Paraneoplastische Gerinnungsstörungen

Background

Cancer-related coagulation disorders are common complications of patients with solid or hematological neoplasms.

Methods

This article gives an overview of paraneoplastic thromboembolic and hemorrhagic complications and therapy of patients with solid or hematological neoplasms under consideration of pathogenetic insights into the interaction of tumor cells and hemostasis. Special attention will be paid to routine clinical laboratory coagulation parameters in terms of their importance for the manifestation of a clinical event (thrombosis or hemorrhage).

Results/Conclusion

Knowledge of thromboembolic or hemorrhagic syndromes in underlying malignancies allows early diagnosis and targeted therapy and helps to reduce morbidity and mortality.

Conclusion

Of particular importance is the implementation of existing guidelines in the clinical treatment of patients with malignancies, e.g. prophylaxis and treatment of venous thromboembolism.     

Gerinnungsstörungen als Notfall bei onkologischen Patienten

Gerinnungsst?rungen bei Patienten mit malignen Erkrankungen k?nnen sowohl direkt als auch indirekt Tumor-induziert sein und tragen wesentlich zu Morbidit?t und Mortalit?t von Tumor-Patienten bei.     

Onkologische Notfälle infolge morphologischer Störungen

An oncological emergency is a clinical situation in which the tumor directly or indirectly affects vital parameters in a life-threatening way. Morphological failure, as well as metabolic and coagulation disorders are the most frequent causes of oncological emergencies. Early recognition of clinical symptoms and correct planning of diagnostic and therapeutic procedures are essential for success in an emergency situation. Using examples of typical morphological failures which can suddenly become life-threatening (intracranial pressure, myelon compression, superior vena cava syndrome, dyspnea, ileus, bleeding, perforation, urinary retention) the relevant clinical syndromes and recommended treatment concepts are described.     

Metabolische Störungen als Notfall bei onkologischen Patienten

Eine Vielzahl von metabolischen St?rungen bei Tumorpatienten, zum einen durch die ausgedehnte Erkrankung, zum anderen durch die Tumorbehandlung, sind beschrieben worden [1]. Wenn es sehr rasch zu derartigen metabolischen Ver?nderungen kommt, insbesondere zu deutlichen Elektrolytverschiebungen, wie Hyperkali?mie, Hyperkalz?mie oder Hyponatri?mie, so handelt es sich um onkologische Notf?lle, die den Tumorpatienten innerhalb kürzester Zeit letal gef?hrden k?nnen. Die frühzeitige Identifikation von Hochrisikopatienten, die Prophylaxe und die zielgerichtete rasche Therapie von metabolischen St?rungen ist essentielles Repertoire des internistischen Onkologen.     

Nachsorge und Behandlung funktioneller Störungen nach operativer Therapie des Rektumkarzinoms

Die Onkologie - Heute können von spezialisierten Chirurgen mehr als 90 % aller Rektumkarzinome ohne onkologische Radikalitätseinbußen sphinktererhaltend operiert werden....     

Grundlagen der Pharmaökonomie und Gesundheitsökonomie

Vor dem Hintergrund explodierender Kosten im Gesundheitswesen müssen Leistungserbringer und Kostentr?ger zunehmend die wirtschaftlichen Konsequenzen der medizinischen Leistungserstellung analysieren und diskutieren. Bisher wurden solche überlegungen und Untersuchungen weniger von denjenigen Personen durchgeführt die unmittelbar am medizinischen Leistungsprozesses teilnahmen, als von Personen und Gruppen au?erhalb des Medizinbetriebes. Das haupts?chliche Problem solcher Untersuchungen war die Tatsache, da? der klinische Bezug und die Realit?t nur unvollst?ndig berücksichtigt wurden. Die Hauptursache dieses Mi?standes war die mangelhafte Integration von Klinikern und Praktikern wie auch das mangelhafte Verst?ndnis für klinisch-?konomische Fragestellungen innerhalb der ?rzteschaft, was auf ein gewisses Wissensdefizit im Bereich der ?konomie zurückzuführen ist.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia is an unusual low-grade lymphoplasmacytic lymphoma characterized by the production of monoclonal IgM. The clinical manifestations associated with WM can be classified as those related to direct tumor infiltration, by the amount and specific properties of circulating IgM, and by the deposition of IgM in various tissues. Asymptomatic patients should be followed without treatment. The management of the disease relies on the administration of systemic chemotherapy to reduce tumor load and on the application of plasmapheresis to remove circulating IgM. Standard treatment consists of oral chlorambucil, which induces response in at least 50% of patients, resulting in a median survival of approximately 5 years. Nucleoside analogues (cladribine, fludarabine) are effective in most previously untreated patients. These agents are the treatment of choice for patients with disease resistant to alkylating agents. New treatment approaches include high-dose therapy with stem-cell support and administration of monoclonal anti-CD20 antibodies.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia (WM) is a clinical syndrome with diverse prognoses, and not all patients require therapy at diagnosis. Serum beta2 microglobulin is a major prognostic determinant, and asymptomatic patients with low beta2 microglobulin levels and preserved hemoglobin can be observed over long periods without therapy. Low-dose alkylating agents and purine analogs are commonly employed as initial therapy but rarely yield complete remissions. Patients who are refractory to or have relapse after alkylator or purine analogue therapy can be salvaged with purine analogs. Improvement in outcome demands a comprehensive approach aimed at increasing and sustaining complete remissions. Such an approach should probably employ Rituxan (IDEX Pharmaceuticals, La Jolla, CA) in conjunction with induction therapy, peripheral stem cell procurement before purine analog therapy, and high-dose therapy followed by maintenance therapy with interferon.     

Waldenström macroglobulinemia

Waldenstr?m macroglobulinemia (WM) is a low-grade lymphoproliferative disorder characterized by the presence of an immunoglobulin M monoclonal protein in the blood and monoclonal small lymphocytes and lymphoplasmacytoid cells in the marrow. The disease is uncommon and there is a lack of clear diagnostic criteria. WM is treatable but not curable and long-term survival is possible. Therefore, the treating physician needs to carefully balance the risks and benefits of treatment. Treatments are aimed at relieving symptoms resulting from marrow infiltration and the hyperviscosity syndrome. Therapies available for initiation of treatment include alkylating agents, purine nucleoside analogs, and rituximab. Chlorambucil has been the mainstay of treatment for many years and remains useful, especially in older patients. Rituximab has become an important new therapy for this disease because of its positive treatment responses, acceptable toxicity, and lack of therapy-associated myelosuppression and myelodysplasia. Currently, rituximab is being combined with chemotherapy. Other options of treatment include interferon and corticosteroids. Emerging therapies include stem cell transplantation (autologous and allogeneic) for younger patients. Currently, there are few comparative data on which to state an absolute opinion concerning the best available treatment for patients with WM.     

Bestmögliches Management

best practice onkologie -     

Medikamentöse Tumorschmerztherapie

Recent surveys report that up to two-thirds of cancer patients suffer from severe pain in their last months, although most could be treated successfully by consequent pharmacologic pain management. This review describes the basis of pain classification, differences between nociceptive and neuropathic pain, and pain measurement. The use of nonopioid and opioid drugs as well as co-analgesics and NMDA receptor antagonists is summarized. Opioid rotation, side effects, and the treatment of breakthrough pain are highlighted. Tables give a brief overview of dosing and the characteristics of particular drugs. However, pharmacologic management should always be embedded in a holistic approach comprising appropriate cancer-specific therapies as well as the psychosocial and spiritual needs of the patient.     

Waldenström's macroglobulinemia

Waldenstr?m's macroglobulinemia is a low-grade lymphoplasmacytic lymphoma. It has an overall incidence of 2.5/million/year. The median age at diagnosis is 63 years. The clinical manifestations are hepatomegaly (20%), splenomegaly (15%), and lymphadenopathy (15%). The most common symptom is fatigue related to a normochromic, normocytic anemia, and the median hemoglobin value at diagnosis is 10 gm/dl. All patients with Waldenstr?m's macroglobulinemia have a circulating tumor marker, the monoclonal IgM protein. Occasionally high levels of the IgM monoclonal protein can produce a hyperviscosity syndrome manifested by oronasal bleeding. Occasionally retinal hemorrhage or serious neurologic complications, such as somnolence or coma, may occur. The most important prognostic factors are hemoglobin, age, weight loss, and a cryoglobulin. Therapy has included alkylating agents, particularly chlorambucil, purine nucleoside analogs such as fludarabine or cladribine, and most recently the use of rituximab. The median survival of symptomatic patients is 65 months. Patients without symptoms should not be treated.     

Waldenström macroglobulinaemia

Waldenstr?m macroglobulinemia (WM) is a lymphoid neoplasm characterised by a monoclonal lymphoplasmacytic expansion accompanied by a serum monoclonal immunoglobulin M (IgM). In some patients, the monoclonal protein will lead to a characteristic hyperviscosity syndrome. Although indolent, WM is incurable and most patients eventually succumb to disease progression. Thus, we need to better understand the natural history and biology of the disease. Recent work has shown that half of patients with WM harbour deletions in the long arm of chromosome 6. Increasing evidence suggests the disease is a defined pathological entity and not purely a clinical syndrome. Current therapeutic modalities include alkylator agents, purine nucleoside analogues, and rituximab. The optimum initial therapeutic strategy is not yet defined, and current clinical trials are addressing the role of combination therapy. In this review, we summarise the current understanding of the pathogenesis, clinical and laboratory features, prognostic factors, and therapeutic options for patients with WM. We also discuss current knowledge of WM and available therapies.     

Speiseröhrenkrebs besser diagnostizieren

best practice onkologie -     

Ganzkörperhyperthermie bei Keimzellentumoren

Durch multimodale Therapiekonzepte k?nnen 70–80 % der Patienten mit fortgeschrittenen Hodentumoren geheilt werden. Die Prognose ist allerdings infaust, wenn kein Ansprechen auf die Prim?r- oder Salvagetherapie erfolgt oder nach Hochdosischemotherapie (HDCT) ein Rezidiv auftritt. Um auch diesen Patienten noch eine – m?glicherweise l?ngerfristig palliative – Behandlungsoption zu er?ffnen, sind weiterhin neue Therapiemodalit?ten zu prüfen. Wir haben daher an unserer Klinik 2 Patienten mit einer Kombination aus Polychemotherapie (Carboplatin, Ifosfamid, Etoposid) und Ganzk?rperhyperthermie (“systemische Krebsmehrschritttherapie”) behandelt, und konnten in beiden F?llen ein gutes Ansprechen der Erkrankung bei guter Vertr?glichkeit beobachten. Ausgehend von der Pr?sentation dieser beiden F?lle wird der von uns initiierte “Multizentrische Behandlungsplan zur Therapieoptimierung des refrakt?ren oder rezidivierten Keimzelltumores mittels Chemotherapie (Carboplatin, Etoposid, Ifosfamid) und Ganzk?rperhyperthermie bzw. systemischer Krebsmehrschritttherapie (sKMT)” vorgestellt.