Treatments for Gall Bladder Cancer
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- 0.008% (1,010) of hospital consultant episodes were for malignant neoplasm of gallbladder in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 84% of hospital consultant episodes for malignant neoplasm of gallbladder required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 33% of hospital consultant episodes for malignant neoplasm of gallbladder were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 67% of hospital consultant episodes for malignant neoplasm of gallbladder were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 31% of hospital consultant episodes for malignant neoplasm of gallbladder required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
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Gallbladder and bile duct cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Surgical treatment of gallbladder cancer is essentially palliative and includes various procedures, such as cholecystectomy, common bile duct exploration, T-tube drain-age, and wedge excision of hepatic tissue.
If the cancer invades gallbladder musculature, the survival rate is less than 5%, even with massive resection. Although some cases of long-term survival (4 to 5 years) have been reported, few patients survive longer than 6 months after surgery for gallbladder cancer.
Surgery is normally indicated to relieve obstruction and jaundice that result from extrahepatic bile duct cancer. The procedure used to relieve obstruction depends on the cancer site. Such procedures may include cholecystoduodenostomy or T-tube drainage of the common duct.
Other palliative measures for both kinds of cancer include radiation, radiation implants (mostly used for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, irinotecan, and gemcitabine). All of these treatment measures have limited effects.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Bladder cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn't invaded the muscle.
Intravesicular chemotherapy is also used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with antineoplastic drugs — most commonly, thiotepa, doxorubicin, mitomycin, or Bacillus Calmette-Guérin immunotherapy.
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn't near the bladder neck or ureteral orifices. Bladder instillation of thiotepa, mitomycin-C, or doxorubicin after transurethral resection may also help control such tumors.
For infiltrating bladder tumors, radical cystectomy is the treatment of choice. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then wear an external pouch continuously. Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Treatment of patients with advanced bladder cancer includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as doxorubicin, methotrexate, vinblastine, and cisplatin. This combination sometimes is successful in arresting bladder cancer. Cisplatin is the most effective single agent.
Investigational treatments include photodynamic therapy and intravesicular administration of interferon-alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily absorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Gallbladder and bile duct cancers:
Treatment
(Handbook of Diseases)
Surgical treatment of gallbladder cancer is essentially palliative and includes various procedures, such as cholecystectomy, common bile duct exploration, T-tube drainage, and wedge excision of hepatic tissue.
If the cancer invades gallbladder musculature, the survival rate is less than 5%, even with massive resection. Although some cases of long-term survival (4 to 5 years) have been reported, few patients survive longer than 6 months after surgery for gallbladder cancer.
Surgery is normally indicated to relieve the obstruction and jaundice that result from extrahepatic bile duct cancer. The type of procedure used to relieve obstruction depends on the site of the cancer. Such procedures may include cholecystoduodenostomy and T-tube drainage of the common duct.
Clinical tip Other palliative measures for both kinds of cancer include radiation therapy, radiation implants (used mostly for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, doxorubicin, and lomustine). All these treatment measures have limited effects.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bladder cancer:
Treatment
(Handbook of Diseases)
Appropriate treatment for bladder cancer varies.
Superficial bladder tumors
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn’t invaded the muscle.
Intravesicular chemotherapy is used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with an antineoplastic — most commonly, thiotepa, doxorubicin, mitomycin, or bacille Calmette-Guérin (BCG).
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn’t near the bladder neck or ureteral orifices. Bladder instillations of thiotepa after transurethral resection may also help control such tumors.
Under study Immunotherapy may be used to fight cancer. BCG is an immunomodulating agent commonly used in the treatment of superficial bladder cancer following surgery to remove the tumor. Biologic response modifiers — such as interferons, interleukins, colony-stimulating factors, monoclonal antibodies, and vaccines — may also be used to alter the interaction between the body’s immune defenses and the cancer cells. The goal is to boost, direct, or restore the body’s ability to fight the disease.
Infiltrating bladder tumors
Radical cystectomy is the treatment of choice for infiltrating bladder tumors. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then continuously wear an external pouch. (See Caring for a urinary stoma.) Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Advanced bladder cancer
For patients with advanced bladder cancer, treatment includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as cyclophosphamide, fluorouracil, doxorubicin, and cisplatin. This combination sometimes is successful in arresting bladder cancer.
Cisplatin is the single most effective agent.
Investigational treatments
Such treatments include photodynamic therapy and intravesicular administration of interferon alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily ab
sorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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