Cancer treatment and research最新文献

The weight of grief is heavy on both patients with terminal illness, and their loved ones. We are now aware that grief is not limited to the time of death-grief reactions begin to occur at the time of diagnosis of terminal illness and evolve over time, impacting the patient and family unit in a variety of ways. Loss of what life "could have been" with better health, decline in physical functioning due to illness, and loss of identity and role within the family or community all play a part in the grieving process.

Judaism offers a rich body of traditional beliefs and practices surrounding end-of-life, death, mourning, and the afterlife. A more detailed understanding of these topics might prove helpful to clinicians seeking guidance for how best to care for Jewish patients, to anyone supporting dying individuals, or to anyone interested in learning more about the subject. The objectives of this chapter are to examine Jewish approaches to key bioethical issues surrounding palliative care, to analyze meaning-making rituals following a loss, at a funeral, and throughout mourning, and to explore Jewish beliefs in an afterlife. Research was collected from sacred texts, legal codes, modern rabbinic responsa literature, and secondary sources. Core, guiding principles include human beings' creation "in the image of God," an obligation to save life, an obligation to mitigate pain, a prohibition against self-harm and hastening death, respect for the dead, and ritualized mourning periods ("shiva," "shloshim," and "shanah"), which feature special liturgy ("kaddish") and practices. Judaism is a religion that values thorough questioning, debate, and argumentation. It also encompasses diverse cultural and ethnic backgrounds, and various denominations. Many Jews are also unaffiliated with a movement or rarely engage with traditional law altogether. For all of these reasons, no summary can comprehensively encapsulate the wide range of opinions that exist around any given topic. That said, what follows is a detailed overview of traditional Jewish approaches to artificial nutrition/hydration, extubation, dialysis, euthanasia and more. It also outlines rituals surrounding and following death. Finally, views and beliefs of the afterlife are presented, as they often serve to imbue meaning and comfort in times of grief, uncertainty, and transition.

The human desire to explore our world has led to dramatic shifts in science, technology, and culture. As our knowledge expands so too has our ability to more definitively reach places once thought inhospitable or beyond our grasp. In the early ages of human history, the oceans represented a vast unknown, full of rage and danger suggesting the domain of a tempestuous god or gods. As sailing and navigation developed our eyes turned to the stars and heavens as the new, final frontier. The emptiness beyond Earth's atmosphere has only recently become a destination to sate our natural curiosity and, at present, life in outer space remains a dream of science fiction or the lucky few who participate in the scientific study of our universe. For those who feel cheated in being born too late to explore Earth, but also born too early to explore the cosmos, there is a burgeoning space memorials industry that may give some consolation.

The qualitative experience of sickness and death matters. Modern medicine has made important strides in addressing physical-and to some extent psychological-suffering at the end of life, but biomedical models are not properly equipped to respond to spiritual distress. Medical professionals and spiritual care professionals have an obligation, grounded in the bioethical principle of beneficence, to address all forms of suffering and to advocate for better dying. At the same time, they must approach care from a patient-centered standpoint that avoids spiritual or medical paternalism. The bond that clinicians and patients form through discussing and addressing spiritual distress allows patients to develop a clearer perspective of how their values can be best honored by the medical care team. Ultimately, modern individuals, caught between the dizzying array of possible life choices and the inevitability of mortality, experience immense spiritual need. The drive to care for these needs among dying individuals is a worthwhile pursuit, and traditional ideas of spirituality must expand to meet the needs of the modern individual.

Prostate cancer is a genetically heterogenous disease and a subset of prostate tumors harbor alterations in DNA damage and repair (DDR) genes. Prostate tumor DDR gene alterations can arise via germline or somatic events and are enriched in high-grade and advanced disease. Alterations in genes in the homologous recombination (HR) repair pathway are associated with sensitivity to PARP inhibition in breast and ovarian cancer, and data from recently completed randomized trials also demonstrate benefit of PARP inhibitor therapy in patients with advanced metastatic castration-resistant prostate cancer (mCRPC) and tumor HR gene alterations. PARP inhibitors have been investigated in first-line mCRPC in biomarker-selected and unselected populations, and are currently under study in earlier disease states in patients with DDR gene alterations. This chapter focuses on the current state of PARP inhibitor development in prostate cancer with particular emphasis on biomarkers and combination therapy approaches.

Chemical modifications on macromolecules such as DNA, RNA and proteins play important roles in almost all biological processes. The revival of RNA modification research began with the discovery of RNA modification machineries, and with the development of better techniques for characterizing and profiling these modifications at the transcriptome-wide level. Hematopoietic system is maintained by hematopoietic stem cells that possess efficient self-renewal capacity and the potential of differentiation into all lineages of blood cells, and the imbalance of this homeostasis frequently causes hematologic malignancies such as leukemia. Recent studies reveal that dysregulated RNA modifications play essential roles in hematologic malignancies. Herein, we summarize recent advances in some major RNA modifications, the detection methods, roles and mechanisms of these RNA modifications in hematologic malignancies.

Once reserved for locally advanced tumors which were deemed inoperable at presentation, preoperative systemic therapy (PST) is nowadays increasingly used to treat early breast cancer. PST allows for in vivo assessment of tumor response, for tailoring of adjuvant systemic therapy and for de-escalation of breast and the axillary surgery. Increased rates of pathological complete response together with more accurate response assessment and surgical planning have led to a significant reduction in surgical morbidity. While surgical assessment remains the standard of care, ongoing studies are evaluating whether surgery can be omitted in patients who achieve a complete pathological response. In this chapter, I will review the impact of PST on surgical de-escalation and the data supporting the safety of this approach.

The occurrence of gastric cancer has been associated with an increased risk of lobular breast tumors in a subset of patients harboring selected germline mutations. Among all, the germline alteration of the gene coding for E-Cadherin (CDH1) was associated with an increased risk of gastric cancer diffuse-histotype and lobular breast cancer. However, the risk assessment of breast neoplasms and the role of multiple prophylactic procedures in these patients has never been systematically addressed. In addition, the performance of the common screening procedures for lobular breast cancer like mammography is suboptimal. Therefore, recalling the need for a better articulation of the patient-centered strategies of surveillance for individuals with germline CDH1 and other similar alterations, to offer comprehensive approaches for prevention, early diagnosis, and treatment. Accordingly, this chapter aims to discuss the value and the role of integrated oncological care in the era of oncology sub-specializations. Additionally, it sheds light on how the harmonization across the health providers can enhance patient care in this setting.

Chemotherapy is a widely recognized form of cancer treatment that uses cytotoxic drugs to treat varieties of cancer. In general, these drugs intend to kill the cancer cell and stop the reproduction of cancer cells by which they can prevent further growth and spread. The goals of chemotherapy can be curative or palliative or adjunctive increasing the efficacy of other treatments such as radiotherapy. Combination chemotherapy is commonly prescribed than monotherapy. Most of the chemotherapy drugs are delivered either via the intravenous route or in an oral form. There is a variety of chemotherapeutic agents and most commonly they are divided into several categories including anthracycline antibiotics, antimetabolites, alkylating agents, and plant alkaloids. All chemotherapeutic agents have various side effects. The most common side effects are fatigue, nausea, vomiting, mucositis, hair loss, dry skin, skin rash, bowel changes, anemia, and increase risk of acquiring infection. However, these agents can also cause inflammation of the heart, lungs, liver, kidney, neurons, and disturbance of coagulation cascade.

Cancer with its high mortality rate is really hard to treat even in this era. Extensive research work is still required to overcome the threat caused by the disease. Currently, the treatment modality is based on the combination therapy, and diagnostics is dependent upon biopsy results. Once the stage of cancer is clear, the treatment is prescribed. To bring a successful treatment approach of patients with osteosarcoma, it requires multidisciplinary team approach including pediatric, medical and surgical oncologist, surgeons, pathologists, pain management, orthopedic oncologist, endocrinologist, and radiologists. Therefore, cancer treatment is to be performed in specialized hospitals able to provide access to all approaches with multidisciplinary team care.