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Revisiting Metastatic Endometrial Cancer

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Dr KK Aggarwal    18 July 2018

For women with newly-diagnosed, metastatic endometrial cancer that are felt to have operable disease, one should go for surgical cytoreduction

For those who undergo surgery one should administer of adjuvant chemotherapy following surgery with carboplatin and paclitaxel 

For some women with metastatic endometrial cancer, endocrine therapy (for megestrol acetate alternating with tamoxifen) is a reasonable alternative to combination chemotherapy if any of the following factors are present: grade 1 or 2 endometrial cancer, tumors positive for estrogen (ER) and progesterone (PR) receptors, and women without (or with minimal) cancer-related symptoms.

For those who progress after front-line endocrine therapy, a platinum-based combination regimen may be offered.

For women who progress six months or longer after a prior line of chemotherapy, repeat treatment with a platinum-based combination, although endocrine therapy is an appropriate alternative.

For women who progress less than six months from their prior regimen, one can offer either single-agent therapy or endocrine therapy.

The prognosis of women who experience disease progression following first- or second-line therapy is poor.

The prognosis of endometrial carcinoma is determined primarily by disease stage and histology (including both grade and histologic subtype). In general, the rate of five-year survival for stage I disease is approximately 80 to 90 percent, for stage II it is 70 to 80 percent, and for stages III and IV it is 20 to 60 percent. Metastasis is IVb (21.1%).

FDA Recalls Valsartan Over Potential Cancer Risk

 

22 countries have recalled Valsartan, now off label, as it contains a chemical NDMA (N-nitrosodimethylamine) impurity that poses a potential cancer risk.

NDMA is an organic carcinogen chemical commonly used to make liquid rocket fuel, softeners and lubricants, among other products. It can also be unintentionally produced through certain chemical reactions and is a byproduct from some pesticide manufacturing, the making of rubber tires or fish processing.

Animal studies have shown that NDMA can cause tumors in the liver, kidney and respiratory tract. Exposure to high levels can cause liver damage and is a probable human carcinogen.

MEDtalks: The risk of gastric cancer associated with dietary intake of nitrites and nitrosodimethylamine (NDMA) and endogenous formation of nitroso compounds was investigated in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. While there was no association between intake of nitrites and NMDA and gastric cancer risk, endogenous production of N-nitroso compounds was significantly associated with non-cardia cancer risk (Carcinogenesis 2006; 27:1497.).

 

Around the Globe

  1. The Narendra Modi government is determined to see the contentious National Medical Commission (NMC) Billpass, expected to be tabled in Parliament during the upcoming Monsoon Session
  2. A major reason these students were able to get admission in medical colleges, despite their poor marks, is the revised NEET notification issued by the MCI that does not make it mandatory for candidates to score minimum 50 per cent marks (or 40 per cent for reserved category) in individual subjects.
  1. Over the past three years, 27 percent of physicians’ report facing sexual harassment from patients, according to a survey conducted by Medscape.
  1. World News: The CDC and the U.S. Food and Drug Administration are investigating a multistate outbreak of Vibrio parahaemolyticus. According to the Center for Disease Control and Prevention website, the outbreak is linked to eating fresh crab meat imported from Venezuela. 
  1. There is growing evidence that mood disorders (bipolar disorder) may be related to overall inflammation and to changes in the microbiome, the bacteria that live in our digestive tract.
  1. The Delhi High Court today directed the Indian Air Force (IAF) to review and change its protocols dealing with issues of stress and substance abuse in the force. The bench disapproved of the manner in which the IAF had kept a 30-year-old corporal confined in a hospital’s psychiatric ward as he was an alcoholic. We want to make sure the IAF does not think that the Mental Health Act does not apply to it.
  1. Sir Richard Hadlee faces another cancer surgery within two months, after confirmation a secondary cancer has been detected in his liver. New Zealands greatest cricketer, 67, underwent bowel cancer surgery in May.  
  1. Exercising during chemotherapy may improve treatment outcomes for cancer patients, according to a recent pilot study at a dedicated cancer hospital in Sydney. Cancer patients in the pilot study were given their chemotherapy drugs while riding exercise bikes. The team hopes that long-term, exercising during the actual infusion process will show benefit to patients by increasing the blood flow to tumours.

About Vibrio parahaemolyticus 

is a gram-negative bacterium that can cause seafood-associated diarrheal illness; it has also been associated with wound infections and septicemia. Gastroenteritis often occurs in the setting of mishandling and/or cross-contamination of seafood after cooking.

Clinical manifestations include diarrhea, abdominal cramps, nausea, vomiting, and fever. Wound infections associated with exposure of wounds to estuarine waters can be severe in the setting of liver disease, alcoholism, or diabetes. V. parahaemolyticus can also cause septicemia, particularly in individuals with underlying liver disease (as with other Vibrios).

Treatment is tetracycline or fluoroquinolone.

Participate in survey on Inflammatory bowel disease:

https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO

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