Surgical oncology clinics of North America
-
Ductal lavage is a minimally-invasive procedure that permits sampling of breast ductal fluids for cytopathologic analysis. The technique is performed with topical anesthesia and involves cannulation of any fluid-yielding nipple orifice with a specially-designed catheter for lavage and aspiration of the ductal system. The procedure is used for women who have clinical evidence of increased breast cancer risk; if atypia is detected, it may strengthen a woman's interest in committing to a risk-reducing strategy or a chemoprevention trial. The technology also is being used as a tool in ongoing translational research studies.
-
The length and quality of life of patients with localized pancreatic cancer will be maximized by accurate preoperative assessment of resectability, a standardized technique of tumor resection, and the routine use of protocol-based adjuvant or neoadjuvant therapy. Continued efforts to enroll patients with localized and advanced pancreatic cancer into well-designed clinical trials should remain a high priority for oncologists across all disciplines. At present, preoperative therapy remains investigational but has a sound clinical basis and remains a reasonable alternative to up front surgery. Future clinical trials for resectable pancreatic cancer will lead to progress only if the principles of multidisciplinary cancer care and quality assurance are incorporated into their design and conduct.
-
Surg. Oncol. Clin. N. Am. · Jul 2004
Review Comparative StudyPalliative care: an essential aspect of quality cancer care.
The past 2 decades in the United States have witnessed major developments in palliative care. Despite major advances in the early detection and treatment of cancer, more than 550,000 people in the United States die each year from cancer. For most of these patients,treatment in the last months of life is focused on attempts to achieve comfort rather than on treatment aimed at cure of disease. This article discusses the goals of palliative care, the progress that has been made in meeting these goals, and the progress that still needs to be made.
-
Surg. Oncol. Clin. N. Am. · Jul 2004
Review Comparative StudyMethodology for scientific evaluation of palliative surgery.
Measuring the success of surgical palliation is not straightforward. To measure the benefits as well as limitations of surgical palliation,surgeons need outcome assessments other than the existing traditional measures of 30-day surgical morbidity and mortality and 5-year survival. This article delineates a scientific method of evaluating and measuring surgical palliation and shares techniques and pitfalls of assessment gained from prior experience.
-
Surg. Oncol. Clin. N. Am. · Jul 2004
Review Comparative StudyGastrectomy for gastric cancer: defining critical elements of patient selection and outcome assessment.
In advanced gastric cancer, palliation of symptoms, rather than cure, is often the most appropriate goal of patient management. There are important differences among patients undergoing non-curative operations for gastric cancer. ⋯ In clinical decision-making, the potential benefits of proposed procedure must be balanced against the duration of hospitalization, treatment of complications, and requirements for additional palliation. Studies designed to measure palliative interventions would benefit from precise designations of palliative intent inpatients receiving non-curative operations.