Showing posts with label Oncology. Show all posts
Showing posts with label Oncology. Show all posts

23 April 2015

Squamous cell carcinoma Ppts and latest 400 published articles



Squamous cell carcinoma

Radiation for Oral Cavity Squamous Cell Carcinoma
http://www.ohsu.edu/

Squamous Cells Physiology
https://www.msu.edu

Squamous Cell Carcinoma
http://www.einstein.yu.edu

Transoral Robotic Surgery for Oropharyngeal Carcinoma and HPV Viral Load 
Marc A. Cohen, MD
http://www.uphs.upenn.edu

Uroepithelial Tumors
Terrence C. Demos, MD
http://www.meddean.luc.edu/

Head and neck cancer
Faina Linkov, PhD
http://www.pitt.edu

Weekly Cases Investigation of Squamous Cell Cancer in Developing Zebrafish
Kiel T. Tietz and Michael A. Pickart
http://minds.wisconsin.edu

Protect the Skin You’re in!
http://fcs.tamu.edu

Variable Gene Expression in Different Human Oral Cancer Cells
Allison Yen, Nathan Overlid
http://dental.pacific.edu/

Skin Cancer: What You Should Know
Randy R. Weigel
http://www.uwyo.edu

Molecular, Cellular and Genetic Basis of Cancer
http://web.stanford.edu

Ozone Loss and Skin Cancer
http://www2.mcdaniel.edu/

Head and Neck Cancer Radiation Therapy
http://radpacs.weber.edu/

The Dangers of Skin Cancer Are we educated enough?
http://www2.gsu.edu/

Latest 400 Published articles of Squamous cell carcinoma

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26 August 2012

Kaposi sarcoma / Multiple hemorrhagic sarcoma



Oral Manifestations of HIV/AIDS
Dr. Patsy K. Fujimoto
http://www.hawaii.edu/

Kaposi’s sarcoma and AIDS-related malignancy
http://biology.ucsd.edu/

Kaposi's sarcoma (KS)
http://www.dentistry.unc.edu

Human Herpesvirus
Krystle Jones
http://ruby.fgcu.edu

Kaposi’s Sarcoma
Michael Hohnadel
http://www.atsu.edu

Human Herpesvirus Infections
Asmita Gupte, M.D.
http://www.mgm.ufl.edu

Oncogenic Viruses
http://biology.fullerton.edu

Kaposi’s Sarcoma
John O. Clarke, M.D.
http://oac.med.jhmi.edu/

Hypothetical new cancer therapy.
Esa K. Crumb
http://www.colorado.edu/

Castleman’s Disease
Anastassia Doutova
http://www.med.unc.edu/


264 free full text published articles of Kaposi sarcoma

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22 August 2012

Paraneoplastic Syndrome



Paraneoplastic Syndrome
Husni Maqboul, M.D
http://elearning.najah.edu/

What is a cutaneous paraneoplastic syndrome?
Brian M. Swan, M.D.
http://sfghdean.ucsf.edu

Saccades and Saccadic Oscillations
Shirley H. Wray, M.D., Ph.D., FRCP
http://novel.utah.edu

Tumor Pathology and Histology 
Carleton T. Garrett, MD, PhD
http://www.pathology.vcu.edu

Paraneoplastic Syndrome
Jack Twersky, MD
http://coegne.nursing.duke.edu

Cancer in the Peripheral Nervous System
Cara E Harth, MD
https://cbase.som.sunysb.edu

Dementia
Roberta Seidman, M.D.
https://cbase.som.sunysb.edu

Renal Cell Carcinoma
http://www.mac.edu

Case Presentation
http://hematology.wustl.edu

Rheumatoid Arthritis
Rozina Mithani
http://www.stritch.luc.edu/

Blistering Skin Eruptions
Jill Tichy, PGY III
https://medicine.med.unc.edu


457 Published articles on Paraneoplastic Syndrome

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31 March 2012

Familial Adenomatous Polyposis



Familial adenomatous polyposis (FAP) is the most common adenomatous polyposis syndrome. It is an autosomal dominant inherited disorder characterized by the early onset of hundreds to thousands of adenomatous polyps throughout the colon.

Inherited Susceptibility to Cancer
Stephen B. Gruber, MD, PhD
Inherited Susceptibility to Cancer.ppt

Colorectal Cancer Screening and Prevention
David R. Rudy, MD, MPH
ColonCancer.ppt

Colon Polyps
Colon Polyps.ppt

Colorectal cancer
Colorectal cancer.ppt

Pediatric Manifestations of FAP
Pediatric Manifestations of FAP.ppt

Understanding Colorectal Cancer
Understanding Colorectal Cancer.ppt

Colorectal Cancer (CRC)
Colon.ppt

Inflammatory Bowel Disease adn Cancer an Update
Duty_to_warn.ppt

Colon lecture
John R Pender, M.D.
Colon.ppt

Why Familial Adenomatous Polyposis?
Gideon Steinbach, M.D., Ph. D., Patrick Lynch, M.D., J.D., Robin K.S. Phillips, M.B., B.S., etal
Why Familial Adenomatous Polyposis?.ppt

CMB Review for Step I
Prepared by Pamela L. Derstine, Ph.D.
CMB-Review.ppt

Pathology of the Gastrointestinal Tract III and IV Small and Large Intestines
Grace Guzman, M.D.
Pathology of the Gastrointestinal Tract.ppt

Colon Cancer
Matt Anderson, MD MSc
ColonCancer.ppt

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20 March 2012

Mycosis Fungoides ppt and 50 free scholarly articles




Mycosis Fungoides is a rare type of skin lymphoma (tumors of the blood)

Mycosis  fungoides: A re-evaluation  of diagnostic criteria
Bruce  R. Smoller, M.D.
Mycosis  fungoides.ppt

Cutaneous Lymphoid  Hyperplasia, Cutaneous T-Cell Lymphoma, Other  Malignant Lymphomas, and Allied Diseases
Rick Lin, DO, MPH
CTCL.ppt

CTCL is term often used to refer to Mycosis Fungoides and related entities
http://www.uhmc.sunysb.edu/CTCL.ppt

When To Suspect  Lymphoma
Lee  Berkowitz, MD
http://www.med.unc.edu/When To Suspect  Lymphoma.ppt

Cutaneous  Vascular Diseases
Rick Lin, DO MPH
http://www.atsu.edu/postgrad/dermatology/ppt/cut1.ppt

Geriatric  Dermatology 
James T. Birch,  Jr., MD, MSPH
Geriatric  Dermatology .ppt

Pediatric  Lymphomas
Education Lecture Series
Pediatric_Lymphomas.ppt

Lymphoproliferative Disorders
Lymphoprolif.ppt

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04 March 2012

Renal paraneoplastic syndrome



Tumor Pathology  and Histology
Path_n_Histology.ppt

Renal  Failure
Michele Ritter,  M.D.
Shelly_Renal_Failure.ppt

Renal  Cell Carcinoma
Jennifer  L. Rogers
Renal  Cell Carcinoma  Rogers.ppt

Acute Renal Failure
Acute Renal Failure.ppt

Renal/ Urinary  System
Renal-Urinary.ppt

Management of  Patients with Renal Disorders
Management of  Patients with Renal Disorders.ppt

Tumor  Host Interactions
Husni Maqboul,  M.D
Tumor  Host Interactions.ppt

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24 February 2012

Medullary Thyroid Cancer Ppts and Recently published articles



Medullary Thyroid Cancer
by Travis Baggett
http://www.bcm.edu/sims/Files/vignette2.ppt

Surgical Treatment  of Medullary Carcinoma of the Thyroid 
by Jacques Peltier  MD, Francis B. Quinn,  MD
CA-thyroid-slides-070120.ppt

Pediatric  Thyroid Malignancies
by Kristen Boyle,  MD
ModificationDate=1264544885803

Evaluation of a Thyroid Nodule
by Michael E. Decherd, MD, Matthew W. Ryan, MD
http://med.mui.ac.ir/clinical/ent/Thyroid-Nodule-2002-01-slides.ppsx

Update in the Management of Thyroid Neoplasms
by David R. Byrd, MD
http://depts.washington.edu/surgstus/Clerkship/Lectures/print/Thyroid_Byrd.ppt

Medullary Thyroid Cancer
by David  M. Gleinser, MD, Susan  D. McCammon, MD
Thyroid-ca-slides-101027.ppt

Thyroid Cancer
by Christopher Muller
ThyroidCA-9810.ppt

Evaluation  of Thyroid Nodules
by Eric  Oliver
RadiologyThyroid.ppt

Evaluation of the Effects of Low Dose Radiation-dose reconstruction
by Lynn  R. Anspaugh, Ph.D
Anspaugh-Radiation_Dose_Reconstruction.ppt

Evaluation of Thyroid Nodules
by Michael L. Tuggy, MD
Thyroid nodules.ppt

Pathology of the Thyroid Gland
by Prof. Dipak Shah
Thyroiddiseases.ppt

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23 February 2012

Chronic Lymphocytic Leukemia - CLL Ppts and Publications




Acute  Lymphocytic Leukemia
by: Heidi  Borgens & Mary Takagi
http://www.plu.edu/~borgenhl/doc/seminar-project.ppt

Overview  of Diagnostic &  Prognostic Factors for  CLL
by Laura  Rassenti, PhD
http://bcrf.ucsd.edu/events/Presentations/LZR_CLL42305V2.ppt

Leukemia
http://www.hawaii.edu/medtech/MEDT451/Leukemia_files/Leukemia.ppt

Clinical  Implications Of TNF  Family In Blood Disorders
by Dheeraj  Mohania
http://www.pitt.edu/~super7/30011-31001/30241.ppt

Chronic Lymphocytic Leukemia CLL
http://www.austincc.edu/mlt/hem/hemlectunit20chronicleukemias.ppt

Chronic  Myelogenous  Leukemia
http://imrp.ouhsc.edu/sites/oumedicine/uploads/images/CML.ppt

Refractory CLL:  Treatment Approaches 
by George  Ansstas, MD
http://hematology.wustl.edu/conferences/presentations/Ansstas20091002.ppt

Latest 50 Published articles

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06 April 2010

Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder



Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder
By: Larry Pennington, MD

Cholangiocarcinoma
Etiology
Ulcerative Colitis
Thorotrast Exposure
Sclerosing Cholangitis
Typhoid Carrier
Choledochal Cysts
Adult Polycystic Kidney Disease
Hepatolithiasis
Liver Flukes

Papillomatosis of Bile Ducts
Cholangiocarcinoma
Extra-hepatic: Distribution
Diagnosis and Initial Workup
Intra and Extra-hepatic Cholangiocarcinoma
Cholangiocarcinoma Intra-hepatic Disease
* Suspicious mass on CT. Quadruple phase CT with 0.5 cm cuts through the liver and portal hepatitis. Consider CTA reconstruction.
* Bx
* If adenoncarcinoma: look for primary with a chest CT and upper/lower endoscopy.
* Colon, pancreas, and stomach are common primary sites.

Cholangiocarcinoma Intra-hepatic Disease-Surgery/Ablation
* Extent of surgical therapy is determined by the location, hepatic function, and underlying cirrhosis.
* Anatomic resections have lowest recurrence rates. However nonanatomic resection increases potential surgical candidates and improves survival.
* Hepatic devascularization prior to resection is preferred
* Ablative therapy gives good local control.

Child’s Classification
Intra-hepatic Disease: Extent of Resection
Intra-hepatic Disease
Representative Case
MRCP of Extra-hepatic Cholangiocarcinoma at the Bifurcation
Klatskin tumor
Cholangiocarcinoma Extra-hepatic
Cholangiocarcinoma Pathology
Extra-hepatic Disease: Surgical Therapy
ERCP: Distal CBD Cancer
Ca of CBD Bifurcation
Node Dissection in Bile Duct Excision
Roux-en-Y Hepaticojejunostomy
Extra-hepatic Disease: Positive Margins or Unresectable
Extra-hepatic Disease: Unstentable
* Bypass if possible
* If not use proximal decompression and feeding jejunostomy
* Chemotherapy/Radiation Therapy/Brachy therapy as tolerated or clinical trial.
Cholangiocarcinoma Prognosis
* Best Result are with distal CBD tumors completely excised. Cure = 40%
* Incomplete resection plus radiation gives a median survival of 30 m.
* Stenting plus chemo/radiation gives a median survival of 17 to 27m
* Those stented alone live only a few months

Cancer of the Gall Bladder
Gall Bladder Cancer
Presentation (1)
Presentation 2
PET Scan and Cholangiocarcinoma
Sclerosing type of Cholangiocarcinoma
Cytological Brushing of Cholangiocarcinoma

Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder.ppt

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04 August 2009

Cutaneous Toxicities of Cancer Therapy



Cutaneous Toxicities of Cancer Therapy
By:Dr.Saiama Waqar

Outline
* Alopecia
* Hyperpigmentation
* Hand-foot syndrome
* Radiation sensitivity and recall
* Hypersensitivity
* Nail dystrophies
* Extravasation injuries
* Skin toxicity from targeted therapies
* Conclusion

Alopecia
* Drugs that target rapidly dividing cells often affect the proliferating cells in the hair follicle
* Terminal hair follicles with rapid matrix formation more affected (scalp more than body hair, eyebrows, eyelashes)
o completely lost in a short time: transplant
o gradually lost over several weeks: cyclic chemotherapy
* Methotrexate: affects the follicle melanocytes, resulting in depigmented band of hair, “flag sign”
* Visible regrowth within 3-6 months
* Often regrows with a change in color or texture (switching from straight to curly), mechanism of change unclear
* Psychologically, one of the most stressful side effects

Grading of alopecia
Grade
Minimal loss, grade 1
< 25%; obvious to the patient but not necessarily to others

Moderate loss, grade 2
25 to 50 %; obvious thinning of scalp hair but not enough to lead to the use of a wig or alternate head covering

Severe loss, grade 3

> 50% of hair lost; generally indicates the need for a wig or alternate head covering in those for whom alopecia is a major concern

Chemotherapy drugs causing alopecia

* Often
o Bleomycin
o Etoposide
o Methotrexate
o Mitoxantrone
o Paclitaxel
* Common
o Cyclophosphamide
o Daunorubicin
o Doxorubicin
o Docetaxel
o Idarubicin
o Ifosphamide
o Paclitaxel
* Infrequent
o 5-FU
o Hydroxyurea
o Thiotepa
o Vinblastine
o Vincristine
o Vinorelbine
* Rare
o procarbazine

Prevention of alopecia
* scalp tourniquets:
o pneumatic device placed around the hairline during chemo infusion
o inflated to a pressure >SBP
o Several studies: effective for preventing hair loss
+ utilized different techniques, variation in chemotherapy regimens, tourniquet pressure, sample size, and criteria to assess alopecia (data difficult to interpret)
o Side effects: headache, varying degrees of nerve compression

Prevention of alopecia
* Hypothermia with scalp icing devices:
o Vasoconstriction of scalp blood vessels, less absorption of chemo as hair follicles less metabolically active at 24C
o ice turban, gel packs, cool caps, thermocirculator, room air conditioner
o 50-80% response, though variable chemotherapy regimens and definitions of alopecia, small sample size
* Not effective in liver disease
o Delayed drug metabolism, persistent levels beyond protective period
* Scalp metastases:
o mycosis fungoides, limited to scalp. CR after chemo without scalp cooling
o 61 pts with met breast cancer and liver dysfunction, 1 pt scalp met

Preventive devices
* 1990- FDA stopped sale of these devices citing absence of safety or efficacy data
* Cranial prostheses (wigs) and scarves use encouraged

Pharmacologic interventions for alopecia
* Topical minoxidil (shorten time to maximum regrowth, did not prevent alopecia)
* AS101(NSCLC pts: garlic-like halitosis and post-infusion fevers)
* Alpha tocopherol (cardioprotection for doxorubicin, noted less alopecia)
* Topical calcitriol (cell lines- protects cancer cells)
* IL-1(rats, cytarabine, cell cycle specific, protected)
* Inhibitors of p53 (mice deficient p53, no alopecia)

Hyperpigmentation
* usually resolves with drug discontinuation
o gingival margin pigmentation seen with cyclophosphamide is usually permanent
* Patterns of pigmentation:
o Diffuse
o Local at site of infusion
* Sites of pressure /trauma
o Hydrea and cisplatin
* Busulfan
o “busulfan tan” can mimic Addison's disease.
o Although busulfan can also cause adrenal insufficiency, the skin change is 2/2 toxic effect on melanocytes
o Distinguish busulfan toxicity from true Addison's disease by normal levels of MSH & ACTH
* Liposomal doxorubicin
o macular hyperpigmentation over the trunk and extremities, including the palms and soles
o not been described with unencapsulated doxorubicin

Drugs causing hyperpigmentation

HAND-FOOT SYNDROME
* also known as palmar–plantar erythrodysesthesia (PPE)
* originally described in patients receiving high-dose cytarabine
* skin lesions begin as erythema and edema of the palms or soles and is associated with sensitivity to touch or paresthesia
* can progress to desquamation of the affected areas and significant pain

Hand foot syndrome
Acral erythema from docetaxel

Pathogenesis
* Unclear: small capillaries in the palms and soles rupture with increased pressure from walking or use, creating an inflammatory reaction
* formulation of drugs and duration of exposure can impact the incidence
o liposome-encapsulated doxorubicin more than standard formulation
o 5-FU bolus lower than CIVI and capecitabine (converted into 5-FU in vivo)

Hand foot syndrome Grading
Grade
Signs and symptoms

1 Minimal skin changes or dermatitis (eg, erythema) without pain
2 Skin changes (eg, peeling, blisters, bleeding, edema) or pain, not interfering with function
3 Skin changes with pain, interfering with function

Treatment
* No proven preventive therapy
o Pyridoxine (vitamin B6) may help reduce the incidence and severity
o Celecoxib reported to reduce incidence
* Management largely symptomatic with reduction of drug doses where appropriate
* emollients and protective gloves can be helpful

Radiation sensitization and recall
* Some chemotherapeutic agents can sensitize the skin to radiation
* recall phenomenon in previously irradiated tissue (wks to yrs after RT)
o when chemotherapy is administered
* Exact mechanism not clearly understood,
o radiation effects on the microvasculature
o altered cutaneous immunologic responses
* maculopapular eruptions with erythema, vesicles, desquamation
o mild rash to severe skin necrosis

Radiation sensitization and recall
* No specific therapy recommended
o topical corticosteroids
o Ultraviolet radiation
* caution about sun exposure
o wear protective clothing
o sunscreen products
+ 5-FU increases photosensitivity to sunlight
+ MTX may reactivate a sunburnes of cancer therapy. Curr Opin Oncol. 2002 Mar;14(2):212-6

Hypersensitivity reactions
* Can occur either from drug itself or from solubility vehicle (eg. Cremophor for paclitaxel)
* Prevention: premedicate
o Steroids (dexamethasone), H1 blockers (benadryl), H2 blockers (pepcid)
* Management of hypersensitivity reactions:
o epinephrine, hydrocortisone, and histamine blockers, along with monitoring of BP

Drugs causing hypersensitivity
NAIL DYSTROPHY
* Color changes
o Mee’s lines - transverse white
o hyperpigmentation
* Beau’s lines - transverse grooves/lines
o related to the effect of chemotherapy causing decreased nail growth
* Paronychia -inflammation of the nail fold
o Seen with cetuximab

Beau’s lines
* Onycholysis (separation of the nail plate from the nail bed)
o can be painful
o anthracyclines, taxanes (especially weekly paclitaxel), and topical 5-fluorouracil
* frozen-glove study to prevent docetaxel-induced onycholysis & cutaneous toxicity
o 45 patients, frozen glove for 90 minutes on the right hand, using the left hand as control
o Frozen glove reduced the nail and skin toxicity

Grading of nail changes
Grade
Nail changes/toxicity

1 Discoloration, ridging (koilonychias), pitting
2 Partial or complete loss of nail(s), pain in nailbed(s)
3 Interfering with ADL
Nail changes with docetaxel

Drugs causing nail changes
* Pigmentary changes
o Bleomycin
o Busulfan
o Cisplatin
o Cyclophosphamide
o Docetaxel
o Doxorubicin
o Etoposide
o Fluorouracil
o Hydroxyurea
o Idarubicin
o Ifosfamide
o Melphalan
o Methotrexate
o Mitomycin
o Mitoxantrone

* Onycholysis
o Paclitaxel
o Docetaxel
o Gemcitabine
o Capecitabine
o Cyclophosphamide
o Doxorubicin
o Etoposide
o Fluorouracil
o Hydroxyruea
* Inflammatory changes
o Gefitinib
o Cetuximab
o Capecitabine
o Docetaxel
o Paclitaxel

Extravasation injury
* The accidental extravasation of intravenous drugs occurs in approximately 0.1% to 6% of patients receiving chemotherapy
* Depending on the agent and amount, the sequelae of extravasation can range from erythema and pain to necrosis and sloughing of the skin
* The most toxic drugs are the vesicants, such as the anthracyclines, vinca alkaloids, nitrogen mustards, as well as paclitaxel and cisplatin

Vesicants and irritants
Treatment of extravasation
* immediate discontinuation of the infusion
* cooling with ice packs
o warm soaks for vinca alkaloids
* for persistent/progressive local symptoms - surgical consult
* early local debridement of can reduce extent of later injury

Extravasation of vinblastine in a 57-year-old male receiving chemotherapy for bladder cancer

Antidotes for extravasation
o topical DMSO (dimethyl sulfoxide) to enhance absorption of the extravasated drug, routine use still controversial
o Thiosulfate -nitrogen mustard extravasation (injection of a 1/6 molar solution into the area of extravasation)
o Dexrazoxane - anthracycline extravasation
* Regardless of antidote, local therapy, and prompt surgical intervention is paramount

Skin Toxicity from targeted therapy
* Because the EGFR is also expressed by basal keratinocytes, sebocytes, the outer root sheath, and some endothelial cells, agents that inhibit EGFR are associated with dermatologic side effects
Erlotinib eruption on the arms

Cutaneous reactions associated with molecularly targeted agents
Monoclonal antibodies to EGFR
Infusion reactions; acneiform eruption; paronychial inflammation; photosensitivity
* Cetuximab, panitumumab

EGFR pathway inhibitors
Acneiform eruption; paronychial inflammation; photosensitivity
* Erlotinib
* Gefitinib
* Lapatinib

Multitargeted tyrosine kinase inhibitors
Skin exanthem; SJS; acute generalized exanthematous pustulosis; Sweets syndrome; hand-foot syndrome; photosensitivity; pigmentary changes, hair depigmentation; alopecia

* Imatinib
* Dasatinib
* Sorafenib
* Sunitinib

EGFR-inhibitor induced skin changes
* (a-c) stratum corneum thickness, (d) apoptosis (apoptotic cells by 10,000).
* On-therapy (gefitinib) biopsy specimen showing (e) keratin plugs and micro-organisms in dilated infundibula and (f) acute folliculitis.

Cetuximab skin toxicity
Moderate rosacea-like eruption from cetuximab
80 year old patient receiving cetuximab and radiation for nasopharyngeal cancer

Erlotinib rash treatment
Severity of Rash
Treatment Protocol
Mild
Topical clindamycin 2%, with hydrocortisone 1% in lotion base applied twice-daily.
Moderate
Topical clindamycin 2%, with hydrocortisone 1% in lotion base applied twice-daily AND oral minocycline 100mg twice-daily for a minimum of 4 weeks and continuing thereafter as required, until resolution of the rash by one severity grade. Scalp lesions will be treated with a topical lotion clindamycin 2%, triamcinolone acetonide 0.1% in equal parts of propylene glycol and water.
Severe
Stop erlotinib therapy for 1 week and restart at 100mg once-daily. Treatment of rash with topical clindamycin 2%, with hydrocortisone 1% in lotion base applied twice-daily AND oral minocycline 100mg twice-daily for a minimum of 4 weeks and continuing thereafter as required. Scalp lesions will be treated with a topical lotion clindamycin 2%, triamcinolone acetonide 0.1% in equal parts of propylene glycol and water until resolution.
Dose modification guidelines for cetuximab (Erbitux) based upon dermatologic toxicity

Cutaneous Toxicities of Cancer Therapy.ppt

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10 July 2009

Pediatric Malignancies



Pediatric Malignancies
By:Jan Bazner-Chandler
CPNP,MSN, CNS, RN

Pediatric Malignancies
Causes
* Genetic alteration
* Environmental influences
* No know prevention
* Metastasic disease
Response to Treatment
Classification of Tumors
Cardinal Signs of Cancer
* Unusual mass or swelling
* Unexplained paleness and loss of energy
* Spontaneous bruising
* Prolonged, unexplained fever
* Headaches in morning
* Sudden eye or vision changes
* Excessive – rapid weight loss.
Diagnostic Tests
* X-ray
* Skeletal survey
* CT scan
* Ultrasound
* MRI
* Bone marrow aspiration
Biopsy
* Identify cell to determine type of treatment
Treatment Modalities
* Determined by:
o Type of cancer
o Location
o Extent of disease

Surgery
Radiation Therapy
Chemotherapy
Administration
Goals of Chemotherapy
Chemotherapy Drugs
Bone Marrow Transplant
Gene Therapy
Management of Cancer
Pain Management
Pain Control
Immunosuppression and Infection
Neutropenia
Treatment of Neutropenia
Varicella
Varicella Immunizations
Central Venous Access Devices
CVAD Infection Prevention
Chemotherapy Side Effect
Management of Side Effects
Malnutrition
Nutrition Interventions
Nausea and Vomiting Interventions
Mucositis Interventions
Constipation
Diarrhea
Hair Loss
Psychosocial Support
Growth and Development
Leukemia
Prognosis
Diagnosis
Peripheral Blood Smear
Bone Marrow
Acute Lymphoid Leukemia
3 Phase Treatment
Induction Therapy
CNS Therapy
Nursing Interventions
Leukemia Time Line
CNS Tumors
Management
Brain Tumors
Astrocytoma
Large right frontal lobe
neoplasm with small area of necrosis
Hodgkin's Disease
Treatment
Long Term Side Effects
Neuroblastoma
Wilm’s Tumor
CT Scan Wilm’s Tumor
Osteogenic Sarcoma
Osteosarcoma Tumor
Limb Salvage
Ewing Sarcoma
Rhabdomyosarcoma
Treatment
Retinoblastoma
Pupil reflex
“Cat Eyes”

Pediatric Malignancies.ppt

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24 June 2009

Sexuality & Fertility Issues in Cancer Patients



Sexuality & Fertility Issues in Cancer Patients
bt:Carolyn Vachani, MSN, RN, AOCN

Scope of Sexuality Issues
* 40-100% of cancer patients experience some form of sexual dysfunction
* Issues do not always resolve after therapy
* Almost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)
* Represents major quality of life (QOL) issue
* With intervention, up to 70% of patients can have improved functioning

To Optimize QOL, Nurses Can:
* Learn evidence-based information on how diagnosis/treatment affects sexual function
* Conduct assessments before/during therapy
* Inform patients of possible changes
* Educate clients & partners
* Provide guidance & suggestions for adapting to changes
* Know resources & refer when needed

Survey of Physician/Patient Communications
Nurses’ Beliefs
Johnson’s Behavioral Model
PLISSIT Model for Communication
Sexual Dysfunction in Men
* Chemo/hormonal therapy: Erectile dysfunction, decreased libido, ejaculatory dysfunction, gynecomastia, penile/ testicular atrophy, and infertility
* Radiation/ brachytherapy: Urinary issues, impotence, bowel dysfunction, penile/ testicular atrophy
* Surgery: Urinary issues, impotence, body image, pain, retrograde ejaculation

Sexual Dysfunction in Women
* Chemo/Hormone therapy: Irregular menses, early menopause, hot flashes, insomnia, irritability, depression, vaginal dryness, painful intercourse, infertility, and decreased libido
* Radiation/ brachytherapy: Pelvic fibrosis, vaginal atrophy/stenosis, scarring, decreased lubrication, urinary effects, erythema, edema, ulceration, decreased elasticity, shortening, and increased irritation of vagina
* Surgery: Body image, bowel changes, ROM issues, menopause, pain, changes in vaginal size/sensitivity, loss of nipple

General Nursing Interventions
Ostomy Surgery: Interventions
Interventions for Male Issues
Interventions for Female Issues
Radiation-Induced Vaginal Stenosis
Other Interventions for Women
Resources
* www.eyesontheprize.org (online community for gynecologic cancers)
* Support groups (Gilda’s Club, Wellness Community)
* www.oncolink.org
* www.ustoo.org (prostate cancer website)
* www.fertilehope.org
* www.resolve.org (fertility)
* ACS Sexuality booklets
(available on ACS website)

Pregnancy & Treatment
Risk of Infertility: Radiation
Radiation Risk to Future Pregnancy
Risk of Infertility: Chemo
Azoospermia likely, and are often given with other highly sterilizing agents, adding to the effect
Busulfan (600 mg/M2)
Ifosfamide (42 g/m2)
BCNU (300 mg/m2)
Nitrogen mustard
Actinomycin D
Azoospermia in adulthood if treated before puberty
BCNU (1 g/m2)
CCNU (500 mg/m2)
Prolonged or permanent azoospermia in 90% of men; platinum agents 50%
Chlorambucil (1.4 g/m2)
Cyclophosphamide (19 g/m2)
Procarbazine (4 g/m2)
Melphalan (140 mg/m2)
Cisplatin (500 mg/m2)
Known Effect on Sperm Count
Chemotherapy (dose to cause effect)

Risk for Infertility: Surgery
* Orchiectomy (bilateral)
* Penectomy
* Prostate or bladder surgery damage
* Prostatectomy
* Hysterectomy
* Oopherectomy (bilateral)

Options for fertility preservation in men
* Sperm banking – only after puberty
* Intracytoplasmic sperm injection (ICSI)
* GnRH agonist/antagonists
* Cryopreservation of testicular tissue, then transplant or grow in vivo (+ births in mice)

Options for Fertility Preservation in Women
* Embryo freezing – cycle 12-14 days, 10-25% chance of pregnancy per embryo stored, cost $8-12,000, then cost of storage, thaw & implanting
* Ovarian transposition (oophoropexy) – move ovaries from XRT field, can be laparoscopic, cost ?, been done for 30yrs, 16-90% success rate
* Egg cryopreservation – cycle 12-14 days, 2% chance of live birth per thawed egg, cost ~$8,000, then cost of storage, thaw, fertilizing & implanting

Options for Fertility Preservation in Women
* GnRH agonist/antagonist : theory is to stop proliferation
* Ovarian tissue freezing: 60% follicles lost to freezing, have been 2 live births
* Radical trachelectomy: for cervical cancer, experimental?
Assessing Ovarian Function in Survivors
* FSH & Estradiol
* Anti-Mullerian hormone (AMH)
* Antral follicle count
Financial Assistance
Local Sites for Sperm Banking
* 3 National organizations (by mail)
o www.cryolab.com
o www.reprot.com
o www.xytextissues.com
* Women’s Institute; 815 Locust / Plymouth Meeting
* Penn Fertility 3701 Market
* Fairfax Cryobank 3401 Market (http://www.fairfaxcryobank.com/)
* Drexel Fertility Bala Cynwyd / Center City
* Reproductive Science Institute Jenkintown (http://www.rsiinfertility.com/)
* Women’s Health Group of PA Bryn Mawr

Local Sites for Women
* Women’s Institute: 815 Locust / Plymouth Meeting (http://www.womensinstitute.org/)
* Penn Fertility: 3701 Market (http://www.pennhealth.com/fertility)
* Drexel Fertility: Bala Cynwyd / Center City (http://www.drexelfertility.medem.com)
* Women’s Health Group of PA: Bryn Mawr (http://www.mainlinefertility.com)

References
Sexuality & Fertility Issues in Cancer Patients.ppt

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17 June 2009

CANCER CHEMOTHERAPY



CANCER CHEMOTHERAPY
By:Dr. Debra Laskin
Rutgers.edu

Cancer (Neoplastic Disease)
Types of Cancers
Hematologic Malignancies
Leukemias
Lymphomas
Hodgkin’s Disease
Non-Hodgkin’s Lymphoma
Solid Tumors
Carcinomas
Sarcomas
Hematologic Malignancies
Tumors of blood forming organs and cells
* Leukemias: Proliferation of immature progenitors which circulate in blood
o Acute lymphocytic leukemia (ALL, BM lymphblasts)
o Chronic lymphocytic leukemia (CLL- immature B cells)
o Acute myelocytic leukemia (AML, BM myeloid cells)
o Chronic myelocytic leukemia (CML, myeloid cells; Philadelphia chromosome)
* Lymphomas: Lymph System
o Hodgkin’s Disease: lymph nodes
o Non-Hodgkin’s lymphoma: lymphocytes (CLL)
Solid Tumors
Can occur in any organ or tissue; malignant (metastatic and invasive)
* Carcinomas: Arises from epithelial cells; malignant by definition
* Sarcomas: Cancer of connective or supportive tissue (bone, cartilage, fat, muscle, blood vessels) and soft tissue

Cancer Chemotherapy Versus Antimicrobial Chemotherapy
I. Goal
II. Selective Toxicity
III. Immune System
IV. Kinetics of killing

Goal
* ACT: Get rid of invading organisms, restore health
* CCT: Kill as many tumors cells as possible without killing too many normal cells; tumor regression, increased patient survival time, alleviation of symptoms

Selective Toxicity
* ACT: Exploit biochemical differences between pathogenic organism and host; selective toxicity
* CCT: Only quantitative differences between normal and neoplastic cells; differences in growth rate, treatment is nonselective

Immune System
Kinetics
Tumor Cell Killing: First Order Kinetics
Tumor burden
Time
Stationary phase
New steady state
Determinants of Responsiveness to Cancer Chemotherapy
Tumor Determinants of Responsiveness
Total Tumor Burden (Size)
Cell Cycle
Cell Cycle Phase
Phases of Cell Cycle
Cancer Chemotherapy
Cell Cycle Specific Agents (self limiting)
Cell Cycle Nonspecific Agents
Drug Resistance
Mechanisms vary with drug
Host Determinants
General health status of patients
Immune status
General Considerations Cancer Chemotherapy
Adjuvant Therapy
Drug Toxicity
Most CCT agents:
Cytotoxic agents- kill all rapidly growing cells, nonselective
Side Effects of Anticancer Drugs
Cancer Chemotherapeutic Agents
Alkylating Agents
Mechanism of Action
Evidence in mammalian cells
Bi-functional: more toxic can cross link DNA
Resistance: excision/DNA repair enzymes; get rid of alkylated DNA
Cell cycle nonspecific
Classes of Alkylating Agents
Nitrogen Mustards
Classes of Alkylating Agents
Nitrosoureas
Classes of Alkylating Agents
Methane sulfonate esters (Alkyl sulfonates)
Folic Acid Analogs-Antifolates
Mechanism of Action
Cytotoxic Effects of Inhibiting DHFR
Leucovorin Rescue
Combination chemotherapy
Adjuvant to surgery
Antimetabolites
DNA Synthesis
Salvage Pathways
Purine Analogs
Mechanisms of Cytotoxicity
Resistance
Lethal Synthesis
Irreversible Ic
5-Fluorouracil
Mechanism of Action
Microtuble Inhibitors: Taxanes
Chromatin Function Inhibitors
Chromatin Function Inhibitors
Antibiotics
Steroid Hormones
Estrogens and Androgens
Immunotherapy: Monoclonal Antibodies
Monoclonal Antibodies
Targeted Therapy
Traditional CCT
Drugs inhibit proliferation

CANCER CHEMOTHERAPY

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29 May 2009

Surgery for Lung Cancer video (Part 2)



Surgery for Lung Cancer (Part 2)

More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part Two:
Diagnosing lung cancer
Types of lung cancer
Lung cancer symptoms
Staging
Lobectomy
Recurrence Rate

Dr. Richard Battafarano, head of thoracic surgery at the University of Maryland Medical Center. Dr. Battafarano is also an associate professor of surgery at the University of Maryland School of Medicine.


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Surgery for Lung Cancer video (Part 1)



Surgery for Lung Cancer (Part 1)

More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part One:
Cancer death rates
Trends in smoking
Lung cancer
Pack years
Second hand smoke

Dr. Richard Battafarano, head of thoracic surgery at the University of Maryland Medical Center. Dr. Battafarano is also an associate professor of surgery at the University of Maryland School of Medicine.

View here

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24 May 2009

Cervical/Vulvar/Vaginal Cancer



Cervical/Vulvar/Vaginal Cancer
By:Steve Remmenga, M.D.
The McClure L Smith Professor of Gynecologic Oncology
Division of Gynecologic Oncology, Department of OB/GYN
University of Nebraska Medical Center

Cervical Cancer

Cervical CA
* International estimates
Pap Smear
* With the advent of the Pap smear, the incidence of cervical cancer has dramatically declined

Cervical CA Etiology
* Cervical cancer is a sexually transmitted disease.
* HPV DNA is present in virtually all cases of cervical cancer and precursors.
* Some strains of HPV have a predilection to the genital tract and transmission is usually through sexual contact (16, 18 High Risk).
* Little understanding of why small subset of women are affected by HPV.
* HPV may be latent for many years before inducing cervical neoplasia.

Cervical CA Risk Factors
* Early age of intercourse
* Number of sexual partners
* Smoking
* Lower socioeconomic status
* High-risk male partner
* Other sexually transmitted diseases
* Up to 70% of the U.S. population is infected with HPV

Prevention
* Educate all providers, men and women regarding HPV and the link to cervical cancer.
* Adolescents are an especially high-risk group due to behavior and cervical biology.
* Delay onset of sexual intercourse.
* Condoms may help prevent sexually transmitted disease.

Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society 2003
* Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.
* Screening should be done every year with regular Pap tests or every two years using liquid-based tests.
* At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more if she has certain risk factors, such as HIV infection or a weakened immune system.
* Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.
* Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

Pap Smear
* Single Pap false negative rate is 20%.
* The latency period from dysplasia to cancer of the cervix is variable.
* 50% of women with cervical cancer have never had a Pap smear.
* 25% of cases and 41% of deaths occur in women 65 years of age or older.

Symptoms of Invasion
* May be silent until advanced disease develops
* Post-coital bleeding
* Foul vaginal discharge
* Abnormal bleeding
* Pelvic pain
* Unilateral leg swelling or pain
* Pelvic mass
* Gross cervical lesion

Cell Type
* Squamous Cell Carcinoma 80-85%
* AdenoCarcinoma 15%
* Adenosquamous
* Others

Staging
* Clinical Staged Disease
o Physical Exam
o Blood Work
o Cystoscopy
o Proctoscopy
o IVP

Staging Cervical Cancer
* Stage I Confined to Cervix
Microscopic Disease
* Squamous carcinoma of the cervix that has <3mm invasion from the basement membrane
* The diagnosis must be based on a cone or hysterectomy specimen.
* No lymph-vascular invasion
* May be successfully treated with fertility preservation in selected patients
* These patients should all be referred for consultation.





Staging

* Stage III Lower 1/3 Vagina, Sidewall or ureteral involvement
* IIIA Lower 1/3 of Vagina
* IIIB Sidewall or Ureteral Involvement
* Stage IV Bladder, Rectal or Distal Spread
* IVA Bladder or Rectal Involvement
* IVB Distal Spread

Treatment of Early Disease
* Conization or simple hysterectomy (removal of the uterus) - microinvasive cancer
* Radical hysterectomy - removal of the uterus with its associated connective tissues, the upper vagina, and pelvic lymph nodes. Ovarian preservation is possible.
* Chemoradiation therapy

Advanced Disease
* Chemoradiation is the mainstay of treatment

What is Standard Therapy for
Stage IB2 - IVA Cervical Carcinoma?
* External beam pelvic radiation (4,000 to 6,000 cGy)
* Brachytherapy (8,000 to 8,500 cGy to Point A)
* I.V. Cisplatin chemotherapy

Symptoms of Recurrence
* Weight loss, fatigue and anorexia
* Abnormal vaginal bleeding
* Pelvic pain
* Unilateral leg swelling or pain
* Foul discharge
* Signs of distant metastases
* NOTE: must distinguish radiation side effects from recurrent cancer

Management of Recurrence
* Chemoradiation may be curative or palliative, especially in women who have not received prior radiation therapy.
* Isolated soft tissue recurrence may occasionally be treated by resection with long-term survival.
Topotecan in Recurrent Cervical Cancer – Overview of Phase II Studies
Reference Regimen Evaluable Prior CT ORR Median OS
Survival
By Treatment Group
Proportion Surviving
Vulvar Cancer
Vulvar Cancer Etiology
* Chronic inflammatory conditions and vulvar dystrophies are implicated in older patients
* Syphilis and lymphogranuloma venereum and granuloma inguinal
* HPV in younger patients
* Tobacco
* Paget’s Disease of Vulva
Symptoms
* Most patients are treated for “other” conditions
* 12 month or greater time from symptoms to diagnosis
* Pruritus
* Mass
* Pain
* Bleeding
* Ulceration
* Dysuria
* Discharge
* Groin Mass
* May look like:
o Raised
o Erythematous
o Ulcerated
o Condylomatous
o Nodular
* IF IT LOOKS ABNORMAL ON THE VULVA
* BIOPSY!
Tumor Spread
* Very Specific nodal spread pattern
* Direct Spread
* Hematogenous

Treatment
* Primarily Surgical
o Wide Local Excision
o Radical Excision
o Radical Vulvectomy with Inguinal Node Dissection
+ Unilateral
+ Bilateral
+ Possible Node Mapping, still investigational

* Local advanced may be treated with Radiation plus Chemosensitizer
* Positive Nodal Status
* Special Tumor
o Verrucous Carcinoma

Vulva 5 year survival
* Stage I 90
* Stage II 77
* Stage III 51
* Stage IV 18

Recurrence
* Local Recurrence in Vulva
o Reexcision or radiation and good prognosis if not in original site of tumor
o Poor prognosis if in original site
Melanoma
Melanoma Treatment
Clear Cell Carcinoma
Treatment

Cervical/Vulvar/Vaginal Cancer.ppt

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22 May 2009

Surgery for Lung Cancer video (Part 2)



Surgery for Lung Cancer (Part 2)

Overview:
More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part Two:
Diagnosing lung cancer
Types of lung cancer
Lung cancer symptoms
Staging
Lobectomy
Recurrence Rate

view

Read more...

Surgery for Lung Cancer Video (Part 1)



Surgery for Lung Cancer (Part 1)

Overview:
More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part One:
Cancer death rates
Trends in smoking
Lung cancer
Pack years
Second hand smoke

view

Read more...

19 May 2009

Laryngeal Cancer



Laryngeal Cancer
Presentation by:Anh Q. Truong
University of Washington, SOM

Anatomy
Anatomy – subdivision
Incidence by Site
Supraglottic
Glottic
Subglottic
Epidemiology
Risk Factors
* Signs and symptoms
Clinical Presentation
* Physical Exam
o Complete head and neck exam
+ Palpation for nodes; restricted laryngeal crepitus.
o Quality of voice
+ Breathy voice = cord paralysis
+ Muffled voice = supraglottic lesion
o Laryngoscopy
+ Laryngeal mirror
+ Fiberoptic exam (lack depth perception)
+ Note: contour, color, vibration, cord mobility, lesions.
o Stroboscopic video laryngoscopy
+ Highlights subtle irregularities: vibration, periodicity, cord closure
Differential Diagnosis
* Infectious
* Inflammatory
* Granulomatous disease (TB, sarcoidosis)
* Papillomatosis
* Lymphoma
Imaging
* CT or MRI
* PET
* Ultrasound
Biopsy and Histology
* Glottis
* Subglottis
Staging
* Nodes
* Mets
Stage Grouping
Advanced stage
* Surgery
o Microlaryngeal surgery
o Hemilargyngectomy
o Supraglottic laryngectomy
o Near-total laryngectomy
o Total laryngectomy
* Photodynamic Therapy
* Radiation
* Chemothrapy
Treatments – Options
Treatment – Early Stage (I/II)
Dose Fractionation
Treatment – Advanced Stage (III/IV) – VA Study
Overall Survival
Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study
Laryngeal Preservation
Concurrent chemoXRT
Anticipated Toxicities
Take Home Points
An Actual Picture of a Laryngeal Cancer

Laryngeal Cancer.ppt

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17 May 2009

Lymphoma Presentations



Low Grade Follicular Lymphomas
Presentation by:Giancarlo Pillot, M.D.
Grand Rounds

Gastrointestinal Stromal Tumors
Presentation by:Aruna Kommareddy, M.D.
Fellow, Hematology/Oncology
Washington University School of Medicine

Treatment of Gastroenteropancreatic Neuroendocrine Tumors
Presentation by:Michael Gu, M.D

Esophageal Cancer and Combined modality Treatment
Presentation by:Aruna Kommareddy, M.D.
Fellow, Washington University School of Medicine

Lenalidomide Therapy for Lymphoma
Presentation by:Todd Fehniger, MD/PhD
Hematology/Oncology Grand Rounds

Cutaneous Toxicities Of Cancer Therapy
Presentation by:Saiama Waqar

Treatment of Postthrombocythemic Myelofibrosis with Myeloid Metaplasia
Presentation by:Maggi Coplin

Hormone Refractory Prostate Cancer: Current Trends and Future Directions
Presentation by:James C. Mosley, III, M.D.

Cutaneous T-Cell Lymphoma
Presentation by:Shachar Peles M.D.
Hematology & Oncology Grand Rounds

Glioblastoma Multiforme Treatment Options

Mitochondrial DNA and Cancer
Presentation by:Steven Sorscher
Source:WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

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All links posted here are collected from various websites. No video or powerpoint files are uploaded on this blog. If you are the original author and do not wish to display your content on this blog please Email me anandkumarreddy at gmail dot com I will remove it. The contents of this blog are meant for educational purpose and not for commercial use. If you use any content give due credit to the original author.

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