Oncology Ny
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The incidence of non-squamous carcinoma of the cervix, relative to squamous cell carcinoma, seems to have been increasing over the past 15 years, and adenocarcinomas currently constitute 10 to 18% of cervical cancers. Uncertainties regarding the clinical behavior and management of women with non-squamous cervical cancer persist. Certain cell types and grade of adenocarcinomas play a role in prognosis and treatment selections. ⋯ Conversely, survival may be poor in early stage non-squamous lesions if they are of high grade or of certain cell types, such as adenosquamous carcinoma. Patients with advanced cancers of other organ systems can now achieve an increase in progression-free interval with neoadjuvant chemotherapy or concomitant irradiation/chemotherapy. Such treatments might also benefit patients with non-squamous cervical cancers.
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Patients with carcinoma of unknown primary site are heterogeneous with respect to tumor biology, clinical characteristics, and response to therapy. These patients should no longer be considered uniformly "untreatable"; careful evaluation can identify treatable subsets. ⋯ Poorly differentiated carcinomas are often responsive to cisplatin-based chemotherapy; effective systemic treatments are also available for some subsets of patients with adenocarcinoma. Surgery and/or radiotherapy is often beneficial for patients with squamous carcinoma, especially those who have isolated cervical lymphadenopathy.
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Pain is a complex somato-psychic experience, and all pains do not respond equally to opioid analgesics. Muscle and deafferentation pains are best eased by alternative treatments. Bone pain responds best to the combined use of morphine and an NSAID. ⋯ Opioid use is governed by three key principles: "By the mouth," "by the clock," and "by the ladder." Morphine remains the strong opioid of choice for most patients. Respiratory depression is not a problem, nor is tolerance. Addiction (psychological dependence) does not occur in patients with opioid responsive pains.