Epidemiological characteristics of this adenocarcinoma type defined by a genetic trait include: This is another histomolecular feature that is providing a potential targeted therapy since these patients are exquisitely sensitive to ALK and MET inhibitor PF Wide genomic gene expression profiling has shown an exquisite fit between histological subclassification as newly proposed and gene expression clusters and pathways: Validation has been performed on external platforms of the prognostic value of the three clusters unpublished studies; Y.
Recently, the molecular landscape of lung adenocarcinoma has been reshaped by high throughput analysis of DNA mutations DNA sequencing of known cancer-related genes in adenocarcinoma allowed the description of 1, somatic mutations, of which have biological relevance. Oncogenes characterised by activating mutations were enlighted, in addition to known EGFR and Ras mutations: Gene copy number alterations have been fully examined by SNP arrays and correlate with signalling pathway A number of mutations and gene copy number alterations target key functional pathways containing both oncogene and tumour suppressor genes.
Gene expression profiling now shows a direct relationship of adenocarcinoma heterogeneity with different expression of cancer-related pathways. Gene clustering and pathways mostly recapitulate adenocarcinoma histological patterns and subtypes They may better predict clinical outcome and pathway deregulation signature than pathologic pattern itself and will also allow prediction of sensitivity to therapeutic agents targeting their components 29 — It has recently appeared that the epigenetic landscape of cancer cells is profoundly distorted.
Epigenetic modifications are defined as mechanisms of gene expression regulation which do not change the primary DNA sequence. Furthermore, it is now apparent that epigenetic modifications contribute to lung tumour formation. This involves both global genomic hypomethylation, leading to chromosomal instability, and regional hypermethylation of DNA at promoter regions of tumour suppressor genes By this last mechanism of silencing, the expression of tumour suppressor genes in the cancer cell can be reduced or eliminated as an alternative mechanism to genetic mutation and allelic loss.
They are recognised as dynamic regulators of gene activity that undergo many post-translational chemical modifications on specific amino-acid residues of core histone tails, including acetylation, methylation, phosphorylation, ubiquitinilation and sumoylation In this regard, histone covalent modification influences a multitude of cellular process like development, cell differentiation, response to environmental signals, and tumourigenesis.
Histone H4 is one of the nucleosomal core histones in which acetylation and methylation at specific lysine in the N terminal tails affect higher order chromatin structure, transcriptional regulation and DNA repair. We have shown their role in the prognosis of small T1N0 adenocarcinoma and early events in squamous cell carcinoma RNA-mediated gene silencing involving microRNA is a promising diagnostic and therapeutic target in lung cancer. MicroRNAs are small noncoding RNAs, encoded in fragile genome sites, subjected to amplification, deletion or silencing by methylation.
There are two families of microRNA concerning tumourigenesis: In , the first identification of the connection between microRNA expression and genes responsible for pulmonary carcinogenesis was provided An inverse relationship was found between the microRNA let-7 and activation of Ras protein: Furthermore, Yanaihara et al. The microRNA profile in lung cancer is found to be completely specific of normal versus tumours and of lung cancer versus any other cancer.
Since microRNA circulates intact in the serum, these are promising early detection markers and prognostic tools. The new multidisciplinary classification of adenocarcinoma will provide clinical significance to the histologic subtyping and is correlated with prognosis and molecular signalling pathways. High throughput analysis of genomic and epigenomic alteration will include, in the next year, a full description of DNA methylation changes, discovery of a new generation of genes epigenetically deregulated responsible for drug resistance, and potential targets for therapy.
Genome-wide promoter epigenetic methylation and histone modification, and microRNA expression profiles of well-defined histological types of lung cancer are promising in identification of genetic and epigenetic alterations that account for carcinogenesis, primary and secondary resistant to targeted treatment. A statement of interest for E. Brambilla can be found at www. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
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Skip to main content. European Respiratory Journal View inline View popup. Abstract Purpose Multidisciplinary cancer conferences mcc s are designed to optimize patient outcomes. Methods Ovid medline was searched from to June using these keywords: Results The keywords retrieved abstracts, and 30 manuscripts were obtained. Conclusions Available evidence supports the belief that mcc s significantly influence clinical decision-making and treatment recommendations. Multidisciplinary clinical conferences, tumour boards, clinical decision-making, patient outcomes, cancer management.
The search was carried out by the authors with the help of an expert librarian from our institution who specializes in literature searches. National Center for Biotechnology Information , U. A useful marker panel for distinguishing small cell carcinoma of lung from poorly differentiated squamous cell carcinoma of lung. Our results show that most studies evaluating mcc s considered the topic of clinical decision-making. Multidisciplinary teams in cancer care: If you are a seller for this product, would you like to suggest updates through seller support?
METHODS The literature was searched for evidence about the impact of mcc s on clinical decision-making, patient management, and overall outcomes. Head-and-Neck Cancers Two of the retrospective studies evaluated mcc s in head-and-neck cancer. Gynecologic Cancers The literature search found five studies in the area of gynecologic cancers. Reference Study design Pts n Conclusions Junor et al. Case discussions at the conference uncovered discrepancies in 32 cases 6. Gatcliffe and Coleman, 9 Prospective Presentation at tumour boards led to treatment alterations in 53 cases.
Of those alterations, 13 were major and led to changes in patient care. Open in a separate window. Genitourinary Cancers Two of the located studies evaluated mcc s in genitourinary malignancies. Gastrointestinal Cancers The search found six studies involving patients with gastrointestinal malignancies. The main reason was patient comorbidities Reasons for not implementing recommendations were related to patient factors not accounted for for example, comorbidity, patient choice.
Breast Cancers Three retrospective studies in the area of breast cancer have assessed the impact of mcc s. Lung Cancers Four studies, including one systematic review, have evaluated mcc s in lung cancer. Brain Cancers Only one retrospective study has looked at the impact of mcc s on patients with brain tumours.
Miscellaneous Cancers Two retrospective studies assessing the value of tumour board conference recommendations with respect to various cancer sites have been published. Multidisciplinary teams in cancer care: Multidisciplinary Cancer Conference Standards in Review. Cancer Care Ontario; Impact of tumor board recommendations on treatment outcome for locally advanced head and neck cancer.
Management of ovarian cancer: Slide review in gynecologic oncology ensures completeness of reporting and diagnostic accuracy.
Tumor board in gynecologic oncology. Int J Gynecol Cancer. The multidisciplinary tumor conference in gynecologic oncology—does it alter management? Improving outcomes in urological cancers: The central urology multidisciplinary team—is it time to change the referral criteria?
An audit of practice in a district general hospital in London. Ann R Coll Surg Engl. Analysis of clinical decision-making in multidisciplinary cancer teams. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Adjuvant chemotherapy in elderly patients with colorectal cancer.
A retrospective analysis of the implementation of tumor board recommendations in a single institution.
Crit Rev Oncol Hematol. The impact of a multidisciplinary breast cancer center on recommendations for patient management: Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer. Decision making in a multidisciplinary cancer team: Systematic review of multidisciplinary teams in the management of lung cancer.
The brain tumor board: A new mechanism for physician participation in a tumor board. Prog Clin Biol Res. Effect of a multidisciplinary amyotrophic lateral sclerosis als clinic on als survival: J Neurol Neurosurg Psychiatry. Survival of Cancer Patients in Europe. Griffith C, Turner J. Eur J Surg Oncol. Are increasing 5-year survival rates evidence of success against cancer? Online tumor conference in the clinical management of gynecological cancer: Articles from Current Oncology are provided here courtesy of Multimed Inc. Support Center Support Center. Please review our privacy policy.
Slide review led to a change in patient management in 29 cases 8. Weekly tumour conference added clinical information, altered the final diagnosis, and affected patient care. Gatcliffe and Coleman, 9. Presentation at tumour boards led to treatment alterations in 53 cases. You must have JavaScript enabled in your browser to utilize the functionality of this website. Proudly serving the health care and helping professions.
Close Recently added item s. Journals eBooks Publish with Us. Over the course of the last decade, the treatment of lung cancer has evolved quite rapidly. New scientific and clinical advances have modified the standard of care and led to improved patient outcomes. At the same time, the treatment of lung cancer has become increasingly complex, requiring the comprehensive review and assessment of multiple issues, genetics, radiology, surgery, reconstruction, chemotherapy, and more.
As a result the harmony and open communication between these specialties facilitated by a multidisciplinary team approach are crucial in providing the best care to patients and ensuring successful treatment. A Multidisciplinary Approach to Diagnosis and Management , written by a multidisciplinary team of authors representing a range of disciplines, is a valuable resource for physicians, fellows, nurses, physician assistants, physical therapists, and all health care providers involved in the treatment of lung cancer.
A Multidisciplinary Approach to Diagnosis and Management summarizes the state-of-the-art issues related to the treatment of lung cancer and describes an approach for optimal multidisciplinary care for individuals who have been diagnosed with lung cancer or who are at higher risk to develop lung cancer. Thomas consolidates and integrates the varied aspects of multidisciplinary care for major topics in oncology, including breast, lung, prostrate, head and neck and more.
The volumes in the Current Multidisciplinary Oncology series will represent all related topic areas, including oncology, radiation oncology, pain, pathology, imaging, psychological support and the primary disease. In addition each volume has a chapter written by a private practice oncologist. Erban MD Charles R. Zaorsky MD Edouard J. Trabulsi MD Charles R. Springer Publishing Company Proudly serving the health care and helping professions.
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