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Treatments for Benign tumor
Treatments of Benign tumor: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Benign tumor.
Benign tumors of the ear canal:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Generally, a benign tumor requires surgical excision if it obstructs the ear canal, is cosmetically undesirable, or becomes malignant.
Treatment for keloids may include surgery followed by repeated injections of long-acting steroids into the suture line. Excision must be complete, but even this may not prevent recurrence.
Surgical excision of an osteoma consists of elevating the skin from the surface of the bony growth and shaving the osteoma with a mechanical burr or drill.
Before surgery, a sebaceous cyst requires preliminary treatment with antibiotics, to reduce inflammation. To prevent recurrence, excision must be complete, including the sac or capsule of the cyst.
Malignant brain tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment includes removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor's histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with diuretics, cortico-steroids, or possibly ventriculoatrial or ventriculoperitoneal shunting of CSF.
A glioma usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
Treatment of oligodendrogliomas and ependymomas includes resection and radiation therapy; for medulloblastomas, resection and possibly intrathecal infusion of methotrexate or another antineoplastic drug. Meningiomas require resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
For schwannomas, microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes the nitrosoureas that help break down the blood-brain barrier and allow other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug actions.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema; osmotic diuretics, such as urea and mannitol, to reduce brain swelling; analgesics to control pain; and antacids and histamine receptor antagonists for stress ulcers. These tumors and schwannomas may also require anticonvulsants such as phenytoin to reduce seizures.
Malignant spinal neoplasms:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of spinal cord tumors generally includes decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it isn't usually indicated for metastatic tumors. If the tumor is slowly progressive or if it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous. If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy with dexamethasone minimizes cord edema and temporarily relieves symptoms until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time. Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy. Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to opioid analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through small-diameter nerve fibers. Chemotherapy generally hasn't proven effective against most spinal tumors, but may be recommended in some cases.
Primary malignant bone tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Excision of the tumor with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemo-therapy.
In some patients, radical surgery (such as hemipelvectomy or amputation) is necessary; however, surgical resection of the tumor (commonly with preoperative and postoperative chemotherapy) has saved limbs from amputation.
Intensive chemotherapy includes administration of doxorubicin, vincristine, cyclophosphamide, cisplatin, dacarbazine, and etoposide in various combinations. Chemotherapy may be infused intra-arterially into the long bones of the legs.
Malignant melanoma:
Treatment
(Professional Guide to Diseases (Eighth Edition))
A patient with malignant melanoma requires surgical resection to remove the tumor. The extent of resection depends on the size and location of the primary lesion. Closure of a wide resection may require a skin graft. Surgical treatment may also include regional lymphadenectomy.
Deep primary lesions may merit adjuvant chemotherapy and biotherapy to eliminate or reduce the number of tumor cells. Clinical trials are currently under way to evaluate the effectiveness of isolated limb perfusion as chemotherapy for the management of malignant melanomas of extremities. Radiation therapy is usually reserved for metastatic disease. It doesn't prolong survival but may reduce tumor size and relieve pain.
Regardless of the treatment method, melanomas require close long-term follow-up to detect metastasis and recurrences. Statistics show that 13% of recurrences develop more than 5 years after primary surgery.
Lymphomas, malignant:
Treatment
(Handbook of Diseases)
Radiation therapy is used mainly in the early localized stage of the disease. Total nodal irradiation is usually effective for nodular and diffuse histologies.
Chemotherapy is most effective with multiple combinations of antineoplastics; remissions and cures may be induced in this manner. Some cases have required intrathecal chemotherapy. Bone marrow and stem cell transplants have also proved helpful.
Bone tumors, primary malignant:
Treatment
(Handbook of Diseases)
❑ Excision of the tumor along with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemotherapy.
❑ In some patients, radical surgery (such as hemipelvectomy or interscapulothoracic amputation) is necessary. However, surgical resection of the tumor (often with preoperative and postoperative chemotherapy) has saved limbs from amputation.
❑ Intensive chemotherapy includes administration of doxorubicin, ifosfamide, cisplatin, and high doses of methotrexate, alone or in various combinations for osteosarcomas. Additionally, vincristine, etoposide, and dactinomycin may be added if the patient has Ewing’s sarcoma. Chemotherapy may be infused intra-arterially into the long bones of the legs.
Brain tumors, malignant:
Treatment
(Handbook of Diseases)
Remedial approaches include removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other signs and symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor’s histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with a diuretic, corticosteroid or, possibly, ventriculoatrial or ventriculoperitoneal shunting of CSF.
❑ Gliomas. Treatment usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
❑ Astrocytomas. Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
❑ Oligodendrogliomas and ependymomas. Treatment includes resection and radiation therapy.
❑ Medulloblastomas. Treatment involves resection and, possibly, intrathecal infusion of methotrexate or another antineoplastic.
❑ Meningiomas. Treatment requires resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
❑ Schwannomas. Microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes a nitrosourea to help break down the blood-brain barrier and permit other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug action.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema and an antacid and a histamine-receptor antagonist for stress ulcers. These tumors and schwannomas may also require an anticonvulsant.
Malignant melanoma:
Treatment
(Handbook of Diseases)
A patient with malignant melanoma requires surgical resection to remove the tumor. The extent of resection depends on the size and location of the primary lesion. Closure of a wide resection may require a skin graft. Surgical treatment may also include regional lymphadenectomy. Cutaneous melanoma is nearly 100% curable by excision if diagnosed when malignant cells are confined to the epidermis.
Deep primary lesions may merit adjuvant chemotherapy and biotherapy or immunotherapy to eliminate or reduce the number of tumor cells. Radiation therapy is usually reserved for metastatic disease; gene therapy may also be a treatment option.
Regardless of the treatment method, melanomas require close, long-term follow-up to detect metastasis and recurrences.
UNDER STUDY: Nerve fiber loss may provide an explanation for the invisible neurologic deficits experienced by many patients with MS. The axons decide the presence or absence of function. Loss of myelin doesn’t correlate with loss of function.
The prognosis varies. MS may progress rapidly,. It can disable the patient by early adulthood, and it also holds the potential to cause death within months of onset. However, 70% of patients lead active, productive lives with prolonged remissions.
Terms to describe MS forms include:
❑ relapsing-remitting — clear relapses (or acute attacks or exacerbations) with full recovery or partial recovery and lasting disability. Between the attacks, there’s no worsening of the disease. This type accounts for up to 90% of all cases.
❑ primary progressive — steady progression or worsening of the disease from the onset with minor recovery or plateaus. This form is uncommon and may involve different brain and spinal cord damage than other forms.
❑ secondary progressive — begins as a pattern of clear-cut relapses and recovery but becomes steadily progressive and worsens between acute attacks.
❑ progressive relapsing — steadily progressive from the onset but also has clear acute attacks. This form is rare.
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