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Updates found with 'common cause'

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Updates found with 'common cause'

Pregnancy and cancer: A challenge for obstetrician and oncologist!As the age of child birth is delayed we may be seeing more cases with cancer in pregnancy.At present estimated incidence of cancer in pregnancy is estimated to be around 1 in 1000 livebirths worldwide.Gestational cancer is the term given to cancer occuring in pregnancy and up to one year postpartum.Like in general population the symptoms of cancer are not unique and they mimic with more commonly occuring diseases, similarly many of the symtoms of cancer in pregnancy are often suspected to be due to underlying pregnancy and other common conditions leading to delay in diagnosis.Tissue diagnosis is key to confirm diagnosis in solid tumors like breast , cervix etc.While for hematological malignancy CBC with PBF is basic investigation to start with and further work up is directed based on clinical suspicion of leukemia or lymphoma.Imaging workup for diagnosis and staging should keep in mind that radiation exposure to fetus should be as low as possible.Radiation may lead to either spontaneous abortion, teratogenesis or carcinogenesis.It should be kept in mind that though teratogenesis is dose dependent , with doses greater than 50mGy continue to be more and more teratogenic. However carcinogenesis is not dose dependent and can occur at any dose leading to increased risk of childhood cancers with a risk of 3-4 times as compared to general population.Chest X-ray , mammography with abdominal shield are safe.CT chest can be done with abdominal shielding.MRI without contrast is preferred modality instaging Brain, Bone, Abdomen and pelvis.Gadolinium contrast can be used if absolutely necessary keeping in mind that there is limited data for its safety in pregnancy.Iodinated contrast may be associated with neonatal thyroid disorder and if used , a careful screening of neonatal thyroid functioning should be done.Overall breast cancer is the most common cancer seen in pregnancy, which usually present in stage Il and lll. While cervical cancer is most common gynecological cancer seen in pregnancy and in 75% patients it is diagnosed in stage l.Treatment of cancer in pregnancy is complex and it should involve multidisciplinary team approach including obstetrician, neonatologist and oncology team.Surgery for cancer can be done during any trimester of pregnancy, with increased risk of miscarriage during first trimester. Pelvic and abdominal surgery are associated with increased feto maternal complications and it should be discussed with the patient.Chemotherapy is avoided in first trimester. In second and third trimester chemotherapy can be given , keeping in mind that not all chemotherapy drugs are equally safe. Platinum chemotherapy is associated with small for gestation and paclitaxel is associated with increased NiCU admission based on recent paper in lancet oncology in 2018 which analysed outcome of around 1300 pregnant cancer patients.As far as targeted therapy is concerned , trastuzumab should be avoided in pregnancy as it is associated with oligohydramnios. Rituximab is used in treatment of NHL and when used in pregnancy it is associated with fetal B cell depletion , the risk of which should be discussed with patients and though the recovery may take up to 6 months in neonate but it is usually complete.Radiation treatment should be delayed till delivery for reasons discussed above.
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Decoding Lynch syndrome -- Colorectal cancer(CRC)Lynch syndrome is the most common cause of inherited Colorectal cancer (CRC-large intestine cancer). It constitutes 3% of all newly diagnosed colorectal cancer burden.In lynch syndrome there is germline mutation in DNA mismatch repair (MMR) genes.It has a autosomal dominant pattern of inheritance.MLH1; MSH2; MSH6; PMS-2 are genes that are commonly mutated which results in changes in repetitive nucleoside sequences known as microsatellite.These changes in microsatellites ie microsatellite instability (MSI) result in change of expression of genes involved in cell growth.MSI is not specific for Lynch syndrome but can be seen in other sporadic CRC patients.Progression of adenoma to carcinoma in these families and patients takes 3 years as compared to a decade or longer in sporadic cancers.Screening for Lynch syndrome is done using IHC or MSI testing from tumor tissue but are confirmed by gene sequencing in somatic or germline specimen.Life time risk of developing CRC in lynch family is 10-47% depending on the gene mutated.CRC in lynch involve usually right colon and the survival in patients with lynch syndrome developing CRC is better.Screening strategy for lynch family include Colonoscopy (every 1-2 years) beginning 5 years prior to the age of the earliest diagnosed CRC patient in family. Prophylactic hysterectomy and bilateral salphingo-oopherectomy after age of 40 years is recommended for preventing endometrial cancer.
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Genetic testing for breast and ovarian Cancer1)what is genetic testing?Answer:-Genetic make up of an individual is like a house map.Any abnormality in the house map will lead to a faulty construction of the house, similarly any abnormality in the gene may lead to disease. This abnormality in genes is referred to as mutations.There are tests which can find out these specific mutations.2) Are there genes identified which increase risk of breast and ovarian cancer?Answer:There are several genes but the most well known and commonly tested genes are BRCA1 and BRCA2.several other candidate genes have been identified and research in this area is ongoing.3)Who should have genetic test for breast and ovarian cancer?Answer:we offer genetic test for women who have strong family history of breast or ovarian cancer. which is as follows:-a) two or more relatives with breast or ovarian cancer; especially if diagnosed at age <50 years.b) close family member with cancer of both breast or breast and ovarian cancer in same individual.c) if you have family members from different generation with breast or ovarian cancer.note: STRONG FAMILY HISTORY DOES NOT MEAN YOU HAVE ABNORMAL GENE AND INFACT MOST WOMEN WITH FAMILY HISTORY DO NOT HAVE THESE MUTATIONS.it is important to consult your doctor who will work out your individual risk prior to ordering these tests and discuss the pros and cons of the test as well.Q how can we lower chances of getting cancer if one turn out BRCA positive?Answer:a) getting screened for breast lump using MRI or mammogram as advised by your doctorb) breast and ovaries removal after completing Your family.c) there are tablets available as wellwhich option will be best for an individual is decided on case to case basis by treating doctor and individual preference.
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Question- Is it possible to cure CML (CHRONIC MYELOID LEUKEMIA) one of the types of blood cancer with tablets (bcr-abl kinase inhibitor) eg imatinib, nilotinib or dasatinib?Answer- We don’t know the answer yet, but studies are now looking for stopping these tablets in patients who achieve desired response with them. This concept is called TFR (Treatment Free Remission)Question- What is TFR?Answer- TFR is defined as maintenance of less than minimal residual or undetectable BCR-ABL transcript level even after stopping BCR-ABL kinase inhibitors.Question – Which patients are ideal candidates for TFR?Answer- Ideal candidates are CML-Chronic phase patients who maintain stable and continuous DMR (deep molecular response) for more than 2 years, without any history of failure of response to any of the available TKIs (Tyrosine kinase inhibitor).Question – What percentage of these carefully selected patients maintain their TFR?Answer- Close to 50% patients maintain TFR for more than 1 year.Question- Important checklist before offering TFR?Answer- Patient compliance is of paramount importance, because regular BCR-ABL monitoring is required to detect reappearance of BCR-ABL levels and prevent transformation into accelerated or blastic phase of CML.Question- What is imatinib withdrawal syndrome?Answer- An imatinib withdrawal syndrome consist of diffuse myalgia/ arthralgia encountered after stopping TKI. Question – Is maintenance of TFR equivalent to cure?Answer- We do not know yet and longer follow up is required to answer this question.
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SCREENING MAMMOGRAPHY - A UNDERUTILISED TOOL AGAINST BREAST CANCER IN INDIAIndian context of breast cancer:Breast cancer is the most common cancer diagnosed in india, close 1.5 lakh new cases are diagnosed each year.It Constitutes around 10% of all new cancer cases diagnosed in a year.In india approximately 40% of breast cancer patients are younger then 50 years while this could be real but may also be due to underreporting of breast cancer in elderly indian women.Almost half of the indian breast cancer patients present in stages III and IV.Advancing age is the most important risk factor for breast cancer.One of the major reasons for late diagnosis is lack of awareness regarding screening programmes in breast cancer.2016 update US preventive service task force makes for following recommendation:-Recommends screening mammography every 2 years in asymptomatic average risk*women between age 50-74 years.*A women is said to be at average risk of breast cancer provided they do not have any preexisting breast cancer or a high-risk breast lesion and wthout any high risk genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.-For average risk women between age group of 40-49 years, the decision to start screening or not should be an individualised knowing that the absolute benefit in survival is small.- Maximum benefit of screening mammography in terms of prolonging life is seen in age group of 60-69 years. Questions regarding breast cancer screening in indian women?- Cost effectiveness was not taken into consideration by US preventive task force, which may be an important consideration in developing country like india.- As we know indian women are being diagnosed at younger age and probably should benefit more if routine screening age is 40 years.
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