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Steady Diet of Soy Cuts Breast Cancer Risk
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Zee
medicine forum Guru Wannabe


Joined: 17 May 2005
Posts: 180

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: What would have really helped immediately after diagnosis? Reply with quote

What a wonderful question! You must be a teacher, or perhaps I should
say; You *are* a teacher. Thank you for asking...

I have had three life-altering illnesses. The word phoenix doesn't
begin to describe it. Thoughout those illnesses (one with which I still
cope, and now, a new one), thoughout illnesses in loved ones with which
I must cope too, the one constant has been action. What is this? What
do we know? What do we *not* know and more importantly, WHY do we not
know? What is good about the information we have? What needs to be
changed about that...

....and how can I do it?

Zee




DaviesUK wrote:
Quote:
What would have really helped immediately after diagnosis?

I found this group extremely helpful and supporting 3 years ago when
I had a
recurrence of breast cancer, and now I'm hoping to put together a
piece on what
those being treated for cancer would like as support and help from
the people
around them.

I feel that friends and family often would like to help but don't
know what to
do, what would *really* be appreciated. I've looked at the FAQ
(thanks, Tim)
and I'd like any other suggestions.

Steph

Please remove -NO-SPAM from the address to reply :-)

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J
medicine forum Guru


Joined: 29 Apr 2005
Posts: 612

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: pharma and cancer: who profits Reply with quote

Zee wrote:

Quote:
Since you aren't the pending oncology patient he made the abusive
comment to I do not know why you think you have anything to say here
David.

Zee

David Wright wrote:
In article <1107759240.604960.218240@z14g2000cwz.googlegroups.com>,
Zee <zwalanga@yahoo.com> wrote:
Right. Like all that educated common sense that flourishes in
clincial
trials of which we now see the evidence: paxil, prozac, vioxx,
celebrex, naproxyn, baycol...

Which pharma pays you to shill here Steph. Which pharma(s) own you,
while the taxpayers of British Columbia think you work for them.
Wouldn't BCMH be interested to see that abusive little post an
oncologist made to a potential oncology patient?

To quote Hawkeye Pierce: "When you're angry, you're ugly."

I'm particularly unfond of your last sentence, which equates to "if
you don't shut up, I'm gonna tell Mom!"

-- David Wright :: alphabeta at prodigy.net
These are my opinions only, but they're almost always correct.
"If I have not seen as far as others, it is because giants
were standing on my shoulders." (Hal Abelson, MIT)

What's a pending oncology patient? Most of us ? <g>
J
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Sbharris[atsign]ix.netcom
medicine forum Guru


Joined: 28 Apr 2005
Posts: 1218

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: pharma and cancer: who profits Reply with quote

Statins may cause liver cancer in rodents, but just about everything
Quote:
does.
I guess that is why they have been so successful evolutionary
speaking.

They must thrive on liver cancer


.. <<

Mice in the wild are annual creatures, not much different from
grasshoppers. Average life expectancy is less than 6 months. They don't

live long enough to get liver cancer, which is rare in mice and rats
younger than 12 months, but common after 24 months. By 12 months the
reproductive life of a rodent is done, but mean life span for most
strains is at least 24 months, and max is as long as 33 months, even
with no restriction in diet.


Very few cancers hit mammals of reproductive age. Generally speaking,
humans "in the wild" don't live long enough to get 99% of cancers,
either. Cancer, by and large, is a disease of civilization, where
people live past 45. The yearly chance of a child getting cancer is
something on the order of 1 in 5000, but as people age the risk goes up

exponentially after about 30-- enough that amost one person in 4 will
eventually die of cancer.


Statins don't give young animals liver cancer either, FYI. Both mice
and rats are far more susceptable to cancer than humans, and their
cells transform much more readily in vitro (in the dish). They are very

poor models of tumor production in many ways.



Quote:
However, the idea that much cancer is caused by
pharmaceuticals and pesticides and polution in general, really does
not
stand up to scrutiny.
Are you for real?


COMMENT:

Yep. Are you? This is one of those issues where political correctness
bears no relation to reality.


Here's a paper for you superbowl hot dip fans. Run in circles, scream
and shout.


In Vivo. 1992 Jan-Feb;6(1):59-63. Related Articles, Links
Carcinogenicity of lifelong administration of capsaicin of hot pepper
in mice.


Toth B, Gannett P.


Eppley Institute for Research in Cancer, University of Nebraska Medical

Center, Omaha 68198-6805.


Capsaicin was administered in a semisynthetic powdered diet at 0.03125%

level for the lifespan of Swiss mice starting from 6 weeks of age. As a

result of C treatment, tumors of the cecum were induced in 22% of
females and 14% of males, whereas the corresponding tumor incidences in

untreated female and male controls were both 8%. Histopathologically,
the tumors were classified as benign polypoid adenomas. Capsaicin is
the main pungent principle of hot pepper, which is consumed in high
quantities by humans worldwide. The capsaicin content of some chili
varieties ranges up to 0.53%.


Publication Types:
Review
Review, Tutorial
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madiba
medicine forum Guru Wannabe


Joined: 05 Jul 2005
Posts: 203

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: HPV and cervical cancer Reply with quote

Edward H <iielskc@fdkvie.net> wrote:

Quote:
I read that the types of HPV that produce visible protruding genital warts
(on males or females) are not associated with cervical cancer in females.
Is this the case?
No, its not the case.


madiba
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madiba
medicine forum Guru Wannabe


Joined: 05 Jul 2005
Posts: 203

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Sunshine might stop skin cancers Reply with quote

Tim Campbell <timcall@sbcglobal.net> wrote:

Quote:
There are many factors involved in the etiology of melanoma. Some years
back there was a study done in the Australian Navy that showed that
those who served on submarines had a greater likelihood of developing
melanoma than those who served on ships.

Well.. maybe the fair-skinned ones opted for subs in the hope of getting
less sunshine. But these factors can be considered when estimating risk
if the study was done well.

madiba
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Peter Moran
medicine forum Guru Wannabe


Joined: 29 Apr 2005
Posts: 109

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

"madiba" <down@thekraal.com> wrote in message
news:1grbsxe.17q55r81jbzhzwN%down@thekraal.com...
Quote:
Tim <timcall@sbcglobal.net> wrote:

The report's authors state: "Manipulation of an intact tumor by FNA or
large-gauge needle core biopsy is associated with an increase in the
incidence of SN metastases, perhaps due in part to the mechanical
disruption of the tumor by the needle." This is a discreet way of saying
that needle biopsy, an increasingly common procedure, was itself
responsible for spreading the cancer, although the authors take pains to
qualify this disturbing conclusion by suggesting that not every cluster
of
cancer cells found in the regional lymph nodes will inevitably end up
developing into clinically apparent cancer.
This is the conclusion they reached:
"The clinical significance of this phenomenon is unclear."

Another point about this 'rigorous' study:
I find the stats unusual to say the least.
I don't use the Wald test myself, but the confidence intervals are
P= .07 for the FNA correlation
P= .04 for the core biopsy correlation
"Tumor size ( P<.001) and grade ( P= .06) also were significant
prognostic factors. "

IMHO this shows a highly significant correlation between mets in the SLN
and TUMOR SIZE -surprise, surprise...
Significant correlation for core biopsies, OK. Just scraped thru the 95%
confidence interval. But neither FNA nor tumor grade are significant
factors.

So there might be something to zapping breast tumors with big fat core
biopsy needles. If anyones seen the latest craze amongst the breast
radiologists (Vacuum-Assisted Biopsy) realises this approach may be
going too far. They drill out so much material that often nothings left
for the surgeons to operate.... Which brings us back to the authors - a
bunch of surgeons. Need I say more?

No need for the slur on surgeons. They have reported the material very
honestly, while allowing that this retrospective study may merely be
reflecting the results of unknown processes of selection.

I can suggest one. Larger tumours will be easier to feel and will be more
likely to be subjected to immediate needle or core biopsy at initial
consultations in the interests of having the earliest possible diagnosis.
Less easy to feel (smaller) lumps will go into other diagnostic pathways
that will include more formal excision-biopsies such as excision following
needle localisation. As you have pointed out, tumour size is such a
dominant influence and the other statistical associations so weak that a
very few cases of such selection would be enough to explain the findings.

Another problem is that it is macrometastases that appeared to be increased,
rather than the expected micrometastases, in such a short time frame.

The authors are not changing their practices and nor should they on the
basis of this study. I guess, however, someone will have to do a
randomised trial.

Peter Moran
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eveline
medicine forum beginner


Joined: 28 Apr 2005
Posts: 12

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

"Peter Moran" <moringa@gil.com.au> wrote in message
news:42013f60$0$259$61c65585@uq-127creek-reader-03.brisbane.pipenetworks.com.au...
Quote:

"madiba" <down@thekraal.com> wrote in message
news:1grbsxe.17q55r81jbzhzwN%down@thekraal.com...
Tim <timcall@sbcglobal.net> wrote:

The report's authors state: "Manipulation of an intact tumor by FNA or
large-gauge needle core biopsy is associated with an increase in the
incidence of SN metastases, perhaps due in part to the mechanical
disruption of the tumor by the needle." This is a discreet way of
saying
that needle biopsy, an increasingly common procedure, was itself
responsible for spreading the cancer, although the authors take pains
to
qualify this disturbing conclusion by suggesting that not every cluster
of
cancer cells found in the regional lymph nodes will inevitably end up
developing into clinically apparent cancer.
This is the conclusion they reached:
"The clinical significance of this phenomenon is unclear."

Another point about this 'rigorous' study:
I find the stats unusual to say the least.
I don't use the Wald test myself, but the confidence intervals are
P= .07 for the FNA correlation
P= .04 for the core biopsy correlation
"Tumor size ( P<.001) and grade ( P= .06) also were significant
prognostic factors. "

IMHO this shows a highly significant correlation between mets in the SLN
and TUMOR SIZE -surprise, surprise...
Significant correlation for core biopsies, OK. Just scraped thru the 95%
confidence interval. But neither FNA nor tumor grade are significant
factors.

So there might be something to zapping breast tumors with big fat core
biopsy needles. If anyones seen the latest craze amongst the breast
radiologists (Vacuum-Assisted Biopsy) realises this approach may be
going too far. They drill out so much material that often nothings left
for the surgeons to operate.... Which brings us back to the authors - a
bunch of surgeons. Need I say more?

No need for the slur on surgeons. They have reported the material very
honestly, while allowing that this retrospective study may merely be
reflecting the results of unknown processes of selection.

I can suggest one. Larger tumours will be easier to feel and will be
more
likely to be subjected to immediate needle or core biopsy at initial
consultations in the interests of having the earliest possible diagnosis.
Less easy to feel (smaller) lumps will go into other diagnostic pathways
that will include more formal excision-biopsies such as excision following
needle localisation. As you have pointed out, tumour size is such a
dominant influence and the other statistical associations so weak that a
very few cases of such selection would be enough to explain the findings.

Another problem is that it is macrometastases that appeared to be
increased,
rather than the expected micrometastases, in such a short time frame.

The authors are not changing their practices and nor should they on the
basis of this study. I guess, however, someone will have to do a
randomised trial.

Peter Moran


Would this finding suggest that radiation prior to any surgical intervention

be prudent?
After all radiation has its own side effects and hazards....and then the
biopsy would not have been possible.
I felt more comfortable about my daughters biopsy when she was admitted
rapidly and the lumpectomy done in a couple days. Her lymph nodes showed no
signs of 'her 2 neu', although 8 were removed along with the sentinal node.


eveline
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madiba
medicine forum Guru Wannabe


Joined: 05 Jul 2005
Posts: 203

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

eveline <evelinep@infinet.com> wrote:

Quote:
"Peter Moran" <moringa@gil.com.au> wrote in message
news:42013f665585@uq-127creek-reader-03.brisbane.pipenetworks.com.au...

"madiba" <down@thekraal.com> wrote in message
news:1grbsxe.17q55r81jbzhzwN%down@thekraal.com...
Tim <timcall@sbcglobal.net> wrote:

The report's authors state: "Manipulation of an intact tumor by FNA or
large-gauge needle core biopsy is associated with an increase in the
incidence of SN metastases, perhaps due in part to the mechanical
disruption of the tumor by the needle." This is a discreet way of
saying
that needle biopsy, an increasingly common procedure, was itself
responsible for spreading the cancer, although the authors take pains
to
qualify this disturbing conclusion by suggesting that not every cluster
of
cancer cells found in the regional lymph nodes will inevitably end up
developing into clinically apparent cancer.
This is the conclusion they reached:
"The clinical significance of this phenomenon is unclear."

Another point about this 'rigorous' study:
I find the stats unusual to say the least.
I don't use the Wald test myself, but the confidence intervals are
P= .07 for the FNA correlation
P= .04 for the core biopsy correlation
"Tumor size ( P<.001) and grade ( P= .06) also were significant
prognostic factors. "

IMHO this shows a highly significant correlation between mets in the SLN
and TUMOR SIZE -surprise, surprise...
Significant correlation for core biopsies, OK. Just scraped thru the 95%
confidence interval. But neither FNA nor tumor grade are significant
factors.

So there might be something to zapping breast tumors with big fat core
biopsy needles. If anyones seen the latest craze amongst the breast
radiologists (Vacuum-Assisted Biopsy) realises this approach may be
going too far. They drill out so much material that often nothings left
for the surgeons to operate.... Which brings us back to the authors - a
bunch of surgeons. Need I say more?

No need for the slur on surgeons. They have reported the material very
honestly, while allowing that this retrospective study may merely be
reflecting the results of unknown processes of selection.

I can suggest one. Larger tumours will be easier to feel and will be
more
likely to be subjected to immediate needle or core biopsy at initial
consultations in the interests of having the earliest possible diagnosis.
Less easy to feel (smaller) lumps will go into other diagnostic pathways
that will include more formal excision-biopsies such as excision following
needle localisation. As you have pointed out, tumour size is such a
dominant influence and the other statistical associations so weak that a
very few cases of such selection would be enough to explain the findings.

Another problem is that it is macrometastases that appeared to be
increased,
rather than the expected micrometastases, in such a short time frame.

The authors are not changing their practices and nor should they on the
basis of this study. I guess, however, someone will have to do a
randomised trial.

Peter Moran


Would this finding suggest that radiation prior to any surgical intervention
be prudent?
After all radiation has its own side effects and hazards....and then the
biopsy would not have been possible.
I felt more comfortable about my daughters biopsy when she was admitted
rapidly and the lumpectomy done in a couple days. Her lymph nodes showed no
signs of 'her 2 neu', although 8 were removed along with the sentinal node.

One would think it speaks for radiation before surgery, but
1) no radiation oncologist wants to get to work without seeing positive
histology, meaning a FNA or core biopsy beforehand..
2) For breast cancer, pre-operative radiation (and chemo) has only been
shown to be beneficial in advanced cases with lymphangiosis, the
so-called inflammatory BC.
--
madiba
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madiba
medicine forum Guru Wannabe


Joined: 05 Jul 2005
Posts: 203

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

Peter Moran <moringa@gil.com.au> wrote:

Quote:
"madiba" <down@thekraal.com> wrote in message
news:1grbsxe.17q55r81jbzhzwN%down@thekraal.com...
Tim <timcall@sbcglobal.net> wrote:

The report's authors state: "Manipulation of an intact tumor by FNA or
large-gauge needle core biopsy is associated with an increase in the
incidence of SN metastases, perhaps due in part to the mechanical
disruption of the tumor by the needle." This is a discreet way of saying
that needle biopsy, an increasingly common procedure, was itself
responsible for spreading the cancer, although the authors take pains to
qualify this disturbing conclusion by suggesting that not every cluster
of
cancer cells found in the regional lymph nodes will inevitably end up
developing into clinically apparent cancer.
This is the conclusion they reached:
"The clinical significance of this phenomenon is unclear."

Another point about this 'rigorous' study:
I find the stats unusual to say the least.
I don't use the Wald test myself, but the confidence intervals are
P= .07 for the FNA correlation
P= .04 for the core biopsy correlation
"Tumor size ( P<.001) and grade ( P= .06) also were significant
prognostic factors. "

IMHO this shows a highly significant correlation between mets in the SLN
and TUMOR SIZE -surprise, surprise...
Significant correlation for core biopsies, OK. Just scraped thru the 95%
confidence interval. But neither FNA nor tumor grade are significant
factors.

So there might be something to zapping breast tumors with big fat core
biopsy needles. If anyones seen the latest craze amongst the breast
radiologists (Vacuum-Assisted Biopsy) realises this approach may be
going too far. They drill out so much material that often nothings left
for the surgeons to operate.... Which brings us back to the authors - a
bunch of surgeons. Need I say more?

No need for the slur on surgeons.
You missed the disclaimer..


Quote:
They have reported the material very
honestly, while allowing that this retrospective study may merely be
reflecting the results of unknown processes of selection.
True, apart from the sloppy stats.


Quote:
I can suggest one. Larger tumours will be easier to feel and will be more
likely to be subjected to immediate needle or core biopsy at initial
consultations in the interests of having the earliest possible diagnosis.
Less easy to feel (smaller) lumps will go into other diagnostic pathways
that will include more formal excision-biopsies such as excision following
needle localisation.
Is that the way things happen at your end? I would've thought that

someone presenting with a large tumour was scheduled for the op right
away, with a pre-op frozen section/ biopsy to insure the diagnosis is
correct.

Quote:
As you have pointed out, tumour size is such a
dominant influence and the other statistical associations so weak that a
very few cases of such selection would be enough to explain the findings.
Another problem is that it is macrometastases that appeared to be increased,
rather than the expected micrometastases, in such a short time frame.

The authors are not changing their practices and nor should they on the
basis of this study. I guess, however, someone will have to do a
randomised trial.
--

madiba
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Peter Moran
medicine forum Guru Wannabe


Joined: 29 Apr 2005
Posts: 109

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

"madiba" <down@thekraal.com> wrote in message
news:1grfbwi.wqdyxcy61jl0N%down@thekraal.com...
Quote:
Peter Moran <moringa@gil.com.au> wrote:

"madiba" <down@thekraal.com> wrote in message
news:1grbsxe.17q55r81jbzhzwN%down@thekraal.com...
Tim <timcall@sbcglobal.net> wrote:

The report's authors state: "Manipulation of an intact tumor by FNA or
large-gauge needle core biopsy is associated with an increase in the
incidence of SN metastases, perhaps due in part to the mechanical
disruption of the tumor by the needle." This is a discreet way of
saying
that needle biopsy, an increasingly common procedure, was itself
responsible for spreading the cancer, although the authors take pains
to
qualify this disturbing conclusion by suggesting that not every
cluster
of
cancer cells found in the regional lymph nodes will inevitably end up
developing into clinically apparent cancer.
This is the conclusion they reached:
"The clinical significance of this phenomenon is unclear."

Another point about this 'rigorous' study:
I find the stats unusual to say the least.
I don't use the Wald test myself, but the confidence intervals are
P= .07 for the FNA correlation
P= .04 for the core biopsy correlation
"Tumor size ( P<.001) and grade ( P= .06) also were significant
prognostic factors. "

IMHO this shows a highly significant correlation between mets in the
SLN
and TUMOR SIZE -surprise, surprise...
Significant correlation for core biopsies, OK. Just scraped thru the
95%
confidence interval. But neither FNA nor tumor grade are significant
factors.

So there might be something to zapping breast tumors with big fat core
biopsy needles. If anyones seen the latest craze amongst the breast
radiologists (Vacuum-Assisted Biopsy) realises this approach may be
going too far. They drill out so much material that often nothings left
for the surgeons to operate.... Which brings us back to the authors -
a
bunch of surgeons. Need I say more?

No need for the slur on surgeons.
You missed the disclaimer..

They have reported the material very
honestly, while allowing that this retrospective study may merely be
reflecting the results of unknown processes of selection.
True, apart from the sloppy stats.

I can suggest one. Larger tumours will be easier to feel and will be
more
likely to be subjected to immediate needle or core biopsy at initial
consultations in the interests of having the earliest possible diagnosis.
Less easy to feel (smaller) lumps will go into other diagnostic pathways
that will include more formal excision-biopsies such as excision
following
needle localisation.
Is that the way things happen at your end? I would've thought that
someone presenting with a large tumour was scheduled for the op right
away, with a pre-op frozen section/ biopsy to insure the diagnosis is
correct.

You cannot really talk turkey to patients about treatment options until you
have a pretty certain diagnosis. The stress for these women is bad enough
without asking them to try and deal with hypothetical situations. There
are other arguments against a rushed approach.

Peter Mroan
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J
medicine forum Guru


Joined: 29 Apr 2005
Posts: 612

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Bexxar Reply with quote

JJ wrote:

Quote:
How much does it cost?

http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=7530854
By Karla Gale

NEW YORK (Reuters Health) - The Bexxar therapeutic regimen
(GlaxoSmithKline), which combines the anti-CD20 antibody tositumomab with
radioactive iodine, can induce prolonged remissions in patients with
follicular lymphoma when used as a first-line therapy, according to the
results of a drug trial reported in The New England Journal of Medicine.

"This appears to be as good as any state-of-the-art chemotherapy regimen
that's out there for follicular lymphoma," Dr. Mark S. Kaminski told
Reuters Health. And with minimal side effects, "it's very
patient-friendly," he added.

Kaminski, an oncologist at the University of Michigan Medical Center in
Ann Arbor, and colleagues enrolled 76 previously untreated patients who
had advanced cases (stage III or IV) follicular lymphoma. The treatment
involved two infusions of Bexxar given approximately one week apart.

Seventy-two patients (95 percent) responded to treatment, and 57 (75
percent) had complete responses. The five-year progression-free survival
rate was 59 percent overall, and 77 percent for patients who had a
complete response. The overall five-year survival rate was 89 percent.

The annual relapse rate declined progressively over time, the authors
note, from 15 percent during the first year to 4.4 percent per year after
3 years.

Side effects were moderate and reversible, and no patients required blood
transfusions or treatment with blood cell growth factors. Furthermore,
"there was no hair loss and only minimal nausea," Kaminski added.

These results "compare favorably" with other first-line therapies for this
type of lymphoma, the authors note.

However, Kaminski stressed that "this article is not advocating Bexxar as
front-line treatment, but it opens the door for further clinical trials so
we can best determine which of the many different approaches to use for
this kind of lymphoma and in what sequence."

But perhaps the "bigger message," he added, is that "this is so effective
up front, don't wait until the last minute to give this to your patients.
Move it further up in the treatment plan."

In a related editorial, Dr. Joseph M. Connors, from the University of
British Columbia in Vancouver, cautions that the superiority of this new
treatment stills needs to be verified with additional "carefully designed"
trials.

Also, Connors added that an economic analysis is needed "to answer the
important question of cost for this potentially very expensive new
treatment."

SOURCE: The New England Journal of Medicine, February 3, 2005.
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Orac
medicine forum beginner


Joined: 23 May 2005
Posts: 32

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

In article <1grgscl.9kj86v1q7svseN%down@thekraal.com>,
down@thekraal.com (madiba) wrote:

Quote:
Peter Moran <moringa@gil.com.au> wrote:

I can suggest one. Larger tumours will be easier to feel and will be
more likely to be subjected to immediate needle or core biopsy at
initial consultations in the interests of having the earliest possible
diagnosis. Less easy to feel (smaller) lumps will go into other
diagnostic pathways that will include more formal excision-biopsies
such as excision following needle localisation.

Is that the way things happen at your end? I would've thought that
someone presenting with a large tumour was scheduled for the op right
away, with a pre-op frozen section/ biopsy to insure the diagnosis is
correct.

You cannot really talk turkey to patients about treatment options until you
have a pretty certain diagnosis. The stress for these women is bad enough
without asking them to try and deal with hypothetical situations. There
are other arguments against a rushed approach.

To be more precise: Patients usually present with the large breast
tumour AND a recent mammography. So one has a tentative
clinical-radiological diagnosis. If its as advanced as it looks saving
time is vital, so one schedules surgery. Depending on the local
infrastructure the woman has between a couple of days to a
week or two before the operation. This time could be used for further
(non-invasive) diagnostics such as MRI, sono, some even do tumour
markers to confirm the tent. diagnosis. We're talking 90% or higher
chance of tumour now, so the lumpectomy/quad.resection/mastectomy can be
discussed and planned.
Intraop SLNode and tumour biopsy sent for frozen sections and off you
go. One could argue that the rushed core biopsy in the practice is the
one leading to the aformentioned problems with unnecessary LN mets.

One could argue that, but one would very likely be wrong. If memory
serves me correctly and you're talking about the same paper I think
you're talking about, the phenomenon in the paper that you mentioned are
not true sentinel lymph node metastases. Sentinel lymph node metastases
are defined as being at least 0.2 mm in size. Anything less is not
considered a metastasis. What was described in the paper was small
clusters of cells, sometimes even individual cells, visible using only
special immunohistochemical stains, if I recall that paper correctly
from when I presented it at our journal club last month. There has been
controversy about what to do with these small clusters of cells ever
since the rise of sentinel lymph node biopsy for axillary staging.
Leaving aside the issue of whether the tumor was manipulated before SLN
biopsy, these the reason we're probably picking these cells up more
frequently is because the sentinel node is sectioned very finely,
whereas in the past, when axillary dissection was the standard of care,
each node would only have one or two sections made. Also, if I recall
the paper correctly, most of the cell clusters were subcapsular, which
are also not considered to be metastases, because you can occasionally
find benign breast epithelial cells in the subcapsular sinusoids
regardless. In any case, the staging guidelines chose this cut-off based
on the presently available data.

In any case, the present staging guidelines do not consider cell
clusters under 0.2 mm to be metastases, although they do note them. The
management of these cells is somewhat controversial, because we don't
yet have long-term studies, but the current standard is to note them and
to treat the patient as node-negative. We usually do not recommend a
completion axillary dissection on such patients, although there is
disagreement over whether this is correct, and many surgeons still do
recommend a completion lymphadenectomy.

Also, remember, that is one paper. There are other papers looking at the
same question. The literature is mixed on this question.

Peter is right. It is best to get a diagnosis before offering definitive
surgery, when possible.

--
Orac |"I am not *trying* to tell you anything. I am simply not
| interested in trying to compensate for your amazing lack
| of observation."
| http://oracknows.blogspot.com
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Steph
medicine forum Guru


Joined: 03 May 2005
Posts: 504

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Bladder Cancer & Kidney Reply with quote

"Donna G." <dgsam2@telusplanet.net> wrote in message
news:81fee7f6.0501302304.180896ad@posting.google.com...
Quote:
My husband has just been diagnosed with bladder cancer (we're not sure
what stage yet) and something was detected on his kidney with
ultrasound so he is going for a Cat Scan next week. We're just trying
to learn everything we can about it all but I'm wondering is there any
chance the kidney and bladder could both be cancerous or is this
unlikely as I've read kidney cancer moves to pancreas and bowel.
Thanks
Donna

Cancer of the bladder and cancer of the renal pelvis (the top of the ureter)
are related. Cancer of the kidney proper is not.
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J
medicine forum Guru


Joined: 29 Apr 2005
Posts: 612

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: sigmoid carcinoma Reply with quote

ironjustice@aol.com wrote:

Quote:
TARGET .. the .. iron ..

---
"Iron excess causes diabetes, renal/kidney disease, mental illness
and especially *free radicals*. THIS is why Jesus espoused *vegetarianism*."
Tom Hennessy, 1997/05/07: rec.food.veg [Now ironjustice@aol.com]
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madiba
medicine forum Guru Wannabe


Joined: 05 Jul 2005
Posts: 203

PostPosted: Thu Apr 28, 2005 11:34 am    Post subject: Re: Needle Biopsies Spread Cancer Reply with quote

Orac <orac@mac.com> wrote:

Quote:
In any case, the present staging guidelines do not consider cell
clusters under 0.2 mm to be metastases, although they do note them. The
management of these cells is somewhat controversial, because we don't
yet have long-term studies, but the current standard is to note them and
to treat the patient as node-negative. We usually do not recommend a
completion axillary dissection on such patients, although there is
disagreement over whether this is correct, and many surgeons still do
recommend a completion lymphadenectomy.

Sounds a bit like the discussion on what to do when tumor cells are
found in the bloodstream. But your point is well taken Orac. I only
reviewed the online abstract and you no doubt had the whole paper if you
discussed it at a journal club. Explains why Fr.Sections are still done
on SLNs (the sectioning is not so fine), its because the small cell
clusters are of no consequence. Yet.

madiba
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