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In particular, recent developments have provided a better understanding of the biology of the disease. The drugs in more advanced stages of research are being studied in patients in clinical trials; these are referred to as being in the clinical phase of development. The most common way for a patient to receive an investigational drug is through a clinical trial. For a detailed discussion of currently approved treatment options, please see the "Treatments for Non-Hodgkin Lymphoma" chapter of this guide. Stem Cell Transplantation Ongoing research in stem cell transplantation is focused on finding better ways to collect stem cells from the bone marrow or peripheral blood; reducing or eliminating graft-versus-host disease in allogeneic (donor) transplants; improving ways to remove all lymphoma cells from stem cell samples used for autologous (self) transplants; and developing more effective regimens for reduced-intensity stem cell transplantation. Clinical Trials and Advances in Treatment 144 Checkpoint Inhibitors A newer class of immunotherapies called checkpoint inhibitors has been developed more recently. However, this therapy can also result in significant side effects, such as "cytokine release syndrome" after treatment. Vaccines Vaccines are commonly used to help protect against viruses and other infections. In these cases, researchers are focused on developing vaccines to help treat, rather than prevent, lymphomas. The hope is that these vaccines might boost the immune system to recognize and kill lymphoma cells early during the course of the disease. The Foundation offers a wide range of lymphoma-focused continuing education activities for nurses, physicians, and social workers, including workshops, conference symposia, and webcasts. Part 5 Clinical Trials and Advances in Treatment 148 Contact Information Helpline: (800) 500-9976 Website: Focus on Lymphoma is the first mobile app that provides patients and caregivers comprehensive content based on their lymphoma subtype and tools to help manage their diagnosis, including a medication manager, doctor sessions tool and side effects tracker. Understanding Non-Hodgkin Lymphoma this patient guide is supported through unrestricted educational grants from: Contact the Lymphoma Research Foundation Helpline: (800) 500-9976 helpline@lymphoma. If you can reasonably anticipate facing contact with blood and/or other potentially infectious materials as part of your job duties, you should receive additional training from your instructor or supervisor including an opportunity for interactive questions and answers. Bloodborne Diseases Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. While there are several different types of Hepatitis, Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer. The Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine will often occur. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. However, because it is such a devastating disease, all precautions must be taken to avoid exposure. After the initial infection, a person may show few or no signs of illness for many years. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections. It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to a student in the classroom, handling blood samples in the laboratory, or cleaning up blood from a hallway. In most work or laboratory situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission. In other words, whether or not you think the blood/body fluid is infected with bloodborne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur. For example, you may have noticed that emergency medical personnel, doctors, nurses, dentists, dental assistants, and other health care professionals always wear latex or protective gloves. This is a simple precaution they take in order to prevent blood or potentially infectious body fluids from coming in contact with their skin. Page 3 Bloodborne Pathogen Training To protect yourself, it is essential to have a barrier between you and the potentially infectious material. It is important to find out where these bags or containers are located in your area before beginning your work. Gloves Gloves should be made of latex, nitril, rubber, or other water impervious materials. If glove material is thin or flimsy, double gloving can provide an additional layer of protection. Also, if you know you have cuts or sores on your hands, you should cover these with a bandage or similar protection as an additional precaution before donning your gloves. You should always inspect your gloves for tears or punctures before putting them on. Always check your gloves for damage before using them Goggles Anytime there is a risk of splashing or vaporization of contaminated fluids, goggles and/or other eye protection should be used to protect your eyes. Again, bloodborne pathogens can be transmitted through the thin membranes of the eyes so it is important to protect them. Splashing could occur while cleaning up a spill, during laboratory procedures, or while providing first aid or medical assistance. Face Shields Face shields may be worn in addition to goggles to provide additional face protection. Aprons Aprons may be worn to protect your clothing and to keep blood or other contaminated fluids from soaking through to your skin. Page 4 Bloodborne Pathogen Training Normal clothing that becomes contaminated with blood should be removed as soon as possible because fluids can seep through the cloth to come into contact with skin. Contaminated laundry should be handled as little as possible, and it should be placed in an appropriately labeled bag or container until it is decontaminated, disposed of, or laundered. Remember to use universal precautions and treat all blood or potentially infectious body fluids as if they are contaminated. Hygiene Practices Handwashing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens. Hands or other exposed skin should be thoroughly washed as soon as possible following an exposure incident. Hands should also be washed immediately (or as soon as feasible) after removal of gloves or other personal protective equipment. Because handwashing is so important, you should familiarize yourself with the location of the handwashing facilities nearest to you. Laboratory sinks, public restrooms, janitor closets, and so forth may be used for handwashing if they are normally supplied with soap. If you are working in an area without access to such facilities, you may use an antiseptic cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. If these alternative methods are used, hands should be washed with soap and running water as soon as possible. Page 5 Bloodborne Pathogen Training Decontamination and Sterilization All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible.

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We describe the case of a young female, asymptomatic, with an incidental finding of a mediastinal mass posteriorly diagnosedas a thymolipoma. Conclusion: Thymolipomas are identified typically in the management of other medical conditions. They are associated with chromosomal alterations such as rearrangement of the cytogenetic bands, loss of chromosomal material or supra-numeric chromosomes. Four categories have been proposed for its classification: lipoma with thymic tissue combined adipose and thymic neoplasm, adipose tissue replacement of a thymoma and replacement of a hyperplasic thymus; being the first type the one we found on our patient. Surgical excision is curative, without complications and there are no descriptions of malignant transformation. Within the differential diagnosis the lipoma, the liposarcoma and the thymic hyperplasia have to be taken into account. Background: Primary malignant tumors of the trachea are rare and uncommon, they represent less than 0. Cai Nanfang Hospital, Guangzhou/China Background: Giant mediastinal tumors are often case reported in sparse and can be difficult for surgical removal. Method: A retrospective review of medical record was conducted at our single institution from 2001 to 2019. Conclusion: With careful preoperative evaluation, our results indicate that surgical management of giant mediastinal tumor is safe and recommended. Patients with a benign or less aggressive malignant tumor who received surgery have a favorable outcome in terms of long-term survival. He underwent an endobronchial biopsy from the left main bronchus followed by left lower lobectomy and mediastinal lymphadenectomy. Left lower lobectomy specimen showed a grossly circumscribed solid tumor in the wall of the left main bronchus abutting the cartilage and demarcated from adjacent lung parenchyma by a thin fibrous capsule. Further work-up did not reveal presence of tumor elsewhere ascertaining a primary lung origin. Method: A 48-year-old man who had an abnormal shadow on a chest radiograph obtained during a medical checkup was referred to our hospital. We administered carboplatin and paclitaxel for up to 6 cycles, combined with radiotherapy (60 Gy/30 fr). Result: package insert, unlike in the case of anthracycline, and the total dose is only limited on the basis of increased side effects regardless of its antineoplasmatic effect. After an univariate analysis, prognostic factors were: the histological type, the Masaoka-Koga stage and the extent of surgical resection. Conclusion: Thymic epithelial tumors present specific problems from anatomical pathology to therapeutic strategy. It usually arises from the salivary glands in the trachea or main bronchi and it is generally classified as a low-grade tumour, but because of its rarity and the unknown malignant potential, the treatment of choice has not been established. Method: A 50-year old Hispanic woman, with no history of previous malignancies or comorbidities, arrived at our institution with cough and dyspnoea. The patient underwent a left thoracentesis (amicrobic, no malignant cells) and a fiberbronchoscopy (regular bronchial suture). Most patients with disseminated disease have significant signs and symptoms such as chest pain or discomfort, dyspnea, and superior vena cava syndrome. Hemorrhagic pericardial tamponade is an uncommon initial manifestation and it is particularly rare for a thymoma to present with pericardial tamponade. Method: the patient presented to our emergency department in a stable condition and reported no previous trauma or muscular weakness. Despite the increase of the lesion, the patient was asymptomatic and maintained a follow-up in our service. Accurate histopathological and immunochemistry analysis are necessary for the final diagnosis. There are few similar cases described in the literature and the is no standard treatment in this scenario. Although they are clinically diagnosed and diagnoses very quickly,but in some cases it is very difficult to diagnose or are diagnosed in the late stages. Objective: To analyze our rarly two cases for diagnosis and treatment in delayed diagnoses for cardiac primary tumor invadation in mediastinum and pericardium tumor wih myocardial and mediastinal invasion in the other case. Most thymic carcinomas metastasize to the mediastinal lymph node, pleura, pericardium and diaphragm. And distant metastasis to the extrathoracic organs such as liver, bone or kidney is considered rare. In this case, mucinous carcinoma of the thymus caused bone marrow metastasis and multiple bone metastasis is very rare. After undergoing surgery for colon cancer, he was admitted to our hospital for treatment of mediastinal tumor. Thymoma or thymic cancer were suspected, so we surgical resection of mediastinal tumor and lymph node dissection were performed. Pathological findings showed that most of the tumor was a mucin component, and atypical cells with a small duct formed inside the mucin, signet ring cells were found. Based on these features, diagnosis of this tumor was mucinous adenocarcinoma of thymus. Bone marrow metastasis originated from thymic cancer was diagnosed as a result of comparing pathological features of the colon cancer and thymic cancer. Conclusion: In this paper, we report a very rare and valuable case with consideration of some literature review. Keywords: Thymic carcinoma, mucinous adenocarcnioma, bone marrow metastasis Background: Thymomas are a group of rare neoplasm of the anterior mediastinum. Due to their low incidence, large cooperative studies are required to evaluate outcomes. Variables including clinical, pathological and therapeutic outcomes were registered in a centralized manner. Conclusion: Survival in patients with thymomas continues to be very favorable, especially in patients who receive adequate local control. Method: From 2014 until 2018, a multinational Latin-American cooperative retrospective cohort study was performed. Clinical, pathological and treatment variables were collected across 7 participating nations. Due to their insidious development, their clinical symptom is often late, after a significant reduction of tracheal diameter, which delays the diagnosis that is often misdiagnosed for late asthma. Treatment was surgical with intubation across the operative field in all patients, including 3 resection anastomosis and 4 plasty (V-plasty lateral resection, Kergin-type plasty, Mattey-type tracheobronchial anastomosis, and a V-resection enlarged to carena). The follow-up was simple in 6 of our patients who all had postoperative fibroscopy within 9 days on average (8 to 16 days), two deaths, one post-operative death unrelated to tracheal surgery on D4, and a second follow-up to complications of post-radiation tracheal stenosis. Endoscopic or radiation disobstruction is a therapeutic alternative for nonoperable tumors. Keywords: resection-anastomosis; trachea; malignant tumor impact on the well-being of both patient and family caregiver and is largely influenced by communication within the family environment. Method: the objective of this study was to develop an informative program for women with lung cancer, implementing the development of strategies in order to get a deepening knowledge of their perceived needs. The collection of these data was what led to the development of the tools used to develop the support strategies. About the social and labor environment, they expressed concern about the social stigma associated with lung cancer, and the culpability for having smoked as well as the concern related to the interruption of working life. The patient education video was approved by the oncology council and launched in Jan 2019. This project demonstrates how one community cancer center developed feasible interventions based on identified needs. The survival was worse in the single agent chemotherapy group while it is superior in platinum doublets group. Conclusion: the presence of liver metastases confers worse prognosis in advanced non-small cell lung cancer patients.

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The radiation destroys thyroid cells, both cancerous and normal thyroid cells, with minimal effects on the rest of your body. Sometimes the dose is higher (100 to 200 millicuries) for people with more extensive disease. Your doctor may have reasons for recommending one option over the other, related to your situation. These can include tiredness, weight gain, sleepiness, constipation, muscle aches, reduced concentration, emotional changes resembling depression, and others. As a result, Thyrogen is increasingly used so that patients avoid experiencing hypothyroidism. The diet, recommended by the American Thyroid Association, increases the effectiveness of the radioactive iodine treatment. These cells will then more readily absorb the radioactive iodine, which will eventually destroy them. The ThyCa diet and guidelines have received input and review by numerous thyroid cancer specialists. What is to be avoided is the added iodine found in iodized salt, which is widely used, especially in processed foods. This does not apply to foods that naturally contain sodium without salt as an ingredient. It is a good idea to cook meals yourself, using fresh ingredients, including fruits, vegetables, and unprocessed meats. This is because some people experience nausea the first day after receiving I-131 therapy. Your home circumstances, such as whether there is an infant or a young child at home, may affect the decision about going home or staying in the hospital for a day or more after your treatment dose. The dishes and eating utensils will stay in the room with you, probably to be placed in plastic bags provided. Do not bring items such as a laptop computer, because it may become contaminated and have to stay in the hospital for pick up at a later date. We encourage you to use the telephone to communicate with your friends and family. The number of days will depend on whether you have small children at home, pregnant women at your workplace, and other factors. Sit in the back seat of an automobile, on the opposite side from the driver, if possible. Use separate bath linen and launder these and underclothing separately for one week. This is because radiation detection devices used at locations such as airports, bus and train stations, trash collection sites, and some international borders and in some buildings may detect low radiation levels. You will have this scan in the nuclear medicine department of the hospital or community radiology center. You will lie still on a narrow bed that moves slowly through the scanner, or else the scanner will move over you while the bed remains still. Or, you may receive the results from your family doctor or endocrinologist at a later meeting or on the telephone. However, sometimes the other side effects last longer or will not occur until several months after the treatment. Others report that the taste changes disappear and then recur several weeks later. If symptoms persist, ask your doctor about products that help ease the problem, such as gels and sprays. If you wear contact lenses, ask your doctor how long you should stop wearing them. Counts usually recover, at least to the normal range, if not to their full pre-treatment level. Doctors generally agree that the risk increases after several doses totaling 500-600 millicuries rather than after a single dose. If you are pregnant when diagnosed with thyroid cancer, your doctor will have specific instructions related to your pregnancy. If surgery is necessary sooner, it is usually performed in the second trimester (22 weeks of pregnancy). Also, pregnant women should not be treated with external beam radiation or chemotherapy until after the baby is born. You should always discuss your individual circumstances and risks factors with your doctor. Your doctor will order blood tests periodically to ensure that you are on the proper dose of thyroid hormone replacement. This goal may change to a level within the normal range if you have an excellent response to treatment. The goal is to prevent the growth of cancer cells while providing essential thyroid hormone to the body. Although all of these medications are synthetic levothyroxine, they are not identical. It is best to take it with a full glass of water, an hour before eating anything or drinking any other beverage. This will ensure proper absorption, because food, minerals, vitamins, and other medications can interfere with absorption. Other medications may interfere with the absorption of levothyroxine-check with your doctor or pharmacist. Understanding Your Blood Tests During the first year after your treatment, your physician may order blood tests several times to make sure you are on the right dosage of thyroid hormone replacement. Among events that may affect your dosage of thyroid hormone replacement are weight gain or loss, pregnancy, and menopause. After removal of the thyroid gland, Thyroglobulin can be used as a "cancer marker. A positive Tg test indicates that thyroid cells, either normal or cancerous, are still present in your body. Depending on the level of Tg in your blood, your doctor may want to monitor you more closely with other tests or scans and/or prescribe additional treatment. This is because some remnant thyroid tissue nearly always remains in your neck after surgery. If you had a lobectomy rather than a thyroidectomy, your remaining lobe will almost certainly produce Tg. From time to time, your doctor may recommend what is called a "stimulated Tg" measurement. If you have TgAb, imaging studies may be used to monitor for persistent or recurrent disease. In addition to these tests described above, some doctors will also recommend the measurement of Free T4. If You Have Hypoparathyroidism If you experienced parathyroid loss or damage during your thyroid surgery, maintaining proper calcium levels will be an ongoing concern. You will have your blood calcium levels monitored, and will receive further instructions.

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It is characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders that include hyponatremia, hypoglyoemia, and lactic acidosis. The fact that it occurs more frequently in winter months suggests that cold exposure may be a precipitating factor. The severely hypothyroid person is unable to metabolize sedatives, analgesics, and anesthetic drugs, and these agents may precipitate coma. It is commonly associated with hyperplasia of the thyroid gland, 176 Pathophysiology multinodular goiter, and adenoma of the thyroid. Occasionally it develops as the result of the ingestion an overdose of thyroid hormone. Thyroid crisis, or storm, is an acutely exaggerated manifestation of the hyperthyroid state. Many of the manifestations of hyperthyroidism are related to the increase in oxygen consumption and increased utilization of metabolic fuels associated with the hyper metabolic state as well as the increase in sympathetic nervous system activity that occurs. The fact that many of the signs and symptoms of hyperthyroidism resemble those of excessive sympathetic activity suggests that the thyroid hormone may heighten the sensitivity of the body to the cadecholamines or that thyroid hormone itself may act as a pseudo catecholamine. With the hypermetabolic state, there are frequent complaints of nervousness, irritability, and fatigability. Other manifestations include tachycardia, palpitations, shortness of breath, excessive sweating, and heat intolerance. Even in persons without exophthalmos there is an abnormal retraction of the eyelids and infrequent blinking and patients appear to be staring. The hair and skin are usually thin and have a silky 177 Pathophysiology appearance. Hyperthyroidism can be treated by surgical, radioactive iodine or the use of drugs. The exophthalmos is thought to result from an exophthalmos-producing factor whose action is enhanced by anti bodies. Thyroid storm Thyroid storm (crisis) is an extreme and life threatening form of thyrotoxicosis. It is often precipitated by stress, such as infection, by diabetic ketoacidosis, by physical or emotional trauma, or by manipulation of a hyperactive thyroid gland during thyroidectomy. Thyroid storm is manifested by a very high 178 Pathophysiology fever, extreme cardiovascular effects and severe central nervous system effects. Mineralocorticoids may be produced in excessive or insufficient amount, depending on the precise enzyme deficiency. Males are seldom diagnosed at birth, unless they have enlarged genitalia or lose salt and manifest adrenal crisis; in female infants, an increase in androgens is responsible for creating the virilization syndrome of ambiguous genitalia. Most often the underlying problem is ideopathic adrenal atrophy, which probably has an auto immune basis. The adrenal cortex has a large reserve capacity, and the manifestations of adrenal insufficiency do not usually became apparent until about 90% of the gland has been destroyed. Mineralocorticoid deficiency: minerals corticoid deficiency caused increased urinary losses of sodium, chloride, and water along with decreased excretion of potassium. The result is hyponatremia, loss of extra cellular fluid, decreased cardiac out put, and hyper calemia. If loss of sodium and water is extreme cardiovascular collapse and shock will ensue. Gluco corticoid deficiency: Because of a lack of glucocorticoids, the patient has poor tolerance to stress. This deficiency causes hypoglycemia, lethargy, weakness, fever, and gastrointestinal symptoms such as anorexia, nausea, vomiting and weight loss. Secondary adrenal insufficiency Secondary adrenal insufficiency can occur as a result of hypopituitarism or because the pituitary gland has been surgically removed. However, a far more common cause than either of these is the rapid withdrawal of qluco-corticoids that have been administered therapeutically. The onset of adrenal crisis may be sudden, or it may progress over a period of several days. The symptoms may also occur suddenly in children with salt-losing forms of the adrenogenital syndrome. Massive bilateral adrenal hemorrhage cause an acute fulminating form of adrenal insufficiency. Hemorrhage can be caused by meningococcal septicemia (called water house-friderichsen syndrome), adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen; subclavicular fat pads or " buffalo hamp" on the back; and a round, plethoric "moon face. In advanced cases, the skin over the forearms and legs becomes thin, having the appearance of parchment. Purple striae (stretch mark), from 183 Pathophysiology stretching of the catabolically weakened skin and subcutaneous tissues, are distributed on the abdomen and hips. Osteoporosis results from destruction of bone proteins and alterations in calcium metabolism. Derangements in glucose metabolism are found in some 90% of patients, with clinically overt diabetes mellitus occurring in about 20%. The gluco corticoids possess mineralocorticoid properties; this causes hypercalemia as a result of excessive potassium excretion & hypertension resulting from sodium retention. Inflammatory and immune responses are inhibited, resulting in increased susceptibility to infection. Cortisol increases gastric secretion, and this may provolce gastric ulceration and bleeding. An accompanying increase in androgen level causes hirsutism, mild acne, and menstrual irregularities in women. Excessive levels of the gluco corticoids may give rise to extreme emotional labiality. The normal menstrual bleeding is because of regular shading (sloughing) of the endometrial wall when the serum estrogen and progesterone level are low. The normal menstrual bleeding is characterized by: Bleeding lasting for about 5 days. Metrorrhagia (Intermenstrual bleeding): - Bleeding between period-Irregular menses Polymenorrhea:- Abnormally frequent menstrual bleeding (Usually before 21 days). Oligomenorrhea:- Abnormally infrequent menstrual bleeding (Usually beyond 35 days) Amenorrhea: - Absence of menstrual bleeding for three consecutive cycles. Postmenopausal bleeding: - Bleeding that occurs one or more years after menopause. Constitutional Disease - Bleeding disorders (like platelet abnormality & coagulation factor defect) - Hypertension. It is often associated with absence of ovulation (persistent unovulatory period) When there is no ovulation, there is no corpus luteum formation, this result in inadequate production of progesterone. Deficiency or absence of progesterone in the circulation results in absence of secretary changes in the endometruim. As estrogen levels decrease from degenerating follicles, with drawl bleeding occurs. Emotional disturbance may stimulate hypothalamus and has resultant influence on gonadotrophic hormones. Pelvic peritonitis (abscess):- inflammation of the pelvic peritoneum and puss collections. When cervix is opened for abortion, this will a pave the way for the normal floras of the vagina to ascend. The risk increase with prolonged duration of labor and operative deliveries Organism: - Pollymicrobials (Normal floras of vagina) - Aerobic organism, and - Anaerobic organism. Obstructions in urinary tract (Obstructive Uropathy) Obstructive disorders may cause considerable renal dysfunction, including hemorrhage, renal failure, if they are left untreated. Normally urine is formed by the nephrones in the renal parenchyma, then collected in the renal pelvic to flow through the ureter and reaches urinary bladder. When the bladder becomes full, urethral sphincters are opened then urine passes through urethra to be voided out. Clinical Features - Acute urinary retention - Symptoms of prostatism (frequency, urgency, dribbling, dysuria, etc) - Chronic retention insufficiency.

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Depending on which method is used, the doctor can also determine whether the cancer has spread to lymph nodes or other organs. The tissue or fluid that is removed is sent to a pathologist, who examines it and then issues a pathology report with his or her findings. Having enough tissue available for molecular testing (which you may also hear called biomarker testing, genetic testing, or mutation testing) can also be an important consideration. These tests can help identify whether your cancer is a match for a specific targeted therapy. Before a biopsy is done, the patient should speak with his or her doctor about having molecular testing of the tumor sample. A light and a camera at the end of the tube allow the doctor to look for abnormal areas. Thoracentesis If a patient has a pleural effusion, doctors can perform a thoracentesis to see if it was caused by cancer that spread to the linings of the lungs. In this procedure, a doctor numbs the skin and then inserts a hollow needle between the ribs to drain the fluid, which can then be sent to the pathologist for testing. Thoracoscopy A surgeon makes a small incision in the skin of the chest wall and inserts a special instrument with a small video camera on the end to examine the lungs and inside of the chest and to remove samples of tissue. A surgeon makes a small incision in the front of the neck at the top of the breastbone. Then a thin, hollow tube with a light and a lens for viewing is inserted through the incision, along the front edge of the windpipe. Instruments are passed through the tube to take samples from the lymph nodes along the trachea. A mediastinoscopy requires general anesthesia and is performed in an operating room. Stage 0 Also called in situ disease, meaning the cancer is "in place" and has not invaded nearby tissues and spread outside the lung. For example, the lung cancer may have spread to the lymph nodes located in the center of the chest, or the tumor may have invaded nearby structures in the lung. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone, or if the cancer has grown into vital structures within the chest, such as the heart, large blood vessels, or the main breathing tubes leading to the lungs. If there is a recurrence, the cancer may need to be staged again (called restaging) using the system above. Biomarker profile Lung cancer describes many different types of cancer that start in the lung or related structures. Other subtypes of non-small cell lung cancer include squamous cell lung cancer, large cell carcinoma, and some rarer types. Non-genetic biomarkers are also important and can help determine the best treatment. Several therapies targeting these mutations are approved for use as first-line treatment (and later) in adenocarcinoma, and others are being studied in clinical trials. The decision to test for mutations should be made together by you and your oncologist. The stage indicates where the cancer is in the lung and whether it has spread to other parts of the body. This is especially true for older patients who are otherwise physically fit and have no medical problems besides lung cancer. The following is more information about treatment options that are currently approved for lung adenocarcinoma. Patients should discuss with their healthcare team whether surgery is the best option for them. Therefore, it should be done by a thoracic surgeon-a surgeon specially trained in operating on people with lung cancer. Patients often seek a second opinion with a thoracic surgeon when considering surgery. Lung cancer surgery may be used in combination with chemotherapy and/or radiation therapy. Chemotherapy and/or radiation therapy may be given either before surgery (neoadjuvant) or after surgery (adjuvant) in order to eliminate any small amount of cancer that was not detected and removed by surgery. Removing more of the lung tissue may provide a better chance to cure the lung cancer. Other types of surgeries may also be performed to treat lung cancer that is only in one lung and has not spread to other organs. Talk to your healthcare team about what you can do before and after surgery to manage that for best quality of life. When non-small cell lung cancer is detected at a very early stage, a lobectomy is the most effective type of surgery, even when the lung tumor is very small. The amount of lung tissue removed is between what is removed in a lobectomy and in a wedge resection. Like wedge resection, it is recommended only for treating stage I lung cancers that are less than 2 cm wide and for elderly patients or those with other medical conditions that make removing the entire lobe dangerous. This type of surgery is sometimes required if the tumor is very large or is close to the center of the chest. The tumor and a portion of the airway are removed and the ends of the airway are rejoined so the remaining lobes can be left in place. A surgeon may do this operation instead of a pneumonectomy to preserve more lung function. Radiation treatment can also be given as the main treatment in early-stage lung adenocarcinoma if surgery is not possible. Radiation therapy is administered by a radiation oncologist, a doctor who specializes in using radiation treatments to treat cancer. Radiation therapy can be roughly classified by the position of the radiation source. A radiation therapy schedule usually consists of a specific number of treatments given over a set period of time. It is also used after surgery, alone or along with chemotherapy, to try to kill any small deposits of cancer that surgery may have missed. Both external beam and internal radiation therapies can be used to shrink tumors to relieve symptoms of advanced lung cancer, such as pain, bleeding, trouble swallowing, cough, and shortness of breath. Chemotherapy Chemotherapy is a word that describes many different cancer treatments that are given in drug form. Here, chemotherapy is used specifically to describe intravenous drugs that are designed to kill cancer cells. We will discuss other drug therapy options, like targeted therapies, angiogenesis inhibitors, and immunotherapy in different sections. Your doctor will help to select the best treatment based on your medical history and fitness. If their doctors recommend it, patients sometimes receive this chemotherapy before surgery, as neoadjuvant. As with other types of non-small cell lung cancer, patients with lung adenocarcinoma are often given two chemotherapy agents as first-line therapy. Most often, the platinum drugs, cisplatin or carboplatin, are combined with another chemotherapy drug. Generally, a person is kept on maintenance therapy as long as the cancer stays controlled. Then the cancer is carefully monitored by the oncologist, and second-line treatment is given if there is disease progression. The second-line chemotherapy options for patients with lung adenocarcinoma include single chemotherapy agents, usually pemetrexed or docetaxel, depending on which treatment the patient has had before. Sometimes angiogenesis inhibitors are added to chemotherapy (see the "Angiogenesis inhibitors" section). Targeted cancer therapy Targeted cancer therapies are a type of therapy that aims to target cancer cells directly.

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An apparently incongruous exposure-response relationship resulting from the use of job description to assess magnetic field exposure. An evaluation of the existing evidence on the carcinogenic potential of extremely low frequency magnetic fields. Epidemiological studies of work with video display terminals and adverse pregnancy outcomes (1984-1992). Safety of magnetic resonance imaging in patients with implanted cardiovascular devices. Nature of the changes in metabolic indices under the effect of radio waves of nonthermal intensity. Static electromagnetic fields generated by corrosion currents inhibit human osteoblast differentiation. Periprosthetic electrochemical corrosion of titanium and titanium-based alloys as a cause of spinal fusion failure. The electroporation effects of high power pulse microwave and electromagnetic pulse irradiation on the membranes of cardiomyocyte cells and the mechanism therein involved. The influence of variable and constant magnetic fields on biota and biological activity of ordinary chernozem soils. Effect of electromagnetic field accompanying the magnetic resonance imaging on human heart rate variability-a pilot study. Is there any risk interaction between electromagnetic field generated by mobile phones and artificial pacemakers. Archives des maladies professionnelles de medecine du travail et de securite sociale. Environmental and health investigation in female workers exposed to a radiofrequency electromagnetic field. Extremely low frequency electromagnetic fields affect proliferation and mitochondrial activity of human cancer cell lines. Permeability changes of cationic liposomes loaded with carbonic anhydrase induced by millimeter waves radiation. Di Giampaolo L, Di Donato A, Antonucci A, Paiardini G, Travaglini P, Spagnoli G, et al. Follow up study on the immune response to low frequency electromagnetic fields in men and women working in a museum. The effect of an ultrahigh frequency electromagnetic field on the functional status of the myocardium. A simple experiment to study electromagnetic field effects: protection induced by short-term exposures to 60 Hz magnetic fields. Short-term magnetic field exposures (60 Hz) induce protection against ultraviolet radiation damage. Effects of electromagnetic radiation on implantation and intrauterine development of the rat. Effect of wide-band modulated electromagnetic fields on the workers of high-frequency telephone exchanges. Effect of electromagnetic pulse exposure on brain micro vascular permeability in rats. Increase in hypoxanthine-guanine phosphoribosyl transferase gene mutations by exposure to electric field. Anxiety-like behavioural effects of extremely low-frequency electromagnetic field in rats. Mortality by neoplasia and cellular telephone base stations in the Belo Horizonte municipality, Minas Gerais state, Brazil. Trends in nonionizing electomagnetic radiation bioeffects research and related occupational health aspects. International trends in electromagnetic radiation bioeffects research proceedings. Influence of electromagnetic rays caused by cellular communication devices on human health (review of literature). The effect of electromagnetic radiation on the monoamine oxidase A activity in the rat brain. Epidemiological evidence of the effects of behaviour and the environment on the risk of human cancer. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer. Assessment of the hazards of electromagnetic fields emitted by the equipment aboard towards humans (nervous and circulatory systems). Analysis of short and long term therapeutic effects of radiofrequency hyperthermia combined with conformal radiotherapy in hepatocellular carcinoma. 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If you have trouble sleeping, talk to your healthcare team to find out what you can do to get more rest. Part 3 Living With the Side Effects of Treatment 102 Hair Loss Certain chemotherapy drugs can cause alopecia (thinning or loss of hair) anywhere on the body, including the scalp, eyebrows, eyelashes, arms, legs, and pelvis. When hair loss occurs, it usually starts two to six weeks after the first chemotherapy treatment. Remember that hair loss caused by chemotherapy is usually temporary; hair will most likely grow back after the end of treatment. When the hair first grows back, it may have a slightly different texture or color than it had before treatment. Over time, the texture and color often return to how they looked before treatment started. Loss of hair in the nose and nasal passages may lead to symptoms of rhinorrhea (runny nose). While nothing can prevent chemotherapy-induced hair loss altogether, patients may follow the tips below for minimizing and managing chemotherapy-induced hair loss. Use a hat or scarf to protect your scalp when you are out in the sun and to help keep you warm when you are indoors or outside in the cold. Many patients choose to wear a wig, scarf, turban, soft cotton hat, or head wrap to disguise hair loss. Long-term use of certain chemotherapy agents such as doxorubicin can cause cardiotoxicity in a small number of patients. However, because the anthracycline class of drugs can damage the heart, those patients who relapse (disease returns after treatment) will usually not receive anthracycline drugs as part of their secondline treatment. This helps reduce their risk for developing chemotherapy-related cardiovascular disease. Careful monitoring by the healthcare team can reduce the chances of patients developing cardiotoxicity. These tests ensure that patients are prescribed a safe chemotherapy dosage given their current heart function. Patients should ask their provider what to do if they have a sore throat, rash, diarrhea, cough, or redness, swelling, or pain around a wound. The doctor should also be contacted if the patient experiences any painful local rash with or without blisters, as this could indicate an infection with shingles (herpes zoster). To reduce the risk of infections, patients may be prescribed antibiotic, antiviral, or antifungal medications. Patients may be at increased risk for viral infections such as shingles (caused by herpes zoster, the virus that causes chicken pox). Sometimes, doctors may prescribe medication to prevent shingles from developing during therapy. Make sure all foods are thoroughly washed and/or cooked; avoid raw foods that may carry germs. Patients may eat less than normal, not feel hungry, or feel full after eating only a small amount of food. Ongoing loss of appetite can lead to weight loss and poor nutrition, which can become serious. Loss of appetite can sometimes be treated with medication or by changing eating habits, such as eating several small meals each day and making nutritious food choices. Additionally, some patients undergoing chemotherapy become more susceptible to viral or fungal infections of the mouth and throat. To help decrease chances of mouth infections, patients should have a complete dental checkup and cleaning before starting chemotherapy. Your doctor may prescribe a gentler mouth rinse that cleans mouth sores without irritating them. Do not eat citrus fruits (such as oranges, grapefruit, lemons, or clementines) or drink citrus juices, and avoid other acidic foods and sodas. Do not floss your teeth if your blood counts are low, as this may cause your gums to bleed. Swish and spit warm salt water (1/4 teaspoon of salt mixed in a coffee cup of warm water) four to six times per day to soothe mouth irritation. Viral infections (for example, herpes) can be prevented or managed with acyclovir, valacyclovir (Valtrex), and other antiviral medications. Fungal infections (for example, candida, monilia) can be managed with miconazole (Monistat), or nystatin (Mycostatin). If severe, fungal infections can be treated with the oral treatment fluconazole (Diflucan). This typically occurs on the day chemotherapy is administered, but it may also occur one or two days later. Doctors may prescribe an antiemetic (a drug that prevents nausea and vomiting) before chemotherapy. Examples of antiemetics include aprepitant (Emend), ondansetron (Zofran, Zuplenz), granisetron (Kytril and others), metoclopramide (Reglan and others), prochlorperazine (Compazine, Procomp, Compro), dolasetron (Anzemet), and a variety of corticosteroids such as prednisone and dexamethasone. In most cases, these antiemetics are able to partially or completely prevent nausea and vomiting. Do not drink milk or have a meal in which the main ingredients are dairy products. Do not eat foods that are too hot or too cold, greasy or fatty, or sweet or spicy. Living With the Side Effects of Treatment 108 Peripheral Neuropathy Some chemotherapy drugs and targeted therapies may damage the nervous system, causing peripheral neuropathy in the hands and feet (sometimes extending to the arms and legs). Symptoms of peripheral neuropathy include pain, numbness, a tingling or prickling sensation, sensitivity to cold and touch, and muscle weakness that can impair fine motor skills such as buttoning a shirt or picking up small objects. Peripheral neuropathy can be a difficult side effect for patients to manage, and it is a common cause of treatment delays. Furthermore, while neuropathy improves or resolves in most patients after completion of therapy, the symptoms can last beyond the end of the treatment period. Patients should notify their doctor as soon as symptoms begin to develop so the treatment regimen and dosing can be modified appropriately. Specific chemotherapy agents may be discontinued or the dosages may be reduced to prevent further complications. These include antiepileptic agents such as pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant); local anesthetics such as lidocaine patches; opioid pain relievers; and antidepressants that also target pain such as duloxetine (Cymbalta) and amitriptyline (Elavil). Complementary therapy techniques such as acupuncture and massage may also help with neuropathy symptoms (see page 94). Finally, patients should avoid tight-fitting shoes or clothes and exposure to cold, as these may exacerbate neuropathy symptoms in the hands and feet. Problems With Sexual Function Psychological factors such as fear about illness, altered body image due to hair loss and depression, combined with physical side effects of treatment on the body and the brain, often cause a drop in sex 109 Understanding Non-Hodgkin Lymphoma drive (libido). Patients should not be embarrassed to talk with their doctor about any problems or concerns they have about changes in their libido or sexual function. The doctor might order tests to track hormone levels or recommend seeing a specialist. Doctors can also prescribe medications to restore erectile function in men, or hormone therapy to alleviate vaginal dryness and other menopausal symptoms in women. It is important for patients to discuss this issue openly with their spouses or partners. Sterility Since chemotherapy and radiation may damage sperm and egg cells, chemotherapy treatments can sometimes cause temporary or permanent sterility (the inability to have children) in both men and women. Options for preserving fertility both before and during treatment include protection of the ovaries or testes, freezing of sperm cells or egg cells, and in vitro creation and freezing of fertilized embryos. Patients should speak with their doctor about fertility preservation before beginning treatment. Because chemotherapy and radiation treatments can cause severe birth defects and other pregnancy complications, it is critical that patients receiving these treatments always use reliable birth control methods during treatment and for several months after the completion of therapy. The exact duration of this precaution depends in part on the treatment regimen administered. Patients should discuss fertility concerns and pregnancy prevention with their doctor and, if needed, with a fertility specialist.


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