Tuesday, 27 May 2008

Surgical oncology, Dec 2007 vol. 16, no. 4

Surgery for palliation and treatment of advanced breast cancer.
p. 249-57, 55 refs
Alvarado-Michael, Ewing-Cheryl-A, Elyassnia-Dino, Foster-Robert-D, Shelley-Hwang-E.

Palliation of hepatic tumors.
p. 277-91, 166 refs
Cunningham-Steven-C, Choti-Michael-A, Bellavance-Emily-C, Pawlik- Timothy-M.
Palliation is treatment aimed at alleviating the symptomatic effects of a disease rather than at curing the disease. The four most common types of liver tumors that often require palliative treatment include hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), metastatic colorectal carcinoma (mCRC), and metastatic neuroendocrine tumors (m NET). Modalities employed in the palliative treatment of these tumors most often include resection, stenting, chemotherapy, radiation, ablation, and the general treatment of liver failure symptoms. Many of these modalities can be applied to the palliative care of all hepatic tumor types, regardless of the specific tumor histology--as incurable cancers often converge along a final common pathway. We herein provide a review of the therapeutic approaches to palliate hepatic tumors, as well as how such therapies are designed to alleviate the symptoms of patients with end-stage liver tumors.
Journal-Article, Review.

Palliation of colorectal cancer.
p. 299-310, 115 refs
Wasserberg-Nir, Kaufman-Howard-S.
Patients with advanced incurable colorectal cancer (CRC) face a grim prognosis. The goal of palliative intervention is directed at alleviating disease-related symptoms and improving quality of life. The provision of optimal palliative care for these patients is a compound and demanding process. This dilemma becomes more challenging when patients with advanced metastatic colorectal disease present with an incurable and asymptomatic primary lesion. Treatment options are numerous and include a variety of surgical and nonsurgical interventions. Most data regarding the role of surgery in palliation of CRC are from retrospective, nonrandomized case series. Surgical resection may provide good palliation of symptoms and prevent future tumor-related complications. Metal stents are also able to provide good palliative relief of obstruction and should be used when appropriate. The best palliative care will often require a multidisciplinary approach that involves input from surgical and nonsurgical teams, where treatment plans will be made in accordance with the wishes of the patient and family with a goal of decreasing morbidity and a focus on quality of life.
Journal-Article, Review.

Palliation of thoracic malignancies.
p. 259-65, 61 refs
Gasper-Warren-J, Jamshidi-Ramin, Theodore-Pierre-R.
The sequelae of advanced malignancies of the chest, whether primary or metastatic, can be severely debilitating. In this review, we discuss the advances in palliative treatment for several intrathoracic complications of malignancy. The treatment of malignant pleural and pericardial effusions now includes a range of chemical sclerosants and percutaneous or surgical interventions. A new generation of promising stent and ablation technologies allows for the treatment of intrinsic or extrinsic airway obstruction. Similar techniques are being explored for esophageal obstruction, while the possible benefit of palliative radiation and chemotherapy continues to be investigated. Although their symptoms are often severe, patients with advanced thoracic malignancies have a growing number and variety of palliative treatment options to improve their quality of life.

Palliative care in orthopaedic surgical oncology.
p. 311-30, 171 refs
Aubert-Pamela-M, O-Donnell-Richard-J.
Hundreds of thousands of Americans are affected every year by skeletal complications of oncologic disease. Recent developments in medical oncology, radiation oncology and radiology, particularly with respect to the use of bisphosphonate medication and radiofrequency techniques, have served to greatly lessen the morbidity associated with metastatic skeletal disease. Similarly, there has been significant advancement in the field of orthopaedic oncology in the areas of internal fixation, endoprosthetic implant design, and minimally invasive kyphoplasty technology. Given the palliative intent of intervention in this patient population, the goal of treatment of skeletal metastases must be optimization of limb function and ultimately, quality of life.
Journal-Article, Review.

Palliative management of gastric cancer
p. 267-75, 99 refs
Cunningham-Steven-C, Schulick-Richard-D.
Advanced gastric cancer and its palliative treatment have a long and interesting history. Today, gastric adenocarcinoma is the second leading cause of cancer death worldwide. Unfortunately, many cases are not diagnosed until late stages of disease, which underscores the importance of the palliative treatment of gastric cancer. Palliative care is best defined as the active total care of patients whose disease is not responsive to curative treatment. Although endoscopy is the most useful method for securing the diagnosis of gastric adenocarcinoma, computed tomography may be useful to assess local and distant disease. The main indication for the institution of palliative care is the presence of advanced gastric cancer for which curative treatment is deemed inappropriate. The primary goal of palliative therapy of gastric cancer patients is to improve quality, not necessarily length, of life. Four main modalities of palliative therapy for advanced gastric cancer are discussed: resection, bypass, stenting, and chemotherapy. The choice of modality depends on a variety of factors, including individual patient prognosis and goals, and should be made on case-by-case basis. Future directions include the discovery and development of serum or stool tumor markers aimed at prevention, improving prognostication and stratification, and increasing awareness and education.
Journal-Article, Review.

Palliation of advanced thyroid malignancies.
p. 237-47, 154 refs
Greenblatt-David-Yue, Chen-Herbert.
While most thyroid cancers are slow-growing and have an excellent prognosis after appropriate treatment, a subset of thyroid cancers behave aggressively, and approximately 1500 individuals in the US will die of the disease in the year 2007. Advanced thyroid malignancies can cause distressing and life-threatening symptoms by local invasion in the neck, growth of distant metastases in the lung, bone, and other organs, and tumor production of bioactive substances in the case of medullary thyroid cancer. This article will review palliative modalities, including surgery, radioactive iodine, external beam radiation, and chemotherapy, as well as novel targeted therapies, for the treatment of patients with advanced thyroid malignancies.
Journal-Article, Review.

Palliative care for patients with advanced pancreatic and biliary cancers
p. 293-7, 22 refs
Nakakura-Eric-K, Warren-Robert-S.
Because most patients with pancreatic and biliary cancer have advanced disease, the palliation of debilitating symptoms is critically important in patient management. A multidisciplinary team consisting of representatives from surgery, medical oncology, gastroenterology, radiology, and palliative care medicine is essential for the optimal palliation of symptoms. In this article, the key issues in palliative care for patients with advanced pancreatic and biliary cancer are discussed. In particular, the prevention and amelioration of suffering due to obstructive jaundice, gastric outlet obstruction, cancer-related pain, pancreatic enzyme insufficiency, and thromboembolic disease is addressed. To this end, an algorithm for the multidisciplinary management of these challenging patients is proposed with the goal of providing clinicians with a useful framework for providing palliative care for patients with advanced pancreatic and biliary cancer.
Journal-Article, Review.

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