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Colorectal carcinoma


Colorectal carcinoma

Colorectal carcinoma

This 72 year old lady presented with a three month history of colicky lower abdominal pain and rectal bleeding. Rectal and sigmoidoscopic examination were unremarkable. A barium enema was requested. This image is from a barium enema series showing a typical 'apple core' stricture. The appearances are typical of a colonic carcinoma. Benign strictures have smooth and tapering edges. The patient proceeded to an uncomplicated sigmoid colectomy. It was a Duke's C tumour and she had adjuvant chemotherapy.
Dr.Syrian's picture
by
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تصنيف Duke C على ما أذكر يشمل اختراق الورم للطبقة المصلية و وصوله لأعضاء مجاورة، ما هيك؟

Stranger4ever's picture
Stranger4ever
بعد التخرج


عضة التفاحة ..
منظر مميز شكرا .

qusei


why dont u try adding TroVax ( cancer vaccine ) to her treatment

it has been shown that it induced an anti-tumor immune response in 95% of patients in stage IV colorectal cancer while 56% of patients remained disease-free at a median follow-up of nine months.

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

TroVax
it is expensive,isnt it ?
qusei


TroVax
TO my knowledge this is still an experimental treatment. Also Dukes C typically correlate with stage III disease (not IV) .One more issue ;it is never enough to say this this drug /treatment can do this or that but you need to know if there is superiority over placebo or not and that was not mentioned to us.\
Finally : the direction of medicine and medical treatment usually does not get altered by one of even two studies : rather you need many studies and accumulation of experience + FDA approval before the treatment hits the market
God Bless

ABIM's picture
ABIM

Quote:
Also Dukes C typically correlate with stage III disease (not IV)

ya i know and therefore if its effective for a more advanced stage this will give it a greater effect
and trovax is for colorectal , renal , breast , prostate cancer regardless staging but one of the trials was done on the colorectal stage 4 pts

Quote:
you need many studies and accumulation of experience + FDA

i have a question :

if a treatment has shown success and FDA didnt yet approve it , am not allowed to use it to resuce my pt's life till i read an approval from FDA ?

and finally :

Quote:
Oxford BioMedica began patient recruitment in a Phase III trial in renal cell carcinoma in November 2006. Phase II trials in renal cell carcinoma, colorectal cancer and prostate cancer are ongoing. Further Phase II and Phase III trials in colorectal cancer and other solid tumours are planned. The development strategy is designed to support initial product registration for TroVax in the United States in 2009.

we are now in 2009 so it will b registered soon inshalla

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امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

Quote:
it is expensive,isnt it ?

i think am missunderstood :

when i said TroVax i didnt mean to say its approved or its cheap and available
my intentions aimed to discuss the effect of TroVax as a cancer vaccine

anyway i have no idea about how much they're selling it for

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة


[

quote]if a treatment has shown success and FDA didnt yet approve it , am not allowed to use it to resuce my pt's life till i read an approval from FDA ?

Well , The answer is quite long. But let me before say : don't let your emotions and enthusiasm take control over your judgement and reasoning. Be careful not to believe easily what drug companies say. By the end of the day they care about selling their product more than saving patients : It is just their business.
So before ANY treatment hit the market it has to scurtinised and challenged very carefuly in multiple studies and an independent meta analysis confirms the superiority of the new treatment over the old existing treatment.
Back to the FDA thing: Any NEW medication has to be approved by FDA to be availabe in the market. However there are 2 situations.
First patients could elect to participate in clinical studies and at that time FDA approval is not needed (just approval for the research protocol by the investigation committee in the institution.
The other exception is that there could be a certain medicine that is avaible to treat certain diseases (already approved to treat certain medical conditions) and hence you will find it in the market. You may choose as a physician to use the medicne"off lable" meaning using it for indications other than the ones approved for initially. For example Tenofovir was first approved for treatment of HIV but it was founf to be very effective against hepatitis B and therefore many physicians started to use it for this indications. Just recently (few months ago) FDA gave it approval but many patients benefited from the drug before FDA would approve its use since it is already present in the market.
SOmetimes problems could arise from using medications off-lable . This may put the physician at risk and make liable if a law suit to be filed on the patient behalf.
One last comment : oncology is very meticulous field especially when it comes to applying evidenc based medicine. In other words you can't assume that if a treatment was effective for stage III disease then it will be effective for stage 4 (or vise versa) without the clear study/ evidence showing that. SO one more time : it is not how things may sound to you reasonable or not rather it is what the EVIDENCE and the observation for the study tells you. There are so many thinga that may make perfect sence but in reality they don't have a standing

ABIM's picture
ABIM

Quote:
Tenofovir was first approved for treatment of HIV but it was founf to be very effective against hepatitis B and therefore many physicians started to use it for this indications.

so to b in the market it has to b approved by FDA
then i can try it on other things if researches approved its advantage

Quote:
don't let your emotions and enthusiasm take control over your judgement and reasoning.

i cant , i am a woman , thats y am afraid of clinical phase.

but i will try
u know i thought things were just lyk house MD series , for a sec they suggest a medication under study , call the reasearcher and inject it in couple of hours

Quote:
There are so many thinga that may make perfect sence but in reality they don't have a standing

i keep forgetting
thx for ur patience with my memory doctor ABIM
hakeem is definitely lucky to have your expierence

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امرأة لا تتكرر
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