Treatment of early-stage breast cancer

Article Abstract:

A report is presented by a consensus panel of investigators, methodologists, specialists, and representatives of the public concerning optimal approaches to treating breast cancer. The panel report was formulated after the Consensus Development Conference on the Treatment of Early-Stage Breast Cancer, sponsored by the National Cancer Institute and the Office of Medical Applications of Research of the National Institutes of Health. It addressed mastectomy (removal of the breast and supporting tissues) compared with approaches that conserve breast tissue (removal of the tumor only, followed by radiation therapy); techniques of breast conservation; the role of adjuvant therapy (chemotherapy); the importance of prognostic factors; and future research directions. Studies with long-term follow-up have shown equivalent survival for patients choosing either mastectomy or breast conservation. Thus, the choice of a treatment is made based on other considerations, such as cosmetic results, psychosocial factors, or certain aspects of the patient's disease. Specific recommendations concerning breast conservation, with examination of lymph nodes in the armpit and subsequent radiation therapy, are presented. Although most patients without lymph node involvement are cured by either mastectomy or breast conservation treatment, chemotherapy further reduces recurrence by approximately one third. Considerable research is needed in this area, and all eligible women should be asked to participate. A good prognosis is associated with smaller tumors (especially those one centimeter or less in diameter); estrogen receptor-positive tumors (slightly better than receptor-negative tumors); lower grade cancers (a measure of aggressiveness); certain histologic types; and other factors. Future research should focus on eight areas: improving methods of rating cancer severity; developing better risk factor profiles; improving systemic chemotherapy regimens; learning more concerning the safety and efficacy of tamoxifen, a chemotherapeutic agent; assessing the quality of life for patients after cancer treatment; evaluating the efficacy of irradiation given as a 'booster'; and improving radiation therapy. Other articles concerning the treatment of breast cancer appear in the January 16, 1991 issue of The Journal of the American Medical Association. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Breast cancer, Chemotherapy

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Adjuvant therapy for patients with colon and rectal cancer

Article Abstract:

The number of new cancers of the colon and rectum reaches 150,000 annually in the United States, or 47 new cases for every 100,000 residents. The average age of occurrence is 60 to 65 years, and most are classified as adenocarcinoma, being derived of the glandular tissue of the gut. Of these tumors, approximately 75 percent are primarily treated by surgery. In addition, other treatment modalities are frequently used in conjunction with surgery, and constitute adjuvant therapy. Adjuvant therapy includes chemotherapy, radiation therapy, and immunotherapy. After extensive study of recent experiences with adjuvant therapy, a United States National Institute of Health Consensus Conference reports on several colorectal patient groups in which adjuvant therapy appears useful. Although surgery remains the most important and critical form of treatment, adjuvant therapy is seen as important for certain individuals. For surgery to be maximally effective, the entire tumor must be removed and none of the margins of the resected tissue should show the presence of tumor. In identifying those patients at greatest risk for a recurrence, of utmost importance is the pathologic state of the patient - the type and location of the tumor, the presence or absence of tumor in nearby lymph nodes, and the finding of tumor distant from the original anatomy site (metastasis). The TNM (tumor/node/metastasis) system is a useful means of describing pathologic state and effectively defines patient categories and risk groups. Patients with colon should be considered separately from those with rectal cancers. Patients at high risk should receive adjuvant therapy, while some patients defined at low risk (Stage I patients) should not. The conference consensus also concluded that the optimal adjuvant therapy for Stage II and Stage III colon cancer has not yet been defined. Combined postoperative chemotherapy and chemotherapy is recommended for certain groups of patients with more advanced disease (Stage II and Stage III). Continued research is considered essential, and priority areas for research are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colorectal cancer, Identification and classification

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Intravenous immunoglobulin: prevention and treatment of disease

Article Abstract:

Immunoglobulins are proteins produced by the immune system that attack specific antigens, or foreign proteins. They have been used to treat conditions associated with immunodeficiency since 1952. A summary is presented from the Consensus Development Conference on Intravenous Immunoglobulin: Prevention and Treatment of Disease, convened by the National Institute of Allergy and Infectious Diseases and the Office of Medical Applications of Research of the National Institutes of Health, in May 1990. The past decade has seen improvements in intravenous immunoglobulin (IVIG) preparations, rendering them useful against many conditions, in addition to those associated with immunodeficiency. This report addresses six main aspects of IVIG therapy, including its efficacy, appropriate dosage, treatment risks, mechanisms of action, and future uses. In addition, effectiveness data from different IVIG preparations are compared. The main uses for IVIG are in cases of primary immunodeficiencies (inborn defects in the immune system), infections in low-birth-weight infants, bone marrow transplantation, Kawasaki syndrome (an acute childhood illness with fever), chronic inflammatory demyelinating polyneuropathies (nerve disease associated with loss of myelin, which insulates nerves), Guillain-Barre syndrome (a neurological disorder associated with weakness and paralysis), and intractable seizure disorders. IVIG also appears to be a promising treatment for children with AIDS; clinical trials are underway. In general, adverse effects from IVIG treatment are few, and usually self-limited. Seven preparations are licensed for use in the US. Further research is needed concerning the mechanisms of IVIG action and the long-term outcomes of IVIG therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Complications and side effects, Physiological aspects, Immunoglobulins, Dosage and administration

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