Sekund?rpr?vention von Hauttumoren nach Organtransplantation

Transplant recipients are at significantly increased risk of cancer development as a long-term complication. Skin cancer is the most common form of cancer representing 40?C50% of post-transplant malignancies. In the first 10?years post-transplantation almost 15?C40% of patients develop skin cancer and epithelial or virally induced cancers are especially highly represented. Secondary prophylaxis is of particular importance in the management of skin cancer. At first patients should be informed about the increased risk of skin cancer and be educated to regularly practice UV protection. To minimize the risk of secondary skin cancer, premalignant lesions (i.e. field cancerization) should be treated early and consistently. A standardized risk adapted follow-up at least twice yearly should be included. A conversion to mTOR inhibitors which show an antiproliferative effect is recommended to substantially improve the prognosis.     

Sekund?rpr?vention des Zervixkarzinoms

The introduction of Papanicolaou smear cytological screening resulted in a significant reduction in cases of cervical cancer. However, cytology as a screening method and the structure of the German cervical cancer prevention program show remarkable deficits which are explained in detail in this overview. Randomized controlled trials and pilot projects based on primary human papillomavirus (HPV) screening confirmed that structured programs with 5 year intervals and central quality assurance are more efficient in preventing cervical cancer than the current German concept.     

Medikamentöse Therapie von Hauttumoren

best practice onkologie -     

Sekund?res Lymph?dem

Secondary lymphedema is a chronic, distressing condition with excess fluid accumulation in the interstitial spaces caused by obstruction of the lymphatic drainage system. This results in limb swelling leading to malfunctions and impairment of everyday life activities. The therapy of choice is complex physical therapy with manual lymphatic drainage, compression bandings and garments, limb exercises and skin care. In oncology secondary lymphedema occurs basically after operations of the breast, the neck and the pelvis. Radiotherapy can also be a cause of lymphedema or can exacerbate this and complications often increase with progressive lymphedema. Therefore, a comprehensive patient education and training is necessary. Moreover, an optimal communication between physician, physiotherapist and medical store is important. Furthermore, lifelong following of behavior recommendations and a good compliance prevent degradation.     

Sekundärneoplasien in der Nachsorge von Lymphompatienten

best practice onkologie -     

Prim?re Krebspr?vention

The approach to winning the war against cancer has scientific, political and public health dimensions. In order to reduce cancer mortality in the future primary prevention is a major goal. Primary prevention can be achieved through the reduction of identified risk factors, such as smoking, uncontrolled alcohol consumption, poor nutrition and caloric imbalance, insufficient physical activity, obesity, metabolic syndrome, chronic inflammation, virus and bacterial infections and psychosocial stress. Progress can be made by the use of the new concept of personalized medicine where the genetic and epigenetic make-up of an individual in health and disease is used as a diagnostic and therapeutic fundament for targeted preventive therapy. Ingredients of plants, vegetables and herbs with scientifically proven preventive properties (nutriceuticals), second generation NSAIDs, COX-2 inhibitors, pharmacological chaperone-like molecules, sirtuin and kinase inhibitors can be applied alone or within a cocktail to support primary cancer prevention. The development of prophylactic vaccination strategies against virus and bacteria-induced tumors are promising investments in primary cancer preventions and all efforts are accompanied and complemented by supportive psychooncological care giving.     

Pr?vention des malignen Melanoms

The incidence of cutaneous melanoma is rising steadily in Germany and worldwide. Primary prevention of melanoma comprises UV protection as the central environmental factor for melanoma development. A significant step forward in secondary melanoma prevention was seen with the inclusion of skin cancer screening in the standard benefits of public health insurances in Germany. Additionally, patients with a high melanoma risk should be examined using dermoscopy and, when indicated, with digital dermoscopic follow-up. This enables the early diagnosis of melanoma at a curable stage.     

Prävention statt Therapie?

Immer mehr Menschen geben immer mehr Geld für so genannte “life style”-Medikamente und fü,r Wellness- oder Fitness-Aktivit?ten aus. Was sind die Gründe dafür? Ist es das neue Ideal der Gesellschaft, da? nur der z?hlt, der jung und fit ist? Ist es der Wunsch, sich selbst um Gesundheit und Krankheit zu kümmern? Ist es die Ansicht, da? die Medizin in den letzten Jahrzehnten nur unwesentliche Fortschritte in der Therapie von Zivilisationskrankheiten wie den Herzkreislauf- oder Krebserkrankungen erzielen konnte? Oder ist es die Vorwegnahme eines Paradigmenwechsels von der Therapie zur Pr?vention? Zweifellos kann nicht ein Grund alleine angeführt werden. Dennoch hat auch die Medizin erkennbar ihr Augenmerk auf die Pr?vention gelenkt. Im folgenden sollen Notwendigkeit und bisher erfolgte Schritte für einen Paradigmenwechsel von der Therapie zur Pr?vention für die Onkologie dargelegt werden.     

Krebspr?vention durch Lebensstil – was ist evidenzbasiert?

Thousands of epidemiologic studies, in addition to clinical trials and basic scientific research create a convincing picture of the current potential for cancer prevention: at least 50% of all cancers could be prevented through a healthy lifestyle. The most important risk factors are smoking, incorrect nutrition and overweight or obesity, as well as lack of physical activity. Cancer risk can be reduced by quitting smoking and sunscreen use, higher intake of plant-based foods, regular physical activity, aspirin use, HPV immunization and use of cancer screening. It is noteworthy to consider that for each type of cancer different risk and preventive factors exist; thus, data need to be interpreted appropriately to develop sound public health recommendations.     

Prim?re Pr?vention des Zervixkarzinoms und dessen Vorstufen

The available prophylactic human papillomavirus (HPV) vaccines consist of recombinant virus-like particles (VLP) of high-risk HPV types 16 and 18 which are associated with 70% of cervical cancers as well as a substantial proportion of vulvar, penile, perianal and oropharyngeal tumors. One of the vaccines contains in addition VLPs of low-risk HPV types 6 and 11 for prevention of genital warts (condylomata acuminata). In clinical trials with up to 8.3 years of follow-up the vaccines demonstrated an efficacy of almost 100% against infection and the high-grade intraepithelial lesions (CIN, VIN, VaIN) induced by vaccine HPV types. Protection against related non-vaccine HPV types (e.g. HPV31, HPV45) has also been shown most probably due to cross-neutralizing antibodies. Population-based trials in Australia demonstrated a reduction in cervical dysplasia and in the incidence of genital warts by more than 70% only 3 years after initiation of the vaccination campaign. Prevention of cases of cervical cancer will only be realized approximately 10 years after introduction of the vaccine. Vaccinating males is a reasonable means to reduce the risk of infection in women and also provides them with a direct benefit through the recently documented efficacy of the quadrivalent vaccine against genital warts.     

Sekundäre Pflanzenstoffe

Epidemiological data show that antitumoral plant foods are relevant for the prevention of cancer. Although nobody will deny the usefulness of a healthy diet, epidemiological data for single substances are contradictory. Prevention cannot be realized with the consumption of one or a defined mixture of some of these substances. Interesting data from preclinical experiments show that some of the identified molecules also have potential as antitumoral agents. These data also reveal a potential for interactions and, in some studies, even a possible direct negative influence in clinical use. Further controlled clinical studies are therefore mandatory.     

Körperliche Bewegung und Sport zur Prävention und Behandlung von Krebskrankheiten

Lifestyle is thought to contribute to about 50–75% of the cancer incidence worldwide. For a growing number of malignant diseases, insufficient exercise in conjunction with overweight and malnutrition are thought to be of critical importance. Insulin-like growth factors are the connecting links among overweight, insufficient physical activity, and cancer; they may be partly responsible for the development of endocrine treatment resistance. Correction of glucose and insulin metabolism is about to become a new and efficient strategy against cancer and has been graded as level IA evidence-based medicine. Data from prospective randomized trials show an effect of continued physical exercise that is comparable to survival rates currently obtained by systemic adjuvant treatments. Therefore, motivating cancer patients during follow-up to engage in continuous and persistent daily physical activities, achieve an optimal body mass index, and maintain healthy nutrition is becoming a very important outcome-related treatment aspect. Such lifestyle activities will also prevent patients from adhering to unproven methods of complementary and alternative medicine.     

Wechselwirkungen von Heilpilzen mit Zytostatika?

best practice onkologie -     

Pharmaco-prévention et nutri-prévention des cancers de la prostate

In 2010, in France, 8,790 men died from prostate cancer despite a low and decreasing mortality rate. The individual risk/benefit ratio of prostate cancer screening is the focus of controversy and currently not in favor of a systematic screening program. Therefore, only prevention could reduce incidence, side effects of treatment and related mortality. Interestingly, prostate cancer prevention is also a field of controversy mainly about 5-alpha-reductase inhibitors. However, it could be expected that pharmaco- or diet-based prevention will be a huge tool for cancer control, even more for prostate cancer burden. This review comprehensively analyses which molecules or compounds could be used in preventive trials. With regard to pharmaco-prevention, three different kinds of drugs could be identified. First drugs, which aim at mainly or even solely reduce prostate cancer risk such as 5-alpha-reductase inhibitors and selective estrogen receptor modulators. Drugs, which aim at wider preventive impact such as: nonsteroidal anti-inflammatory drugs or difluoromethylornithine. Lastly, drugs for which reducing prostate cancer incidence is merely a side effect such as statins, metformin or histones desacetylase inhibitors. With regard to diet-based prevention, two main approaches could be identified: aliments and nutriments, on one hand, and vitamin and minerals, on the other. Interestingly if compounds reach experimental plausibility, natural foods or even global diet seem to have a higher impact. Lastly, besides assessment of efficacy, effectiveness required the critical step of compliance, which might actually be the weakest link of the prevention chain.