1/40. Discussing disease progression and end-of-life decisions.Because most patients now want to know the truth about their diagnosis and prognosis, the ability to discuss the cancer diagnosis, disease recurrence, or treatment failure, and to solicit patients' views about resuscitation or hospice care, are important verbal skills for oncologists and other oncology health care providers. Moreover, the ability to clearly articulate a treatment plan or elicit patient preferences for treatment are a prerequisite to informed consent. Despite these imperatives, clinicians do not routinely receive training in key communication skills that could enable them to accomplish these tasks. A body of literature is available, however, that identifies communication strategies that can (1) facilitate the establishment of a close rapport with the patient, (2) identify the patient's information preferences, (3) ensure comprehension of key knowledge and information, (4) address the patient's emotions in a supportive fashion, (5) elicit the patient's key concerns, and (6) involve the patient in the treatment plan. In this article, we use dialogues between a physician and a hypothetical patient with advanced ovarian cancer to illustrate how communication techniques can be applied to accomplish these goals. We identify important benefits of the use of these techniques for both the physician and patient, and pose several questions regarding the training of physicians in this area.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/40. Ovarian cancer associated with ovulation induction: a case report.A case report of a 38 year old lady who developed ovarian malignancy following 3 cycles of ovulation induction therapy is presented. She was observed to have clinically normal ovaries at laparotomy for tubal infertility 12 months previously. Although direct causal link between ovarian stimulation and cancer has not been established yet, a case is made for increased monitoring of patients receiving ovulation induction medication by physicians.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/40. Unusual recurrence of cervical adenosquamous carcinoma after conservative surgery.The use of less radical procedures for the treatment of early cervical cancers is gaining interest among physicians and young patients. Some authors have described surgical procedures aimed at reducing the surgical aggressiveness but the safety of such procedures remains debated. After a polypectomy, a young patient had a diagnosis of stage Ia(2) cervical adenosquamous carcinoma in 1995. As she wished to preserve her fertility, she underwent a cone biopsy and pelvic lymphadenectomy, without evidence of tumor spread. In 1998, at the 13th week of gestation, she had a diagnosis of a pelvic mass. The mass was a recurrence of carcinoma involving the myometrium, just underneath the peritoneum. She underwent a radical hysterectomy with bilateral oophorectomy. An ovarian metastasis was also detected at pathological exam. She received chemotherapy postoperatively and remains alive without evidence of disease. The recurrence of cervical cancer is traditionally regarded as an issue concerning the cervix, the parametria, or the lymph nodes. When the uterus is preserved we must also consider the possibility of a recurrence involving the corpus. With wider acceptance of limited therapeutic approaches we must be prepared for the detection of previously unknown patterns of recurrence and the follow-up modalities must be consequently adapted.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/40. Ruptured metastatic ovarian carcinoma presenting as acute abdomen.Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |
5/40. risk in numbers--difficulties in the transformation of genetic knowledge from research to people--the case of hereditary cancer.Difficulties in communicating diagnostic information are exacerbated when the 'diagnosis' is a 'genetic risk' for cancer. The risk estimation demanded in this situation differs from other types of probability estimations. Observations of participants in 45 consultation sessions between physicians and potential patients were conducted at a clinic for hereditary cancer to explore the communication of genetic information. Thirty-three sessions were audiotaped, transcribed verbatim and analyzed, along with notes from the other sessions. A dominant theme was found to be numerical discussion of risk. Further analysis resulted in the description of problems for practitioners in the process of translating scientific knowledge into clinical management. Problems in providing information include unclear aims of the consultation sessions, mixing various types of background information and probabilities, recognizing how low the predictive values are, and difficulties in communicating the relationship between probability and conclusions. Problems in communicating information about the genetic risk for cancer are of at least two types: dilemmas arising from uncertainties implicit in the nature of the information itself and difficulties in communicating information in a manner that those concerned can interpret. These issues need clarification, so that information with far-reaching consequences can be made as clear and comprehensible as possible for those involved.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/40. cachexia in patients with advanced cancer.Cancer cachexia generally is considered to be the end stage in the progression of nutritional deterioration and wasting of malignancy (Ottery, 1995). In patients with advanced cancer, this condition is very common and decreases quality of life, as well as survival (Fearon et al., 2001; Ottery; Smith & Souba, 2001; Whitman, 2000). However, if early diagnosis and intervention can control cachexia, the potential exists to greatly improve a patient's quality of life and prolong survival. Because metabolic alterations inhibit the effective use of conventional nutritional support, anti-inflammatory agents or fish oil are possible options. Orexigenic agents may be prescribed if patients wish to improve oral intake. steroids and progestational agents may be used to attempt to improve mood and appetite. Nutrition affects symptoms that need to be managed effectively. nurses should work aggressively to correct factors that contribute to decreased food intake (e.g., nausea, pain) and correct factors that worsen debility (e.g., anemia). Information must be presented so that informed choices can be made and realistic eating goals set. An interdisciplinary approach that involves the nurse, physician, dietician, and possibly social worker or case manager, as well as the patient and family, is necessary to identify nutritional alterations, assess specific needs, and plan individual interventions. Whitman (2000) stated that counseling is the most effective and least expensive intervention. It may be conducted by any member of the healthcare team and should be combined with other interventions. Palliation of cachexia in patients with advanced cancer is a challenge for nurses. Hopefully, early and judicious use of these interventions may decrease the significant morbidity and mortality that result from cancer cachexia.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/40. carcinoembryonic antigen: clinical and historical aspects.To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The ohio State University hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |
8/40. knowledge and attitudes of gynecologists regarding genetic counseling for hereditary breast and ovarian cancer.In a survey we investigated whether gynecologists are sufficiently knowledgeable to perform genetic counseling. It provides information for the development and evaluation of a counseling manual for professionals in primary health care. The members of the sample, consisting of 529 gynecologists in northern germany, were mailed a questionnaire concerning their knowledge of and attitudes towards genetic counseling and testing for hereditary breast and ovarian cancer (HBOC). The response rate was 32.5% (n = 172). The majority of the respondents (82%) have received requests from patients for genetic testing. Most would offer basic genetic counseling to their patients, 66% feel knowledgeable enough to do so. physicians set high value on communicating clinical management options, but also consider psychosocial aspects to be important. The results suggest that HBOC genetics play a noticeable role in the practice of gynecology in germany. There is consensus about the need for further educational training to deal with cancer genetics in physicians' daily practice.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/40. Successful infertility treatment in a cancer patient with a significant personal and family history of cancer.BACKGROUND: infertility can be a devastating problem for a couple desperate to conceive. Unfortunately, these same women with infertility also bear the burden of an increased risk of ovarian and breast cancer. We present a case of a woman with infertility who persevered despite a personal and family history of cancer to achieve her goal of having a family. Case: The patient's father had died of breast cancer at an early age. The patient had been unsuccessfully treated for infertility elsewhere before transferring to our institution. A diagnostic laparoscopy revealed an early ovarian cancer treated by oophorectomy only. RESULTS: After a period of observation, infertility treatment was resumed, leading to the successful cesarean delivery of triplets. Although recurrent ovarian cancer was diagnosed at delivery, the patient remains disease free, with three healthy children, 4 years after optimal tumor reductive surgery for stage IC low malignant potential ovarian cancer. CONCLUSIONS: infertility patients with significant cancer issues may achieve a term delivery and remain disease free for a meaningful length of time with the assistance of their physicians.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/40. Examples of the marked variability in the relationship between the serum ca-125 antigen level and cancer-related symptoms in ovarian cancer.OBJECTIVE: While the clinical utility of the serum ca-125 antigen level in demonstrating objective evidence of regression or progression of disease in women with ovarian cancer is well-established, the relationship between both the absolute value of this tumor maker, or its rate of change over time, and the short-term clinical course (e.g., development of cancer-related symptoms) in individual patients remains poorly defined. case reports: Five women currently under the care of physicians in the Gynecologic Cancer program of the Cleveland Clinic demonstrate the marked variability in the correlation between the serum ca-125 antigen and the natural history of disease for individual patients with ovarian or primary peritoneal cancers. In these cases, persistent elevations (>100 units/ml for >2 years), rapid changes (<200 units/ml to >2000 units/ml over < or = 2 months), or extremely high CA-125 values (>5000 units/ml) failed to accurately predict the presence, time to development, or severity of symptoms. CONCLUSION: In the second-line and palliative management of ovarian or primary peritoneal cancers, it is important to emphasize the critical need for clinical judgement in the decision to initiate or alter therapy in individual patients based solely on changes in the serum level of the ca-125 antigen.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
| | Next -> |