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Books > Medicine > Clinical & internal medicine > Diseases & disorders > Oncology
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Selective Sentinel Lymphadenectomy for Human Solid Cancer (Mixed media product, 2005 ed.)
Loot Price: R2,913
Discovery Miles 29 130
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Selective Sentinel Lymphadenectomy for Human Solid Cancer (Mixed media product, 2005 ed.)
Series: Cancer Treatment and Research, 127
Expected to ship within 10 - 15 working days
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In human solid cancer, the lymph node (LN) status is the most
important prognostic indicator for the clinical outcome of
patients. Recent developments in the sentinel lymph node (SLN)
concept and technology have resulted in the application of this
revolutionary approach to define the first draining or SLN to which
the cancer may have metastasized. The underlying thesis in solid
cancer biology is that metastasis generally starts in an orderly
progression, spreading through the lymphatic channels to the SLN in
the nearest LN basin. Thus, the logical approach is to harvest that
specific SLN for thorough analysis. Because a tumor-free SLN is
usually associated with a negative residual LN basin, a negative
SLN is an excellent indication that micrometastasis has not
occurred in the regional LNs. When the SLN is involved, it is
unknown whether or not metastasis is limited only to the SLN or if
the disease has spread to the remainder of the nodal basin. For
this reason, if an SLN is positive, a complete lymph node
dissection is recommended. Therefore, selective sentinel
lymphadenectomy (SSL) should be considered as a staging procedure
so that patients with negative SLNs (about 80%) may be spared an
extensive LN dissection. Malignant melanoma has been proven to be
the most ideal tumor model to study the role of SLN. Subsequently,
SSL has been applied to breast cancer, colon cancer and other types
of solid cancer. The multidisciplinary approach encompassing the
surgeon, nuclear medicine physician, and pathologist is the key to
such a successful procedure. Such a team can be formed readily with
appropriate training. Beyond the technical aspects of harvesting
the SLN, the implication ofmicrometastasis remains to be defined.
Because the follow-up of melanoma and breast cancer patients after
SSL is crucial, ongoing clinical trials are in progress to
determine the biological and clinical significance of SLNs.
Although the concept of SLN is viable in other types of cancer,
such as gynecological and gastrointestinal, the technical aspects
of the procedure need to be perfected and verified. The most
exciting possibility of SSL is that it will lead to early diagnosis
of micrometastasis in regional LNs. Early diagnosis makes it useful
as a clinical staging procedure, and opens up new opportunities to
study micrometastasis and its evolution within the SLNs. Examining
the multifaceted aspects of micrometastasis, such as
differentiation of different clones with respect to the primary
tumor, acquisition of adhesion molecules, and host interaction with
the microscopic tumor, will shed new light on the biology of early
metastasis. New molecular and genetic tools may be used to dissect
the mechanisms of lymphatic and hemotogenous routes of metastasis.
If such mechanisms can be understood, new therapeutic advances may
be developed to prevent the process of micrometastasis. Rather than
targeting larger tumor burdens such as Stage IV disease, targeted
adjuvant clinical trials can be developed for high risk patients
following definitive surgical resection. SSL is a standard staging
procedure for patients with melanoma and is rapidly evolving into a
standard procedure for breast cancer as well.
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