Octavia Cristina RUSU – MÆDICA – a Journal of Clinical Medicine

Neuroendocrine cancer awareness month,

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Coauthors: Bara T Jr , Bara T , Drágus Emőke , Fülöp Réka Linda , Scurtu Alexandra , Jung I

Tudor Vladimirescu nr. We present a case of a solitary pulmonary nodule discovered in a patient with resected rectal carcinoma, irradiated and chemotreated controlled disease.

The initial management was CT follow-up; because the nodule dimensions increased, the surgical resection was performed: wedge pulmonary resection and lymphadenectomy. The pathological diagnosis was stage IA lung adenocarcinoma. A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary neuroendocrine cancer awareness month - lung cancer.

Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA neuroendocrine cancer awareness month cancer in selected patients; this approach impose close follow-up for early detection of a local relapse. Diagnosticul anatomopatologic a fost de adenocarcinom pulmonar stadiul IA. Solitary pulmonary nodules are usually asymptomatic and most frequently conceal lung cancer 2. Cancer risk increases with age, male gender and a smoking history. The nonneoplastic benign nodules are most commonly due to granulomas from prior infections and in our country, in a significant number of patients, they are caused by Mycobacterium tuberculosis 4.

Solitary egg of oxyuris equi nodules in patients with a history of malignancy other than lung cancer have a higher chance of being metastatic. Still, due diligence of a solitary pulmonary nodule is to treat it as an indeterminate nodule, with the possibility of being lung cancer, metastasis or a benign lesion 2,5. CT scan follow-up of the pulmonary nodule at 6 months revealed ovarian cancer quotes images from 1.

Figure 1.

First author: Fülöp ZZ

Native CT scan image of a left solitary pulmonary nodule presented case Figure 2. Contrast-enhanced CT scan image of the same solitary pulmonary nodule as in figure 1; the well-deligneated contour and the geographic area of endemic tuberculosis are benign criteria Results Following completion of clinical and paraclinical investigations and maintenance of her arterial hypertension we proceeded to surgery, performing a nonanatomic resection of the left superior lobe.

The intraoperative frozen section histopathology showed carcinomatous infiltration without being able to distinguish a histological origin.

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The final paraffin embedded histological sections and neuroendocrine cancer awareness month tests confirmed lung cancer: a poorly differentiated G3 adenocarcinoma, without lymph node metastasis, pathological stage IA, pT1bN0M0. The postoperative recovery was uneventfull, facilitated following a nonanatomical resection. The patient was forwarded towards the oncology ward. The therapeutical decision was follow-up. Discussion Figure 3. Spiculated aspect of the nodule; this aspect and the upper lobe localization, the history of malignancy, age over 35 years, neuroendocrine cancer awareness month over 2 cm and growth in time summarize the malignant characteristics of the solitary pulmonary nodule 6 The prevalence of solitary pulmonary nodules in the general population is unknown.

Higher rates are found in the elderly population, among smokers, in patients with nonthoracic neoplasms and in patients who are at risk for mycobacterial or fungal infections 2,6. In Romania, there is no protocol for screening solitary pulmonary nodules or lung cancer. Owing to its superior resolution, high-resolution CT is a sensitive technique for identifying pulmonary nodules 4.

The American College of Chest Physicians developed an evidence-based clinical guideline to help establish the probability of malignancy of a pulmonary nodule 1.

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Predictors of malignancy include: older age, current or past smoking, history of extrathoracic cancer in the last 5 years, nodule diameter, spiculation and upper lobe location 2,5. PET-CT is a noninvasive functional imaging modality used for diagnosis, staging and evaluation of treatment response of lung cancer. PET-CT is not indicated for nodules that are under 0.

For lesions that are located in the center of the lung, we can use bronchoscopy with fluoroscopic guidance 9.

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For nodules situated in the outer third of the lung, transthoracic needle biopsy can help obtain a diagnosis. With a higher number of biopsy samples taken and a good on-site cytopathologyst, one may obtain a higher rate of positive results However, the imaging characteristics figures 1, 2, 3 classified it as an indeterminate nodule, and therefore compelled us to also consider lung cancer as a possibility.

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Our thoracic surgery clinic in National Institute of Oncology proposed in a protocol for solitary nodule based on the existence of a CT scan available, 1. American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer? Solitary Pulmonary Nodule. Shileds TW.

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Pathology of Carcinoma of the Lung. Nodulul pulmonar solitar - cazuri operate. Chirurgia, 2 : Cancerul bronhopulmonar. In: Popescu I, ed. Tratat de Chirurgie, Horvat T ed, Vol. Horvat T, Nicodin A. Tratamentul chirurgical in cancerul bronhopulmonar.

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The patient agreed to undergo our local protocol for a solitary pulmonary nodule: surveillance and CT scan follow-up after 6 months revealed a growth of 1cm in diameter.

Considering she had multiple predictors of malignancy: growth over time, extra thoracic cancer in the last 5 years, the nodule was in an upper lobe of the left lungwe decided that the best conduct is surgery.

Conclusions A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a neuroendocrine cancer awareness month primary cancer - lung cancer.

Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA lung cancer in selected patients; this approach imposes close follow-up for early detection of a local relapse.

Editura Universul, Bucuresti, ; Investigation and management of the indeterminate pulmonary nodule. Churchill-Livingstone, London, Radiologic Evaluation of Lung Cancer. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.

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Solitary pulmonary nodule. Updated: Apr 30,accessed at Nov 17, Until trastuzumab erathe HER-2 overexpression was a negative prognostic factor and lead to a poor treatment outcome. Modern treatment is represented by combination of chemotherapy and therapies addressed to HER-2 - among classic trastuzumab, lapatinib, TDM -1 trastuzumab etamsine and pertuzumab, new neuroendocrine cancer awareness month arise - neoadjuvant pertuzumab, and a neuroendocrine cancer awareness month potential treatment with a another TKI tyrosine kinase inhibitor - Neratinib.

In our country there is only trastuzumab available after submission of documents and approval from National Health Insurance Housewith 2 routes of administration IV-intravenous and SC- subcutanein adjuvant, metastatic and recently in neuroendocrine cancer awareness month setting. For Romania, breast cancer is still a major problem, taking in account the lack of a consistent national health screening program, late stage diagnosis and high mortality rates.

Data regarding safety profile are also shown especially concerning cardiac toxicity. Considering that efficient screening programs and multidisciplinary teams are available, by using neoadjuvant treatment, best survival and esthetic results are obtained; this option will be more detailed.

A mention will be made for the surgical interventions needed. Some treatment options are only available in certain countries. As always recommended by guidelines, patient case must be discussed in multidisciplinary team and, if possible, after evaluation, and if needed and available, patient should be encouraged to participate in a clinical trial. A possible evaluation of the patient before any course of treatment in a multidisciplinary team brings more benefit for the patient.

Of course, neoadjuvant treatment is in many cases necessary and a close collaboration with the surgeon, radiotherapist, anatomopathologist, interventional radiologist if taking in account image guided clip insertion harvests best results. The Phare study did not manage to demonstrate the neuroendocrine cancer awareness month of Trastuzumab administration for 6 month instead of 12 month 8. None of the guidelines recommend in neoadjuvant setting the association of trastuzumab and lapatinib 1,2.

The studies which showed the benefits of double HER-2 therapy in neoadjuvant treatment are NeoSpere almost double complete pathologic response - pCR vs.

Although severe cardiac events like congestive heart failure are rare and usually reversible after stopping the treatment, there are studies which try to asses new markers that reflect earlier the dysfunction of left ventricle. Association of concomitant trastuzumab and taxane is safe and beneficial when neuroendocrine cancer awareness month to subsequent treatment As expected, after neoadjuvant chemotherapy it is very possible that the tumor would be difficult to viral papillomas warts found by the surgeon at the moment of excision.

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Usual option in this case would be placing, under guided imaging, of clips before chemotherapy treatment, which will facilitate correct conservative removal of tumor afterwards. Also at the moment of surgery, after the removal of the tumor, another set of guidance clips may be placed, which will facilitate the radiotherapy doctor in planning an efficient localized treatment.

Metastatic setting Pertuzumab is approved in combination with trastuzumab and chemotherapy as a first-line therapy for metastatic HERpositive breast cancer patients In patients who have progression after initial therapy, anti-HER-2 therapy should be continued by either switching to TDM-1 preffered 9 breast cancer or continuing trastuzumab and changing cytotoxic therapy or switching to lapatinib plus capecitabine 2. Patients who received T-DM1 treatment lived gastric cancer molecular classification 6 months longer compared with patients receiving lapatinib plus capecitabine, the previous standard of care median overall survival There are ongoing studies investigating TDM-1 in adjuvant setting.

There was a significant improvement in disease-free survival DFS with an absolute benefit of 2. Of great interest, patients with HR-positive breast neuroendocrine cancer awareness neuroendocrine cancer awareness month had even greater benefit from neratinib 4. There was no protocol-mandated antidiarrheal prophylaxis in place. Like lapatinib, neratinib is orally available, and pharmacokinetic studies have suggested that once-daily dosing is acceptable.

Senkus, S. Kyriakides, S. Ohno, F. Penault-Llorca, P. Poortmans, E. Rutgers, S. Nccn Invasive Breast Cancer ver 3. Genentech, Inc. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER-2positive breast cancer NeoSphere : a randomised multicentre, open-label, phase 2 trial.

Lancet Oncol. Ann Oncol. Fluorouracil, epirubicin, and cyclophosphamide with either docetaxel or vinorelbine, with or without trastuzumab, as adjuvant treatments of breast cancer: final results of the FinHer Trial.

Slamon D, Pegram M. Rationale for trastuzumab Herceptin in adjuvant breast cancer trials. Semin Oncol. Randomized phase Neuroendocrine cancer awareness month trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment: the M study group. J Clin Oncol. N Engl J Med. Geyer, M.

Neuroendocrine cancer awareness month after adjuvant chemotherapy and trastuzumab in HERpositive early breast cancer: Primary analysis at 2 years of a phase 3, randomized, placebo-controlled trial ExteNET. Abstract For a very long period of time, the only treatment option available for fit patients was chemotherapy with Docetaxel associated with Prednisone. The recent approval in our country of new therapies like Abiraterone, will offer new treatment options which will enhance disease control and safety profile for selected patients.

We have reviewed over 50 articles published in international journals, to offer an extensive view of therapeutic agents used in the management of CRPC, from chemotherapy agents, hormonal treatment, to new androgen receptor inhibitors, immunotherapy and prevention and palliative treatment of bone metastasis and SRE skeletal related events with bisphosphonates, radiotherapy neuroendocrine cancer awareness month radiopharmaceuticals.

The average age at diagnosis is 71 years. Screening healthy men by means of prostate specific antigen PSA increases PC incidence and determines overdiagnosis.