Procedure For Treatment Of Cancer Research Articles

Highlights in the evolution of diagnosis and treatment of laryngeal cancer.

To present selected highlights from the evolution of diagnosis of laryngeal disease and treatment of laryngeal cancer from ancient Greece until the 20th century. Historical study of diagnosis of laryngeal disease and treatment of laryngeal cancer from the ancient Greek medical scriptures until the most recent evolutional steps in the 20th century. Original Greek-language texts of ancient and Byzantine medical writers were studied and literature on history of medicine was investigated to reveal early knowledge of diagnostic and therapeutic techniques for laryngeal disease and cancer of the larynx. Diseases of the upper aerodigestive tract were known and treated by ancient Greek physicians, and, later, Byzantine doctors, apart from preserving ancient medical concepts, contributed their own ideas, mainly about surgery and postoperative care. The initial therapeutic approach for the disorders caused by laryngeal tumors was either tracheotomy or endotracheal intubation in an attempt to prevent suffocation. In more recent times, construction of the laryngoscope and other modern examination instruments, as well as the final acceptance of histological diagnosis based on tissue biopsy, has allowed for accurate diagnosis and successful treatment of laryngeal lesions. Preoperational biopsy, application of pharyngoesophageal speech and advanced vocal devices for the laryngectomees, and invention of antibiotic and anesthetic agents had led, by the middle of the 20th century, to the establishment of extended and radical surgical techniques as optional treatment for laryngeal cancer. In addition, the discovery of x-rays and radium introduced radiotherapy as an alternative in the treatment procedure for cancer of the larynx. Progress in the evolution of laryngological diagnosis and practice demanded efforts by many daring and courageous investigators and surgeons, contributing new ideas and techniques in the development of modern laryngology.

Racial and ethnic disparities in the receipt of cancer treatment.

A disproportionate number of cancer deaths occur among racial/ethnic minorities, particularly African Americans, who have a 33% higher risk of dying of cancer than whites. Although differences in incidence and stage of disease at diagnosis may contribute to racial disparities in mortality, evidence of racial disparities in the receipt of treatment of other chronic diseases raises questions about the possible role of inequities in the receipt of cancer treatment. To evaluate racial/ethnic disparities in the receipt of cancer treatment, we examined the published literature that addressed access/use of specific cancer treatment procedures, trends in patterns of use, or survival studies. We found evidence of racial disparities in receipt of definitive primary therapy, conservative therapy, and adjuvant therapy. These treatment differences could not be completely explained by racial/ethnic variation in clinically relevant factors. In many studies, these treatment differences were associated with an adverse impact on the health outcomes of racial/ethnic minorities, including more frequent recurrence, shorter disease-free survival, and higher mortality. Reducing the influence of nonclinical factors on the receipt of cancer treatment may, therefore, provide an important means of reducing racial/ethnic disparities in health. New data resources and improved study methodology are needed to better identify and quantify the full spectrum of nonclinical factors that contribute to the higher cancer mortality among racial/ethnic minorities and to develop strategies to facilitate receipt of appropriate cancer care for all patients.

Follow-up After Breast-Conserving Therapy: Comparison of Conventional Imaging Methods with MRI

Purpose: Breast-conserving therapy is now the standard procedure for the surgical treatment of breast cancer. With the risk of local recurrence being 1-2% or more per year after treatment, follow-up including clinical examination, mammography and even sonography is important. Material and Methods: We studied the efficacy of contrast-enhanced dynamic magnetic resonance tomography (MRI) for the diagnosis of local recurrences after breast-conserving therapy compared with palpation, mammography and ultrasound. Results: In 71 patients local recurrence was diagnosed after breast-conserving therapy. The sensitivity for the diagnosis of local recurrence was 52% for palpation, 66% for mammography, 86% for ultrasound and 92% for MRI. All multicentric local recurrences were diagnosed by MRI. Mammography was not able to detect 24 of 71 local recurrences in radiodense breasts. Ultrasound detected 18 of these 24 recurrences and MRI detected 22. Conclusion: Ultrasound should be included into routine follow-up protocols after breast-conserving therapy to achieve an acceptable sensitivity for the detection of local recurrences. Under defined conditions and indications MRI is the best method to complement clinical examination, mammography and ultrasound with the highest sensitivity for the diagnosis of local recurrences in the radiodense breast.

Serial Pathological Examination of Resected Specimens as a Basic Procedure in Safe Conservative Breast Cancer Treatment

Serial Pathological Examination of Resected Specimens as a Basic Procedure in Safe Conservative Breast Cancer Treatment

Pathologic features and clinical outcome after anatomic radical prostatectomy by transcoccygeal approach

Objectives A nonrandomized prospective study was conducted aimed at verifying the clinical outcome and pathologic features of a group of patients submitted to transcoccygeal radical prostatectomy. Methods Radical transcoccygeal prostatectomy was performed at our institution in 26 patients after laparoscopic (24 cases) or open surgical (2 cases) pelvic lymphadenectomy. Eighteen patients were selected because they were considered to be at risk for nodal metastases on the basis of preoperative staging prostate-specific antigen level of 20 ng/mL or greater and/or Gleason score greater than 5); the remaining 8 manifested incidental prostate carcinoma. Results Intraoperative complications included rectal injury in 1 patient (3.8%) and massive blood loss in another. Transitory leakage at the site of the urethrovesical anastomosis and urethrorectal fistula occurred postoperatively in 2 patients. The rate of positive surgical margins was 26.9%. The mean follow-up time is 27 months (range 3 to 39 months). Total urinary continence was obtained in 21 patients (80.8%); 5 patients (19.2%) still require urinary pads. Four patients (15.4%) have experienced tumor recurrence evidenced only by increased serum prostate-specific antigen levels. Local tumor recurrence with positive biopsy of the urethrovesical junction was diagnosed in 3 patients (11.5%), and 1 (3.8%) experienced systemic tumor recurrence. Conclusions Radical transcoccygeal prostatectomy is a safe procedure for the surgical treatment of prostate cancer, both from a clinical and a pathologic point of view. Operative complication as well as pathologic features and clinical outcome reported in this series of patients must be related to selection criteria used in most cases. The exact role of radical transcoccygeal prostatectomy in the clinical setting has yet to be defined. According to these preliminary results, radical transcoccygeal prostatectomy should be further investigated in the treatment of incidental carcinoma after transurethral resection of the prostate or suprapubic prostatectomy and could become an elective indication in such cases.

Accommodating modern cancer treatment procedures in an outpatient facility.

The aging of the American population, the recent increasing prevalence of smoking in females, and the decline in heart disease mortality are setting the stage for cancer to be the most common cause of death in the United States by the year 2000. The technology exists today to increase survival rates from 50% to 75%, but this continuing care will increase cancer-related expenditures to 20% of the nation's total health care expenditures. Many advances in cancer diagnosis and treatment offer promise for less invasive procedures, and some new interventions focus on prevention or early detection of limited disease in ambulatory patients. The likelihood and the length of hospital admissions are declining, and the proportion of care delivered in an inpatient setting is expected to represent less than 10% of total cancer patient care. While the delivery of care shifts to the outpatient setting, the need for a continuum of care, interdisciplinary collaboration, and access to regional centers for technology and research is likely to encourage the formation of systems that combine a tertiary care hub and a network of community-based ambulatory centers.

Elective modified neck dissection for treatment of the clinically negative (N0) neck.

Radical neck dissection was the dominant surgical procedure for treatment of metastatic head and neck cancer in the cervical lymph nodes for much of the 20th century. Proponents of radical neck dissection, such as George Crile, Sr. [1] and Hayes Martin [2], maintained the Halsteadian principle that oncologically sound surgical management of metastasis requires en bloc resection of lymph nodes and surrounding soft-tissue structures. While radical neck dissection provides effective control of regional metastasis, major cosmetic and functional deficits often accompany the procedure.

Surgical treatment of breast carcinoma since Hippocrates of Cos

The pessimistic prognosis for cancerous diseases made by the founder of occidental medical science, Hippocrates of Cos (ca. 460 BC--ca. 370 BC), resulted also in the fact that the surgical treatment of breast cancer was performed rather as a last resort. Not until the rise of scientific surgery in the 16th century did European surgeons begin to develop different procedures in the surgical treatment of breast cancer. In 1774, in a treatise rewarded by the Academy, the French surgeon Bernard Peyrilhe, who may be considered one of the founders of experimental cancer research, demanded radical operative surgery in cases of breast cancer. Peyrilhe first formulated the principles of that surgical concept which is connected with the name of the American surgeon William Stewart Halsted (1852-1922), a concept which has long remained influential.

Video-assisted thoracoscopic wedge resection of T1 lung cancer in high-risk patients.

This study assessed the reliability and safety of VATR for treatment of peripheral T1 lung cancer in high-risk patients. Surgical resection is the best therapy for stage I lung cancer. Patients with poor cardiopulmonary status or those who are elderly (> 75 years of age) are considered to be at high risk from thoracotomy and are frequently referred for radiation therapy or expectant palliative management. Data from previous studies suggest that survival with wedge resection is similar to that with lobectomy. The authors propose VATR, which is minimally invasive, as a therapeutic option in patients considered to be at high risk for resection by thoracotomy. Between November 1990 and November 1992, more than 400 thoracoscopic lung resections were performed. Thirty patients with poor pulmonary function (forced expiratory volume FEV1] < 1 L or < 35% predicted; arterial oxygen tension [PaO2] < 60 mmHg on room air; diffusion capacity [DCO] < 40%) underwent 31 VATRs (1 patient had a staged procedure for bilateral synchronous lung cancers). All patients had T1 peripheral lesions with no bronchoscopically visible lesions. Computed tomography of the chest revealed no evidence of mediastinal disease in all patients. Patients had a mean FEV1 value of 0.9 L (38% predicted) and a mean age of 71 years. Tumors were located in left upper lobe (LUL) in 13 patients, in right lower lobe (RLL) in 7 patients, in right upper lobe (RUL) in 6 patients, in left lower lobe (LLL) in 4 patients, and in right middle lobe (RML) in 1 patient. Computed tomography-guided wire localization, methylene blue surface injection, and intraoperative ultrasonography were used to assist in defining difficult lesions. All lesions were successfully resected without converting to thoracotomy. One patient died on the 34th postoperative day of myocardial infarction (operative mortality rate of 3%). Five patients had prolonged air leaks (< 5 days), with a median chest tube time of 3 days. Two patients experienced pneumonia. The authors concluded that VATR is a safe and reliable procedure for treatment of peripheral T1 lung cancer in high-risk patients. Long-term follow-up will be required to determine the efficacy of this procedure regarding survival and locoregional recurrence.

Role of bronchoplastic procedures in surgical treatment of primary lung cancer

Role of bronchoplastic procedures in surgical treatment of primary lung cancer

The case for and against two-step procedure for the surgical treatment of breast cancer.

In recent years there have been numerous suggestions that malignant breast tumors are best handled by a two-step procedure. The bases for these suggestions evolve from two factors. There is a perceived desire on the part of the patient to know the exact diagnosis prior to having a general anesthetic so that all treatment options can be thoroughly explored and a mutually acceptable operative procedure decided on. The interval between the biopsy and the definitive operation can be used to study those conditions that would modify treatment decisions. A contrary view holds that a one-stage procedure eliminates the need for a biopsy as a separate operation, is more acceptable to some patients who do not wish to worry during the 1-day or 2-day interval between the two stages, and routine testing in the asymptomatic patient with Stage I or Stage II breast carcinoma will yield positive results in only 1% to 2% of the cases and is probably not worthwhile. In recent years, the increasing acceptance of aspiration biopsy has eliminated the need for a formal excisional biopsy in most cases. For the patient who prefers a one-stage procedure, an aspiration biopsy in the office is probably not worthwhile. Fine-needle aspiration biopsy with cytology is less painful and more accurate than core needle biopsy. A negative result on an aspiration biopsy should not be accepted as definitive where there are other clinical indications that the lesion may be malignant. Women with large breasts who have a small lesion located near the chest wall or who have a nonpalpable lesion detected by mammography are not good candidates for aspiration biopsy; neither are they good candidates for excisional biopsy under local anesthesia as an outpatient.

An Appraisal of Long-Term Results in Surgical Treatment of Breast Cancer

The results of the surgical treatment of breast cancer at the Johns Hopkins Hospital revealed that the five-year survival rate for radical mastectomy was 52% and the ten-year survival rate was 33%. These results were reviewed and compared with prior time periods and only a slight increase in the survival rate was noted. The most impressive feature of the surgical treatment of breast cancer is the striking similarity and surprising uniformity of long-term end results despite widely differing therapeutic techniques as reported from this country and abroad. Further comparisons between individual series differing in composition, classification, and case selection will never resolve our divergent differences of opinion. There is an urgent need for a large cooperative and randomized clinical trial designed biometrically to compare the results of alternative and equivalent surgical procedures in the treatment of breast cancer.