#abdominal sarcoma prognosis

[gicancerindia]

Small Intestine Cancer

Small intestine cancer

Small intestine cancer, also known as cancer of the small bowel, is a rare type of cancer that occurs in the tissues of the small intestine. The small intestine is a vital part of the digestive system responsible for absorbing nutrients from the food we eat.

While small intestine cancer is relatively uncommon compared to other types of cancer, it is important to understand its potential risks, symptoms, diagnosis, and treatment options.

Types of Small Intestine Cancer:

There are different types of small intestine cancer, including adenocarcinoma, sarcoma, carcinoid tumors, lymphoma, and gastrointestinal stromal tumors (GIST). Adenocarcinoma is the most common type, accounting for the majority of cases.

Risk Factors:

The exact cause of small intestine cancer is often unknown. However, certain factors may increase the risk of developing this condition. These factors include:

Age: Small intestine cancer is more commonly diagnosed in people over the age of 60.

Genetic syndromes: Certain inherited genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, may increase the risk.

Crohn's disease or celiac disease: Chronic inflammation of the small intestine due to these conditions may slightly increase the risk.

Radiation exposure: Previous radiation treatment to the abdomen or pelvic area can increase the risk of developing small intestine cancer.

Symptoms:

The signs and symptoms of small intestine cancer can vary and may include:

Abdominal pain or cramps

Unexplained weight loss

Nausea and vomiting

Fatigue and weakness

Blood in the stool

Changes in bowel habits

Anemia (low red blood cell count)

It is important to note that these symptoms can be caused by various other conditions as well, and the presence of these symptoms does not necessarily indicate small intestine cancer. However, if any of these symptoms persist or worsen, it is recommended to consult a healthcare professional for further evaluation.

Diagnosis:

Diagnosing small intestine cancer typically involves several steps, including:

Medical history and physical examination: A doctor will review the patient's medical history, ask about symptoms, and perform a physical examination.

Imaging tests: Imaging techniques such as CT scans, MRIs, and X-rays may be used to visualize the small intestine and detect any abnormalities.

Endoscopy: Procedures like upper endoscopy or capsule endoscopy may be performed to directly visualize the small intestine and obtain tissue samples for further testing.

Biopsy: A biopsy involves removing a small sample of tissue from the suspected tumor for laboratory analysis to determine if it is cancerous.

Treatment:

Treatment options for small intestine cancer depend on various factors, including the type and stage of cancer, as well as the individual's overall health. The primary treatment methods may include:

Surgery: Surgical removal of the cancerous tumor and nearby lymph nodes is often the main treatment for small intestine cancer.

Radiation therapy: High-energy X-rays or other radiation sources can be used to destroy cancer cells or shrink tumors.

Chemotherapy: Medications are used to kill cancer cells or stop their growth. Chemotherapy can be given orally or intravenously.

Targeted therapy: Certain drugs can target specific molecules or pathways in cancer cells to inhibit their growth.

In some cases, a combination of treatments may be recommended, and the healthcare team will work closely with the patient to develop an individualized treatment plan.

Prognosis:

The prognosis for small intestine cancer varies based on factors such as the stage at diagnosis, the type of cancer, and individual health. Early detection and prompt treatment can improve outcomes. However, as small intestine cancer is often diagnosed at advanced stages, it can be more challenging to treat successfully.

Conclusion:

Small intestine cancer is a rare form of cancer that affects the tissues of the small intestine. Understanding its risk factors, symptoms, and diagnostic procedures can help in early detection and timely treatment. If you experience persistent or concerning symptoms, it is important to consult with a healthcare professional for proper evaluation and guidance.

[jcrmhscasereports]

Myxoid liposarcoma of the spermatic cord: A rare entity by Emmanuel E. Sadava in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

An 81-year-old man consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly. Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomy was performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The histopathological report confirmed findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Key words: liposarcoma, liposarcoma of the spermatic chord, abdominal wall surgery, inguinal mass.

INTRODUCTION

Sarcomas constitute a heterogeneous group of rare solid tumors of mesenchymal cell origin. Collectively they account for approximately 1% of all adult malignancies with an annual incidence of 2.5 cases per million population[1]. In adults, the most common soft tissue sarcomas are liposarcomas. Overall, they account for approximately 17% of all soft tissue sarcomas. Most cases arise from de novo, therefore, the development from a preexisting benign lipoma is rare. Liposarcomas usually appear as a slowly enlarging, painless mass in a middle-aged person with a slightly higher incidence in men.

These tumors are classified in three main biologic forms: 1) well-differentiated liposarcoma; 2) myxoid and/or round cell; and 3) pleomorphic. The latter being a rare high-grade with a high recurrence rate and poor prognosis. The well-differentiated and myxoid types have favorable prognoses. However these tumors locally recur after incomplete excision[2].

The anatomic site of the primary disease represents an important prognostic factor, influencing treatment and outcome. Extremities (43%), the trunk (10%), visceral (19%), retroperitoneum (15%), or head and neck (9%) are the most common primary sites. Scrotal location is relatively rare, accounting for 3.6% of all liposarcomas. The origin of intra scrotal liposarcomas include the spermatic cord (76%), testicular tunic (20%), and the epididymis (4%).

CASE REPORT

An 81-year-old man with a medical history of follicular cutaneous lymphoma and an open left hemi-colectomy for colon cancer consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly (Figure 1). Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. Ultrasound-guided biopsies of the mass were requested and their histopathology analysis revealed myxoid stroma with fusocelular proliferation.

A radical resection was suggested but, a week prior to the surgical procedure, the patient was diagnosed with COVID infection during which he intercurred with myocardial infarction and ischemic stroke. He underwent a double coronary angioplasty with drug-eluted stents and required anticoagulation and antiplatelet therapy posteriorly. The case was discussed at a multidisciplinary meeting and a conservative management of the inguinal tumor was decided. The patient was reassessed 12 month later with a new MRI, which showed the inguinal mass increased in size (99mm) compared to the previous study, and a computed tomography (CT) with no evidence of metastatic disease. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomy (Figure 2) was performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The patient had an uneventful recovery and was discharged from the hospital on postoperative day two.

The histopathological report confirmed a 130x120x120mm low-grade fibro myxoid neoplasm (Figure 3). The surgical margins were negative. Immunohistochemistry showed strong reactivity for S100 and vimentin, whereas SOX10, desmin, CD34 and estrogen receptors were negative. These findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Figure 1: Pelvis MRI T2 axial and coronal images illustrating a left inguinal canal soft tissue density measuring 78 x 68mm.

Figure 2: A Intraoperative image of the liposarcoma. Left inguinal surgical approach with the spermatic cord lesion and left testicle in vivo. B: Intraoperative image of left inguinal mass (a) excision with radical orchiectomy (o).

Figure 3: A Hematoxylin and eosin staining: fusocelular and myxoid infiltrative neoplastic proliferation, made up of ovoid cells and finely granular chromatin. Scarce elongated cytoplasm arranged in fascicles accompanied by elongated, thin, curvilinear blood vessels with zones of perivascular cellular condensation. B: Immunohistochemistry positive for S-100.

DISCUSSION

Liposarcomas invade through local extension and rarely invade through the lymphatic route, making regional lymph node dissection lose its value and having no impact on survival. Nevertheless, high-grade subtypes are associated with high rates of recurrence and hematogenous spread; lungs, liver and peritoneum being the most common sites of metastasis.  Surgical resection (with appropriate negative margins: >1cm) is the standard primary treatment in most patients with stromal cell sarcomas. Complete tumor resection is the primary prognostic factor for local recurrence, and liposarcomas are not the exception. Performing an “en-bloc” resection involving a high orchiectomy (including the surrounding tissue) is important to obtain negative margins [1].

Local recurrence rates for sarcomas, including liposarcomas of the spermatic cord, have been reported to be as high as 30-50%. Because of this, and despite the patient’s disease-free status, long term follow-up remains a crucial step in the detection of recurrences that might still be potentially curable. Current controversy arises on the use of adjuvant chemotherapy or radiotherapy. Being a rare and infrequent entity makes it hard for a single institution to accumulate enough cases to perform prospective randomized controlled trials. Extrapolated data from retrospective analyses support the use of adjuvant radiation on selected high-risk situations (tumor recurrence, high-grade tumors or residual disease). Concerning the role of chemotherapy, the use of adjuvant chemotherapy remains controversial and there is no definitive role in the management of localized liposarcomas[3].

In conclusion, myxoid liposarcomas of the spermatic cord are infrequent entities. As most soft tissue sarcomas, they have an indolent course and should be considered as a differential diagnosis of inguinal masses with no palpable changes during Valsalva´s maneuver. Complete surgical resection with high-orchidectomy “en-bloc” is encouraged.

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[treatmentdisease-blog]

New Post has been published on Details of the treatment of certain diseases. Human Diseases and methods of treatment

New Post has been published on http://bit.ly/2EJ8wvX

Kaposi’s sarcoma (microbiology) liposarcoma pathology outlines

[dsrctbensjourneyblog]

Footnotes … What does google know anyway ...

So in case like us you have never heard of DSRCT … This is what it is … well what google says anyway … 

DSRCT stands for Desmoplastic small-round-cell tumor Desmoplastic small-round-cell tumor (DSRCT) is an aggressive and rare cancer that primarily occurs as masses in the abdomen.  Other areas affected may include the lymph nodes, the lining of the abdomen, diaphragm, spleen, liver, chest wall, skull, spinal cord, large intestine, small intestine, bladder, brain, lungs, testicles, ovaries, and the pelvis. Reported sites of metastatic spread include the liver, lungs, lymph nodes, brain, skull, and bones. The tumor is classified as a soft tissue sarcoma.  It is considered a childhood cancer that predominantly strikes boys and young adults. Diagnosis Differential diagnosis Because this is a rare tumor, not many family physicians or oncologists are familiar with this disease. DSRCT in young patients can be mistaken for other abdominal tumors including rhabdomyosarcoma, neuroblastoma, and mesenteric carcinoid. In older patients DSRCT can resemble lymphoma, peritoneal mesothelioma, and peritoneal carcinomatosis. In males DSRCT may be mistaken for germ cell or testicular cancer while in females DSRCT can be mistaken for Ovarian cancer. DSRCT shares characteristics with other small-round blue cell cancers including Ewing's sarcoma, acute leukemia, small cell mesothelioma, neuroblastoma, primitive neuroectodermal tumor, rhabdomyosarcoma, and Wilms' tumor.  Prognosis The prognosis for DSRCT remains poor.Prognosis depends upon the stage of the cancer. Because the disease can be misdiagnosed or remain undetected, tumors frequently grow large within the abdomen and metastasize or seed to other parts of the body. Kinda depressing …  then it continues with more depressing lingo … now I get the doctors suggestion not to look it up … however … my person will not be a statistic he will beat this … and when he gets tired I will continue fighting for him till he catches his second breath ...

[cancer-surgeon-in-ahmedabad]

ONCO SURGEON | Best Cancer Surgeon in Ahmedabad ,Gujarat,India | Dr. Nitin Singhal

Cancer Regarding Information

Although we have all heard the word "cancer" from many sources, the exact facts and descriptions of the disease are not very widely known.Cancer is one of the deadliest diseases in the world and if it is detected at an early age, it is completely curable. So it is important to have awareness about it and this article is a consolidation of facts and details related to this disease. What is cancer? Cancer is not a single disease but a class of diseases that are generally characterized by random and out-of-control growth in the cells of the human body. These random cell growths attack other normal cells around them, causing their destruction. Cancer cells divide uncontrollably and form lumps or tissue masses called tumors. These tumors affect the part of the body where they grow and disrupt their normal functioning. Cancer cells also spread to other parts of the body through the blood or lymph and cause further cell destruction .

ONCO SURGEON IN AHMEDABAD,Gujarat or researchers who study the diagnosis, treatment, and prognosis of cancer. The study of cancer itself is known as oncology. types of cancer Cancer can usually affect every part of the body and can spread disease by destroying neighboring cells. Different types of cancer are usually named after the place where they originate in the body. For example, breast cancer is cancer that arises in the cells of the breast. With more than 100 types of cancer, this class of diseases is divided into five broad categories. Cancer arising in the skin or in the tissues covering the internal organs is called carcinoma. Cancer that begins in bone, fat, muscle, cartilage or blood vessels is called a sarcoma. Cancer in the blood-forming tissues such as the bone marrow is known as leukemia. This type of cancer enters the bloodstream and spreads to all parts of the body. * Cancers that start in the body's immune system are known as lymphoma and myeloma. Cancer in the cells of the brain and spinal cord is known as central nervous system cancer. symptoms of cancer Symptoms of cancer are an important factor in early detection, although some types of cancer do not show any symptoms until they are in an advanced stage. Although each type of cancer has many symptoms, there are some symptoms that are common in most cancers.

The patient may exhibit a broad spectrum of symptoms that may not be very specific to the type of cancer, such as fatigue, unintentional weight loss, fever, bowel changes, and chronic cough. Pain is mostly a symptom of advanced cancer. Lower back pain can be a symptom of colon or ovarian cancer while shoulder pain can be a symptom of lung cancer. Although abdominal pain can usually be caused by a variety of reasons, colon cancer is also associated with intense abdominal pain. How harmful is cancer? The disease cancer claims the lives of millions of people around the world every year. It is dangerous and life-threatening when it develops into a tumor and spreads around it. The cells can move into the body through the lymphatic system or the blood and destroy other healthy cells in the body. Such a process is known as invasion and affects internal organs other than the place of origin of the cancer. A tumor that grows, invades, and spreads by destroying other tissues is known as a metastasized tumor and is a very serious condition that often goes beyond the level of treatment. How does cancer happen?

Cancer is primarily an environmental disease where about 90–95% of the scenarios are caused by factors such as lifestyle and environmental conditions. Only 5-10% of cases are due to genetic disorders. Common factors that lead to environmental causes of cancer are tobacco, obesity, infection, radiation and environmental pollutants. These factors affect the basic underlying genetic cell material leading to disease. Best Cancer Surgeon, Doctor in Ahmedabad, Gujarat cancer treatment course Definitive diagnosis of cancer requires clinical examination of the biopsy specimen. Sometimes the initial indication of malignancy may be symptomatic or through radiographic imaging abnormalities. Once diagnosed, cancer is usually treated with chemotherapy, surgery or radiation, or a combination of two or more methods. Treatment also depends on the type of cancer and the stage of the disease. There are several specific treatment methods that are followed depending on the type of cancer and medical advances have bought in many new types of targeted therapies for specific types of cancer. Targeted therapy also works on cancer cells showing abnormal behavior and reduces the damage done to normal cells. How can you effectively prevent cancer? Cancer prevention is easier than cancer treatment. Although there are many factors that can lead to cancer, some simple changes in your lifestyle can help you prevent them. Below are some ways

Are you Search for a ONCO SURGEON IN AHMEDABAD,Gujarat,Best Cancer Doctor ,Cancer Treatment in Ahmedabad where you can get best treatment at low cost? Then Dr. Nitin Singhal is the your best choice.for More Information Visit Us : https://www.drnitinsinghal.com

[lupine-publishers-igwhc]

Lupine Publishers | Ovarian Mucinous Borderline Tumor with Malignant Muralnodules: A Report of Two Cases

Lupine Publishers | Interventions in Gynecology and Women's Healthcare

Keywords: Mucinous ovarian tumor; Mural nodule; Anaplastic carcinoma; Angiosarcoma; Poorly differentiated carcinoma; Poor prognosis

Introduction

Mucinous tumors of the ovary account for about 15% of all ovarian tumors; 80% are benign, while only 3-4% are invasive carcinoma; the remainder are borderline tumors [1]. Rarely, mucinous tumors may exhibit mural nodules containing a carcinomatous or sarcomatous component; these mural nodules are more commonly associated with mucinous borderline tumors but can also arise within mucinous carcinoma [1, 2]. Prat and Scully first described mucinous ovarian tumors with mural nodules in a series of 7 cases in 1979; these lesions were termed mucinous tumors with sarcoma-like nodules [3,4]. However, classification of mural nodules arising in mucinous ovarian tumors remains unclear, and several authors have proposed different classification systems [5-14]. Anaplastic carcinoma is the most common type of mural nodular malignancy; these tumors can infiltrate borders and invade blood vessels; they readily metastasize and generally have a poor prognosis [6,7]. We describe two cases of postmenopausal women with malignant mural nodules arising from mucinous borderline tumors of the ovary.

Case reports

Figure 1: A Photograph showing ovarian mass containing mural nodules, B: Mural nodules observed in wall of ovarian mass.

Case 1: A 58-year-old female presented with a several month history of weight gain and abdominal discomfort; CT scan of the abdomen and pelvis demonstrated a large pelvic mass arising from the uterus and right adnexa, with septations and enhancing components. Preoperative tumor markers were elevated: CA-125 at 367, and CA19-9 at 2266. Peritoneal ascitic fluid contained atypical cells suspicious for malignancy. Hysterectomy, bilateral salpingooophorectomy, and omentectomy were performed. Grossly, the ovarian lesion was 31.0cm x 29.0 cm x 15.0cm in size. Capsule was collapsed, and mucoid material was observed oozing from the surface, which was otherwise whitish and smooth; cut surfaces revealed multiloculation, with clear mucinous material (Figure 1A). Several solid areas consisting of firm, tan-white, somewhat mucoid tissue were noted in the wall of the ovarian mass (Figure 1B). Histology revealed a complex mucinous neoplasm with benign, borderline, and malignant change, containing multiple solid nodules of anaplastic carcinoma (Figure 2).

Figure 2: Microscopic appearance of ovarian tumor (hematoxylin & eosin staining). A. Mucinous borderline tumor, B. Mucinous borderline tumor with mural nodule containing focus of anaplastic carcinoma, admixed with discrete borders.

Figure 3: Microscopic appearance of mural nodule containing anaplastic carcinoma (hematoxylin & eosin staining). Tumor cells showed eosinophilic cytoplasm, high grade eccentric nuclei, and prominent nucleoli.

A small focus of intraepithelial carcinoma was identified within the mucinous borderline tumor. Tumor cells had eosinophilic cytoplasm, high grade eccentric nuclei, and prominent nucleoli; some areas showed spindle cell proliferation and rhabdoid differentiation (Figure 3). The ovarian surface was involved by anaplastic carcinoma; this component was also present in lymphovascular spaces in the left fallopian tube, paratubal soft tissue, and paradnexal tissue. A macroscopic extraperitoneal focus of anaplastic carcinoma was detected in the omentum. The anaplastic carcinoma component showed diffuse immunopositivity for CK7, and weak positivity for CK20; p53 was diffusely positive (Figure 4). The mucinous borderline component was also positive for CK7 and CK20, as well as PAX8, CDX2, and villin. In both components, p16 showed mosaic staining, and ER and PR were negative.

Figure 4: Immunohistochemical features of ovarian lesion, showing mucinous borderline tumor and mural nodule with anaplastic carcinoma. Both the mucinous borderline and anaplastic carcinoma components showed diffuse immunopositivity for CK7 (A), the anaplastic component showed weak positivity for CK20, while the borderline component was strongly positive for CK20 (B); both components showed mosaic staining for p16 (C), anaplastic component was diffusely positive for p53 (D).

Case 2: A 52-year-old female presented with a two-month history of abdominal discomfort, bloating, and weight gain. CT scan of the abdomen and pelvis showed a large cystic mass with internal septations and several solid components, favoured to arise from the right ovary. Preoperative CA-125 was slightly elevated at 42. Peritoneal ascitic fluid was negative for malignant cells. Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and peritoneal biopsies were performed. Grossly, the ovarian lesion was 30.0 cm x 18.0 cm x 15.0 cm in size with a smooth, intact capsule, and one 40 mm solid nodule, which consisted of tan, hemorrhagic, friable, multicystic tissue (Figure 5). Microscopically, a mucinous borderline tumor with intraepithelial carcinoma and a mural nodule was observed. The nodule was predominantly composed of pleomorphic spindle cells, but also had an epithelial component (Figure 6). Spindle cells contained hyperchromatic nuclei and were arranged in a vaguely fascicular pattern with some vascular-like spaces; no vascular invasion was seen (Figure 6).

Figure 5: Photograph showing ovarian lesion containing a solid nodule.

Figure 6: Microscopic appearance of ovarian tumor (hematoxylin & eosin staining). A. Mucinous borderline tumor. B. Mucinous borderline tumor with mural nodule containing pleomorphic spindle cells. C. Mural nodule containing pleomorphic spindle cells and poorly differentiated carcinoma. D. Angiosarcoma component.

Figure 7: Immunohistochemical features of ovarian lesion, showing a small focus of mucinous borderline tumor and mural nodule with poorly differentiated carcinoma. Both the mucinous borderline and poorly differentiated carcinoma components showed diffuse immunopositivity for CKAE1/AE3 (A), and CAM5.2 (B).

Figure 8: Immunohistochemical features of ovarian lesion, showing mural nodule with spindle cell component consistent with angiosarcoma, which showed diffuse immunopositivity for vimentin (A), CD31 (B and C), and ERG (D).

Immunohistochemical stains for CK AE1/AE3 and CAM5.2 highlighted the mural nodule’s epithelial component, which was consistent with invasive poorly differentiated carcinoma (Figure 7). The spindle cell component was negative for pancytokeratins, and diffusely positive for vimentin, CD31 and ERG; consistent with angiosarcoma (Figure 8). The case was sent for outside consultation, and the mural nodule was determined to be a malignant spindle cell neoplasm consistent with angiosarcoma with admixed foci of poorly differentiated carcinoma. Ultimately, the mural nodule was classified as a malignant mesodermal mixed tumor (carcinosarcoma).

Discussion

Mucinous borderline tumors of the ovary containing malignant mural nodules are rare entities; a small number of cases have been described since 1979 [6,8,9,14]. Prat and Scully (1979) proposed a classification system dividing mural nodules into three classes based on histology: type 1 nodules (pleomorphic and epulis like), type 2 nodules (pleomorphic and spindle cell) and type 3 nodules (giant cell-histiocytic) [3]. Other reports have described mural nodules based on gross examination: sarcoma-like, which are typically multifocal and contain large areas of hemorrhage, anaplastic or undifferentiated carcinomas, which are often multifocal but less hemorrhagic than sarcoma-like mural nodules; and sarcoma, which tend to be solitary nodules [10-12]. Additional reports have classified mural nodules into five or six groups: anaplastic carcinoma, sarcoma, sarcoma-like, mixed, and smooth muscle sarcoma; carcinosarcoma may be considered a grouping, as well as leiomyoma [1,5,14,15]. In our two cases, the patients were close in age and presented with similar symptoms: weight gain and abdominal discomfort. Imaging of both ovarian lesions showed similar large cystic pelvic masses with septations. Gross examination of the lesions also revealed similarities: both lesions were over 30cm in greatest dimension, multiloculated, and contained solid nodules within the wall. Microscopic features of the mural nodule in case 1 were easy to discern, given the eosinophilic cytoplasm, high grade eccentric nuclei, with focal spindle cell proliferation, which are characteristic of anaplastic carcinoma. The mural nodule in case 2, however, had both a spindle cell and epithelial component and required expert consultation to diagnose as angiosarcoma with poorly differentiated carcinoma. Therefore, the mural nodule in case 2 may be categorized as carcinosarcoma, mixed, or sarcoma, depending on which classification scheme is referred to. Prognosis for patients with mural nodules arising from mucinous borderline tumors of the ovary is generally thought to be poor, especially for sarcomatous and anaplastic mural nodules [7-13]. A more favorable prognosis is expected in patients where the malignant mural nodule is confined to the ovary and/or lacks vascular invasion [9-15]. In addition, type 3 nodules (giant cellhistiocytic) in the classification proposed by Prat and Scully (1979) are also thought to behave in a benign manner and therefore portend a good prognosis [3]. However, a larger study of 34 cases of anaplastic carcinoma arising in mucinous ovarian tumors concluded that foci of anaplastic carcinoma in unruptured stage I mucinous tumors may not foretell an unfavorable prognosis; one third of patients who were followed up died within 8 months, but these were stage >1C tumors; only one patient with stage 1A disease died [14]. In case 2, mural nodules had not disseminated beyond the ovary, and no lymphovascular invasion was identified. The patient remains free of local recurrence or metastases approximately 3 years after surgery; she continues to undergo active surveillance every 6 months with CT scans. The patient in case 1 is only a few months post operative and is currently disease free despite the presence of lymphovascular invasion and dissemination of the anaplastic component to the ipsilateral fallopian tube, paratubal soft tissue, paradnexal tissue, and omentum (pT3c). She is currently receiving chemotherapy with Carboplatin and Paclitaxol. A Lynch Study demonstrated intact staining for both the mucinous borderline tumor and anaplastic carcinoma component in this lesion.

Conclusion

We present two cases of a rare entity: mural nodules arising in a mucinous borderline tumor of the ovary. In case 1, anaplastic carcinoma arose in a nodule, and metastases of this primary neoplasm were observed diffusely around the pelvis; precluding the fact that anaplastic carcinoma within a mucinous neoplasm leads to aggressive behaviour. Case 2 was unusual since two different malignant components were observed within the mural nodule. There is conflicting evidence in the literature regarding progression of mural nodules; our first case was limited to the ovary, and the patient experienced a favourable outcome; the second case was an anaplastic mural nodule that disseminated around the pelvis, and the patient is still undergoing treatment; these results seem to fit with past reports detailing behaviour of these tumors. Ultimately, close follow up of patients with mural nodules arising in mucinous borderline tumors of the ovary is imperative given the tendency of these lesions to spread to lymphovascular spaces and metastasize. In addition, progression of malignant neoplasms arising in mucinous borderline tumors should be included in the differential diagnosis when undifferentiated tumors are identified in the omentum and the patient has a history of a pelvic mass.

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[delicatemagazinedreamer]

Current Knowledge on the Diagnosis and Management of Retroperitoneal Liposarcoma Treatment

RLS (retroperitoneal liposarcoma) is a rare, physiologically heterogeneous cancer that develops in the retroperitoneum, the lining of the abdominal cavity that surrounds the abdominal organs. Retroperitoneal Liposarcoma Treatment grow constantly and are often not identified until they are very large, hence their prognosis is poor when compared to other retroperitoneal sarcoma subtypes. 

Although the cause of these tumours is uncertain, genetic mutation is thought to be one of the elements that contribute to their growth. Men and women are equally affected by this condition, with men having a slight advantage. This tumour has no distinguishing signs and is usually discovered when it has progressed to an advanced stage.

Read more @ https://digitalgrowinfo.blogspot.com/2022/02/retroperitoneal-liposarcoma-treatment.html

[jesse-pinkman123]

Retroperitoneal Liposarcoma Treatment Market Size Share Trends Forecast 2026

Retroperitoneal Liposarcoma Treatment Market – Drivers

The global Retroperitoneal Liposarcoma Treatment Market is expected to exhibit a moderate growth rate, owing to low incidence of this disease across the globe. According to the World Health Organization (WHO) 2016, liposarcoma is the most common type of sarcomas (cancer of soft tissue) and is classified as a rare disease, which accounts for around 17-20% of all the cases (2.5 per Mn population) of sarcoma. Furthermore, rising incidence of genetic disorders is one of the major factors responsible for the global retroperitoneal liposarcoma treatment market growth. According to a report published by the Genetics Education Center, University of Kansas Medical Center, around 15% of all the cancers have an inherited susceptibility and around 12% of the hospital admissions in the U.S. accounted for the treatment of genetic causes in 2013. Various other factors contributing to market growth include changing lifestyle and growing awareness among populace regarding availability of treatment for liposarcoma through initiatives undertaken by various organizations. For instance, Liposarcoma Genome Project initiative by Massachusetts General Hospital Cancer Center conducted research to understand the differences between well-differentiated and de-differentiated liposarcoma, to support the development of treatment for the rare disease. However, high costs associated with the treatment procedures and low accessibility of the treatment due to rareness of the disease are expected to be factors hindering the market growth.

Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous cancer, which occurs in retroperitoneum, lining of the abdominal space that covers the abdominal organs. Retroperitoneal liposarcoma grow continuously and may not get diagnosed until they are very large thus, its prognosis is poor compared to the other subtypes of retroperitoneal sarcomas.

* The sample copy includes: Report Summary, Table of Contents, Segmentation, Competitive Landscape, Report Structure, Methodology.

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The reason for the development of these tumors are still unknown, however, genetic mutation is considered to be one of the factors leading to the generation of these tumors. Incidence of this disease is equal in men and women, with a slight predominance of men. This tumor has no characteristic symptoms and are usually diagnosed during the advanced stage.

Furthermore, the effectiveness of radiotherapy or chemotherapy for the treatment of this tumor is not properly defined, as they are massive in size and might involve adjacent visceral organs and critical structures. However, affected population who received adjuvant chemotherapy showed survival benefits and improvement, as compared to patients who underwent surgery alone. In the case of surgeries, sometimes, preoperative radiation is given to shrink the tumor. This allows smaller doses of radiation to a smaller field and make the surgery technically more feasible. The European Organisation for Research and Treatment of Cancer (EORTC) is currently conducting a randomized trial comparing 50.4 Gy (Gray-unit to measure radiation therapy) of pre-operative radiation therapy with short-course radiotherapy, followed by surgery to direct surgery alone. Thus, continuous researches that are being conducted for the development of treatment for this disease is expected to create lucrative opportunities in the retroperitoneal liposarcoma treatment market during the forecast period.

Retroperitoneal Liposarcoma Treatment Market - Regional Analysis

On the basis of region, the global retroperitoneal liposarcoma treatment market is segmented into North America, Latin America, Europe, Asia Pacific, Middle East, and Africa. North America holds the maximum share for retroperitoneal liposarcoma treatment, owing to increasing research and development of novel therapies and potential drugs for dedifferentiated liposarcoma. For instance, the Sarcoma Foundation of America (SFA) aids sarcoma patients by providing funding for research to private researchers and conducts education campaigns for patients suffering from various types of sarcomas.

Browse Research Report: https://www.coherentmarketinsights.com/ongoing-insight/retroperitoneal-liposarcoma-treatment-market-1861

Furthermore, Asia pacific also generates the significant value in retroperitoneal liposarcoma treatment market, owing to the presence of significant population suffering from the disease in this region. For instance, according to the Journal of Blood & Lymph 2013, in India around 35% of the patients suffering from sarcoma died due to dedifferentiated liposarcoma.

Retroperitoneal liposarcoma Treatment Market – Competitor Landscape

Increasing regulatory approvals by the U.S. FDA for various products manufactured by large companies is expected to boost the overall growth of the retroperitoneal liposarcoma treatment market. For instance, in 2015, the U.S. FDA granted priority review for the New Drug Application (NDA) for YONDELIS (trabectedin), manufactured by Janssen Research & Development, LLC to treat patients with advanced soft tissue sarcoma (STS), which includes liposarcoma and leiomyosarcoma subtypes in 77 countries, within North America, Europe, South America, and Asia. Furthermore, in 2016, Eisai Co., Ltd. received the approval in Japan for its in-house developed anticancer agent Halaven (eribulin mesylate) for the treatment of patients suffering from soft tissue sarcoma.

Market players operating in the global retroperitoneal liposarcoma treatment market include Eli Lilly and Company, Baxter International, Bristol Laboratories Ltd., Pfizer Inc., Teva Pharmaceutical Industries Ltd., Mylan N.V., Actavis plc, Fresenius Kabi Ltd., Accord Healthcare Inc., Taro Pharmaceuticals Inc., Sandoz, Bedford Laboratories, and Zydus Cadila.

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Juniper Publishers- Open Access Journal of Case Studies

Case Report: A Rare Case of Tumor: A Metastatic GIST

Authored by Kalaji Manhal

Abstract

Gastrointestinal Stromal Tumors “GIST” is a rare form of digestive tract cancer with an estimated incidence of 15 cases per million population with an average age of 60 years. The surgical methods remain the main form of treatment and the only curative one. This case study is about a 5-year-old patient who presented non-specific abdominal pain and impaired general state. The CT-scan showed a voluminous abdominal mass located in the stomach as well as two liver metastases. We decided to perform a surgical biopsy of the gastric mass in order to identify its type. The anatomopathological analysis concluded in a Gastrointestinal Stromal Tumor, probably of gastric origin. In this context, we decided to initiate an Imatinib treatment: 400mg a day per os in one take. The patient initially responded very well to the treatment with a decrease of the size of the gastric tumor but, after 4 years, the mass started to further increase in volume.

After multidisciplinary discussion and involvement of the patient, surgical resection was agreed upon. No lymph node resection was done since lymph node metastases are rare. We performed a total gastrectomy with complete monobloc surgical resection of the tumor as well as a metastasectomy of the two liver lesions, an ablation of lesion on the ligamentum teres hepatis and hepatic hilum and finally a preventive cholecystectomy

Keywords: GastroIntestinal Stromal Tumors (GIST); Imatinib, Surgery

Abbrevations: GIST: Gastro-Intestinal Stromal Tumor

Introduction

Although gastrointestinal stromal tumors (GIST) are the most frequent sarcomas, they have been very poorly studied up until twenty years ago [1].

These tumors are the most common mesenchymal tumors of the gastrointestinal tract but still represent less than 1% of all gastrointestinal tumors [2]. GIST is a group of mesenchymal tumors that derive from interstitial cells of Cajal and which develop from the Muscularis propria. They may be acquired or genetic [3].

Imatinib has revolutionized the management of locally advanced and metastatic GIST. However, the surgical methods remain the main form of treatment and the only curative one [4]. This case report presents a metastatic gastric gastrointestinal stromal tumor recently removed in a 65-year-old male patient, the outcome and a literature review of the pathological identification, sites of origin, prognosis and treatment.

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Case

A 65-year-old male patient with no significant medical history other than type 2 diabetes consulting for non-specific abdominal pain associated with a 2kg weight loss and an impaired general state, which wasn’t investigated. Family history was noncontributory.

The abdomen was soft and painless during physical examination.

A contrast-enhanced thoraco-andominal CT-scan showed a voluminous abdominal mass measuring 25 x 20cm located in the stomach as well as two liver lesions. No pulmonary lesions were found. After a multidisciplinary discussion, we decided to proceed to a surgical biopsy of the gastric mass in order to identify the etiology. The anatomopathological analysis revealed a Gastrointestinal Stromal Tumor, probably of gastric origin. We decided to start a treatment with Imatinib (Glivec) 400mg [5]. The medical treatment with Imatinib worked well at first but a further increase in volume of the mass, but not the metastases, was discovered after four years. After a new multidisciplinary discussion, given the resectability of the lesion, it was decided to perform a surgical “en bloc” resection of the tumor [6].

Discussion

Until 1998, gastrointestinal stromal tumors remained largely unknown. In the beginning of the 80’s, the generalization of immunohistochemistry techniques allowed us to take enabled a big step in the diagnosis, but also in the treatment of these tumors since they are characterized by a very frequent expression of KIT (CD117), whose expression is specific to the interstitial cells of Cajal. GISTs are slightly more prevalent in male patients, with an average diagnosis age of 60 years [7,8].

Our patient suffered from abdominal discomfort and abdominal bloating. After further questioning, he confirmed a feeling of early satiety. He denied any other symptoms.

If surgery is the standard procedure for all GIST of small intestine or rectum it is not the case for gastric GIST. The treatment strategy in these cases is affected by several factors: the size of the tumor, its location, its adhesions to nearby structures and presence or absence of metastasis [1,9] (Figure 1-7).

Some studies have suggested the high frequency of small gastric GIST (<10mm in diameter) in adults after 50 years of age. The evolution of those tumors is not certain, and they could even regress in the future. Other studies seem to show that the risk of malignancy in GIST of the stomach is very low or inexistent when their diameter is smaller than 2cm [10-12].

Thus, for gastric GISTs of less than 2cm, the choice between clinical surveillance and surgery will be based on symptoms (minor at this size), patients’ general condition and location of the lesion in the stomach, facilitating resection or not. Endoscopic excision may be a treatment option for gastric GISTs of this size. Some Asian teams use this technique, which remains less invasive. It can also be combined with laparoscopy, but its efficiency remain uncertain. For non-metastatic gastric GIST greater than 2cm, complete surgical excision is the standard procedure with or without prior Imatinib treatment [13,14].

Our case is different from all these situations since it is a metastatic gastric GIST. The studies show that in responding or stable patients using Imatinib and potentially accessible for an R0 resection, the role of surgery remains to be clarified. Its feasibility has been shown, but its impact on survival hasn’t yet been established. Two randomized trials (continuation of Imatinib versus surgery and continuation of Imatinib) were suspended due to slow recruitment. The Chinese trial, which included only 41 patients, did however show a non-significant trend in favor of the “surgery” group [15].

Our institution believes surgery remains the best solution and the only curative one if R0 is possible, even in metastatic cases [13]. We therefore proceeded to a total gastrectomy with complete monobloc surgical resection of the tumor as well as a metastasectomy of the two liver lesions, a removal of the ligamentum teres hepatis and hepatic hilum metastases and, finally, a preventive cholecystectomy. No lymphadenectomy was performed since lymph node metastases are rare, even in advances cases, and all the forty-eight lymph nodes associated to the surgical piece showed no anatomopathological signs of malignancy. At six months postoperatively, an abdominal contrast-enhanced CT scan showed no sign of resurgence.

Conclusion

Even though this is an isolated case, it might be worth thinking about the management of stable metastatic GIST under Imatinib. A new randomized study could, of course, allow a big step in the management of these tumors. Unfortunately, recruitment is a main limitation since these cases are rare.

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Lung Cancer: A Overview

Lung cancer is cancer that forms in lung tissues, usually in the cells lining the air passages. It is the leading cause of cancer death in both men and women worldwide.Smokers are at the highest risk of lung cancer, though lung cancer may also occur in non-smokers.

WHAT CAUSES LUNG CANCER?

There can be various causes of lung cancer. Some of them are mentioned as follows:

1) Smoking:

About 90% of lung cancer cases are due to smoking, both in smokers and passive smokers. The risk of lung cancer increases with the number of cigarettes smoked over time. It is referred to as pack-years of smoking history by doctors (the number of packs of cigarettes smoked per day multiplied by the number of years smoked).                                                                                    Smoke in the form of pipe, cigar and tobacco can also cause lung cancer, though the risk is not as high as with cigarettes. Tobacco smoke contains over 7,000 chemical compounds and most of them are carcinogenic (cancer-causing). Nitrosamines and polycyclic aromatic hydrocarbons are the two primary carcinogens in tobacco smoke.                                                                 It is believed that smoking causes lung cancer by damaging the cells lining the lungs. When one inhales the smoke, changes in lung tissue begin immediately. At first, the lungs can repair the damage; however, with repeated exposures, normal cells lining the lungs are increasingly damaged and it becomes difficult for the lungs to continue the repair. Over time, the damage causes cells to act abnormally, thereby increasing the chances of developing lung cancer.    Passive smoking, i.e., inhalation of secondhand smoke from other smokers is also a major risk factor for the development of lung cancer. 

 2) Exposure to radon gas:

Radon gas is a known cause of lung cancer. Radon is a naturally occurring radioactive gas that results from the natural breakdown of uranium in soil, rocks and water. It is invisible, odourless; however, can be detected with simple test kits. Radon decays and forms products which emit a type of ionizing radiation. Radon gas can travel through soil and enter homes through cracks/gaps in foundation, pipes, drains, etc.

 3) Exposure to asbestos:

Asbestos fibres are silicate fibres that can persist for a lifetime in lung tissue following exposure to asbestos. Exposure to asbestos usually occurs at the workplace as asbestos was used in the past for thermal and acoustic insulation materials. Other than lung cancer, a type of cancer of the pleura or the lining of the abdominal cavity, i.e. peritoneum called mesothelioma is also associated with asbestos exposure.

 4) Exposure to other cancer-causing agents (carcinogens):

Other carcinogens at the workplace which can increase risk of lung cancer include radioactive ores such as uranium; inhaled chemicals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers; diesel exhaust, etc.

 5) Family history of lung cancer, inherited genetic mutations:

People with a parent, sibling or child with lung cancer have an increased risk of the disease.

 7) Previous history of lung cancer:

The person who has survived lung cancer has a greater risk than the general population of developing second lung cancer. 

 8) Air pollution:

Prolonged exposure to polluted air from vehicles, industry, and power plants, can increase the chance of developing lung cancer. 

 9) Previous radiation therapy:

Previous radiation therapy to the chest for another type of cancer increases the risk of developing lung cancer.

 LUNG CANCER PREVENTION:

All lung cancers can not be prevented. However, some measures can be taken to prevent the risk of lung cancer. They include:

 Quit smoking.

 Non-smokers should avoid all forms of smoke- pipe, cigar, tobacco; and   also passive smoking.

 Avoid radon exposure.

 Avoid or limit exposure to cancer-causing agents/carcinogens.

 Maintaining a healthy diet.

 TYPES OF LUNG CANCER:

Lung cancer can be divided into two major types depending on the microscopic appearance of the tumour cells. This helps in deciding the line of treatment. The two types include:

1) Small cell lung cancer (SCLC): 

This type of lung cancer is usually seen in heavy smokers. It is the most aggressive and rapidly growing of all types. It is less common and comprises 10 to 15% of all lung cancers. It is sometimes also called oat cell cancer. SCLC has a rapid metastasis and spreads to many sites within the body and is often diagnosed after the extensive spread. 

2) Non-small cell lung cancer (NSCLC):

 This type of lung cancer is most common and comprises about 80 to 85% of all lung cancers. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. NSCLC has three main types divided according to the type of cells found in the tumor. They are as follows:

i) Adenocarcinoma: This type of lung cancer is mainly seen in current or former smokers, however, is also the most common type seen in non-smokers. It is more common in women than men, and more likely occurs in younger people. Adenocarcinoma arises in the outer, peripheral parts of the lung. 

Adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) is a subtype of adenocarcinoma which frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls. It may also look like pneumonia on a chest X-ray. It is more common in women. People with adenocarcinoma in situ tend to have a better prognosis than those with other types of lung cancer.

ii) Squamous cell carcinoma: Squamous cell carcinomas start in squamous cells, which are flat cells lining the inside of the airways in the lungs. They account for about 25% to 30% of all lung cancer cases. They are mostly found in be found in the central part of the lungs.

iii) Large cell (undifferentiated) carcinoma: Large cell carcinomas are the least common type of NSCLCs and account for 10 to 15% of all lung cancers. It can appear in any part of the lung and tends to grow and spread quickly, which makes it harder to treat. 

iv) Other subtypes: Few other subtypes of NSCLC, such as adenosquamous carcinoma and sarcomatoid carcinoma, are much less common.

 3) Other types of lung cancers: 

They are much less common than NSCLC and SCLC and comprise only 5%-10% of lung cancers.

i) Lung carcinoid tumors/ Bronchial carcinoids:  They account for up to 5% of lung cancers and occur mostly in persons under age 40. Carcinoids generally have slow growth and spread more slowly than bronchogenic cancers. Many times, they are detected early enough to be surgically removed.

ii) Other types like adenoid cystic carcinomas, lymphomas, and sarcomas, as well as benign lung tumors such as hamartomas, are rare. 

 SYMPTOMS OF LUNG CANCER:

Lung cancer usually doesn't cause signs and symptoms in its early stages. Signs and symptoms typically appear when the disease is advanced. Symptoms of non-small cell lung cancer and small cell lung cancer are basically the same. They may include:

 Lingering or worsening cough.

 Coughing up phlegm or blood.

 Chest pain that worsens on breathing deeply, laughing, or coughing.

 Hoarseness.

 Shortness of breath.

 Wheezing.

 Weakness and fatigue.

 Loss of appetite and weight loss.

 Bone pain.

 Recurrent respiratory infections including bronchitis or pneumonia.

 Swelling of the neck and face.

 Pain and weakness in the shoulder, arm, or hand.

 Interrupting fever, severe headaches.

 Trouble swallowing.

 Additional symptoms depend on the cancer spread and where new tumors form. For example:

 In lymph nodes: lumps in the neck or collarbone.

 In bones: pain in the back, ribs, or hips.

 In brain or spine: headache, dizziness, balance issues, or numbness in arms or legs.

 In liver: yellowing of skin and eyes (jaundice).

If one observes any of the above symptoms persisting, they should immediately consult the doctor and get it checked.

 DIAGNOSIS OF LUNG CANCER:

After a physical examination, the doctor will tell how to prepare for various diagnostic tests which may include any of the following:

i) Imaging tests:

 An X-ray image of lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in the lungs that might not be detected on an X-ray. MRI and PET scans can also be used.

ii) Sputum cytology:

If one has cough and is producing sputum/ phlegm, microscopic examination can determine the presence of lung cancer cells.

iii) Tissue sample (biopsy):

A sample of abnormal cells can be removed by biopsy procedure which can determine if tumour cells are cancerous or not. The biopsy can be performed in several ways:

Bronchoscopy: In this procedure, the patient is under sedation and doctor guides a thin, lighted tube through the nose or mouth and down the air passages to the tumor site, to remove a tiny tissue sample. The instrument used is called a bronchoscope. This procedure is useful for tumors near the centre of the lung. 

Mediastinoscopy: In this procedure, an incision is made at the base of the neck; a lighted instrument is inserted and surgical tools are inserted to take tissue samples from lymph nodes. This procedure is done under general anaesthesia.

Needle biopsy: In this procedure, using imaging tests such as X-ray or CT images as a guide, a needle is inserted through the chest wall and into the suspicious lung tissue. 

A biopsy sample can also be taken from lymph nodes or other areas where cancer has spread, such as the liver.

Careful analysis of cancer cells in the pathology lab can help in diagnosis.

LUNG CANCER STAGES:

Once lung cancer has been diagnosed, the doctor will try to determine the extent (stage) of your cancer. Knowledge of cancer's stage helps the doctor to decide the line of treatment.

Tests for determining the stages include Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) scan and bone scans. 

Four main stages in non-small cell lung cancer (NSCLC) are:

Stage 1: Cancer is found in the lung, but it has not spread outside the lung.

Stage 2: Cancer is found in the lung and nearby lymph nodes.

Stage 3: Cancer is in the lung and lymph nodes in the middle of the chest.

          Stage 3A: Cancer is found in lymph nodes, but only on the same side of the chest (ipsilateral) where cancer first started growing.            Stage 3B: Cancer has spread to lymph nodes on the opposite side of the chest (contralateral) or to lymph nodes above the collarbone.   Stage 4: Cancer has spread to both lungs, into the area around the lungs, or to distant organs.

 Small-cell lung cancer (SCLC) has two main stages:

 Limited stage: Cancer is found in only one lung or nearby lymph nodes on the same side of the chest (ipsilateral).

Extensive stage: Cancer has spread:

i. throughout one lung

ii. to the opposite lung

iii. to lymph nodes on the opposite side

iv. to fluid around the lung

v. to bone marrow

vi. to distant organs

 TREATMENT OF LUNG CANCER:

The treatment plan for a patient depends on the type of lung cancer, its stage and spread; side effects of the treatment; patient's age and overall state of health, patient's preferences and goals. Various treatment options include:

1) Surgery:

During surgery, tumorous part of the lung is removed along with a margin of healthy tissue. During surgery, lymph nodes from the chest can also be removed to check them for signs of cancer.

Surgery is an option when cancer hasn’t spread too far in the body. It is usually the best way to treat non-small-cell lung cancer. If one has larger lung cancer, the doctor may recommend chemotherapy or radiation therapy before surgery to shrink cancer. The doctor may recommend chemotherapy or radiation therapy after surgery to rule out the risk of cancerous cells being left behind after surgery or the risk of recurrence.

Various surgical procedures for lung cancer may include:

i. Wedge resection: removal of a small section of lung that contains the tumor along with a margin of healthy tissue.

ii. Segmental resection: removal of a larger portion of the lung, but not an entire lobe.

iii. Lobectomy: removal of an entire lobe of one lung.

iv. Pneumonectomy: removal of an entire lung.

 2) Radiofrequency Ablation:

This procedure is a treatment option in patients who have non-small cell lung cancer and can’t undergo surgery. A needle is guided by the doctor through the skin until it touches the tumor inside the lung and then an electric current is passed through it to heat and kill the cancerous cells.

 3) Radiation therapy:

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancerous cells. It can be used for both non-small-cell and small-cell lung cancers. 

In patients with locally advanced lung cancer, radiation may be used before surgery to shrink a tumor to make it easier to remove or after surgery to kill any cancer cells left behind. It can also be combined with chemotherapy treatments. If surgery cannot be done in a patient, combined chemotherapy and radiation therapy may be the primary treatment.

In patients with advanced lung cancers and those which have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain or bleeding.

 4) Chemotherapy:

Chemotherapy uses drugs to kill cancer cells. It can be used in both types of lung cancers. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally as pills. A combination of drugs usually is given in a series of treatments over weeks or months, with breaks in between so that patient can recover.

Chemotherapy can be used after surgery to kill any cancerous cells that may be left. It can be used alone or in combination with radiation therapy. Chemotherapy may also be used before surgery to shrink cancer size and make the removal easier.

In people with advanced lung cancer, chemotherapy can help to relieve pain and other symptoms.

 5) Stereotactic body radiotherapy:

Stereotactic body radiotherapy is also known as radiosurgery. It is an intense radiation treatment aiming many beams of radiation from different angles at cancer. This treatment is typically completed in one or a few treatments. It may be an option for people with small lung cancers who can't undergo surgery and it may also be used to treat lung cancer spreading to other parts of the body, including the brain.

 6) Targeted drug therapy:

Targeted drug treatments focus on specific abnormalities present in cancerous cells, block them and cause cancer cells to die. Some of the drugs include Afatinib, Bevacizumab, Ceritinib, Erlotinib, Gefitinib, etc.

 7) Immunotherapy:

Immunotherapy uses one's immune system to fight cancer. Drugs used include Atezolizumab, Nivolumab, etc. Immunotherapy treatments are generally done in people with locally advanced lung cancers and cancers that have spread to other parts of the body.

 8) Palliative care:

Lung cancer patients experience signs and symptoms of cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a speciality area of medicine that involves working with a doctor to minimize the signs and symptoms. Palliative care is seen to improve mood and quality of life.

 Various medical specialists need to collaborate to collectively plan the treatment of lung cancer. A thoracic surgeon is the one who specializes in the chest and lungs. A pulmonologist is the lung specialist. Oncologists are the ones who treat cancerous tumours (medical oncologist and radiation oncologist). Pathologists work with these doctors to assist in treatment planning and identify if a particular treatment is working or not. 

An excellent team of specialists like that of thoracic surgeons, pulmonologists, medical oncologists, radiation oncologists and pathologists can be found under one roof at 'Kingsway Hospitals, Nagpur'.

 At Kingsway Hospitals, the centre for cancer has the expertise and technology to provide comprehensive care for patients with all types of cancers, including lungs cancer, solid tumors and other blood-related diseases. The hospital offers a broad scope of cancer-related services, ranging from public education, screening, diagnosis, treatment, pain management, and palliative care.

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New Post has been published on Details of the treatment of certain diseases. Human Diseases and methods of treatment

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Epithelioid sarcoma — prayers for elijah foundation sarcoma pelvis

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Retroperitoneal Liposarcoma Treatment Market Insight Strategies Volume Outlook

Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous cancer, which occurs in retroperitoneum, lining of the abdominal space that covers the abdominal organs. Retroperitoneal liposarcoma grow continuously and may not get diagnosed until they are very large thus, its prognosis is poor compared to the other subtypes of retroperitoneal sarcomas.

The reason for the development of these tumors are still unknown, however, genetic mutation is considered to be one of the factors leading to the generation of these tumors. Incidence of this disease is equal in men and women, with a slight predominance of men. This tumor has no characteristic symptoms and are usually diagnosed during the advanced stage.

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Furthermore, the effectiveness of radiotherapy or chemotherapy for the treatment of this tumor is not properly defined, as they are massive in size and might involve adjacent visceral organs and critical structures. However, affected population who received adjuvant chemotherapy showed survival benefits and improvement, as compared to patients who underwent surgery alone. In the case of surgeries, sometimes, preoperative radiation is given to shrink the tumor.

This allows smaller doses of radiation to a smaller field and make the surgery technically more feasible. The European Organisation for Research and Treatment of Cancer (EORTC) is currently conducting a randomized trial comparing 50.4 Gy (Gray-unit to measure radiation therapy) of pre-operative radiation therapy with short-course radiotherapy, followed by surgery to direct surgery alone. Thus, continuous researches that are being conducted for the development of treatment for this disease is expected to create lucrative opportunities in the retroperitoneal liposarcoma treatment market during the forecast period.

Retroperitoneal Liposarcoma Treatment Market – Drivers

The global retroperitoneal liposarcoma treatment market is expected to exhibit a moderate growth rate, owing to low incidence of this disease across the globe. According to the World Health Organization (WHO) 2016, liposarcoma is the most common type of sarcomas (cancer of soft tissue) and is classified as a rare disease, which accounts for around 17-20% of all the cases (2.5 per Mn population) of sarcoma. Furthermore, rising incidence of genetic disorders is one of the major factors responsible for the global retroperitoneal liposarcoma treatment market growth. According to a report published by the Genetics Education Center, University of Kansas Medical Center, around 15% of all the cancers have an inherited susceptibility and around 12% of the hospital admissions in the U.S.

accounted for the treatment of genetic causes in 2013. Various other factors contributing to market growth include changing lifestyle and growing awareness among populace regarding availability of treatment for liposarcoma through initiatives undertaken by various organizations. For instance, Liposarcoma Genome Project initiative by Massachusetts General Hospital Cancer Center conducted research to understand the differences between well-differentiated and de-differentiated liposarcoma, to support the development of treatment for the rare disease.

Retroperitoneal Liposarcoma Treatment Market - Regional Analysis

On the basis of region, the global retroperitoneal liposarcoma treatment market is segmented into North America, Latin America, Europe, Asia Pacific, Middle East, and Africa. North America holds the maximum share for retroperitoneal liposarcoma treatment, owing to increasing research and development of novel therapies and potential drugs for dedifferentiated liposarcoma.

For instance, the Sarcoma Foundation of America (SFA) aids sarcoma patients by providing funding for research to private researchers and conducts education campaigns for patients suffering from various types of sarcomas. Furthermore, Asia pacific also generates the significant value in retroperitoneal liposarcoma treatment market, owing to the presence of significant population suffering from the disease in this region. For instance, according to the Journal of Blood & Lymph 2013, in India around 35% of the patients suffering from sarcoma died due to dedifferentiated liposarcoma.

Click To Read More On:  Retroperitoneal Liposarcoma Treatment Market

About Coherent Market Insights:

Coherent Market Insights is a prominent market research and consulting firm offering action-ready syndicated research reports, custom market analysis, consulting services, and competitive analysis through various recommendations related to emerging market trends, technologies, and potential absolute dollar opportunity.

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Coherent Market Insights

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#3200

Seattle, WA 98154

Tel: +1-206-701-6702

Email:sales@coherentmarketinsights.com

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Obturator to Femoral Nerve Transfer for Femoral Nerve Palsy Using a Modified Technique-Juniper-Publisher

Introduction

Though uncommon, femoral nerve palsies are potentially devastating injuries which can occur as a result of penetrating trauma or malignancies, however the most common cause is inadvertent iatrogenic injury following intra abdominal surgery such as gynaecological/vascular surgery or total hip replacement [1]. We present a case of iatrogenic femoral nerve injury with a delayed presentation resulting in an 8.5cm nerve defect, which was managed with both traditional cable grafting and a contemporary nerve transfer utilising a modification of an existing technique.

Case Report

In September 2015 a 49 year old female presented to our institution 6 months following a laparoscopic inguinal hernia repair which had resulted in a complete transection of the right femoral nerve. There was a 6 month delay in diagnosis of the iatrogenic injury. The patient had an extraperitoneal exploration of the right groin which confirmed the diagnosis, and an 8.5cm nerve defect at the level of the inguinal ligament was cable grafted with 4 cables sural nerve grafts. After discussion with the patient and appropriate review of the literature and cadaver dissection, the patient had a nerve transfer procedure 3 weeks following the cable grafting.

Procedure 1

In conjunction with General Surgical colleagues a supra- inguinal extraperitoneal approach was performed exposing the femoral neurovascular bundle in the right iliac fossa. This incision was then extended distally and the inguinal ligament was divided and later repaired for exposure of the nerve. A prominent neuroma was identified where the nerve was divided, associated with mesh and metallic tacs from the hernia. Ipsilateral sural nerve was harvested and a reversed cable graft using four 8.5cm cables was used to close the defect.

Procedure 2

Nineteen days after the first operation an obturator to femoral nerve transfer was performed. An anterior longitudinal incision incorporating the existing scar was used to expose the distal end of the cable graft, the distal femoral nerve and its terminal branches. The medial sensory branch and the branches to the rectus femoris and vastus lateralis were identified and the latter two confirmed to be non functional with electrical stimulation. The anterior branch of the obturator nerve was identified and traced distally to identify the branch entering gracilis. The nerve to gracilis was transected distally and passed over the adductor longus muscle to reach the femoral nerve. It was then redirected sub muscularly under the adductor longus muscle (Figure 1). With this more direct route, the end of the gracilis branch was able to reach four centimetres more distally. The nerve to gracilis was then neurotised to the femoral nerve branch to rectus femoris. The neurotisation was undertaken under microscope magnification with 9-0 S&T sutures (Insert Trade Details) and reinforced with Tiseel™ fibrin glue (Baxter pharmaceuticals).

Discussion

Complete femoral nerve injuries are uncommon and usually leave the patient with significant morbidity, requiring orthoses for simple mobility. Traditionally a nerve defect of this size would be managed with autologous cable grafting as initially performed. The large size of the nerve defect and also the significant distance from the distal end of the graft to the neuromuscular junction result in a poor prognosis for functional recovery. Whilst tendon transfers provide a good reconstructive option for some neurological injuries, (example radial nerve palsy), there are few satisfactory options available for femoral nerve palsy. Fischer et al. [2] reported on a hamstring transfer after soft tissue sarcoma resection with significant complications and modest results of extension force.

Nerve transfers have been well described in the literature for upper limb reconstruction [3]. There is in contrast a paucity of reconstruction options in lower limb nerve injury. Nerve transfers provide an attractive option, as performing the neurotisation distally minimises the distance and hence time required for neural regeneration and ultimately functional recovery. Motor end plates are known to undergo extensive change post denervation and functional reinnervation is unlikely beyond 18 months due to progressive fibrosis [4]. This case also posed further time pressure as referral to our institution was delayed by 6 months since the nerve injury. By performing the second procedure of the obturator to femoral transfer, viable axons were delivered approximately 13cm closer to the neuromuscular junctions providing greater potential for reinnervation prior to loss of the motor end plates. The pattern of the femoral nerve branching pattern has been previously described in a cadaver dissection by Tung et al. [3]. There have only been two previous papers in the literature discussing case reports of 3 similar procedures. Campbell et al. [5] reported a single case of total obturator to femoral nerve transfer 3 months post schwannoma resection with good functional result. This was performed above the inguinal ligament. Goubier et al. [6] conducted a cadaveric feasibility study in 2012 confirming the possibility of performing a subcutaneous transfer of two obturator motor branches to the femoral nerve in the thigh.

Tung et al. [3] reported on 2 cases of a subcutaneous obturator to femoral nerve transfer for complete femoral nerve injury- 1 performed acutely and the other 5 months post injury. The second patient was also supplemented with a superior gluteal nerve transfer after the first patient had incomplete recovery and an inability to climb stairs. This showed encouraging results. In our patient we have combined the existing obturator to femoral nerve transfer and added a cable graft in an attempt to provide a belt and braces reconstruction. We also determined that directing the gracilis branch deep to adductor longus rather than superficial to this muscle provides an increase in effective length of the nerve, allowing a more distal nerve repair, which is theoretically beneficial.

Iorio et al. [7] noted the proximity and potential of the anterior branch of the obturator nerve to gracilis in femoral nerve injuries. In their cadaveric study they proposed using this nerve for a donor for cable grafting, hypothesising that a motor nerve may maximise functional outcomes. They also noted that the average donor length was 11.4cm. The anterior branch of the obturator nerve has also been considered for restoring other neurological losses. In a cadaveric study in 2014, Houdek et al. [8] deemed it feasible to transfer the anterior branch of the obturator nerve to pelvic nerves in order to restore bowel and bladder function. Interestingly Spiliopoulos et al. [9] published a case report of the reverse nerve transfer - femoral branch to obturator to restore adduction following another iatrogenic injury. They reported a good outcome with full power and normal gait.

Conclusion

We present a novel 'belt and braces' approach for managing this unusual injury, using a modification of a nerve transfer which has only been reported in the literature three times previously to our knowledge.

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[cancersfakianakis1]

A Comparison of Outcomes and Prognostic Features for Radiation-Associated Angiosarcoma of the Breast and Other Radiation-Associated Sarcomas

Publication date: Available online 29 January 2019

Source: International Journal of Radiation Oncology*Biology*Physics

Author(s): Jeffrey K. Mito, Devarati Mitra, Constance M. Barysauskas, Adrián Mariño-Enriquez, Elizabeth A. Morgan, Christopher D.M. Fletcher, Chandrajit P. Raut, Elizabeth H. Baldini, Leona A. Doyle

Abstract

Purpose

Radiation-associated sarcomas (RAS) are considered to have a poor prognosis. While the incidence is anticipated to rise, contemporary data regarding predictors of outcomes are few. We performed a retrospective analysis to identify RAS prognostic factors, as well as subset analyses for radiation-associated angiosarcoma arising after treatment for breast cancer (RAAB) and other RAS subtypes (other-RAS).

Methods and Materials

Patients with localized RAS evaluated at an institutional multidisciplinary sarcoma clinic were identified. Clinical and histologic review was performed, and outcomes assessed to identify prognostic features. A subset of cases underwent molecular analysis by next generation sequencing (NGS).

Results

Amongst 176 patients, histologic subtypes of RAS included angiosarcoma (41%), undifferentiated sarcoma (40%), leiomyosarcoma (8%), MPNST (6%) and osteosarcoma (2%). Sixty-seven patients (38%) had RAAB and 109 (62%) had other-RAS. RAAB had significantly shorter latency from time of initial radiation compared to other-RAS (8 vs. 15 years, p <0.001). Treatment approaches included surgery (91%), chemotherapy (44%), and radiation therapy (27%). Median follow-up was 3.2 years; 3-year overall survival (OS) was 74%. On multivariate analysis, positive margins (p<0.0001), deep tumor location (intra-thoracic/intra-abdominal, p=0.002), and high grade (p<0.0001) were associated with worse OS. In particular, 3-year OS with negative vs. positive margins was 90% vs. 66%. Patients with RAAB vs. other-RAS showed a trend for higher 3-year OS (84% vs. 68%, p=0.09), significantly higher 3-year metastasis-free survival (82% vs 67%, p=0.001), but similar 3-year local recurrence-free survival (54% vs. 61, p=0.28). NGS identified overall low tumor mutational burden, recurrent MYC amplification in RAAB, and few clinically-actionable mutations.

Conclusions

Margin negative excision, superficial tumor location, and low tumor grade are determinants of improved OS for RAS suggesting that complete surgical excision, when possible, is an optimal component of treatment. RAAB is a clinicopathologically distinct type of RAS with shorter latency from initial RT, different recurrence patterns, and when aggressively managed potentially better outcomes compared to other-RAS.

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[pharmaceuticalhealthcareana-blog]

Retroperitoneal Liposarcoma Treatment Market Share, Outlook 2026

Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous cancer, which occurs in retroperitoneum, lining of the abdominal space that covers the abdominal organs. Retroperitoneal liposarcoma grow continuously and may not get diagnosed until they are very large thus, its prognosis is poor compared to the other subtypes of retroperitoneal sarcomas. The reason for the development of these tumors are still unknown, however, genetic mutation is considered to be one of the factors leading to the generation of these tumors. Incidence of this disease is equal in men and women, with a slight predominance of men. This tumor has no characteristic symptoms and are usually diagnosed during the advanced stage.

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Furthermore, the effectiveness of radiotherapy or chemotherapy for the treatment of this tumor is not properly defined, as they are massive in size and might involve adjacent visceral organs and critical structures. However, affected population who received adjuvant chemotherapy showed survival benefits and improvement, as compared to patients who underwent surgery alone. In the case of surgeries, sometimes, preoperative radiation is given to shrink the tumor. This allows smaller doses of radiation to a smaller field and make the surgery technically more feasible.