#Cancer Recurrence

[pankajayurveda]

Why does cancer come back even after treatment? This is a question that many cancer patients and their families struggle with. Tahira Kashyap’s second battle with breast cancer raises this important question. In this blog, I explore the Ayurvedic perspective on cancer recurrence and how Ayurveda can help address the root causes of disease.

Ayurveda believes that true healing goes beyond just treating the body; it’s about healing the mind, spirit, and lifestyle. In this article, I delve into how emotional health, doshic imbalances, and lifestyle factors play a critical role in the recurrence of cancer. 🌿

Key insights from Ayurveda on cancer recurrence:

🌱 Emotional Health

🍃 Doshic Imbalance

🌀 Diet and Lifestyle

🌿 The Mind-Body Connection

Read the full blog to understand how Ayurveda can provide a holistic approach to preventing cancer recurrence: 🔗 Read More

[katakaluptastrophy]

Periodically, I remember how absolutely fucked up the necromancers in TLT are meant to look. Like, necromancy does an absolute number on people physically.

Harrow is "rather small and feeble".

Necromantic Ianthe is "the starved shadow" of her non-necromantic twin.

Our first description of Palamedes is "a rangy, underfed young man" who is "gaunt".

Silas is "knife-faced...He had a necromancer build."

Ianthe parodies make-over scenes in House novels with "if the hero’s a necromancer it’ll be described like, ‘His frailty made his unearthly handsomeness all the more ephemeral'"

Jod acknowledges to Wake that even small children with aptitude would look odd to non-House eyes: "“I have access to any number of cute pictures of necromantic toddlers with their first bone. They don’t make for fat-cheeked roly-poly babies, but they’ve got a certain something."

In As Yet Unsent, Judith brags about her previous physical fitness: "I could run a kilometre in ten minutes, which was among the fastest for my adept group in the junior reserves." Which is about double the time you might expect for a physically fit woman her age.

In non-necromancer-friendly New Rho, Harrow's body is mistaken for a child's and has to be explained as a result of starvation and trauma to seem plausible: "Pyrrha explained without missing a beat that what with everything Nona had gone through she had been ill and still didn’t eat very much, which was why she was so knobbly and undergrown. The nice lady said that yes, many of the children had problems like that, but it was still hard to imagine Nona was anywhere over fourteen, wasn’t it?"

Tamsyn Muir's descriptions of the Canaan House gang on Tumblr back this up: "Judith is somewhat less completely scrawny than other necromancers on the cast, though she should be less built than Marta is", Palamedes is "seriously underfed" and "bony", Harrow is "scrawny".

And that's just what I can think of off the top of my head - I'm sure there's more.

Anyway, necromancers aren't slender in a conventionally attractive way, they're gaunt in a concerning way...and probably the only reason no one instantly clocked that Coronabeth wasn't a necromancer was because they all just thought it was par for the course that a Third House princess would have had a lot of plastic surgery flesh magic.

[laureala]

hold onnn. link possibly dead or injured from the amelia patient situation. show me to me rachel!!!!!!

[sodisco]

Ultrakill but the cancerous rodent has been replaced by my four pound nine year old Chihuahua that just had a tumor removed today (less green version under the cut)

[sunrise-hospitals-delhi]

Comprehensive Guide to IVF Treatment in Delhi at Sunrise Hospital

In vitro fertilization (IVF) is a beacon of hope for couples facing infertility, offering a pathway to parenthood. IVF treatment in Delhi has gained prominence due to the city’s advanced medical infrastructure and skilled specialists. Sunrise Hospital, located in South Delhi, stands out as a premier destination for infertility treatment in Delhi, led by Dr. Nikita Trehan, a renowned best gynecologist in Delhi and best laparoscopic gynecologist in Delhi.

What Is IVF Treatment?

IVF, or in vitro fertilization, is an assisted reproductive technology (ART) that involves fertilizing an egg with sperm outside the body in a laboratory. The resulting embryo is then transferred to the uterus, aiming for a successful pregnancy. IVF treatment in Delhi is recommended for couples with conditions like blocked fallopian tubes, low sperm count, endometriosis, or unexplained infertility. At Sunrise Hospital, the process is streamlined with cutting-edge technology and personalized care, ensuring high success rates.

Key Steps in IVF Treatment

Ovarian Stimulation: Hormonal medications stimulate the ovaries to produce multiple eggs.

Egg Retrieval: Mature eggs are collected using a minor surgical procedure.

Sperm Collection: A sperm sample is obtained, or donor sperm is used if needed.

Fertilization: Eggs and sperm are combined in a lab, often using techniques like Intracytoplasmic Sperm Injection (ICSI).

Embryo Culture: Embryos are monitored for growth over a few days.

Embryo Transfer: Healthy embryos are placed in the uterus.

Pregnancy Test: A test confirms pregnancy about two weeks after transfer.

Sunrise Hospital excels in each step, leveraging advanced embryology labs and the expertise of Dr. Nikita Trehan, a best endometriosis surgeon in Delhi, to optimize outcomes.

Why Choose Sunrise Hospital for IVF Treatment in Delhi?

Sunrise Hospital is recognized as the best gynecologist hospital in South Delhi and a leader in infertility treatment in Delhi. Located at F-1 Kalindi Colony, this 50-bedded facility is a Center of Excellence for laparoscopic surgery in Delhi and maternity care. Here’s why it’s the top choice:

Expert Leadership: Dr. Nikita Trehan, Managing Director, brings over 20 years of experience in gynecology, obstetrics, and laparoscopic surgery in Delhi. Her global recognition includes world records for complex surgeries.

State-of-the-Art Facilities: The hospital features advanced IVF labs, ultrasound technology, and operation theaters for procedures like hysteroscopy and laparoscopy.

High Success Rates: Sunrise Hospital boasts a 70% pregnancy success rate for IVF, aligning with global standards, thanks to its focus on personalized treatment plans.

Comprehensive Care: From recurrent miscarriage treatment in Delhi to endometriosis specialist in Delhi services, the hospital addresses all fertility challenges.

Patient-Centric Approach: Compassionate care, transparent pricing, and emotional support make the journey stress-free.

As the best hospital for maternity in Delhi, Sunrise Hospital ensures a holistic experience, from conception to delivery.

The Role of Dr. Nikita Trehan in IVF Success

Dr. Nikita Trehan is a pioneer in IVF treatment in Delhi and a globally acclaimed best laparoscopic gynaecologist in Delhi. Her credentials include:

Extensive Experience: Over two decades in gynecology and reproductive medicine.

Minimally Invasive Expertise: Specializing in laparoscopic surgery in Delhi, she performs procedures like fibroid removal and endometriosis treatment with minimal recovery time.

High-Risk Pregnancy Management: As a best gynecologist in South Delhi, she handles complex cases, including recurrent miscarriage treatment in Delhi.

Academic Contributions: Dr. Trehan trains doctors worldwide and publishes in international journals, ensuring she stays at the forefront of fertility advancements.

Her empathetic approach and technical prowess make her a trusted endometriosis specialist in Delhi, helping countless couples achieve parenthood.

Common Fertility Challenges Addressed by IVF

Infertility affects about 11% of couples, and IVF treatment in Delhi at Sunrise Hospital addresses a range of issues:

1. Endometriosis

Endometriosis, where tissue similar to the uterine lining grows outside the uterus, can cause infertility. Sunrise Hospital offers the best endometriosis treatment in Delhi, with Dr. Nikita Trehan performing laparoscopic surgeries to remove endometrial tissue, improving IVF success rates.

2. Recurrent Miscarriages

Repeated pregnancy loss requires specialized care. Recurrent miscarriage treatment in Delhi at Sunrise includes genetic testing, hormonal assessments, and tailored IVF protocols to enhance implantation success.

3. Male Infertility

Low sperm count or poor sperm quality is addressed through techniques like ICSI, where a single sperm is injected into an egg. Sunrise Hospital’s andrology services ensure comprehensive male infertility treatment.

4. Unexplained Infertility

When no clear cause is identified, IVF offers a solution. The hospital’s advanced diagnostics pinpoint subtle issues, optimizing treatment plans.

5. Polycystic Ovary Syndrome (PCOS)

PCOS, a common cause of infertility, is managed with ovulation induction and IVF, supported by Dr. Nikita Trehan’s expertise in hormonal imbalances.

Advanced Treatments at Sunrise Hospital

Sunrise Hospital offers a suite of advanced fertility treatments, making it the best gynecology hospital in Delhi:

Intrauterine Insemination (IUI): A less invasive option for mild infertility, where sperm is placed directly in the uterus.

Intracytoplasmic Sperm Injection (ICSI): Enhances fertilization for male infertility cases.

Preimplantation Genetic Testing (PGT): Screens embryos for genetic disorders, reducing miscarriage risks.

Egg and Embryo Freezing: Preserves fertility for women delaying pregnancy due to career or medical reasons.

Laparoscopic Surgery: Dr. Nikita Trehan, a best laparoscopic surgeon in Delhi, performs minimally invasive procedures for conditions like fibroids and endometriosis.

Donor Programs: Egg, sperm, or embryo donation options for couples with specific needs.

Surrogacy: Comprehensive surrogacy services with legal and medical support.

These treatments, combined with Sunrise Hospital’s cutting-edge labs, ensure tailored solutions for every patient.

Why Delhi Is a Hub for IVF Treatment

Delhi’s reputation as a medical hub makes it ideal for IVF treatment in Delhi. The city offers:

World-Class Hospitals: Facilities like Sunrise Hospital rival global standards.

Expert Specialists: Delhi is home to the best gynecologist in Delhi, best orthopedic surgeon in Delhi, and best pediatricians in Delhi, ensuring comprehensive care.

Affordable Costs: IVF in Delhi is cost-effective compared to Western countries, with Sunrise Hospital offering transparent pricing (IVF costs range from ₹130,000 to ₹250,000 per cycle).

Medical Tourism: International patients flock to Delhi for treatments like laparoscopic surgery in Delhi and infertility care, supported by hospitals like Sunrise.

Sunrise Hospital enhances Delhi’s appeal with its multilingual staff and dedicated international patient services.

Tips for a Successful IVF Journey

A successful IVF treatment in Delhi requires preparation and lifestyle adjustments. Dr. Nikita Trehan at Sunrise Hospital recommends:

Maintain a Healthy Diet: Focus on fruits, vegetables, lean proteins, and whole grains to support egg and sperm quality.

Stay Active: Light exercise like yoga or walking improves circulation and reduces stress.

Avoid Toxins: Eliminate smoking, alcohol, and excessive caffeine.

Manage Stress: Counseling and meditation, available at Sunrise Hospital, help ease emotional strain.

Follow Medical Advice: Adhere to hormonal injections and appointment schedules for optimal results.

Choose the Right Clinic: Opt for a reputed best hospital for pregnancy in Delhi like Sunrise for expert care.

Supporting Services at Sunrise Hospital

Beyond IVF treatment in Delhi, Sunrise Hospital offers multidisciplinary care:

Maternity Services: As the best hospital for maternity in Delhi, it provides prenatal care, delivery, and postpartum support.

Pediatric Care: Collaborations with the best pediatricians in Delhi ensure newborn health.

Orthopedic Support: For mothers with mobility issues, Sunrise Hospital connects with the best orthopedic doctor in Delhi and best orthopedic surgeon in Delhi.

Gynecological Surgeries: From best endometriosis treatment in Delhi to fibroid removal, Dr. Nikita Trehan’s laparoscopic surgery in Delhi expertise is unmatched.

This integrated approach makes Sunrise Hospital the best gynecologist hospital in South Delhi for all women’s health needs.

Patient Success Stories

Sunrise Hospital has transformed thousands of lives through infertility treatment in Delhi. A couple from Mumbai shared, “After years of failed attempts, Dr. Nikita Trehan’s expertise and the hospital’s advanced IVF lab gave us our twins. The care was exceptional!” Another patient praised, “As an endometriosis specialist in Delhi, Dr. Trehan’s laparoscopic surgery improved my chances, and I’m now a proud mother.”

These testimonials highlight why Sunrise Hospital is the best hospital for pregnancy in Delhi.

Conclusion

IVF treatment in Delhi at Sunrise Hospital offers hope and success for couples dreaming of parenthood. With Dr. Nikita Trehan, a best gynecologist in South Delhi and best laparoscopic gynaecologist in Delhi, leading the charge, the hospital combines expertise, advanced technology, and compassionate care. Whether you need recurrent miscarriage treatment in Delhi, best endometriosis treatment in Delhi, or comprehensive maternity services, Sunrise Hospital is the ultimate destination.

[ifwebefriends]

Being chronically ill sucks for many reasons but one reason is that all the doctors are so focused on keeping your body from attacking itself/collapsing in on itself that it’s like “uhh I think my brain/emotions are kinda being neglected here :/“

[iliveinprocrasti-nationn]

hello endocrinologist. please call me back.

[goutamedhacare]

Breast Cancer Recurrence: Can Treatment Abroad Lower Your Risk?

What is Breast Cancer Recurrence?

Breast cancer recurrence means that cancer has returned after treatment and a period when it was undetectable. It can reappear in the same location (local recurrence), in surrounding tissues or lymph nodes (regional recurrence), or in distant organs like the lungs, bones, or brain (distant recurrence or metastasis).

Recurrence doesn’t necessarily mean previous treatment failed. Some microscopic cancer cells might survive treatment, lying dormant in the body for years before reactivating.

Types of Breast Cancer Recurrence

Local Recurrence: Returns in the same breast, chest wall, or surgical scar.

Regional Recurrence: Appears in lymph nodes near the collarbone or underarm.

Distant Recurrence (Metastasis): Spreads to remote organs like bones, liver, or brain.

Each type requires different treatments, but they all carry an emotional burden for the survivor. The good news? With advancements in global healthcare, recurrence risks can be minimized.

What Increases the Risk of Recurrence?

Several factors can increase Breast Cancer Recurrence risk:

Stage and grade of cancer at diagnosis

Hormone receptor (HR) status: HR-negative cancers are more aggressive

HER2 status: HER2-positive had high recurrence but is now treatable with targeted therapies

Lymph node involvement at diagnosis

Skipping or stopping hormone therapy or other follow-up treatments

Despite these risks, seeking treatment abroad is becoming a powerful option to improve survival outcomes and minimize recurrence.

How Does Treatment Abroad Help?

1. Advanced Technology and Diagnostics

Top international hospitals in India, Germany, the USA, Turkey, and South Korea provide cutting-edge tools like:

3D mammography and breast MRI for better detection

PET-CT fusion imaging for precise staging

Proton therapy and IMRT to target cancer cells more accurately

These innovations are often not available or affordable in all regions, making medical travel a strategic choice.

2. Multidisciplinary Cancer Teams

Hospitals abroad offer integrated care where oncologists, radiologists, surgeons, geneticists, and therapists collaborate. This synergy leads to more personalized treatment plans and lowers the chance of missing hidden cancer cells.

3. Genetic and Molecular Testing

Access to tests like Oncotype DX, MammaPrint, or BRCA gene testing helps personalize treatment. These can predict the risk of recurrence and inform decisions about chemotherapy or preventive surgery.

4. Access to Targeted Therapies

International centers offer newer treatments such as:

CDK4/6 inhibitors for HR-positive cancers

PARP inhibitors for BRCA mutation carriers

Immunotherapy for triple-negative breast cancers

These therapies are game-changers in lowering recurrence risk for high-risk individuals.

5. Clinical Trials and Experimental Options

Top hospitals abroad often host global clinical trials that offer access to breakthrough treatments. For survivors or high-risk patients, these could mean better protection against recurrence.

6. Comprehensive Aftercare and Monitoring

Abroad, many centers offer long-term monitoring programs with:

Regular imaging

Blood tests for tumor markers

Diet and lifestyle counseling

Psychological support

This 360-degree care not only improves recovery but also detects recurrence early—when it’s easier to treat.

How EdhaCare Supports You

Navigating treatment options abroad can be overwhelming, but this is where EdhaCare steps in. As a trusted medical tourism facilitator, EdhaCare specializes in connecting patients with top international cancer hospitals.

Here’s what EdhaCare offers:

Customized Hospital Shortlisting: Based on your medical reports and needs, we find the best hospitals globally.

Doctor Consultations: Schedule virtual consultations with top oncologists before travel.

Medical Visa & Travel Assistance: EdhaCare manages paperwork, visa processing, and logistics.

Language and Cultural Support: Get on-ground translators and local support during your treatment journey.

Follow-Up Coordination: Continued communication with your treating doctors even after returning home.

Whether you are in remission or just diagnosed, EdhaCare helps you access the most comprehensive cancer care globally.

Why Prevention is Better Than Fear

Living under the shadow of Breast Cancer Recurrence is emotionally exhausting. But choosing a proactive approach by seeking advanced care abroad gives you not just hope, but control. When you choose to get treated at world-class hospitals with the support of EdhaCare, you’re investing in peace of mind, better outcomes, and most importantly—your life.

Final Words

The fight against breast cancer doesn’t end with remission—it continues in the form of vigilance and smart choices. And today, one of the smartest decisions you can make is to consider international treatment options.

Don’t let fear of recurrence hold you back. Let EdhaCare help you take that next, powerful step toward a healthier future. Connect with us today and explore a world of advanced breast cancer care beyond borders.

[myrawjcsmicasereports]

 5-year survival and prognostic factors for resectable colon cancer: a single institution experience in Lebanon by Ernest Diab in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: This study aims to analyze the 5-year overall survival (OS) and the progression-free survival (PFS) of patients with localized colon cancer (CC) and study the impact of various prognostic factors. It is the first study evaluating survival and prognostic factors for resectable CC in the region.

Patients and methods: The medical records of 79 patients at Hotel-Dieu de France (HDF) hospital were reviewed. OS and PFS were analyzed using the Kaplan–Meier method. Results: Advanced stages, advanced grades, and vascular invasion at the time of colectomy were correlated with lower 5-year OS and PFS, showing a statistically significant association. No significant association was observed between cancer sidedness and survival after colectomy.

Conclusion: Survival and recurrence after CC resection remain important problems. Tumor stage, tumor grade, and vascular invasion are prognostic factors that affect survival after colectomy.

Keywords: colon cancer; colectomy; survival analysis; overall survival; progression-free survival; recurrence.

Introduction

Colon cancer (CC) represents a significant public health concern due to its high incidence and severity. It ranks among the leading causes of cancer-related morbidity and mortality globally. In terms of frequency, it is the third most commonly diagnosed cancer in men and the second in women. Furthermore, it stands as the third leading cause of cancer-related mortality in both men and woman (1). The survival of CC depends on the stage of the disease at the time of diagnosis and the response to treatment. The 5-year survival rate decreases as the stage increases: it is greater than 90% for stage I and less than 15% for stage IV. Early detection would therefore be important and effective (2). About 90% of patients with CC are treated surgically (3). Radical surgical resection is the standard treatment for AJCC stage I to III CC. Adjuvant chemotherapy (CT) is given to patients with high-risk stage II and stage III (4). High-risk patients are those with the following characteristics: stage T4, perforation or obstruction, low grade, lymphatic and vascular invasion, less than 12 nodes examined and a high preoperative carcinoembryonic antigen (CEA) (5). Although most patients diagnosed at localized stages (stages I, II and III) recover, 35% develop a recurrence, mainly within the first 5 years (6). Published rates of survival and recurrence after colectomy vary widely (7). In the Middle East, and more specifically in Lebanon, there are very few studies on this subject. Lebanon ranks second in terms of incidence of CC among countries in the Middle East and North Africa (MENA) region with increasing incidence over the past few years (8). Data collection is not easy in Lebanon and the National Cancer Registry (NCR) was inactive for many years due to unstable political and economic situation. Indeed, several data are missing in the Lebanese NCR such as overall survival (OS) and progression-free survival (PFS) after surgical resection of CC.

Our objective is to study the OS at 5 years and the PFS of patients with CC at localized stages after surgical resection in our institution, and this by analyzing the impact of several prognostic factors such as tumor stage, sidedness, grade, size, patient's age at the time of colectomy and adjuvant CT.

Material and methods

Study estimates and sampling

This is an applied survival study in patients who underwent surgical resection for CC at localized stage between January 2015 and December 2016 at Hotel-Dieu de France (HDF) hospital (Beirut, Lebanon). The medical records of 95 patients who underwent primary CC resection were reviewed. The information was collected from the medical records of the patients, present in the archives of the hospital and in the clinics of the attending physicians.  The patients were followed and included in a database until January 2022 or until their death if this occurred before January 2022. Primary tumors located at the level of the cecum, ascending colon and transverse colon were defined as tumors of the right colon, while those located at the level of the splenic angle, descending colon and sigmoid colon were defined as tumors of the left colon. The AJCC TNM staging system (8th edition) was used for staging.

OS was defined as the time from resection of the primary tumor to death from any cause. PFS was defined as the time from the date of surgery to the date of detection of recurrence, last follow-up, or death. We excluded patients who underwent surgical resection for stage IV CC, and for a non-neoplastic cause as well as those who had rectal cancer. The final sample included 79 patients who underwent curative resection for stage I, II or III CC (Figure 1).

 Flowchart of patients included in the study

Ethical considerations

The protocol and all the study procedures were approved by the ethics committee of Saint-Joseph University in Beirut. The Helsinki declarations of 1963 were considered: respect, confidentiality, and patient anonymity.

Statistical analysis

Data were analyzed using SPSS software version 29. The categorized variables were compared by Pearson’s χ² test, and quantitative variables were compared by the Student’s t-test. OS and PFS were analyzed using the Kaplan–Meier method. P values less than 0.05 were considered statistically significant.

Results

Basic patient characteristics

Among the 79 patients included in the study, 42 (53.2%) were men and 37 (46.8%) were women. The median age of patients at the time of colectomy was 66.1 ± 13.3 years. Table 1 represents the clinical and pathological characteristics at the time of colectomy. Conventional adenocarcinoma (74.7%) was the predominant histological type of resected tumors followed by mucinous-type adenocarcinoma (22.8%) and signet ring cell adenocarcinoma (2.5%). Grades 1 and 2 tumors (79.7%) predominated over grades 3 and 4 (20.3%) and median tumor size was 4.78 cm ± 1.6 (2 - 8.5) (table 1). Most patients had stage II-A CC with a frequency of 34.2%. The distribution of patients by stage is shown in table 1. Most patients presented an absence of lymphatic invasion (82.3%), vascular invasion (88.6%) and perineural invasion (89.9%). In addition, the majority (84.8%) presented a conservation of mismatch repair (MMR) protein expression (table 1). 14 patients (17.7%) presented a recurrence with a predominant hepatic location (62.5%). The 5-year OS of the patients included in our study was 88.6% with a median survival time of 64.8 months. The percentage of deaths was 11.4% (table 1).

Impact of cancer stage on survival after colectomy

The OS rate at 5 years was 100% for stage I tumors, 92.7% for stage II and 73.9% for stage III, with a significant difference (p = 0.02). The median 5-year survival was 76.7 months for stage I tumors, 66.9 months for stage II and 53.0 months for stage III. The PFS was 74.6 months for stage I, 64.6 months for stage II and 48.2 months for stage III. Patients with stage I CC had higher 5-year OS (figure 2-A) and PFS (figure 2-B) than patients with stage II and stage III, with a significant difference (p = 0.003 for OS and p = 0.01 for PFS)

 Kaplan-Meier curves of OS (A) and PFS (B) of CC after curative surgery, at stages I, II and III.

Impact of cancer sidedness on survival after colectomy

Clinical and pathological characteristics depending on the sidedness of cancer

Among the patients included, 42 (53.2%) had a right-sided colon cancer (RCC) and 37 (46.8%) had a left-sided colon cancer (LCC). The baseline characteristics of patients with RCC and LCC are shown in table 1.

Patients with RCC were older at the time of colectomy than patients with LCC (67.7 years versus 64.3 years, p=0.26) and the majority were females (57.1% versus 35.1%, p=0.05). A lower BMI was noted in patients with RCC compared to those with LCC (24.6 ± 4.3 vs 26.8 ± 4.7, p = 0.04) (table 1).

The distribution of the different histological types is shown in Table 1. Conventional adenocarcinoma has a higher tendency to occur in the left colon (89.2% vs 61.9%) rather than in the right colon. However, mucinous-type adenocarcinoma has a higher tendency to occur in the right colon (37.5% vs 8.1%) rather than in the left colon. This trend is statistically significant with a χ² test giving a p-value equal to 0.01. The most frequent location was in the cecum (20%) for RCC and in the sigmoid colon (42%) for LCC (table 1).

Tumors of patients with RCC had larger size (5.1 ± 1.7 (2 – 8.5) vs 4.4 ± 1.3 (2.5 – 8), p = 0.05) and more advanced histological grade (31% vs 8% at grades 3 and 4, p = 0.012) than tumors of patients with LCC. The tumors of patients with LCC were mostly stage T1 and T2 (37.8% vs 11.9%, p = 0.05) while those of patients with RCC were mostly stage T3 and T4 (88.1% vs 62.1%, p = 0.05). Patients with RCC had more advanced N stage (38.1% vs 18.9% at stages N1 and N2, p=0.13) and more advanced AJCC cancer stage (38.1% vs 18.9% at stage III, p=0.03) than patients with LCC. Regarding lymph node involvement, the number varied between 0 and 10 positive nodes for RCC, and between 0 and 4 positive nodes for LCC (p = 0.006). No significant difference was observed regarding lymphatic, vascular or perineural invasion between RCC and LCC. A higher percentage loss of MMR protein expression was observed in patients with RCC (23.8% vs 5.4%, p = 0.023) compared to those with LCC (table 1).

Among the operated patients, 8 patients (19.0%) with RCC and 6 patients (16.2%) with LCC developed a recurrence after colectomy (p = 0.74). Regarding the location of metastases, liver metastases (66.7% vs 60.0%, p = 0.7) and peritoneal carcinomatosis (33.3% vs 20.0%, p = 0.7) were more frequent for LCC, while pulmonary location was more frequent for the RCC (20.0% vs 0%, p = 0.7) (table 1).

Survival analysis of RCC and LCC after colectomy

The OS rate at 5 years was 83.3% for RCC and 94.6% for LCC (p = 0.1). Patients with LCC showed higher survival time (69.4 ± 10.1 (45 – 83.8) vs 60.7 ± 16.1 (4 – 84), p = 0.01) than those with RCC. For PFS, the median duration was 57.7 months for RCC and 66.3 months for LCC. Patients with LCC had a higher 5-year OS (figure 3-A) and PFS (figure 3-B) than patients with RCC (p= 0.296 for OS and p = 0.380 for PFS).

 Kaplan-Meier curves of OS (A) and PFS (B) of RCC and LCC after curative surgery, at any stage.

Impact of cancer grade on survival after colectomy

Concerning the distribution by grades and the impact on survival after colectomy, the median 5-year survival was 68.8 months for grades 1 and 2 tumors and 48.7 months for grades 3 and 4 tumors (p < 0.001). Figure 4 represents a box plot showing the difference in survival between the 2 groups of grades.

Box plot showing median survival in months as a function of cancer grades at the time of colectomy.

Impact of tumor size on survival after colectomy

Regarding the impact of tumor size at the time of colectomy on survival, we obtained a weak negative correlation with a correlation coefficient equal to -0.2. This result is represented by a scatterplot showing a non-significant correlation (p = 0.09).

Scatterplot showing the relationship between tumor size at the time of colectomy and median survival in months.

Impact of patient age at colectomy on survival after colectomy

By studying the impact of the patient's age at the time of colectomy on survival, we obtained a moderate negative correlation with a correlation coefficient equal to -0.1. This result is represented by a scatterplot (figure 6) showing a non-significant correlation (p = 0.60).

Scatterplot showing the association between patient age at colectomy and survival in months.

Impact of different tumor factors on survival after colectomy

The presence of lymphatic, vascular or perineural invasion at the time of colectomy was associated with a lower median survival at 5 years (table 2). This association was significant for vascular invasion only (p = 0.02).

 Association between survival and various tumor factors. Values are presented as mean ± standard deviation. The values in bold are those considered significant for a p value less than 0.05.

Impact of taking adjuvant treatment on survival after colectomy

Patients with stage II CC who received adjuvant CT had a higher 5-year OS (figure 7-A) and PFS (figure 7-B) than patients with stage II CC who didn’t receive CT (p= 0.287 for OS and p = 0.206 for PFS).

 Kaplan-Meier curves of OS (A) and PFS (B) of stage II CC depending on taking adjuvant CT.

Discussion

CC is a deadly disease whose spread has accelerated in recent years. Regarding Lebanon, the country has one of the highest colorectal cancer (CRC) incidence rates in the MENA region. Limited knowledge exists regarding the epidemiology and pathological characteristics of CC in the Middle East, including Lebanon. Additionally, there is a lack of data concerning the OS and PFS outcomes after colectomy in this region. The main objective of our study was to analyze OS at 5 years and PFS after colectomy by studying the impact of several factors.

Our study includes slightly more men than women with a ratio of 1.14. This difference in frequency is already described in Lebanon with a higher prevalence of CC in men.

The majority of CC in our study were in the right colon (53.2%). Indeed, since the 1990s, researchers have begun to observe an increase in the prevalence of RCC compared to LCC in several countries and this can be explained by an improvement in the screening system. However, the low percentage of patients with stage I CC in our study (19.0%) is an indicator that the screening system in Lebanon is not yet fully established, and justifies the need for public health interventions (9).

RCC was more prevalent among women in our study (57.1% vs 35.1%, p = 0.005) than LCC. Indeed, women have been shown to have a higher risk of developing RCC than men (10).

Patients with RCC had lower 5-year OS and PFS than those with LCC. But this association between sidedness of tumor and patient survival was not statistically significant (p = 0.296 for OS and p = 0.380 for PFS). Even though several meta-analyses have demonstrated that RCC has a worse prognosis than LCC, recent studies have shown that there is no significant difference in 5-year OS and time to recurrence between patients with RCC and LCC after curative resection (11) (12).

Indeed, a simple comparison of the characteristics of patients with RCC and LCC reveals several significant differences. Patients with RCC in our study had older age at colectomy, lower BMI, more advanced tumor grade, more advanced AJCC stage, higher number of lymph node metastases, higher percentage of lymphatic and vascular invasion and higher loss of MMR protein expression than those with LCC. In fact, patients with RCC have a worse prognosis than those with LCC because they have a worse clinical background. Therefore, to really be able to assess the impact of the sidedness of the tumor on 5-year OS and PFS, it would be necessary to homogenize the history of the two groups.

There was a statistically significant association between the presence of a higher tumor stage at the time of colectomy and a lower 5-year OS (p = 0.003) and PFS (p = 0.01). We can therefore conclude that tumor stage is a prognostic factor for CC.

Regarding tumor grade, patients with a grade 3 or 4 tumor had lower 5-year OS than those with a grade 1 or 2 tumor with a statistically significant difference (p < 0.001). Among our patients, we demonstrated that there was a significant association (p = 0.02) between the presence of vascular invasion and the reduction in 5-year OS, which is consistent with the results of several other studies (13). We can therefore conclude that the tumor grade and the presence of vascular invasion are prognostic factors in CC.

Patients with RCC in our study had a more advanced tumor grade and a higher percentage of vascular invasion than those with LCC, which is consistent with the results of several other studies (11) thus explaining the poorer prognosis of RCC.

We obtained a higher percentage of mucinous-type adenocarcinoma in RCC than LCC. We have not studied the impact of the histological type of cancer on survival, but studies have described a poorer prognosis for mucinous adenocarcinomas (14).

Regarding the size of the tumor, there was a weak correlation between a larger size at the time of colectomy and a lower 5-year OS. But this association was not statistically significant (p = 0.09). However, a recent study showed that tumor size was associated with a poor prognosis of CC and was considered a risk factor for recurrence and metastasis (15).

The median age of the patients was 66.1 years. Investigating the impact of patient age at colectomy on survival, we found a moderate correlation between older age and lower 5-year OS, but this association was not statistically significant (p = 0.60). This can be explained by the fact that intraoperative complications and postoperative morbidity are higher in elderly patients.

Among the patients included in our study, a total of 34 patients (43.0%) received adjuvant CT. To study the impact of taking adjuvant CT on survival, we focused on patients with stage II CC. Among the 41 patients (51.9%) who had stage II CC, 16 (47.1%) was at high-risk and received adjuvant CT: 10 (62.5%) had stage T4 cancer, 5 (31.3%) had lymphatic or vascular invasion, and 1 (6.3%) had an occlusion. We found that adjuvant CT improves the prognosis of patients with stage II CC, result that is supported by previous studies (16). However, detailed date on the type of CT have not been taken into consideration in our study.

Loss of expression of MMR proteins was more frequent in RCC (23.8% vs 5.4%, p = 0.023) than in LCC, which is consistent with previous studies (11).

Indeed, we did not analyze the impact of the loss of expression of MMR proteins on survival, but a recent study showed that adjuvant CT was a poor prognostic factor for stage II RCC with loss of MMR protein expression and therefore patients should know the MMR protein expression status before receiving adjuvant CT (11).

A significant difference (p = 0.04) in BMI between patients with RCC and LCC was observed. Indeed, it has already been shown that patients with RCC have a lower BMI than those with LCC, probably because most patients are women and have an advanced age (11). In our study, we did not analyze the association between BMI and survival, but studies have shown that a high BMI is a good prognostic factor for CC (11) probably because patients who have a low BMI have very little visceral fat to cover the tumor which can cause it to spread rapidly.

Conclusion

CC is a major public health problem in Lebanon and the incidence is likely to increase over the next few decades. Survival and recurrence after CC resection remain important problems, and early detection is very important. Our study is the first evaluating survival and prognostic factors for resectable CC in the region. Although there was no significant association between cancer sidedness and survival, patients with RCC have worse prognostic factors. We found that tumor stage, tumor grade as well as vascular invasion at the time of colectomy are prognostic factors that affect survival after colectomy in the Lebanese population. However, further studies would be interesting to carry out on larger samples.

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[howlsmovingmind]

I love medicine as a practice.

It’s so beautiful and interesting. It is the practice of healing and understanding of humans in the most intimate way possible. The understanding of how our smallest cells operate to make our whole bodies work. How the body thrives when fed and nourished. How love is needed to make our bodies work.

Surgeons cut open patients with so much precision and with such delicacy. Taking out what hurts, and putting you back together. Someone wrote about the intimacy of surgery, and I'm partial to agree.

Medicine is a practice of love.

Medically Interesting,

Howl

[iliveinprocrasti-nationn]

portals are so fucking frustrating. i’m trying to access blood test results that are vital to my next steps in care but either there’s a glitch or their portal information is wrong or whatever but either way i can’t access my results for the next three days at least because they’re marking my correct identity verification answers as wrong. i’m going to call tomorrow and stuff to hopefully get it fixed but. it’s stupid but i’m crying about it because i’m just so tired of dealing with this shit

[denvax]

Navigating the Costs of Ovarian Cancer Treatment: Insights and Considerations

Ovarian cancer, often referred to as the "silent killer," poses significant challenges for patients and healthcare providers alike. Alongside the physical and emotional toll, one crucial aspect that patients and their families must confront is the financial implications of treatment. As a leading practitioner at Denvax Immunotherapy Clinic, specializing in cancer care, Dr. Jamal A. Khan sheds light on the cost considerations associated with ovarian cancer treatment, particularly in the context of India.

Understanding Ovarian Cancer Treatment:

Ovarian cancer treatment typically involves a multidisciplinary approach tailored to the individual patient's condition, including factors such as the stage of cancer, histological subtype, and overall health status. Common treatment modalities may include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy, either alone or in combination.

Factors Influencing Ovarian Cancer Treatment Cost:

Several factors contribute to the cost of ovarian cancer treatment in India:

Diagnostic Procedures: The initial diagnostic workup for ovarian cancer, including imaging studies, blood tests, biopsies, and molecular tests, incurs expenses that vary depending on the complexity and extent of evaluation required.

Surgical Intervention: Surgery is often a cornerstone of ovarian cancer treatment, aiming to remove the tumor and surrounding tissues. The cost of surgery depends on factors such as the type of procedure (laparoscopic vs. open surgery), surgeon's fees, hospital charges, anesthesia, and post-operative care.

Chemotherapy and Targeted Therapy: Chemotherapy drugs and targeted therapy agents used in ovarian cancer treatment incur significant expenses, including the cost of medications, administration, supportive care, and monitoring for side effects.

Immunotherapy: Immunotherapy, a cutting-edge treatment approach that harnesses the body's immune system to fight cancer, may be utilized in certain cases of ovarian cancer. The cost of immunotherapy includes the price of biologic agents, administration, and monitoring for immune-related adverse events.

Radiation Therapy: Radiation therapy, although less commonly used in ovarian cancer treatment, may be recommended in specific situations to target residual disease or manage recurrent tumors. The cost of radiation therapy depends on the number of sessions, radiation equipment, and medical personnel involved.

Hospitalization and Ancillary Services: Hospitalization for surgery, chemotherapy infusions, or complications of treatment adds to the overall cost of ovarian cancer care. Ancillary services such as laboratory tests, imaging studies, consultations with specialists, and supportive care interventions also contribute to expenses.

Ovarian Cancer Treatment Cost in India:

In India, the cost of ovarian cancer treatment cost in India varies widely depending on factors such as the geographical location, type of healthcare facility (public vs. private), choice of treatment center, and specific treatment modalities utilized. Generally, ovarian cancer treatment costs in India are significantly lower compared to Western countries, making it a more affordable option for patients seeking quality care at a reasonable price.

Addressing Ovarian Cancer Recurrence:

For patients facing ovarian cancer recurrence, the financial implications of treatment can be particularly daunting. Recurrent ovarian cancer often requires ongoing surveillance, repeated courses of chemotherapy or targeted therapy, and potentially experimental treatments or clinical trials, all of which contribute to escalating costs. Additionally, palliative care and supportive interventions aimed at managing symptoms and improving quality of life may entail additional expenses.

Navigating Treatment Costs:

Despite the financial challenges associated with ovarian cancer treatment, patients can take proactive steps to manage costs and access resources:

Insurance Coverage: Explore health insurance options that provide coverage for cancer treatment, including surgery, chemotherapy, and hospitalization. Review policy details, including coverage limits, co-payments, and exclusions related to pre-existing conditions.

Government Schemes: Investigate government-sponsored healthcare schemes and initiatives that offer financial assistance for cancer treatment, including subsidies, reimbursement programs, and access to subsidized medications through public healthcare facilities.

Clinical Trials: Consider participating in clinical trials or research studies evaluating novel treatment approaches for ovarian cancer. Clinical trials may offer access to innovative therapies at reduced or no cost, along with comprehensive medical care and close monitoring by healthcare professionals.

Financial Counseling: Seek guidance from financial counselors or patient advocacy organizations specializing in cancer care. These resources can provide information on financial assistance programs, charitable foundations, and community support services available to help offset treatment costs.

Open Communication: Maintain open and honest communication with your healthcare team about financial concerns and limitations. They can offer guidance on treatment options, cost-effective alternatives, and strategies to optimize resources while prioritizing patient well-being and treatment outcomes.

In conclusion, navigating the costs of ovarian cancer treatment in India requires careful consideration of various factors, including treatment modalities, healthcare infrastructure, insurance coverage, and financial assistance programs. By understanding the financial landscape and exploring available resources, patients can make informed decisions and access quality care while minimizing the financial burden associated with ovarian cancer treatment.