Two decades earlier for locally advanced laryngeal cancer total laryngectomy and postoperative radiotherapy was standard of care. Now Radiotherapy with concurrent chemotherapy is considered standard care for patients desiring laryngeal preservation, and total laryngectomy is reserved for recurrent or residual disease as salvage therapy. The advantage of chemo radiation is larynx is preserved in 60-70% patients with better locoregional control. The drawback of primary chemo radiation, if there is recurrent or residual tumor then conservative laryngeal surgery cannot be performed as spread of tumor is very unpredictable and post operative complications are very high so ultimately patient end up undergoing total laryngectomy and losing natural voice.
A 62 year old patient diagnosed as squamous cell carcinoma larynx (supraglottic) cT3N1M0 (i.e. malignant lesion in the supraglottic larynx with fixation of ipsilateral vocal cord with ipsilateral enlarged level II lymph node [upper jugular]).The metastatic workup was within normal limits. The case was discussed in the tumor board and planned for concurrent chemo-radiation .The patient tolerated the treatment well but symptoms still persisted. After a month of this treatment patient was evaluated by CT scan neck which showed lesion in the supraglottis with post radiotherapy changes, flexible laryngopharyngoscopy revealed lesion in the left supraglottis with post RT changes. Biopsy was taken, reported as squamous epithelium with post RT changes. PET CT scan revealed FDG avid lesion in the larynx and hypopharynx. Rigid Direct laryngoscopy was done under GA which revealed lesion in the left sided supraglottis with extension to left hypopharynx .Biopsy report was a moderately differentiated squamous cell carcinoma.
Patient was planned for salvage surgery and underwent Total laryngopharyngectomy with patch pectoralis major pharyngoplasty with Left RND and right Lateral neck dissection with deltopectoral flap reconstruction for skin defect and Provox I voice prosthesis insertion .The patient’s postoperative recovery was uneventful. After 4weeks deltopectoral flap final insetting was done. The final histopathology report was moderately differentiated squamous cell carcinoma with minimal thyroid cartilage invasion, all margins were negative and a single lymph node was positive. No evidence of a leak was found after gastrograffin swallow after 15 days. Patient is on regular follow up doing fine and is able to communicate well using Provox voice prosthesis. The course of disease in this patient would support that
In summary larynx preservation, and a chemo-radiation regimen should be prescribed to patients who has good performance status, who is eager to be in this regimen and is ready for regular intensive follow up .The salvage laryngectomy is part of the protocol because if this is not done then overall survival is poorer than primary laryngectomy followed by radiotherapy. This can only be done by an experienced trained person in a comprehensive cancer care institution where all this expertise is available under one roof and coordination and planning can be done.
Posts tagged ‘Carcinoma’
Early detection through regular breast self-exams and a regular program of mammogram and physical exams show excellent results in curing it. Breast self exam is the process developed by the American cancer society for women to examine the breasts monthly. This process can reveal breast problem. Any swelling or unusual lumps or hardness in the breast is the indication of breast disease and a reason to rush to your doctor.
Treatment for DCIS is usually much more aggressive than it’s in situ cousin, LCIS (or lobular neoplasia). Even though it is a serious condition, there is plenty of time to educate yourself and weigh all your options concerning treatment and possible reconstruction. There is close to a 100% rate of success in treating DCIS with the standard medical treatment.
Some women may choose to take tamoxifen and may possibly participate in the STAR clinical trial. The STAR trial compares the effects and preventative effectiveness of tamoxifen and raloxifene. Both drugs reduce the amounts of hormones in the breast tissue. These drugs are usually taken for a period of five years. Tamoxifen has shown in studies to reduce the occurrence of more advanced breast cancer by up to 49% in women that have had LCIS or that have additional risk factors for developing breast cancer.
There are no ways to prevent breast cancer. However, breast cancer can be treated effectively if it is detected in an early stage. Self Breast Examination for lumps and unusual changes should be carried out each month, preferably at the same time each month to minimize effects of menstruation. A clinical breast examination should be done once every year from ages 29 – 39, and once every year from the age of 40.
Mucinous or colloid breast cancer accounts for five percent or less of breast malignancies. In this type, the cancer cells retain the ability to secrete mucin, a liquid material that accumulates within the cells. This type of cancer has a good prognosis and is not prone to spread to the lymph nodes and blood system.
Radiation therapy should be strongly considered for young women, women who have close margins, women with DCIS measuring more than ½ centimeter (cm) and/or those do not have low grade DCIS. On the other hand, studies show that even older women with DCIS measuring less than ½ cm, who have wide margins and/or low grade DCIS, benefit from the addition of radiation therapy.
Carcinoma is used if the abnormal cells have not yet spread to other parts of the breast and has only remained at the root location. This is actually considered the stage 0 in breast cancer staging. Although this increases the risk of developing breast cancer in the future, this is actually not considered as already a breast cancer.
Fibrocystic change is a breast condition, which is non-cancerous and has no risk whatsoever of increasing breast cancer. In some cases, however, this condition can cause detection with mammography a bit difficult because in fibrocystic breasts the breast density may tend to eclipse the breast cancer on a mammogram.
Unfortunately, the early stages of breast cancer may not have any symptoms. This is why it is important to follow screening recommendations. As a tumor grows in size, it can produce a variety of symptoms including: lump or thickening in the breast or underarm, change in size or shape of the breast, nipple discharge or nipple turning inward, redness or scaling of the skin or nipple, ridges or pitting of the breast skin.
Renal cell carcinoma is a type of kidney cancer that develops within the small tubules of the kidney that are responsible for filtering blood and waste products. It is the most common type of kidney cancer in adults, representing 90 percent of all kidney cancer types. An estimated 58,000 people were diagnosed with renal cell carcinoma in 2010 with more than half of them being men. It is the 10th leading cause of cancer death in men. Since 1975, the number of reported kidney cancer cases has risen 2 percent annually. Fortunately, survival rates have improved over the last 40 years with newer and better treatment methods.
Although researchers are not certain of the exact causes of renal cell carcinoma, they have determined that it is the result of several factors which include: lifestyle habits, occupational exposure, genetically inherited disorders related to blood flow and the kidney, and a family history of renal cell carcinoma.
Lifestyle factors that might lead to kidney cancer include smoking, obesity, high calorie non-nutricious diet, and lack of physical exercise. Men and women who work in the iron, and steel industries, as well as chemical and asbestos related environments have seen higher reported cases of kidney cancer. Another main factor which has been correlated with renal cell carcinoma is some specific medical conditions that are inherited. A higher reported incident rate of kidney cancer has been reported in patients who also have these conditions.
* Von Hippel-Lindau (VHL) Disease:
* Hereditary Papillary Renal Cell Carcinoma:
* Birt-Hogg-Dube Syndrome:
* Hereditary Leiomyomatosis Renal Cell Carcinoma Syndrome:
* Hereditary Renal Oncocytoma:
* Polycystic Kidney Disease:
The problem with renal cell carcinoma is there is a lack of noticeable symptoms in the early stages. Even so, there have been improved diagnosis methods are detecting this type of cancer earlier. An awareness of common symptoms can aid in an earlier diagnosis and treatment outcome. The most common symptoms of renal cell carcinoma include:
* Painless urination of blood occurs in approximately 50 percent of patients.
* Sudden, unexplained weightloss.
* Pain in the sides, near where kidneys are located.
* Presence of a hard mass, growth or lump on the sides of the abdominal cavity are noticed in 45 percent of renal cell patients.
* Fever occurs in 10 percent of patients.
* Anemia occurs in about 20 percent of patients.
* High blood pressure.
The treatment options for renal cell carcinoma patients include surgery, arterial embolization, chemotherapy, radiotherapy, hormone therapy, targeted therapy, and biological therapy. Targeted and immunotherapy are two treatment options growing in favor for two reasons. First, renal cell carcinoma doesn’t respond as well to chemotherapy and radiation as it does for other cancers, second, doctors want to avoid any partial or total removal of the kidneys at all costs.
Targeted therapy is a broad-based term used to describe a new class of drugs that seek to stop or inhibit the growth (dividing process) of new cancer cells by interfering with specific molecules that “signal” for new cancer cells to grow and develop. Since targeted therapy drugs are directed only at the molecules that “allow” the process of creating cancer cells, they generally do not harm healthy cells in the way that chemotherapy and radiation does, and is generally considered less harmful with side-effects than chemotherapy and radiation. The two targeted therapy drugs approved for renal cell carcinoma include: Sorafenib (Nexavar®), and Sunitinib (Sutent®).
Immunotherapy is a new treatment method which uses natural substances to encourage the body’s own immune system to fight off disease, or laboratory made immune system components to fight off unwanted disease. Immunotherapy agents are not called drugs or medication, but rather, Biological Immune Response Modulators (BIRMS). There are many types of BIRMS, including cancer vaccines which are just one form of immunotherapy. Targeted therapy and immunotherapy also have some drugs and BIRMs that overlap since these two fields are closely related. The two most commonly used BIRMs for the treatment of renal cell carcinom are Interferon, a natural protein produced by the immune system cells to fight against foreign agents including cancerous cells, and Interleukin, which is used in patients with advanced stages of renal cell carcinoma by boosting their immune system and slowing down the cancer growth.
Arterial Embolization is another unique treatment method for cancer. In this procedure, doctors aim to halt the blood flow to the tumor in order to halt it’s growth and eventually shrink it so that it can be treated with other methods with less damage to healthy cells.
As stated above, surgery, as a treatment option, is approached carefully where tumor-only removal or partial removal is preferred over total removal of the kidneys. In advanced cases, a total nephrectomy (kidney removal) as well as radical nephrectomy (removal of the kidney along with the adrenal gland, lymph tissue).
Patients from Nigeria get treatment of Merkel cell carcinoma in India done at excellent hospitals of Mumbai under best cancer surgeons of India having a vast experience in treating cancer patients. Treatment of Merkel cell carcinoma in India is provided at hospitals that support services and palliative care facilities with best health care and provide patient with a helpful advice individually. Treatment of merkel cell carcinoma is done by leading surgeons of India who are well–trained qualified specialist with many years of excellent reputation.
What is Merkel cell carcinoma?
Merkel cell carcinoma, also called neuroendocrine cancer of the skin, is a rare type of disease in which malignant (cancer) cells are found on or just beneath the skin and in hair follicles. Merkel cell carcinoma usually appears as firm, painless, shiny lumps of skin. These lumps or tumors … Merkel cell carcinoma (MCC) is an aggressive tumor, the incidence of which is seemingly increased in immunocompromised patients. Merkel cell carcinoma is an uncommon aggressive primary cutaneous neuroendocrine carcinoma. Histologically, the differential diagnosis includes the ‘small round cell’ tumor group, particularly metastatic small cell carcinoma and blastic hematological malignancies involving skin/soft tissues….
What are the causes of Merkel cell carcinoma?
The exact causes of Merkel cell carcinoma are not known. Factors strongly associated with the development of Merkel cell carcinoma are:
The best available information on characteristics of patients with Merkel cell carcinoma comes from a study of 1,034 patients summarized in the table below (Agelli, 2003). The average (median) age of the patients with Merkel cell carcinoma was 74 years. The most common sites of involvement were head followed by arms (upper limb). At the time of diagnosis, half of the patients had disease localized to the skin, while the other half had Merkel cell carcinoma that was no longer confined to the skin.
Treatment options for Merkel cell carcinoma
Treatment is generally based on the stage of the disease. There are four major treatments for Merkel cell carcinoma: 1) surgical excision of the primary lesion, 2) lymph node surgery, 3) radiation therapy, and 4) chemotherapy. Each will be reviewed below in greater detail. Depending on how well a patient tolerates the treatments, surgery, radiation therapy and chemotherapy may be given at the same time or one after the other.
Wide surgical excision
The goal of wide excision is to control local recurrence and lymph node metastases. Merkel cell carcinoma should be removed with clear margins as judged by pathology examination. As noted below however, even with margins >2cm, surgery alone has a very high recurrence rate up to 42% depending on the study. This recurrence rate can typically be cut in half or better by the addition of radiation therapy.
To optimize the appearance and function of your scar, your surgeon may make an excision in the shape of a football (ellipse). The length of your scar will be roughly three times the diameter of the excision around the tumor (when possible, the excision is usually 2 cm beyond the tumor). Therefore, the scar may be up to 8 times as long as the width of the original MCC tumor.
Mohs micrographic surgery
Cutaneous neoplasms that develop on the head & neck are more likely to recur and metastasize via lymphatics to regional lymph nodes. It may not be possible to excise some Merkel cell carcinoma on the face with a margin of at least 2 cm. For these reasons, your doctor may refer you to Mohs micrographic surgery. Mohs micrographic surgery allows for conservation of skin to maintain function and appearance of sensitive areas of the body (face). Complete removal of the Merkel cell carcinoma is evaluated under the microscope during surgery. Our analysis of published studies on the treatment of Merkel cell carcinoma suggests that radiation therapy needs to be added to Mohs micrographic surgery to optimize control of the disease. Addition of radiation therapy to Mohs micrographic surgery appears to cut recurrence by roughly one-half (see table below, adapted from Longo & Nghiem, 2003).
Radiation therapy
Radiation therapy, also referred to as radiotherapy or XRT, is the treatment of cancer with penetrating beams of energy waves or streams of particles that can destroy cancer cells. Radiation therapy is delivered to the cancer cells and a small margin of surrounding normal tissue, sometimes referred to as the radiation field. Radiation therapy damages the genetic material of cancer cells making them unable to grow. Radiation therapy also damages healthy cells in the field of radiation. Adjuvant radiation therapy is radiotherapy that is used to destroy any cancer cells that may remain after surgery and/or chemotherapy.
We typically recommend radiation therapy to the primary site as well as the draining lymph node basin. This recommendation is based on numerous studies showing marked improvement in control of disease at the primary site and draining lymph node basin when radiation therapy is added (Lewis, 2006).
Follow-up care
Merkel cell carcinoma is optimally cared for by a team of doctors from dermatology, surgery, medical oncology, and radiation oncology. Most recurrences of Merkel cell carcinoma and most deaths from this disease occur within the first 3 years. Patients should have regular appointments for skin and lymph nodes examinations every 3-6 months for the first 3 years. CT scans are sometimes performed every 6 months for a few years after a high-risk diagnosis. Unfortunately, by the time Merkel cell carcinoma is visible on a CT scan; curative treatment is no longer possible. Therefore, scans are not routinely recommended. If Merkel cell carcinoma has not recurred or metastasized in the first three years, it may not be necessary to visit a doctor as often. However, you should contact your doctor immediately if you have any unusual lesions or symptoms.
Why India?
Treatment of Merkel cell carcinoma in India is provided at hospitals of Mumbai and Chennai with comprehensive surgical, medical and emergency services supported by state-of-the-art diagnostic and treatment facilities and innovative surgery techniques. Medical tourism in India is geared to expose clients to the best quality private and public healthcare in India, with a personalized flair, whilst facilitating treatment by highly qualified specialists at affordable and competitive prices.
Adrenocortical carcinoma is also called cancer of the adrenal cortex. A tumor of the adrenal cortex may be functioning (makes more hormones than normal) or nonfunctioning (does not make hormones). The hormones made by functioning tumors may cause certain signs or symptoms of disease….
The cells in the adrenal cortex make important hormones that help the body function properly. When cells in the adrenal cortex become cancerous, they may make too much of one or more hormones, which can cause symptoms such as high blood pressure, weakening of the bones, or diabetes. Cancers that make hormones are called functioning tumors. However, many cancers of the adrenal cortex do not make extra hormones and are called nonfunctioning tumors….
Adrenocortical carcinoma is a rare tumor that affects only 1 to 2 persons per one million population. It usually occurs in adults, and the median age at diagnosis is 44 years. Although adrenal carcinoma is potentially curable at early stages, only 30% of these malignancies are confined to the adrenal gland at the time of diagnosis. Radical surgical excision is the treatment of choice for patients with localized malignancies and remains the only method by which long-term disease-free survival may be achieved. Overall 5-year survival for tumors resected for cure is approximately 40%.
Retrospective studies have identified two important prognostic factors: completeness of resection and stage of disease. Patients without evidence of invasion into local tissues or spread to lymph nodes have an improved prognosis…..
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The squamous cell carcinoma is actually a pores and skin cancer it’s best to be aware of. There are melanoma and carcinoma elevating significant issues among professional medical practitioners all over. Significant interest is necessary for stopping the spread of cancer to other parts of the body.
How the carcinoma is essentially brought on?
The prolonged publicity for the UV rays can cause squamous cell cancer. The use of sunscreen is chosen and promoted so broadly as being a sun security system. Sunlight, tanning beds, lamps and repeated sun exposure will enhance the chances of incidence of carcinoma. There are more preventive measures to help keep away from skin cancers.
The carcinomas are brought on anywhere on body regardless with the sun publicity. Untreated squamous cell carcinoma will spread and boost complications. Most widespread spots for tumor appearance are:
• Red nodule just like formation on confront, neck, decrease lip, fingers, arms as well as other components of body
• Flat scaly crust with lesion on encounter, neck, ears, hands or arms
• Ulceration or even a lifted pores and skin area with pre-existing ulcer or scar formation
• Raised red patch or just ulcer such as sore on genital location or anus
• Ulcer or sore white locations inside the mouth
It’s quite difficult to spot these carcinomas as they appear on skin with distinctive sun harm indicators. There’s wrinkling, pigmentation at the same time as damage of some elasticity when a person develops squamous cell carcinoma. Several squamous cell carcinomas do develop into actinic keratoses at the same time.
Most effective alternative is to see a physician instantly as you find out about these uneven pores and skin rashes or growths. The outcome of remedy is going to be observed as optimistic when the diagnoses are created at the earliest. A dermatologist shall be in a position to recommend effective treatment possibilities.
Therapeutic radiations, chemical toxic compounds, Human Papilloma Virus (HPV), smoking, genetic disorder, skin injury and usage of some immunosuppressant medications are generally few factors to the trigger of squamous cell carcinoma.
Since the patches of all scaly pores and skin will not be removed on its very own, there are actually curing techniques as follows:
• Surgery
• Cryosurgery
• Grafting
• Laser therapy
• Chemotherapy
• Photodynamic therapy
• Shave excision
• Dermabrasion
To get rid of scars, the squamous cell carcinoma leaves people endure reconstruction surgical treatment. The uneven skin might be restored. As technology developed to new extent, the safety of patients along with the complete elimination of tumor cells help in giving people a healthy existence in the earliest. You are able to often come across ways to obtain correct treatment for your skin cancer.
Adrenocortical carcinoma is a rare tumor afflicting only 1-2 persons per one million populations. It usually occurs in adults and the median age at diagnosis is 44 years. The cause is unknown. Although potentially curable at early stages, only 30% of these malignancies are confined to the adrenal gland at the time of diagnosis. Because these tumors tend to be found years after they began growing, they have the opportunity to invade nearby organs, spread to distant organs (metastasize) and cause numerous changes in the body because of the excess hormones they produce.
Tumors of the adrenal gland are classified as either functioning or nonfunctioning:
The symptoms associated with functioning adrenocortical tumors vary. They depend on which hormones are overproduced and on the patient’s age.
Our patient Mr. IQS is a young male aged 37 yrs, is known case of recurrent non functioning (nonsecretory) malignant right adrenocortical carcinoma with adhesion to liver and IVC. He had undergone debulking surgery of right adrenal mass in some hospital on 21/2/2011. Per-operative finding was large 12x10x15 cm tumor in suprarenal region involving sub hepatic IVC, inferior surface of right lobe of the liver. Tumor was adherent to right kidney, right renal vein and IVC. Approximately 75% of tumor was removed leaving behind a cuff of tumor adherent to IVC and liver.
Post operatively he was evaluated by leading medical oncologists at various hospitals and advised for T. Temozolamide 250 mg for 5 days every month for 6 months. Even this was started after 15/5/2011. Meanwhile he had recurrence of disease with large right adrenal mass. He was evaluated at several hospitals and advised to undergo palliative chemotherapy as they found it as an inoperable disease.
Patient came toDharamshilaHospitalon 31/7/2011. His recent MRI dated 28/6/2011 and whole body PET CT Scan dated 6/7/2011 showed large heterogeneous mass in right suprarenal region measuring 17.1×17.1×14 cm. Mass was displacing the right lobe of liver with adhesion to its inferior surface. Right kidney was also displaced with loss of fat plane between them. IVC was also displaced antero medially with mass appearing adherent to the IVC just below the caudate lobe. No intra luminal filling defects in IVC. There was no free fluid or other metastasis. There was no distant or nodal metastasis onPET CT.
Slide reviewed in our hospital also confirmed the diagnosis of adrenocortical tumor with necrosis. Case was discussed in tumor board and planned for surgery if resectable followed by adjuvant treatment. With limited benefits other modalities like chemotherapy and radiotherapy, other than surgery, patient’s relatives and patient were given the options of surgery versus chemotherapy with mitotane. They decided to go ahead with surgery despite of explained high risk.
Patient then underwent exploratory laparotomy with resection of large right adrenal tumor with right nephrectomy done under general anesthesia on 13/7/2011. Perop finding – large necrotic tumor measuring approximately 25×20 cms arising from right adrenal area pushing liver up with adhesion to second part of duodenum, IVC, right kidney and hepatic flexure of colon. It was also infiltrating the retroperitoneum. It was separated from duodenum and colon. While separating from inferior surface of liver, the tumor capsule was breached. Approximately 2.5 kg of necrotic tumor mass was removed. Remaining capsule of the tumor started bleeding profusely. It was controlled by abdominal packing. IVC and aorta were exposed. Right renal vessels isolated, ligated and cut. The remaining tumor with residual right adrenal gland and right kidney where resected leaving behind a small portion of part of capsule adherent to IVC. Hemostasis could not be achieved despite of all measures as it was diffuse bleeding. Hence abdominal packing was done with some hemostasis. Abdomen was closed with no. 32 drain in situ.
Intra operatively patient received 29 units of packed red cells (PRC), 18 units of fresh frozen plasma (FFP) and 6 units of random donor platelets (RDP) along with other supportive measures. Gradually patient’s condition improved in ICU. He was weaned off ventilator on second post operative day. Removal of abdominal packs and clot evacuation with peritoneal lavage done under GA on 16/07/2011.
He received several blood units and other blood components in the post operative period (43 PRC, 67 FFP, 10 RDP and 7 single donor platelets (SDP) in total). Gradually over the period his condition improved with good supportive care. He was shifted to HDU on 20/07/2011. Then he was shifted to ward on 22/07/2011. Later he was discharged on 29/07/2011 in a satisfactory condition. Now patient is doing well on follow up visit. He is planned for adjuvant radiotherapy to tumor bed and IV chemotherapy along with mitotane.
Three consultant surgical oncologists, Dr. Niranjan Naik, Dr. Mudit Agrawal and Dr. Vinod Tikku performed the surgery. Good support of anaesthesia team ( Headed by HOD of Anaesthesia, Dr. Neha Agrawal), blood bank facility (Headed by HOD of Pathology, Dr. R. Dawar) and entire OT and ICU team contributed to the successful outcome of the patient.
Adrenal carcinoma may be curable if treated at an early stage. Radical surgical excision is the treatment of choice for cancers which have not spread to other organs. This remains the only method by which long-term cure may be achieved. Approximately 40% of all patients who undergo a radical resection of this cancer will be alive 5 years later.
In a retrospective, nonrandomized comparison of patients with first recurrence of adrenocortical cancer, 18 patients were treated with chemotherapy (primarily mitotane) and 15 patients were treated with surgical resection plus similar chemotherapy. Surgical resection of recurrent adrenocortical cancer was often extensive, with morbidity in 20% of patients and no mortality. Mitotane therapy was ineffective at controlling tumor growth. Median survival from the time of diagnosis for all patients was only 23 months and no patient was cured. Disease-free interval greater than 12 months was associated with prolonged survival, but it only occurred in six patients (18%), with a similar frequency in both treatment groups. Surgical resection of recurrent disease was associated with prolonged survival from the time of first recurrence. The potential benefit of this resection was evident in the 5 patients (33%) who were able to live greater than 5 years from the time of first recurrence with improvement in symptoms and signs of hypercortisolism. Although no patient with recurrent adrenal cancer could be cured, resection of recurrent disease was associated with a slight prolongation of survival and good palliation of Cushing’s syndrome.
