Radiofrequency Ablation (RFA) of Lung Tumors
RFA is a promising local therapy that has evolved rapidly in recent years for the treatment of primary and secondary cancers in the lung. The feasibility and safety profile in humans are well established. Complications following RFA are similar to those of CT-guided lung biopsies. However, sufficient long term results beyond 5 years are not yet available due to the relatively short time that this technology has been in use. Patients with smaller tumors (less than or equal to 3 cm) and fewer tumor nodules (less than or equal to 5 lesions) who are considered poor surgical candidates or who develop residual or recurrent disease despite maximal conventional therapy, and have tumors that are away from vital structures are the best candidates for RFA. Hence, RFA can be safely offered to patients who cannot undergo surgical resection. However the role of RFA in patients who are candidates for surgical resection is unproven, and there is no evidence on whether RFA is more or less effective that focused radiation (sterotactic body radiation therapy). Overall, RFA is a highly promising modality that may be used to our patients' advantage either as a solitary treatment or in combination with conventional therapy.
Showing posts with label Other Cancer Mass. Show all posts
Showing posts with label Other Cancer Mass. Show all posts
Tuesday, September 2, 2008
Breast Cancer
Breast Cancer Death Rates Differ by Race
On whole, the report shows the continuation of a welcome trend -- a steady decrease each year in the rate of breast cancer deaths. Thanks to better methods of detecting cancers early and treatment advances, American women today are less likely to die of breast cancer than they have been in decades, said Harmon J. Eyre, MD, chief medical officer of the American Cancer Society.
Looking at the issue of race -- and the socioeconomic and genetic factors associated with race -- it becomes clear that this good news is better for some groups of women than for others. "Perhaps most troubling," said Eyre, "is the striking divergence in long-term mortality trends seen between African-American and white females that began in the early 1980s and that by 2004 had led to death rates being 36% higher in African-American women."
Other key statistics included in the report:
* An estimated 178,480 new cases of invasive breast cancer in women will be diagnosed in 2007, and approximately 40,460 deaths will be recorded. Only lung cancer accounts for more cancer deaths in women.
* In 2004 (the latest year for which figures are available), approximately 2.4 million women living in the US had a history of breast cancer. Breast cancer accounts for more than 1 in 4 cancers in US women.
* On average, the breast cancer death rate decreased by 2.2% each year between 1990 and 2004. Younger women saw an even more significant decline during that period.
* Breast cancer incidence among white women -- that is, the rate at which new breast cancers are diagnosed in this group -- fell by 3.7% a year during 2001-2004. Also declining during this time: the use of mammography and hormone replacement therapy (HRT) by white women. There was no significant change in breast cancer incidence among African-American women during this time, coinciding with stable mammography rates and HRT use.
* Among women 50 and older, incidence rates have been on a steep decline (by 4.8% per year) since 2001. Among women under age 50, incidence rates have remained stable since 1986.
* Since 2000, the incidence rate of smaller tumors has declined by 3.8% per year. In contrast, the incidence rate of larger tumors (>5.0 cm) has increased by 1.7% per year since 1992. (Larger tumor size at diagnosis is associated with decreased survival.) Both trends may be tied to an increase in obesity in postmenopausal women, HRT use, or both.
On whole, the report shows the continuation of a welcome trend -- a steady decrease each year in the rate of breast cancer deaths. Thanks to better methods of detecting cancers early and treatment advances, American women today are less likely to die of breast cancer than they have been in decades, said Harmon J. Eyre, MD, chief medical officer of the American Cancer Society.
Looking at the issue of race -- and the socioeconomic and genetic factors associated with race -- it becomes clear that this good news is better for some groups of women than for others. "Perhaps most troubling," said Eyre, "is the striking divergence in long-term mortality trends seen between African-American and white females that began in the early 1980s and that by 2004 had led to death rates being 36% higher in African-American women."
Other key statistics included in the report:
* An estimated 178,480 new cases of invasive breast cancer in women will be diagnosed in 2007, and approximately 40,460 deaths will be recorded. Only lung cancer accounts for more cancer deaths in women.
* In 2004 (the latest year for which figures are available), approximately 2.4 million women living in the US had a history of breast cancer. Breast cancer accounts for more than 1 in 4 cancers in US women.
* On average, the breast cancer death rate decreased by 2.2% each year between 1990 and 2004. Younger women saw an even more significant decline during that period.
* Breast cancer incidence among white women -- that is, the rate at which new breast cancers are diagnosed in this group -- fell by 3.7% a year during 2001-2004. Also declining during this time: the use of mammography and hormone replacement therapy (HRT) by white women. There was no significant change in breast cancer incidence among African-American women during this time, coinciding with stable mammography rates and HRT use.
* Among women 50 and older, incidence rates have been on a steep decline (by 4.8% per year) since 2001. Among women under age 50, incidence rates have remained stable since 1986.
* Since 2000, the incidence rate of smaller tumors has declined by 3.8% per year. In contrast, the incidence rate of larger tumors (>5.0 cm) has increased by 1.7% per year since 1992. (Larger tumor size at diagnosis is associated with decreased survival.) Both trends may be tied to an increase in obesity in postmenopausal women, HRT use, or both.
Saturday, August 9, 2008
Overview of Mesothelioma of the Tunica Vaginalis
Mesothelioma of the tunica vaginalis is the rarest form of malignant mesothelioma. The authors of this article state their awareness of only 98 other cases. Different articles have reported slightly different numbers, but the basic truth of these statements refers to the extreme rarity of the disease. Asbestos exposure is the most commonly reported causative factor, but specific conclusions are very difficult with such a small population set to learn from. Histologically speaking, most cases of the disease are of the epitheloid subtype (60-75%), with the biphasic subtype making up the remainder of diagnoses. The authors state that “pure sarcomatous mesothelioma is exceedingly rare.” The average age of diagnosis is 60 years-old and because the disease specifically grows from the tunica vaginalis—the lining that surrounds the testes—it only affects men.
In most cases, the disease remains undiagnosed until the area is operated on or an autopsy reveals the presence of the malignancy after a patient has died. If a patient does present with a testicular issue, the disease is likely to be misdiagnosed for a number of more common conditions. This situation—as is the case with most forms of mesothelioma—means that the malignancy is likely to be in a less treatable state when a diagnosis is finally returned.
Overview of the Case
The authors describe the patient as a 60 year-old man with swelling on the left side of his scrotum. The man smoked for twenty years, but was not occupationally exposed to asbestos. Like all forms of mesothelioma, asbestos exposure is the main indication for this varient, so it is likely that the patient was simply not aware of his exposure to the mineral. Many diagnostic tests returned normal results, but sonographic testing revealed a number of troubling findings, including an enlarged left testicle and a large hydrocele in the left scrotum. A 1.5 x 1 x1.5-cm polypoid mass (polyp) demonstrating “increased vascularity” was discovered in the scrotal wall, and two similar masses were discovered in the tunica vaginalis.
The patient then received a left hydrocelectomy and scrotal exploration and had tissue removed for biopsy. The biopsy revealed mesothelioma of the tunica vaginalis, biphasic subtype. After a left radical orchitectomy and hemiscrotectomy, a 4-cm tumor attached to the tunica vaginalis was discovered. Immunohistochemical analysis conducted on the tumor confirmed the mesothelioma diagnosis.
Further testing revealed that the cancer had metastasized to the retroperitoneal lymph nodes. The patient then began chemotherapy. 21 months after initial diagnosis, PET indicated distant tissue infiltration and CT demonstrated significant metastases in the lungs and mediastinum. After this discovery, the patient was started on another course of chemotherapy.
Color Doppler Sonography
As we stated above, most cases of mesothelioma of the tunica vaginalis are not diagnosed until surgery or autopsy. Due to its rarity, most physicians will not have any experience with the disease and will certainly not be on the lookout for it. Regarding the case under discussion, the authors were able to identify the disease fairly early and were able to start treatment for it soon after discovery—which was almost certainly a factor in the patient’s survival 21 months after initial diagnosis. The authors state that imaging methodologies have traditionally been of limited use, but research into the sonographic representation of the tumor has begun to identify characteristics particular to it. Along with that research, the use of newer technologies in the analysis of tissue structures has also been important. For this particular case presentation, the authors used color Doppler sonography to identify areas of increased blood flow (hypervascularity) in the identified scrotal masses, which indicated the presence of a possible malignancy. Color Doppler sonogrography is an ultrasonic imaging technology that identifies blood flow and represents these varying rates using colors. Many scrotal masses are relatively benign conditions and do not demonstrate increased vascularity, so the use of an imaging technology that is sensitive to increased blood flow can help to differentiate the mesothelioma from other conditions. If a malignancy is suspected, fine needle aspiration or the removal of tissue—in addition or, or instead of, the excision of the affected testicle—can be attempted to definitively determine a diagnosis.
Conclusion
The authors conclude that color Doppler sonography may be an important new tool for the diagnosis of mesothelioma of the tunica vaginalis. Mesothelioma is a very aggressive tumor in all its forms, so early diagnosis and treatment is a key element in maximizing patient survival time. Because the disease is so rare, it is unlikely that studies will be attempted to precisely quantify this technology’s diagnostic value, so case reports such as these remain the best way to learn more about mesothelioma of the tunica vaginalis.
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