Immuntherapien bei gynäkologischen Tumoren

best practice onkologie - Die Anwendungsgebiete von Immuncheckpointinhibitoren haben sich in den letzten Jahren enorm erweitert. Auch bei gynäkologischen Krebserkrankungen ist das Interesse an...     

Sexualität nach gynäkologischen Krebserkrankungen

Background

Sexuality is an important factor for health-related quality of life and can be compromised by cancer and the subsequent therapy. In gynecological cancer, impairment of sexual function plays a crucial role. Surgery affects female organs with consequences for sexual function beyond that of chemotherapy or radiotherapy.

Objectives

Limitations of sexual function and fertility induced by surgery, chemotherapy or radiation for cancer treatment need to be discussed with every patient. Premature menopause and loss of fertility may be crucial for younger patients but impairment of sexuality may also be important for elderly patients; therefore, we describe potential consequences of gynecological cancer therapy and how they may be prevented or addressed.

Results

From an oncological point of view, local or systemic estrogens can be considered as safe for most gynecology patients. Besides local symptomatic treatment, complementary therapy, psycho-oncological support and exercise are effective for symptom control and supportive.

Conclusion

It is of major importance to sensitize physicians working with gynecological cancer patients to the issues of quality of life and sexuality. Although sexuality is a taboo subject, the potential long-term consequences of oncological therapy on sexual function, possibly on fertility and quality of life have to be discussed with the patient. Physicians have to learn how to actively approach distressing topics. A special training in sexual medicine may be helpful.

     

Therapierelevante Biomarker in der gynäkologischen Onkologie

best practice onkologie - Die Entdeckung der ersten Biomarker liegt inzwischen Jahrzehnte zurück. Die prognostische und teilweise auch prädiktive Wertigkeit ist weiterhin Gegenstand...     

Lebertransplantation bei Malignomen und Vorläufererkrankungen

Background

Since the first liver transplantation performed by Starzl in 1963, malignancies belong to the range of indications. The simultaneous treatment of malignant tumors, potential intrahepatic metastases and the underlying liver disease is considered to be advantageous for transplantation; however, the initial results were sobering due to high recurrences and low survival rates. The outcome was only improved after the establishment of selection criteria, multimodal therapy concepts, new immunosuppressants and intensive follow-up.

Method

Research and analysis of the current literature.

Results

Primary hepatic malignant neoplasms are the most common indications for liver transplantation, mainly hepatocellular carcinomas (HCC). Due to the establishment of selection criteria for HCC (Milan criteria) the 5?year survival was improved to 75?% and the recurrence rate decreased to < 15?%. Hilar cholangiocellular carcinoma, metastases of neuroendocrine tumors, hepatoblastomas and hemangioendotheliomas are less common indications for liver transplantation. Multimodal therapeutic concepts are essential for organ transplantation due to malignancies. Additionally, novel molecular markers allow more precise therapies and prognostic predictions. Precancerous lesions, such as liver cirrhosis and chronic bile duct disease are also indications for liver transplantation. In Germany, patients with non-resectable colorectal liver metastases and intrahepatic cholangiocellular carcinomas are not eligible for transplantation; however, due to multimodal treatment and careful patient selection, a good outcome could be shown in several studies. Unfortunately, due to the current shortage of donor organs an extension of the indications for liver transplantation is not to be expected in the near future.

     

Lebertransplantation bei primären Non-HCC-Tumoren und sekundären Malignomen der Leber

Liver transplantation currently represents not only an effective but also a safe treatment for many patients with liver disease. Liver transplantation is also a crucial part of the treatment of hepatic malignancies and is the current treatment of choice in early stages of hepatocellular carcinoma (HCC) in cirrhosis. In other primary and secondary liver malignancies, liver transplantation can be a curative treatment option as well. However, these malignancies comprise a heterogeneous group of liver tumours that are considerably different in terms of tumour characteristics, treatment modalities, and prognosis. Therefore, the importance of liver transplantation in the treatment strategy varies among the different tumour entities. The current criteria for organ allocation influence and limit the use of this treatment modality in these heterogeneous settings. Supported by the advancing establishment of living donor liver transplantation, the importance of transplantation in the general oncological concept of some of these tumour entities is currently increasing again. This review gives an overview, based on the current literature, of the role of liver transplantation for treating primary non-HCC tumours and secondary malignancies of the liver.     

Seltene gynäkologische Tumoren

Apart from the common gynaecological carcinomas there exist a large number of rare non-epithelial malignant tumours. In this context, ovarian stromal cell tumours account for 5% and germinal cell tumours of the ovary for 15% of ovarian neoplasms. Uterine sarcomas represent only 2-3% of all rare genital malignancies. The standard non-epithelial ovarian tumour therapy is in many cases a fertility-conserving operation. However, in advanced stages a debulking operation is required analogue to the therapy of ovarian tumours. In this situation adjuvant BEP chemotherapy with platinum should be carried out. The basic module in the treatment of uterine sarcomas calls for a radical operative procedure which can be followed up with post-operative platinum-based chemotherapy. In contrast gestational trophoblastic disease should primarily be treated by chemotherapy.     

Vorstellungen zur Therapie von Malignomen mit Krebsdiäten

Context

Diets against cancer are built on the idea of a deficit or abundance of nutritional components which lead to cancerogenesis. In line with this concept, these components are reduced (starving of the tumor) or the deficit is corrected.

Method

We evaluated the cancer diets described in this article according to their usefulness for cancer patients searching the literature and comparing them to the ESPEN guidelines.

Results

This lay concept is not in accordance with scientific data on cancerogenesis. None of the cancer diets (e.g. raw cost, fasting for cure, cancer cure total of Breuss, Budwig diet, Gerson’s regimen macrobiotic and low carbohydrate or ketogenic diet) have been proven in controlled clinical trials. They can all lead to malnutrition (to different extents in severity and time).

Conclusion

Tumor patients should be advised by physicians not to undertake these diets.     

Brustkrebs bei Männern

best practice onkologie -     

Spättoxizität und Survivorship bei Keimzelltumoren

Context

Germ cell tumors and Hodgkin’s lymphoma are currently the malignant diseases with the highest cure rates. Even in advanced or metastasized disease stages these neoplasms can be cured by multimodal treatment approaches. Nevertheless, the curative treatment modalities applied, e.g. intensive systemic chemotherapy, radiotherapy and surgery, have side effects directly during the course of treatment and even delayed toxicity can occur, which may affect the health and quality of life of cancer survivors. This is why prevention and early detection as well as adequate treatment of toxic side effects affecting medical and psychosocial aspects are essential to maintain or improve patient quality of life.

Material and methods

Research of literature and analysis of clinical trials.

Results

Not only chronic dysfunction of many organ systems (e.g. cardiovascular risk) but also secondary cancer, infertility and the fear of relapse are common reasons for a variety of psychosocial problems which can prevent cancer survivors from living a normal daily life after curative treatment.

Conclusion

Survivorship programs offer these patients the opportunity of dynamic support adapted to their needs on the way to patients becoming long-term survivors.     

Familiäre Belastungen bei Krebs

best practice onkologie - Eine Krebserkrankung geht sowohl für Patient:innen als auch für ihre Angehörigen mit erheblichen körperlichen und psychosozialen Belastungen einher....     

Abdominalchirurgische Notfälle bei Krebspatienten

Der abdominalchirurgische Notfall, der Eingriffe umfa?t, die innerhalb von 4–24 h nach Klinikeinweisung als dringlich durchgeführt werden müssen, kommt h?ufig auch bei Tumorpatienten vor. Im Gegensatz zu benignen Ursachen ist die Diagnose bei Tumorpatienten weitaus schwieriger zu stellen und die Operationsindikation unter Vorbehalt der Allgemeinsituation individuell zu stellen.     

Axilläre Lymphknotenmetastasen bei CUP

Women who present with axillary lymph node metastases and no other distant metastases and no evidence of a breast cancer primary represent a potentially curable subset of individuals with CUP. The standard approach is to perform an axillary lymph node dissection followed by adjuvant systemic treatment and radiotherapy according to published guidelines for lymph node positive primary breast cancer. Mastectomy is not mandatory. In most cases occult breast cancer is associated with good prognosis. Reported 5-year survival rates after treatment of an occult primary breast cancer with axillary metastases range from 60–90%.     

Pilzinfektionen bei abwehrgeschwächten Patienten

In der Behandlung von Tumorerkrankungen und h?matologischen Neoplasien wurden durch die Verbesserung der Behandlungsoptionen Fortschritte erzielt. Im Rahmen der Therapie mit Zytostatika oder Immunsuppressiva kommt es vermehrt zum Auftreten von bakteriellen und nicht-bakteriellen Infektionen.     

Lebensqualität und Lebensquantität bei Morbus Hodgkin

Mit dem Einsatz moderner Therapiestrategien gelingt es, die Mehrzahl der Patienten mit Morbus Hodgkin zu heilen. Nachdem auch in den fortgeschrittenen Stadien die Prognose deutlich verbessert werden konnte, k?nnen 85% der Patienten auf eine Heilung hoffen. Dieses wirft die Frage auf: “Was erwartet den geheilten Patienten?”. Hierbei ist zu unterscheiden zwischen den objektiven Ereignissen, die wir als Sp?tfolgen der Erkrankung und der Therapie kennen, und den Ereignissen, die sich vornehmlich im subjektiven Erleben der Patienten widerspiegeln. In den letzten Jahren ist es uns gelungen, gerade auf diesem Gebiet erhebliche Fortschritte zu erzielen. So ist es heute selbstverst?ndlich, zur Beurteilung der allgemeinen Lebensqualit?t des Patienten dessen subjektive Einsch?tzung reproduzierbar zur Grundlage zu machen. Schon 1988 hat Murphy in einem Beitrag darauf hingewiesen, dass Lebensqualit?t (LQ) operationalisierbar und damit zuverl?ssig messbar ist. Hier gilt es allgemein, die immer noch vorherrschende Skepsis gegenüber der LQ-Forschung auszur?umen und gleichzeitig die Bedeutung der LQ-Einbu?en, die den Patienten erwarten, anschaulich zu erkl?ren. Im folgenden Artikel soll versucht werden, die als Therapiekomplikationen bekannten frühen und vor allem sp?ten Folgen der Erkrankung und ihrer Therapie zusammenzufassen und die neuesten Erkenntnisse der LQ-Forschung wiederzugegeben.     

Stammzelltransplantation bei pädiatrischen soliden Tumoren

Die Onkologie - Die Hochdosischemotherapie mit autologem Stammzellsupport, auch autologe Stammzelltransplantation (SZT) genannt, hat seit ihrer Einführung zur Behandlung solider Tumoren eine...