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The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on cancer or other clinical topics then use Trip today.
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A, Nicoletti L, Costantini S. [The role of transvaginal ultrasound and sonohysterography in the diagnosis and staging of endometrial adenocarcinoma]. Radiol Med. 2001;101(5):365-370. 24. Dessole S, Rubattu G, Farina M, et al. Risks and usefulness of sonohysterography in patients with endometrial carcinoma. Am J Obstet Gynecol. 2006;194(2):362-368. 25. Alcazar JL, Errasti T, Zornoza A. Saline infusion sonohysterography in endometrial cancer: assessment of malignant cells dissemination risk. Acta Obstet (...) . Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology. 2004;231(2):372-378. 38. Sala E, Wakely S, Senior E, Lomas D. MRI of malignantneoplasms of the uterine corpus and cervix. AJR Am J Roentgenol. 2007;188(6):1577-1587. 39. Nagar H, Dobbs S, McClelland HR, Price J, McCluggage WG, Grey A. The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer. Gynecol Oncol. 2006;103(2):431- 434. ACR Appropriateness
-differentiated tumours, perineural tumours, ulcerated and symptomatic lesions; lesions in patients with significant risk factors (while balancing the risk of COVID-19 complications for these high-risk patients). ? Consider deferring treatment of melanoma in situ for 2-3 months. British Association of Dermatologists & British Society for Dermatological Surgery COVID-19 – Skin cancer surgery guidance First published 24.03.20 (v 1); updated 26.03.30 (v 1.1), 30.03.20 (v1.2), 07.04.20 (v 1.3) 2 ? Consider (...) Covid-19: Clinical Guidance for the Management of Skin Cancer Patients during the Coronavirus Pandemic British Association of Dermatologists & British Society for Dermatological Surgery COVID-19 – Skin cancer surgery guidance First published 24.03.20 (v 1); updated 26.03.30 (v 1.1), 30.03.20 (v1.2), 07.04.20 (v 1.3) 1 CLINICAL GUIDANCE FOR THE MANAGEMENT OF SKIN CANCER PATIENTS DURING THE CORONAVIRUS PANDEMIC This is a very fluid situation and guidance may change over the next days
. This guideline aims to define the best evidence for the diagnosis and management of SCCUP. Management decisions for SCCUP are best decided in the context of a multidisciplinary tumor board and with careful consideration of HPV status, disease burden and distribution in the neck, a patient’s overall health and well-being, potential treatment-related toxicity, and rehabilitation potential for functional recovery. THE BOTTOM LINE Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head (...) % of cases. The difficulties in finding the primary tumors may be explained by their small size as well as the difficult access to anatomic locations that can be missed by physical examinations and/or imaging studies. The presence of a neck mass in adults for over two weeks and without evidence of infection is highly suspicious of malignancy. Diagnostic delays may result in progression of disease with increased morbidity, loss of function, and increased mortality. , Concerning associated symptoms
, Rhodes L, Blanco I, Chung WK, Eng C, Maher ER, Richard S, Giles RH. von Hippel-Lindau Disease: genetics and role of genetic counseling in a multiple neoplasia syndrome. J Clin Oncol. 2016 Jun 20;(34)18: 2172-81. Epub: 2016 Apr 25. PubMed PMID: 27114602. 50 Norquist BM, Harrell MI, Brady MF, et al. Inherited mutations in women with ovarian carcinoma. JAMA Oncol. 2016 Apr;2(4):482-90. PubMed PMID: 26720728. 51 Offit K, Pierce H, Kirchhoff T, et al. Frequency of CHEK2*1100delC in New York breast cancer (...) Testing of Solid and Hematologic Tumors and Malignancies) or reproductive testing for hereditary cancer syndromes (see Clinical Appropriateness Guidelines for Reproductive Carrier Screening and Prenatal Diagnosis). All tests listed in these guidelines may not require prior authorization; please refer to health plan. Genetic Counseling Requirement Genetic testing included in these guidelines is covered when: 1. The patient meets coverage criteria outlined in the guidelines 2. A recommendation
Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. Recent guidelines recommend consideration of the use of oral edoxaban or rivaroxaban for the treatment of venous thromboembolism in patients with cancer. However, the benefit of these oral agents is limited by the increased risk of bleeding associated with their use.This was a multinational, randomized, investigator-initiated, open-label, noninferiority trial with blinded central outcome adjudication. We randomly (...) assigned consecutive patients with cancer who had symptomatic or incidental acute proximal deep-vein thrombosis or pulmonary embolism to receive oral apixaban (at a dose of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily) or subcutaneous dalteparin (at a dose of 200 IU per kilogram of body weight once daily for the first month, followed by 150 IU per kilogram once daily). The treatments were administered for 6 months. The primary outcome was objectively confirmed recurrent venous
Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. Urothelial carcinomas of the upper urinary tract (UTUCs) are rare, with poorer stage-for-stage prognosis than urothelial carcinomas of the urinary bladder. No international consensus exists on the benefit of adjuvant chemotherapy for patients with UTUCs after nephroureterectomy with curative intent. The POUT (Peri-Operative chemotherapy versus sUrveillance in upper (...) Tract urothelial cancer) trial aimed to assess the efficacy of systemic platinum-based chemotherapy in patients with UTUCs.We did a phase 3, open-label, randomised controlled trial at 71 hospitals in the UK. We recruited patients with UTUC after nephroureterectomy staged as either pT2-T4 pN0-N3 M0 or pTany N1-3 M0. We randomly allocated participants centrally (1:1) to either surveillance or four 21-day cycles of chemotherapy, using a minimisation algorithm with a random element. Chemotherapy
, randomised study, we recruited men with biopsy-proven prostate cancer and high-risk features at ten hospitals in Australia. Patients were randomly assigned to conventional imaging with CT and bone scanning or gallium-68 PSMA-11 PET-CT. First-line imaging was done within 21 days following randomisation. Patients crossed over unless three or more distant metastases were identified. The primary outcome was accuracy of first-line imaging for identifying either pelvic nodal or distant-metastatic disease (...) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Conventional imaging using CT and bone scan has insufficient sensitivity when staging men with high-risk localised prostate cancer. We aimed to investigate whether novel imaging using prostate-specific membrane antigen (PSMA) PET-CT might improve accuracy and affect management.In this multicentre, two-arm
-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: an ASTRO-ESTRO consensus statement Introduction The coronavirus (SARS-CoV-2) outbreak is considered a global pandemic by the World Health Organization. 1 Most infected people develop a mild respiratory illness, but based on an early census from the U.S. Centers for Disease Control, 20-30% of persons aged = 45 years require hospital admission, and fatality rates range from 10-17% in persons aged = 85 years, 3-11% among persons aged (...) or those with comorbidities who are at higher risk of more serious SARS-CoV-2 infection, 6 and for whom concomitant chemotherapy will have less benefit, the use of chemotherapy should be restricted. In the later scenario of severely reduced capacity (where some patients would need to go without radiotherapy), there was strong support for hypofractionated radiotherapy. For early larynx cancer (T1N0), 50 Gy / 16f was most commonly recommended, 7,8 and there are data for 55 Gy / 20f in T2N0 disease. 9,10
[online only] 1 for more details of the literature search). Articles from the search were included if they reported data on outcomes of local therapy (therapeutic or prophylactic mastectomy, nipple-sparing mastectomy, RT) among women with newly diagnosed nonmetastatic or advanced breast cancer and a high- or moderate-penetrance germline mutation. Disease outcomes considered in the studies included in the literature were ipsilateral events, including true recurrences and new primary tumors, survival (...) short to evaluate lifetime risk. CLINICAL QUESTION 2 What is the appropriate surgical management of the index malignancy for women with newly diagnosed nonmetastatic breast cancer who have a selected moderate-penetrance mutation? Recommendation 2.1 For women with newly diagnosed breast cancer who have a mutation in a moderate-penetrance breast cancer gene, mutation status alone should not determine local therapy decisions for the index tumor or CRRM (Type: formal consensus; Evidence quality: low
adenomas 5 mm in size. Future studies may clarify whether length- ening the interval beyond 10 years may be possible. A 10- year follow-up after normal colonoscopy is recommended regardless of indication for the colonoscopy, except for in- dividuals at increased risk for CRC, such as those with his- tory of a hereditary CRC syndrome, personal history of in?ammatory bowel disease, personal history of hereditary cancer syndrome, serrated polyposis syndrome, malignant polyp, personal history of CRC (...) disease, personal history of hereditary cancer syndrome, serrated polyposis syndrome, or malignant polyp, personal history of CRC, or family history of CRC, and must be judiciously applied to individuals with a personal or family history of CRC, favoring the shortest indicated interval based on either history or polyp findings. b Follow-up may be with colonoscopy or other screening modality for average risk individuals. c A3-yearfollow-up interval is favored ifconcern about consistency in distinction
for Malignant Colorectal Polyps. PARIS CLASSIFICATION The Paris classi?cation has been the most used interna- tional endoscopic classi?cation of colorectal lesion morphology (Figure 1). 12 Although studies have shown only moderate agreement among Western experts using the Paris classi?cation, the application of a minimal standard terminology of colorectal lesions provides the ?rst step in stratifying which lesions are more likely to contain advanced pathology and informs their removal strategy. 13,14 (...) ) lesions have submu- cosal invasion. 15–18 Lateral spreading tumors Non-polypoid lesions 10 mm or larger in diameter are referred to as laterally spreading tumors (LSTs). They have a low vertical axis and extend laterally along the colonic luminal wall. The morphologic subclassi?cations of LSTs facilitate the endoscopic removal plan, as they informaboutsubmucosal?brosisortheriskofsubmucosal invasion. Granular-type LSTs have a nodular surface and are composed of the homogeneous even-sized (LST-G-H
receptor–positive breast cancer who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years; those with a contraindication to tamoxifen may be offered a gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor. Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of therapy. Men with early-stage disease should not be treated (...) with bone-modifying agents to prevent recurrence, but could still receive these agents to prevent or treat osteoporosis. Men with advanced or metastatic disease should be offered endocrine therapy as first-line therapy, except in cases of visceral crisis or rapidly progressive disease. Targeted systemic therapy may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women. Ipsilateral annual mammogram should be offered to men with a history of breast
the increased risk of adverse events. Dose reductions can minimize treatment-related toxicities. CDK4/6 inhibitors as first/second-line treatment offer clinical advantage, but may be delayed if the likelihood of tumor control is high with endocrine therapy alone (first line, no prior endocrine treatment, no visceral disease). 35 Dose reduction of palbociclib does not diminish efficacy. 36,37 High Risk Lesions and Pre-Invasive BC High-risk lesions such as atypical hyperplasia and lobular carcinoma in-situ (...) , staging evaluation is preferred but may be unavailable. Surgery is typically indicated only in the absence of metastatic disease. Treatment will depend on resource availability (see Medical Oncology section). Re-operation for margins or axillary staging is Priority C when there is a low likelihood of residual disease. 19 Patients with estrogen receptor positive (ER+) ductal carcinoma in situ (DCIS) and low volume ER- DCIS are Priority C1 whereas patients at high-risk for occult invasion are Priority
irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med . 1999 ; 341 : 476–484 | | | In ES disease, treatment typically involves chemotherapy alone x 9 Green, R.A., Humphrey, E., Close, H., and Patno, M.E. Alkylating agents in bronchogenic carcinoma. Am J Med . 1969 ; 46 : 516–525 | | | with or without PCI. x 10 Slotman, B., Faivre-Finn, C., Kramer, G. et al. Prophylactic cranial irradiation in extensive small (...) will commission a replacement or reaffirmation within 5-years of publication. 1. Introduction Small cell lung cancer (SCLC) is the second most common thoracic malignancy, representing approximately 13% of newly diagnosed lung cancers. x 1 in: N. Howlader, A. Noone, M. Krapcho, (Eds.) SEER Cancer Statistics Review . National Cancer Institute , Bethesda, MD ; 1975-2016 ( Available at: ) . ( Accessed November 22, 2019 ) SCLC is a particularly aggressive malignancy, with only about one-third of patients diagnosed
Regional Therapies for Colorectal Cancer Liver Metastases Guideline 2-30a A Quality Initiative of the Program in Evidence-Based Care (PEBC), Ontario Health (Cancer Care Ontario) Regional Therapies for Colorectal Cancer Liver Metastases P. Karanicolas, R. Beecroft, R. Cosby, E. David, M. Kalyvas, E. Kennedy, G. Sapisochin, R. Wong, K. Zbuk and the Gastrointestinal Disease Site Group Report Date: March 10, 2020 For information about this document, please contact Dr. Paul Karanicolas or Dr. Robert (...) of participants who achieve either a complete or partial response to treatment. ? OS – overall survival – the time from randomization to death (any cause). ? PFS – progression-free survival – the time from randomization to tumour progression or death (any cause). ? THP – time to hepatic progression – time from start of treatment to progression of disease in the liver. ? TTLP – time to liver progression – time from randomization to progression of disease in the liver. ? TTP – time to progression – time from
(NENs) arise from the diffuse neuroendocrine cell system and may occur at many different disease sites. Most frequently, these neoplasms occur in the digestive system, followed by the lung. The term NEN encompasses well- differentiated neuroendocrine tumours (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). NECs represent only 10%–20% of all NENs. The main focus of these guidelines is on sporadic small intestinal (SI)-NENs and pancreatic NENs (Pan-NENs) since these are the most (...) Neuroendocrine Tumour Society (ENETS) was recently widely adopted by the eighth edition of the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system  for various types of GEP-NETs. For all NECs, the staging system of adenocarcinomas must be applied . Furthermore, the primary tumour site has an impact on the prognosis in advanced disease. 6 Patients with Pan-NETs or colorectal NETs have a less favourable prognosis than patients with small intestinal