| Ans |
B cell lymphoma falls into a different category from T cell lymphoma. They are entirely different cell types. It is believed that T cell lymphoma fare worse than B cell lymphoma.
In the category of B cell lymphoma, they may be indolent, aggressive or highly aggressive. The treatment will vary with the different groups.
Generally, aggressive and very aggressive lymphoma will need chemotherapy and even additional immunotherapy for treatment.
Indolent early stage lymphoma can be treated with radiation therapy alone.
Dr Toh Han Chong
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| Qn 2 |
How accurate is the PET Scan to detect local and distant recurrence/ satellite lesions of colorectal cancer after the primary lesion has been removed?
Can this be used as a follow-up tool to detect recurrences/ inadequate resection?
How often should it be performed for follow-up purposes?
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| Ans |
PET is a useful tool for detection of recurrence, although the background metabolic activity of liver may mask small FDG-avid hepatic lesions. It has also missed subcentimeter lesions elsewhere.
As a tool for mass screening, PET cannot be recommended as a standard of care. Cost effectiveness study is not likely to show significant improvement in survival. This is because realistically, vast majority of recurrences are not curable even when detected early.
However, selected patients may prefer more intensive surveillance programme in the hope that they will pick up resectable solitary hepatic or pulmonary metastases. For such purposes, CEA measurement and CT-scans should be able to do the same at much lower cost.
In our centre, PET scan is used in patients who have seemingly resectable solitary metastasis. The objective is to exclude occult metastases which will rule out resection.
Dr Koo Wen Hsin
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| Qn 3 |
For a patient with multi-focal primary hepatocellular carcinoma, what is the value of TACE (benefits and risk)? How should I advise the patient? This patient has Child's C liver cirrhosis and COPD.
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| Ans |
Multifocal hepatoma is currently not treatable. The aim of any form of therapy is to prolong life or reduce symptoms. TACE is useful in multifocal HCC only if the lesions can be effectively tackled, so size and number of lesions become important considerations. Also if there is portal vein thrombosis, TACE is contraindicated. In patients with Child C disease, there is a real danger of liver decompensation with TACE and this should be considered in the options. If TACE is deemed not feasible, alternative methods like megesterol therapy have been reported in small series to prolong survival.
Dr London Lucien Ooi
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| Qn 4 |
I'd like to know the recent advances in management of renal cell
carcinoma after redical nephrectomy.
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| Ans |
In localised kidney cancer, radical nephrectomy is the most important. Following surgery, no role for adjuvant treatment (including immunotherapy, chemotherapy or radiotherapy).
In recurrence disease, if localised, there maybe a role for resection of the metastatic lesion.
In recurrence disease, if disseminated, and of clear cell histology, targeted therapy with sorafenib or sunitinib should be the most effective in control of disease; otherwise, immunotherapy is acceptable.
For non-clear cell histology, no consensus on how to manage as above mentioned treatment is not likely to be effective. Clinical trial enrollment is the best option.
Dr Tay Miah Hiang
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| Qn5 |
In Transitional cell carcinoma of Bladder, if the tumor mass can't
remove and there is secondary in liver, what is your treatment
options?
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| Ans |
The patient has stage 4 bladder carcinoma and I presume the histology is transitional cell subtype.
The above condition is a chemosensitive condition. If the renal function is adequate, I will prefer to give gemcitabine 1000 mg /m2 (Day 1 and Day 8) and cisplatin 70 mg/m2 (Day 1 only) of 21-days cycle. If the renal function is compromised, replacing cisplatin with carboplatin is acceptable. The other option is paclitaxel or docetaxel in combination with cisplatin or carboplatin.
The older regimen of MVAC is too toxic.
Dr Tay Miah Hiang
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