1,721,208 research outputs found
Follow-up in oncologia
No full textLa questione del follow-up oncologico è un argomento ancora molto dibattuto.
La conoscenza della storia naturale del tumore, l’effetto di strategie di cura
sempre più affidabili, la accettabilità, la efficacia diagnostica, la sicurezza degli
strumenti ed i costi sono i principali fattori in gioco per garantire la efficacia
di programmi di sorveglianza. E purtroppo questi fattori non sono completamente
conosciuti.
L’incertezza ha ricadute etiche e psicologiche. Se non siamo sicuri di quanto
un follow-up possa modificare l’outcome di un paziente che ha avuto il
cancro, vi è da chiedersi come possiamo sostenerne la opportunità, stressare
le indicazioni, togliere le incertezze e rendere sicuro l’approccio da parte del
paziente.
Eppure i programmi di sorveglianza sono di fatto applicati per tutti coloro
che hanno avuto un tumore.
In un contesto in cui ci sono diversi dubbi, poche certezze, ma una buona
dose di potenziale efficacia è particolarmente necessario analizzare criticamente
tutte le implicazioni di un programma di follow-up del cancro cercando di
arrivare ad un razionale di scelte il più vicino possibile a quanto sappiamo.
Questo volume vuole dare un contributo alla conoscenza delle basi tecniche
su cui poggiare un programma di sorveglianza in oncologia, non solo per sostenere
la ricerca di una omogeneità di proposte ma anche per ridurre il rischio
di prendere decisioni che possono portare a soluzioni sbilanciate in termini di
costi-efficacia e non di rado attivate per accondiscendere alle richieste di paziente
e famiglia, quando non per calmare insicurezze personali
Risk Factors of Cholangiocarcinoma
No full textWe present the current knowledge on the etiology of cholangiocarcinoma. Due to the important differences existing in the epidemiological features of intra- and extrahepatic cholangiocarcinoma, risk factos are discussed separately for ICC and ECC. Well established risk factors include inherited/congenital disorders of the bile ducts (blie duct cysts, primary sclerosing, cholangitis, Caroli's disease), recurrent cholangitis, choledocholithiasis, hepatolithiasis, parasitic infestation, hemochromatosis, Wilson's disease, acquired liver disease (cirrhosis and viral hepatitis)and exposure to Thorotrast. Recent investigations focused on personal and environmental exposures, including cigarette smoking, alcohol consumption, obesity/diabetes and asbestos exposure. Limited knowledge on the role of genetic polymorphisms is available to date
Cholangiocarcinoma
No full textCholangiocarcinoma presents a challenge for cancer specialists all over the world. Neoplasia of the biliary tract are rare, accounting for approximately 3% of all gastrointestinal tumours with an incidence of about 3 per 100,000; but rate have been rising rapidly in recent years. Thi cancer is one of the major killes. at the time of diagnosis less than 30% of patients are candidates for complete resection. For unresectable cholangiocarcinomas, median survival is less than 1 year. Given the rarity of the disease, the literature of cholangiocarcinoma is scant. However, the incrising incidence of the highly lethal malignancy should capture the attention of physicians and stimulate further research
Carcinogenesis of Cholangiocarcinoma
No full textDaily clinical practice and recent molecular studies have clearly shown that primitive liver tumours are an extremely heterogeneous group of disease without a steotyped phenotype or molecular signature. Accumulated evidence strongly supports the notion that such heterogeneity stems from the existence within the liver and along the biliary tree of distinct cells of origin susceptible to diffrent risk of factos and liver injuries. Although this new scenario has yet to be fully elucidated, a new physio-pathological classification of primitive liver tumour subtypes based on different cells of origin has been rpoposed. This new classification not only responds to the urgent need to provide homogeneous diagnostic, prognostic and therapeutic categories for these malignancies, but also seems more coherent with the current epidemiological data and risk factors associated with such diseases. The present chapter summarises current knowledge of the putative different cell types that may serve as cells of origin in primitive liver tumours. It also discusses the proposed new physio-pathological classification of different tumour subtypes based on these cells and it association with the current known risk fqactors for these diseases
Adjuvant Treatment and Follow-up Strategies
No full textDespite radical resection, the five-year overall survival rate for cholangiocarcinoma does not exceed 40% in the best surgical series. To date, adjuvant tratments such as radiotherapy, chemotherapy or a combination of both have been explored but mainly in small retrospective series. Available data indicate that chemotherapy can reduce the risk od distant relapse while radiotherapy can decrease the risk of local failure. The benefits of chemotherapy and radiotherapy seem to be greated for high-risk patients such as those with nodal involvement or microscopically non-radical resection, whereas the overall effects of adjuvant treatment are less clear for average risk patiens. Ongioing randomised trials will definitively clarify the value and overall benefit of adjuvant treatments in bilary tract cancer.In the absence of literature evidence, the purpose of follow-up care must be discussed with the patients to devise an individualized treatment strategy
Diagnostic and Therapeutic Algorithms for Cholangiocarcinoma
No full textCholangiocarcinoa (CC) is a challenging disease, most patients presenting with unresectable tumours at the time of diagnosis. Imaging techniques (US, CT, MRI) and invasive tests (ERC or EUS with brushing and FNA or biopsy US or TC guided) with a pathological confirmation are required to establish a definitive diagnosis of CC. The ultimate curative treatment strategy for CC is surgery. Thus, a multidisciplinary team in a referaal centre should first expolre the surgical option and distinguish resectable from unresectable disease. Secondly, in both situations it is necessary to screen patients with jaundice which may required decompression of the biliary tract with drainage/stent function is essential to minimize the risk of postoperative liver falilure. If future liver failure is suspected, portal vein embolization or an associating liver partition and portal vein ligation for staged hepatectomy should be considered. Surgery could lead to a curative resection and so an adjuvant tharapy may be administered. Otherwise, after a non-curative resection or in unresectable locally advances metastatic or recurrent cholangiocarcinoma first-line chemotherapy is the suggested option, possibly associated with radiotherapy or locoregional treatmens. Whne the disease is no longer controlled by any line of chemotherapy, best supportive care should be suggested
Genetic heterogeneity in cholangiocarcinoma: a major challenge for targeted therapies
Full text linkCholangiocarcinoma (CC) encompasses a group of related but distinct malignancies whose lack of a stereotyped genetic signature makes challenging the identification of genomic landscape and the development of effective targeted therapies.Accumulated evidences strongly suggest that the remarkable genetic heterogeneity of CC may be the result of a complex interplay among different causative factors, some shared by most human cancers while others typical of this malignancy.Currently, considerable efforts are ongoing worldwide for the genetic characterization of CC, also using advanced technologies such as next-generation sequencing (NGS). Undoubtedly this technology could offer an unique opportunity to broaden our understanding on CC molecular pathogenesis. Despite this great potential, however, the high complexity in terms of factors potentially contributing to genetic variability in CC calls for a more cautionary application of NGS to this malignancy, in order to avoid possible biases and criticisms in the identification of candidate actionable targets. This approach is further justified by the urgent need to develop effective targeted therapies in this disease.A multidisciplinary approach integrating genomic, functional and clinical studies is therefore mandatory to translate the results obtained by NGS into effective targeted therapies for this orphan disease
Chemotherapy in Patients with Advanced Cholangiocarcinoma
No full textThis chapter analyses the role of chemotherapy in the palliative treatment of patients with locally advanced or metastatic cholangiocarcinoma.In the wake of evidence of the superiority of cheniotherapy over best supportive care, many studies have evalueted diffrent chemotherapeutic agents. Among them gemcitabine proved the most avtice against biliary tract cancer and its combination with platinum compounds like cisplatin (Gemcis) or oxaliplatin (Gemox) has proved the best systemic therapeutic strategy. Given the results of recent large phase III studies, gemcitabine in association with cisplatin should be considered the standard of care in the first-line setting of advanced cholangiocarcinoma even if no comparative study between Gemcis and Gemox has ever been conducted and a literature analysis of hte main published studies showed that the results obtained with Gemox are not very different from those obtained with Gemcis. Few studies on a salvage chemotherapy after failure of first-line treatment have been coducted due to the rarity of the disease and the frequent rapid decline of perfomance status of patients in this advanced setting
Antitumoral Efficacy of Two Turmeric Extracts According to Different Extraction Methods in Hepatocellular Carcinoma Cell Lines
Full text linkCurcuminoids, bioactive molecules contained in turmeric, have been reported to exert anticancer effects in several human cancers, including hepatocellular carcinoma (HCC). However, the extraction method can significantly affect the structural characteristics of curcuminoids and their biological properties. On this basis, in the present study we investigated the content of curcuminoids and the anticancer activity of two turmeric powders extracted according two different methodologies: solvent extraction with ethyl acetate vs an ancient Indian extraction method of boiling of rhizomes in water followed by dehydration at the sun. Results obtained showed that extraction with ethyl acetate resulted in a significant recovery of curcuminoids and anticancer activity both in terms of cell cytotoxicity and migration/invasiveness inhibition in HCC cell lines, compared to common Indian practice. Overall these findings suggest that turmeric powders could have different efficacy, depending on the extraction method. This aspect should be taken into account when choosing the best product to be employed in the prevention and treatment of human diseases, including cancer
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