Ettinger Supportive Care in Cancer Therapy

2009
ISBN: 978-1-59745-291-5
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 298 Seiten, eBook

Reihe: Cancer Drug Discovery and Development

Supportive care of the cancer patient begins with the diagnosis of cancer and terminates with the end of life. The supportive care is for symptoms related to the cancer and/or its treatment; physical, psychosocial and emotional issues associated with the cancer. Patients with cancer, in general, are living longer. Even those with advanced, metastatic disease have an increase in their survival. This, in part, is due to better therapies, novel treatments and the multimodality approaches to treating many cancers. In Supportive Care in Cancer Therapy , edited by David Ettinger, the contributors provide an up-to-date, concise review of specific consequences of cancer and its treatment. The chapters will allow the reader to better understand the sequelae associated with all aspects of cancer and how to treat them in order to achieve control of symptoms and provide psychosocial care to improve the quality of life of the cancer patient. In addition, the reader will gain informationon the care of the older patient as well as the dying patient.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Ettinger, David S.

Inhaltsverzeichnis

Management of Dyspnea.- Skeletal Metastases: Optimal Management Today.- Cancer Pain.- Anorexia and Cachexia.- Fatigue.- Pathogenesis and Management of Venous Thromboembolism in Cancer Patients.- Depression in Cancer Patients.- Anemia.- Neutropenia.- Nausea and Vomiting.- Oral Mucositis.- Diarrhea and Constipation: Supportive Oncology Management.- Menopausal Symptoms.- Supportive Care of the Older Cancer Patient.- Integrative Oncology: Complementary Therapies in Cancer Care.- End-of-Life Decisions.

Leseproben

IMAGING OF SKELETAL METASTASES (S. 21-22)

Plain Film Radiography

Plain film radiography is a convenient and inexpensive method for monitoring skeletal metastases. It is useful in assessing the structural integrity of bone and the risk of impending pathologic fracture. Given the relative cost and convenience in obtaining plain radiographs, they are often the first imaging study used to evaluate bone pain. Plain films are also useful in confirming larger lesions noted on PET or bone scintigraphy. Plain film radiography is frequently used in surgical planning and to determine response to treatment following surgical stabilization or radiotherapy. Plain film radiography is often the preferred imaging test for multiple myeloma which often features “cold” lesions on bone scintigraphy. However, plain film radiographs often have limited sensitivity in that approximately 30–50% of bone mineral must be lost before skeletal lesions can be detected.

Skeletal lesions may have either an osteolytic, osteoblastic, or mixed pattern on plain film radiography. Osteolytic lesions result when bone destruction predominates, while osteoblastic lesions result when bone formation predominates. Prostate cancer tends to have a more blastic appearance while lung, thyroid, and renal carcinoma lesions have a more lytic appearance. Breast carcinoma lesions tend to have a more mixed appearance. In patients who undergo radiation for lytic disease, osteoblastic changes will often emerge over time, frequently at the edges of the lesion.

Bone Scintigraphy

Technetium diphosphonate bone scans are valuable studies in detecting occult skeletal lesions. These studies involve the incorporation of tagged diphosphonate into hydroxyapatite during bone mineralization. Historically, bone scintigraphy has been the modality of choice for detecting occult skeletal lesions with sensitivity rates of 72–90% (23– 26) . Bone scintigraphy can generate nonspecific findings, however, due to increased tracer uptake from a variety of inflammatory or traumatic conditions. These changes are often confused with metastases. Another drawback of bone scintigraphy is that it shows relatively poor anatomic detail compared to other imaging modalities. In addition, lesions such as multiple myeloma that do not involve new bone formation may appear “cold” or “negative” on these studies.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is an additional imaging modality which is useful for detecting skeletal metastases. MRI is a highly sensitive technique for evaluating the bone marrow and early sites of skeletal metastases. The sensitivity of MRI is based on the water content of various tissues, the high water content of skeletal metastases can present a sharp contrast to that of normal bone marrow. Specificity of MRI may be limited in some cases of inflammation or infection which may appear similar to skeletal metastases.

The relatively higher cost and impracticality of performing extensive MRI imaging of multiple skeletal sites at the same time in routine clinical practice has resulted in MRI being used mostly for confirmation of lesions at specific symptomatic sites. Recently, however, full-body MRI has been studied as a screening tool for the detection of skeletal metastases and has been shown to be equal to or slightly more sensitive than bone scintigraphy (27) . MRI is especially valuable in imaging lesions in the spine as it may be useful in differentiating pathologic compression fractures from osteoporotic compression fractures. In addition, MRI is the preferred modality for evaluating lesions which may be associated with neurologic impairment or epidural extension in the case of vertebral lesions with cord compression or other forms of nerve impingement.