Sentinel Lymph Side Effects

New Merkel Cell Staging Emphasizes Pathological Node Evaluation

Sentinel lymph node biopsy is an important but greatly underused tool for staging and prognosis of Merkel cell carcinoma, according a recent multicenter analysis of 5,823 cases of the aggressive skin cancer.

This massive study led to the first consensus staging system for Merkel cell carcinoma. The new system replaces five conflicting staging systems published in the last 17 years, none of which were based upon more than 251 cases.

"The situation was a complete mess. If a person said, 'stage III Merkel cell carcinoma,' you didn’t know if they were talking about a deep primary, nodal disease, or distant metastatic disease," recalled Dr. Paul Nghiem, senior author of the analysis and new staging system.

The crucial difference between the new staging system and the prior ones lies in its emphasis on determining the pathological status of the nodes, according to Dr. Nghiem, a dermatologist at the University of Washington, Seattle.

Prior studies had established that roughly one-third of patients with clinically node-negative Merkel cell carcinoma (MCC) have microscopic nodal disease. Yet pathological nodal evaluation hasn’t been the norm; indeed, it wasn’t performed in more than two-thirds of the 5,823 cases of MCC obtained from the prospective National Cancer Data Base , which served as the basis for the new staging system.

Dr. Nghiem and his coworkers demonstrated that pathological nodal evaluation is a clinically important unused resource. For example, 5-year relative survival was 79% in patients with Stage IA disease under the new system, defined as local disease not more than 2 cm in diameter and with negative lymph nodes by pathological exam.

In contrast, survival in stage IB patients – local disease not greater than 2 cm, but with nodes that were negative only by clinical evaluation – was only 60%. The same pattern was seen in stage II and III disease under the new system.

Pathological lymph node evaluation not only results in more accurate staging and determination of prognosis, it also has important therapeutic implications.

"If the biopsy is positive, nodal treatment reduces recurrences in that nodal bed," Dr. Nghiem said.

He and his coworkers have shown that lymph node adjuvant radiation therapy and completion lymphadenectomy are similarly highly effective therapies for both microscopic and palpable lymph node involvement ( Cancer 2010;116:1783-90 ). So treatment of the node bed in sentinel lymph node-positive disease should be either radiotherapy or surgery, but not both. It doesn’t make sense to subject patients to the added side effects of dual therapy when either therapy alone is so effective, he continued.

What's the News in the Front Line About Cancer? | Female Cancers Guide

Cure.htm

Cancer is not a single entity. 50% overall cure rate … up to 90-95% for some cancers, near zero for others.Regarding Breast Cancer, the incidence has fallen by 3.5 percent a year between 2001 and 2004. In addition, more women are surviving the disease. Since 1990, death rates have fallen by 2.2 percent a year.

New predictive and prognostic tools have been developed, including gene expression technology, which helps doctors know whether a patient will respond to certain therepies. These have allowed for more tailored, and thus more successful, treatment.

Many procedures are helping to improve a patient’s quality of life. Sentinel lymph node biopsies, for example, spare women the postsurgical side effects caused by the automatic removal of the axillary lymph nodes near the breast.

Now, for Lung Cancer, the incidence in men has declined by 1.8 percent each year since 1991. But the incidence in women has remained unchanged from the peak it reached in 1998, while lung-cancer death rates for women have gone up by 0.2 percent per year since 1995. Why? Men started to quit smoking beofre women did, and women took up smoking later than men did. Still, 15 percent of all cases occur in people who have never smoked.

Fortunately, there are now drugs that choke off the blood supply in the tumors. Still early detection is the best choice, as it increases cure up to 92 percent. This can be done with CT scans that detect nodules, tiny spots on the lungs, years before they might be seen on regular X-rays.

And for colorectal Cancer, although it is the second-most-deadly cancer in America, its incidence has been dropping steadily for both men and women since the late 1990s. More people are surviving too.

Advances are linked directly to the increased use of screening tests, which in healthy adults should begin at age 50. Some tests done to detect colorectal cancer are able to prevent it by removing polyps before they actually develop into cancer. Then, we have already drugs that work by direcly targeting cancer cells without damaging healthy cells.

Finally, for the Skin Cancer, of the various forms, melanoma is the most deadly. Researchers are on the verge of developing a vaccine, which will take care of that. But the incidence of less lethal forms like the basal and squamous cell carcinomas is increasing. The main cause is overexposure to the sun.

New tools such as the dermatoscope allow doctors to see moles at a high degree of magnification, which lets them identify subtle changes and develop the proper treatment.

The sentinel lymph node concept

Side Effects of Drugs Annual 29, A Worldwide Yearly Survey of New Data and Trends in Adverse Drug Reactions

Minimally Invasive Surgical Oncology

Textbook of breast cancer, a clinical guide to therapy

Review of surgery, basic science and clinical topics for ABSITE