODUCTION The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems. PATIENTS AND METHODS This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems. RESULTS OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05. CONCLUSIONS The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients.

Province Wide Clinical Governance Network for Clinical Audit for Quality Improvement in Endometrial Cancer Management

2012 ◽  
Vol 22 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Vincenzo Dario Mandato ◽  
Debora Formisano ◽  
Debora Pirillo ◽  
Gino Ciarlini ◽  
Lillo Bruno Cerami ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Clinical Audit ◽  
High Standard ◽  
Standard Of Care ◽  
Reggio Emilia ◽  
Oncology Group ◽  
Hub And Spoke ◽  
Process Indicators ◽  
Cancer Management ◽  
Before And After

BackgroundAccording to the hub-and-spoke model introduced in the Provincial Healthcare System of Reggio Emilia, early endometrial cancer is treated in peripheral low-volume hospitals (spokes) by general gynecologist, whereas more complex cancers are treated by gynecological oncologists at the main hospital (hub).ObjectiveTo guarantee a uniformly high standard of care to all patients with endometrial cancer treated in hub and spoke hospitals of Reggio Emilia Province.MethodsThe specialists of the 5 hospitals of Reggio Emilia Province instituted an inter hospital and multidisciplinary oncology group to write common and shared guidelines based on evidence-based medicine through the use of clinical audit. They valued the process indicators before and after guidelines introduction identifying the site of improvement and verifying the standard achievement.ResultsDiagnostic hysteroscopy use increased significantly from preguideline period, 53%, to postguideline period, 74%. Magnetic resonance use and accuracy increased significantly from preguideline to postguideline periods: 8.1% to 35.3% and 37.3% to 74.7%, respectively. Laparoscopy use increased from 1.6% (preguideline) to 18.6 (postguideline). Early surgical complications decreased from 16% (preguideline) to 9% (postguideline). Radiotherapy use increased from 14.% (preguideline) to 32.3% (postguideline).ConclusionIt is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.

The clinical value of CEA and CA 15-3 in breast cancer management

1995 ◽  
Vol 10 (1) ◽  
pp. 35-41 ◽  
Author(s):  
E.C. Coveney ◽  
J.G. Geraghty ◽  
F. Sherry ◽  
E.W. McDermott ◽  
J.J. Fennelly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Lead Time ◽  
Locoregional Recurrence ◽  
Recurrent Disease ◽  
Systemic Disease ◽  
Clinical Value ◽  
Cancer Management ◽  
Breast Cancer Management

The value of tumour-associated antigens CEA and CA 15-3 was studied in patients with breast cancer over a 4-year period. A total of 252 patients with primary or recurrent disease had available and corresponding CEA and CA 15-3 values at diagnosis and during follow-up and were studied in detail. Preoperative and three-monthly serial postoperative levels were measured in each patient. Ten of 11 patients presenting with primary and concurrent metastatic disease had elevated CA 15-3 levels (> 25 I.U./ml) as compared to 6 with CEA (> 5 ng/ml). Fourty-seven patients developed locoregional recurrence of which 15 had concurrent metastatic disease. CA 15-3 was elevated in 14 cases while CEA in 11. Of 32 patients with locoregional recurrence alone, 18 later developed metastatic disease at a mean follow-up time of 17.5 months. There was a significant correlation between CA 15-3 value at locoregional recurrence and time to subsequent metastasis (r = 0. -0.57, P = 0.0133). CEA was elevated in 64%, CA 15-3 in 87% and either marker in 94% of 87 patients diagnosed with metastatic disease. Of 53 patients with serial markers and metastatic disease, 72% (38/53) had rising CA 15-3 levels prior to diagnosis with a mean lead time of 9.9 months. Use of CEA in conjunction improved lead time detection to 83%. This study demonstrates that CA 15-3 is superior to CEA at detecting metastatic disease at initial presentation and during follow-up. Use of CEA in conjunction with CA 15-3 improves the detection of systemic disease.

A New Era of Organ-Preserving Treatment in Pediatric Intraocular Retinoblastoma in Russia: A Multicenter Cohort Study

2018 ◽  
Vol 5 (1) ◽  
pp. 51-69 ◽  
Author(s):  
Тatiana L. Ushakova ◽  
Igor A. Тrofimov ◽  
Оlga V. Gorovtsova ◽  
Аndrey A. Yarovoy ◽  
Svetlana V. Saakyan ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Systemic Chemotherapy ◽  
Focal Therapy ◽  
Primary Treatment ◽  
Local Chemotherapy ◽  
Multicenter Cohort Study ◽  
Cancer Disease ◽  
Tumor Spread ◽  
Group D

Background.Retinoblastoma (RB) is a life threatening cancer disease. A breakthrough in the treatment of children with RB is associated with the improvement of conservative treatment that was administered in at least one of the two tumor-affected eyes in most bilateral cases, that was chemotherapy both systemic and local (selective intra-arterial and intravitreal) in most cases combined with laser therapy, cryotherapy, or brachytherapy. The development of such techniques as local chemotherapy is focused on preservation of visual functions, reducing the number of enucleations and radiotherapy (RT) course. The success of the healing of RB is closely associated with a multidisciplinary approach to diagnosis and treatment, as well as specialized longterm follow-up clinical examination.Objective.eye and vision preservation against large intraocular tumors with different growth types and localization without the course of remote radiation therapy was the main purpose.Methods.In the period from September 2012 to January 2016, the study enrolled 45 patients with RB when at least one eye had intraocular tumor spread corresponding to the group C or D. According to the ABC international classification, patients have a relatively good prognosis for organ-preserving treatment. 4 of 18 children with bilateral RB had undergone primary enucleation of worse eye the worst eye, group E; 49 (77.8%) of the 63 affected eyes had features for groups C and D. In this study, no patient received local chemotherapy initially, only after prior systemic chemotherapy. Selective intra-arterial chemotherapy (SIAC) was applied to 41 patients (45 eyes; mean course number was 2), and 32 patients (34 eyes) had undergone intravitreal chemo therapy (IViC) (mean course number was 2). Focal therapy and local chemotherapy were the main methods of treatment for progression (new lesions on the retina) in 8 (16.3%) of 49 eyes with tumors of group C (n=1) and D (n=7); the relapse in 14 of 49 (new lesions on the retina) in eyes with tumors of group C (n=5) and D (n=6) and (new lesions on the retina and the vitreous) in eyes with tumors of group D (n=3) (28.5%), and stabilization of disease n=23 (46.9%). We should note that 2 patients underwent repeated course of in case of systemic chemotherapy, 1 patient — a Gamma Knife procedure due to registered disease stabilization, progression or relapse.Results.10 (20.4%) of 49 eyes saved due to the combined chemotherapy. In 45 patients diseasefree survival rate was 56.1±8.9 % (with mean follow-up period 26.9±2.5 months). 1 of 45 patients died from leukemia. 44 of 45 patients are alive without metastasis. The mean follow-up was 20 months (3 to 43 months). Eye salvage rate in group C — 14 (93.3%) of 15, in group D — 31 (91.2%) of 34.Conclusion.These methods: second line of systemic chemotherapy, RT, and a Gamma Knife procedure should be considered as a failure of primary treatment. Our study demonstrated a high efficacy of local chemotherapy with promissing techniques of conservation therapy, which safety increases due to experience.

Benign notochordal cell tumor of the clivus with chordoma component: report of 2 cases

2020 ◽  
Vol 133 (5) ◽  
pp. 1355-1359
Author(s):  
Maria Peris-Celda ◽  
Laura Salgado-Lopez ◽  
Carrie Y. Inwards ◽  
Aditya Raghunathan ◽  
Carrie M. Carr ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Cell Tumor ◽  
Surgical Removal ◽  
Anatomical Site ◽  
Adjuvant Radiation ◽  
Resonance Imaging ◽  
Adjuvant Radiation Therapy ◽  
Notochordal Cell ◽  
Transsphenoidal Resection

Benign notochordal cell tumors (BNCTs) are considered to be benign intraosseous lesions of notochord origin; however, recent spine studies have suggested the possibility that some chordomas arise from BNCTs. Here, the authors describe two cases demonstrating histological features of BNCT and concomitant chordoma involving the clivus, which, to the best of the authors’ knowledge, have not been previously documented at this anatomical site.An 18-year-old female presented with an incidentally discovered clival mass. Magnetic resonance imaging revealed a 2.8-cm nonenhancing lesion in the upper clivus that was T2 hyperintense and T1 hypointense. She underwent an uneventful endoscopic transsphenoidal resection. Histologically, the tumor demonstrated areas of classic chordoma and a distinct intraosseous BNCT component. The patient completed adjuvant radiation therapy. Follow-up showed no recurrence at 18 months.A 39-year-old male presented with an incidentally discovered 2.8-cm clival lesion. The nonenhancing mass was T2 hyperintense and T1 hypointense. Surgical removal of the lesion was performed through an endoscopic transsphenoidal approach. Histological analysis revealed areas of BNCT with typical features of chordoma. Follow-up did not demonstrate recurrence at 4 years.These cases document histologically concomitant BNCT and chordoma involving the clivus, suggesting that the BNCT component may be a precursor of chordoma.

Sign in / Sign up

Export Citation Format

Share Document