Monday, July 12, 2010

Preoperative radiotherapy for colorectal cancer radiotherapy

Another cancer radiotherapy is the use of preoperative radiotherapy.

Preoperative radiotherapy has the following advantages: a good blood supply of the target cells, high ammonia level in Asia, on the radiation sensitivity of high clinical outcome. Radiation can shrink tumors, lower lesions of (down-staging), to enhance tumor resection rate, not only undercut rate, rectal success rate has improved markedly. Small intestine were significantly narrowed the scope of exposure, the incidence of radiation damage of small intestine was significantly reduced. Recovery occurred after continuous intestinal radiation proctitis, anastomotic stricture, and intestinal dysfunction, the chances of complications such as greatly reduced. The sacral fascia fibrosis after radiation thickening of the vascular protective effect of strengthening the presacral, presacral vein surgery less chance of injury, especially for locally advanced disease, surgery safety relative to preoperative radiotherapy there are so many advantages, but there is a fatal drawback, may be carried out as part of radiation therapy without radiation therapy, which is treated too far, because of radiation, after all, has some damage to normal cells.

In addition, the current special emphasis on the patient before surgery on the correct assessment of disease through clinical examination, B-cavity, pelvic CT / MRI, a series of simulated intestinal microscopic examination of the diseased patients to make more accurate assessment of the operation provide the basis before radiotherapy, to avoid unnecessary and inappropriate treatment.

From the mid-70s has at least 12 on the resectability of rectal cancer with preoperative radiotherapy randomized study reported, but no application of full dose (≥ 45Gy), the majority of the radiation technique used and not satisfied, from radiation to surgery after not enough time interval of (4 to 6 weeks), resulting in only six reported local recurrence rate was statistically significant.

Sweden, a group of reports (SRCT) 1183 patients were receiving surgery alone or surgery plus short-term preoperative radiotherapy, radiation dose of 25Gy, in 5 days 3 or 4 applied radiation field, radiotherapy after surgery a week showed the local recurrence rate significantly decreased (27% vs1% P <0.001), 5-year survival rate was significantly increased ((48% vs58% P = 0.004). But the second group received AP resection is the same as the ratio of ((59% vs58%), Therefore, the Swedish preoperative radiotherapy 5 days a week program did not agree with the U.S. counterparts, who believe that this program has several shortcomings: ① chemotherapy is not appropriate at the same time; ② not help to improve the success rate of sphincter preserving surgery; ③ increased incidence of postoperative complications. Paty so that the greatest advantage of preoperative radiotherapy is beneficial to improve the success rate of sphincter preserving surgery.

Minsky reported 30 cases of rectal cancer from the anal margin of 1.5-6cm of the original development of AP resection, in the full dose by 5040cGy after preoperative radiotherapy, 83% completed a low anterior resection for colon-anal anastomosis.

Rouanet and other similarly reported low rectal cancer after preoperative radiotherapy can do 78% of rectal surgery. This preoperative radiotherapy, surgery postponed at least 8-10 weeks, increased the risk of tumor spread far, this has recently carried out many scholars combined preoperative chemotherapy in the neoadjuvant treatment, short-term effect is significant again with postoperative chemotherapy, to prevent the spread, the 5-year survival is possible in theory, of course, the final conclusion will wait for the results of long-term follow-up to confirm.

TCM Treatment of Lung Cancer

Chinese medicine for lung cancer, as early as the Song Dynasty some of the treatment side the book contains information on Ben, cough, breathlessness and cough pain, coughing blood, mediastinoscopy stasis, nausea, vomiting phlegm birth, such as lung cancer, thin yellow noodles common prescription card. Jin and Yuan Li Dongyuan pulmonary Ben pill product of interest, the rule permits are similar to the symptoms of lung cancer. Modern physicians practice in a large number of clinical practice and research identified the syndrome is more stable model to modern medical methods of diagnosis, after examination, under the guidance of TCM theory, to distinguish right from wrong actual situation, be cubic removal medicine. According to the combination of local and overall view of the syndrome differentiation with disease differentiation therapy combined with anti-cancer treatment Fuzheng combination of methods, applied to lung cancer treatment, in improving symptoms, modulation of immune function, prolong survival achieved certain aspects efficacy.

1) Spleen dampness type.

Main symptoms: cough, phlegm, A thin white color, Shenpi fatigue, chest tightness, pay less, bloating loose stools, body floating arsenic, looking disappointed white, moving the shortness of breath, fat tongue, the tongue side of teeth marks, pale tongue, thin greasy tongue coating, How How slow or slide.

Governing Law: Spleen Qi, phlegm cancer.

Recipe: Six Gentlemen Decoction ("Woman prescription") addition and subtraction, Astragalus 20g, Radix Codonopsis 30g, Atractylodes 10g, Poria 12g, tangerine peel 10g, law Pinellia 10g, Polyporus 15g, Chinese yam and medicine 20g, Coix Seed 20g, 8 Sapporo month 15g, Houttuynia 30g, iron leaves 30g, diffusa 30g, licorice 5g.

Slightly by the Framework of phlegm hard pumice, Gualou; sweating shortness of breath Jiamai winter, Schisandra, and to increase the amount Codonopsis; pleural effusion Nan Xiao, edema plus Tinglizi, Solanum nigrum, Plantago; heat were added gypsum, Zhimu, buffalo.

Analysis: prescription Codonopsis, Atractylodes, Poria, Polyporus, Yiyiren spleen dampness; peel, Houttuynia phlegm, Sanjie, clearing the lungs; Astragalus, Codonopsis, Atractylodes, Poria fill the gas lung and spleen, spleen Qi Wang is abundant; coupled August Sapporo, Hedyotis diffusa detoxify cancer; iron leaves blood stasis. Combination of various drugs, playing a total of spleen qi, Blood cancer of the function.

2) Heat Yin evidence.

Main symptoms: cough without phlegm, or sputum slightly less difficult, blood stained sputum, or a small amount of hemoptysis, upset, dry mouth, chest pain and shortness of breath, hot flashes, night sweats, urine short red, emaciation, red tongue less-chun, moss, or spend less stripping, pulse breakdown.

Governing Law: Ziyinqingre and lungs fluid, accompanied cancer.

Recipe: Lily Tang ("Medical side Annals") addition and subtraction, lily, raw land, Rehmannia the 10g, Scrophularia 12g, Radix 15g, Chinese angelica 5g, white peony root 10g, Chuanbei 10g, almonds, 10g, 20g of Cortex Mori , Gualou shell 20g, Scutellaria 15g, Scutellaria barbata, Hedyotis diffusa each 30g.

Shortness of breath, fatigue and Astragalus, Codonopsis; chest pain plus peach kernel, safflower, centipede; sputum blood plus Puhuang carbon, multiple intersecting carbon, Agrimony, White RB or Yunnanbaiyao; low heat plus silver Bupleurum, Cortex Lycii, Artemisia .

Analysis: Lung gold is not raw water, water, dry Huo-yen, so the water by two to kidney cooling King and AIDS drugs, Lily and lung nerves, Radix clearing heat and moistening, Scrophulariaceae help two places to raw water, Fritillaria Lung Yu San and Chu Tan, angelica, peony nourishing and to Calming the Liver, lung and Lee declared Campanulaceae refreshment, and licorice to reconcile various drugs, and then with barbata, snake tongue grass together and used anti-cancer drugs can be Yin Ye gradually to full, virtual fire from clear, the condition under control.

3) Qi stagnation type.

Main symptoms: cough, sputum hell, coughing blood, chest tightness, chest pain, such as thorns, the pain has set office, constipation, dark lips, Violet, and even then a wrong skin, skin exposed to superficial vein engorgement, dark tongue, or ecchymosis blood spots, thin yellow tongue coating thin tired or bored, thready pulse astringent or thin string.

Governing law: promoting blood circulation and stopping pains, combined with the anti-cancer.

Recipe: Blood Stasis ("Correction of Medicine"), subtraction, Bupleurum 6g, Chishao 1Zg, Fructus 1Zg, Angelica 15g, habitat 15g, walnuts 9g, SM 20g, Gualou 12g, safflower 3g, Health Astragalus 15g, green tangerine peel the 5g, Campanulaceae 3g, diffusa 30g, thousands of toad skin 12g, stone see through 15g.

Analysis: The block party for qi, blood stasis in the chest and set up, peach kernel, safflower, red peony root, angelica, Salvia blood circulation and blood, Bupleurum, Citrus Green, Citrus aurantium Qi Chest, Eustoma Open lung, with the detoxification of dry toad skin cancer, since colored snake tongue grass, stone see through, all-organic combinations, for qi stagnation of lung cancer patients, quite out of step.

4) Qi and Yin deficiency.

Main symptoms: cough, less sputum, blood stained sputum, or hemoptysis sputum, Shenpi fatigue, shortness of breath, disinclination to talk, move the breathlessness and fear the wind spontaneous sweating, chest tightness, poor appetite, pink or reddish tongue, the tongue body fat edge have scalloped or thin yellow tongue coating thin since, pulse small or thin.

Governing Law: Nourishing Yin detoxify cancer.

Recipe: Shengmaisan ("Book of Master within the trauma theory") co-Bufei soup ("Wing type seal side"), ginseng 9g, Radix 15g, Schisandra 9g, Radix Astragali 30g, Cortex Mori 9g, Rehmannia 15g, Chuan Tony 12g, banzhilian 30g, Houttuynia 15g, Hedyotis diffusa 30g.

Cough, weight increase Coltsfoot Flower, Aster, Peucedanum; sputum Huang clamshell, Xianzhuli, skullcap, Morus alba; fever plus honeysuckle, forsythia, antelope horn; hemoptysis plus Baiji, Agrimony, thistle grass, madder .

Analysis: Shengmaisan from Cough lung deficiency Shangyin of view, taking ginseng Gan Ping lungs and large rely on strength for King and medicine, Radix Gan Han YangYinShengJin as minister, Schisandra acid convergence Tianjin. Astragalus lungs in addition Bufei soup using gas, supplemented by Aster, Morus alba refreshment, Rehmannia kidney. Gift to the snake tongue grass, barbata, Houttuynia detoxify cancer, the number of drug combination, taken Qi, Sheng Jin convergence lung cancer three methods in order to rule the chart, so that both Qi and Yin Fu, Lung Yun Jin-sheng, cancer drug to control.

5) kidney deficiency syndrome.

Main symptoms: cough, shortness of breath, moving the breathlessness, ringing in the ears dizzy, weak waist, side green limbs, chills Shenpi, Hung red tongue, thin white fur, the pulse was fine.

Governing Law: kidney yang, combined with the cancer.

Recipe: Jinkuishenqiwan ("Golden Chamber") addition and subtraction, the system attached to pieces 12g, cinnamon 6g, Rehmannia 12g, Fructus Corni 15g, Chinese yam and medicine 20g, Alisma L2g, Poria 15g, walnut meat, 15g, 15g Cyathula * Cistanche 15g, flea 20g, Hedyotis diffusa 30g.

Hemoptysis more than those who add Agrimony, multiple intersecting carbon, Puhuang carbon; chest pain plus Cyperus rotundus, turmeric; anorexia fatigue were added villosum, fried malt; a malignant pleural effusion were added nigrum, Tinglizi, jujube; Sunburn increases burst collapse are Astragalus, Ginseng, or Panax quinquefolius.

Analysis: The deficiency is the key to lung cancer is virtual, so they chose mainly Jinguishenqi Warming kidney. Prescription dry yellow nourish the kidney yin, dogwood, yam nourishing the liver and spleen, and a small amount of Gui, Fu Zi Wen kidney in Sanyang, is intended to grow slightly less fire to health kidney, prescription paeonol, Alisma, Poria clear diarrhea anger, Wetting of water, and Warming kidney match medicine, intended to fill in a crash, without getting tired, just as King Yue as saying: "Good BHD who will be in the Yang Deficiency, then the yang may help the biochemical yin infinite. "Yang for patients with lung cancer pathogenesis and set up, so this in order to obtain a certain effect.

Radiation side effects and treatment of gastric cancer

Radiotherapy is one of the main method of treatment of gastric cancer, but radiotherapy in killing cancer cells also have some side effects, side effects following radiation therapy to cancer and its treatment methods are described below:

1 Fatigue: During radiotherapy, the human body to self-energy-consuming rehabilitation. Diseases of the stress from daily treatment, and radiation effects on normal cells can lead to fatigue. Most of radiotherapy for liver cancer patients will feel tired after a few weeks, and continuing with the radiation would be more a sense of fatigue.

After radiotherapy, weakness and fatigue will gradually disappears. During radiotherapy, patients with gastric cancer should be less to do something. If you are tired, then the idle would be less activity, more rest. Sleep early at night, may need to rest during the day.

2, Skin: gastric cancer patients after radiotherapy, the skin often becomes dry. Patients with these symptoms should tell the doctor, the doctor will make recommendations to eliminate your discomfort. After a few weeks after radiotherapy, the majority of skin reactions would eliminate. Patients should take their skin care, here are some suggestions:

(1) the use of cold water and mild soap; let the water through the skin of radiotherapy, not friction.

(2) clothes in the treated area should not wear too tight.

(3) Do not rub, scratch sensitive parts of grasping.

(4) Do not put hot or cold things, such as hot towels or ice packs on the skin of radiotherapy, unless a doctor recommends it.

(5) in the treatment you are receiving treatment and the end of weeks, do not rub on the site of radiotherapy powder, skin cream, perfume, deodorant, creams, lotions and household medicines unless a doctor permission. (Many skin products will leave a layer of the skin, this may prevent radiation or rehabilitation).

(6), radiation therapy and radiation therapy after one year, do not let the site of radiotherapy exposure to the sun. If you want to stay a few minutes in the sun, we must wear a protective effect of clothing (such as wide-brimmed hat and long-sleeved shirts) and use sunscreen.

3, blood: the radiation is almost not reduce the number of white blood cell count or platelets. These blood cells help the body fight infection and prevent bleeding. If the patient's blood test showed liver radiotherapy reduced the leukocyte count or platelet count, treatment will be suspended a week in order to increase the patient's blood cells.

4, diet: cancer radiotherapy side effects include diet and digestive problems. In the course of treatment, you may have no appetite. Even if you feel hungry, more protein and calorie intake is also important. Doctors found a very good appetite, patients can better cope with cancer and its side effects.

The following is to help solve the food problem of gastric cancer patients in the guidelines and methodologies.

(1) If you chew and swallow food feel pain, I suggest you eat powdered or liquid food. These foods can be bought in stores, but also a lot of taste. They can be used with other foods.

(2) The following suggestions will help you to raise your appetite appetite and make you eat as much as possible.

1) Eat small meals.

2) do not drink, alcohol will increase the side effects of radiotherapy.

3) may take some spleen appetizer of Chinese medicine.

(3) If you can only eat small quantities of food, you can through the following methods to improve energy intake:

1) The Food and adding butter or margarine.

2) drink milk instead of water.

3) After eating something to drink milk.

4) add some vegetables or cream sauce.

5, emotional: many patients feel depressed, fear, anger, failure, loneliness or helplessness. You may feel tired because radiation to destroy your mood. You can on these issues to the doctor or the local Cancer Society advice, and find people who care about you the opportunity to work together to solve these problems.

Overall, gastric cancer radiotherapy will inevitably damage the body's normal cells, it is recommended in patients with radiotherapy, while taking some anti-tumor effect and the righting of Chinese medicines such as Traditional Chinese Academy of Sciences of the spleen and kidney particles, on the one hand enhance the effect, on the one hand to reduce the side effects of cancer radiation therapy to improve immune function.

"Sixteen-Character Policy" treatment of gastric cancer

Surgical excision:

Treatment of choice for gastric cancer surgery. In addition to gastric cancer, no lymph node metastasis, or less than 2 cm protruding's do reduce the operation, except for gastric cancer with radical surgery should be done, plus lymph node dissection.

Patients should pay attention to the patient's urine output and drainage. Urine can determine how much heart and lung function of patients. Drainage tube is like a sentinel, can detect the wound recovery, open surgery or later, if there is exudate oozing out of anastomotic bleeding or stomach bleeding, the drainage tube can be seen a look.

Chemotherapy supplemented by:

Adjuvant treatment of gastric cancer to chemotherapy, and radiotherapy less use. More than in the postoperative adjuvant chemotherapy in the past, aimed to consolidate the surgery, surgery to kill residual tumor suppression and tumor cells. More recent years, advocates of preoperative chemotherapy, also known as neoadjuvant chemotherapy in gastric cancer is diagnosed, the surgery is not necessarily right away, first give a number of chemotherapeutic agents to control and shrink the tumor before surgery, to improve the success rate of surgery. This is like not playing around the Northeast campaign strategy, first tumor and lymph nodes are controlled, the final in the operation around and annihilate. So after the diagnosis of gastric cancer surgery not fixing authorities merely to go.

Comprehensive treatment:

Cancer treatment and, like most other tumors, therapeutic measures should be integrated, the various methods of each other, coordinate, rationalize the use, in order to achieve the best effect. In addition to surgery, chemotherapy and radiotherapy, there are Chinese medicine, immunotherapy, etc., can choose to use, enhance immunity and quality of life and reduce the recurrence risk transfer.

Attention to rehabilitation:

As the saying goes, "stomach-third rule, seven support", not the surgical treatment of gastric cancer, chemotherapy after the end, there is a long-term recovery, follow-up and rehabilitation process, which is important in patients with long-term survival. Do not over-diet diet, not picky eaters, but do not drink and smoke, eat right medicine can improve the immunity. And then just normal to be treated, regular physical activity, participate in group activities, regular follow-up.

About cancer drugs attack

Attack cancer Background:

● Cetuximab treatment of advanced lung cancer, a study published in 2008 found that the standard chemotherapy and targeted therapies that can make patients with advanced non-small cell lung cancer survival rate greatly increased.

● gemcitabine treatment of pancreatic cancer in 2008, for early pancreatic cancer in a large study found that: After primary tumor resection, chemotherapy with gemcitabine prolong the patient's overall survival.

● endocrine therapy to reduce breast cancer recurrence

Recent study found that breast cancer if detected early, adequate treatment with tamoxifen or the application of aromatase inhibitors, endocrine therapy, can significantly reduce the risk of recurrence.

● long-acting interferon treatment of melanoma

Malignant melanoma patients, application of this new year of interferon therapy can reduce the risk of recurrence of 18%.

● PARP inhibitor treatment for refractory breast cancer a new targeting drug --- PARP inhibitors to treat three types of refractory breast cancer. The drug can increase the sensitivity of tumor cells to treatment, and promote tumor cell death.

● Trastuzumab improved HER-2 (+) advanced gastric cancer survival of HER-2 is involved in the regulation of tumor growth and an important factor. Trastuzumab combined with standard chemotherapy in patients with advanced gastric cancer can be the class of 26% lower risk of death, prolonged survival of 13.8 months.

● With the standard treatment for advanced bile duct cancer British researchers found that, with gemcitabine monotherapy, compared with gemcitabine and cisplatin in patients with advanced bile duct cancer can be prolonged survival of 11.7 months, and reduce the risk of disease progression.

● reduction of prostate cancer after radiation transfer previous studies have shown that patients with early prostate cancer after about 1 / 3 of the transfer can occur. New research shows that postoperative radiotherapy may reduce the risk of distant metastasis 29%, survival up to 14.7 years

Friday, July 9, 2010

Auxiliary: cancer more easily

If we say that surgery, radiotherapy, chemotherapy is the treatment of cancer of the weapon, it is to protect patients adjuvant armor. Shen Lin, Tumor Hospital, Peking University, Professor of Medicine told reporters, treatment increased, supporting the progress of medicine is also very fast.

Antiemetic including the 5 - HT blockers and adjust the body's stress hormones, as well as the patient semi-dormant or dormant sedatives. Many cancer treatment by inhibiting the bone marrow makes white blood cells, platelets and so reduce. Light by stopping can be restored, serious use of granulocyte colony stimulating factor 2-3 days to increase white blood cells.

For thrombocytopenia, may be blood transfusion or use of thrombopoietin. For pain patients, mild to moderate use of non-steroidal painkillers, heavy to use opioid analgesics. Reaction of the other special needs to a variety of symptomatic treatment, such as liver function impairment, you can use the liver cell membrane protective agent; nerve impaired, oral vitamin B; mucosal damage, using acid suppression agent.

Overcome by individual treatment of cancer

"In the 21st century, the clinical oncology should focus on evidence-based medicine, standardized and individualized." Chinese Academy of Engineering, Chinese Academy of Medical Sciences Cancer Hospital Medicine Professor Sun Yan told "Life Times" reporter said.

"Tumor pathogenesis and clinical course of treatment is full of complexity and diversity of the years new technologies, new drugs are emerging, if not a certain treatment guidelines and selection of evidence, doctors in the choice of treatment may face more confusion when . Thus, evidence-based medicine, standard treatment is the basis for cancer therapy. "Sunyuan Shi said.

Of course, just do standard is clearly not enough.

"Today, the hottest topic in cancer treatment is individual therapy, which is Chinese experts should be more areas of concern, there are many things you can do." Sunyuan Shi stressed that, in fact, Chinese traditional medicine has been in the emphasis on "individual treatment "concept, its essence lies in" syndrome differentiation "and" the same disease with different treatment, different diseases, "which offers a lot to learn from cancer treatment.

"It's just, Chinese medicine is to distinguish cold and heat, and cancer treatment to distinguish the disease in the late morning, a gene mutation, receptor and key enzymes."

Get lung cancer, the early, middle and late treatment of patients vary widely. Early stage, surgery is the preferred solution; by advanced, chemotherapy, radiotherapy status will be greatly enhanced. Again, the targeted therapy gefitinib in non-small cell lung cancer is better, but not suitable for all patients, the efficacy of Europeans and Americans and Asians, on the far, with or without EGFR mutations and K-ras mutation is key.

As for breast cancer, in addition to the applicable principles of operation, the estrogen and progesterone receptors is not positive, Her-2 gene over-expression is not the treatment program is also completely different. Appropriate treatment is selected program will directly affect the patient's prognosis.

Sun Yuanshi that surgery, chemotherapy, radiotherapy and other methods used for the integrated treatment of individual patients to provide the maximum possible. "The development of targeted therapy in oncology in the development process more landmark, target detection will be the diagnosis of cancer and to develop individualized treatment programs a must and should be more attention."