Small clinical trials with Avastin had previously already shown encouraging results in women with ovarian or peritoneal cancer recurring. This international clinical trial has focused on 1,873 women recently diagnosed with advanced cancer (stage 3 and 4) ovarian, peritoneal and tubes fallopiens who underwent surgery to remove the largest possible part of the tumor. These patients were divided into three groups. In the first, women were treated with standard chemotherapy (paclitaxel combined with carboplatin) plus placebo. In the second, she received the same chemotherapy over Avastin. In the third group, patients were also treated with chemotherapy plus Avastin but with the one followed by ten months with Avastin alone. The latter group had a survival of 14 months (median) compared with 10 months for those who have had chemotherapy, a statistically significant difference, say the authors of the research. Ovarian cancer is the sixth largest in the world order of frequency among the gynecological cancers and affects 230,000 women each year, nearly 140,000 die. This is the eighth cause of cancer deaths among women.

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It is a malignant tumor developed at the expense either of liver cells (hepatocellular carcinoma) or bile duct cells (cholangiocarcinoma) or blood vessels (angiosarcoma).

The primary liver cancer was rare in Europe and America, but its frequency is increasing rapidly (5000 cases per year in France) because of the hepatitis C epidemic and is more common in Africa and Asia.

- Hepatocellular carcinoma, or hepatocellular carcinoma (HCC) is the most common liver tumors, and it occurs in 20% of a healthy liver, liver more frequently diagnosed with a pre-existing liver disease (cirrhosis, chronic hepatitis) . Unlike Europe, where alcoholic cirrhosis is the main cause of this type of tumor, in the countries of Africa and Asia, HCC is often linked to hepatitis B and C, sometimes to the pollution of food, including aflatoxin.

- Cholangiocarcinoma, much rarer, is especially common in Southeast Asia, where it criminalizes the role of certain parasites.

- The angiosarcoma, the rarest of all primary tumors of the liver, is sometimes linked to chronic poisoning (vinyl chloride, arsenic).

SYMPTOMS AND SIGNS

Hepatocellular carcinoma results in a large liver detectable by palpation and by a pseudo-infectious fever. It causes mild pain, localized in the upper abdomen, which is often the first symptom of the disease. It may also result in the aggravation of cirrhosis is already known and more often discovered during routine surveillance of this disease.

DIAGNOSIS AND EVOLUTION

The diagnosis is based on ultrasound, CT scan and ultrasound-guided liver biopsy.

The detection of alpha-feto-protein in the blood diagnosis says: this protein, absent from the serum of healthy adults or patients with other liver diseases, is present in two out of three patients with HCC

The risk of metastases, mainly lung and bone, is important.

TREATMENT

It involves the surgical removal of the tumor whenever possible, by partial hepatectomy. Exceptionally, a liver transplant can be considered. In ways not covered by surgery, treatment involves general or local chemotherapy (injecting the product directly into the tumor through a catheter into the hepatic artery) or tumor destruction by alcohol (local injection alcohol) or heat (radiofrequency).

PREVENTION AND PROGNOSIS

The prevention of primary tumors of the liver based on the fight against alcoholism in the early vaccination against hepatitis B, treatment of chronic hepatitis B and C and the eviction of infected blood donors. Early diagnosis of hepatocellular carcinoma occurring in a cirrhotic disease should lead to improved prognosis, which is currently severe.

Secondary liver cancer

It is the most common cancer of the liver in temperate countries, it may declare at any other cancer, but it is more common in cancers of the digestive system (colon, stomach, pancreas, bile ducts) and in gynecologic cancers (uterine, breast). A secondary liver cancer is called synchronous when discovered at the same time as the primary cancer, metachronous if diagnosed after treatment of primary cancer.

SYMPTOMS AND SIGNS

The secondary liver cancer can result in impaired general condition or jaundice. Clinical examination may reveal an enlarged liver palpated nodule (“liver brown”), painful or not.

DIAGNOSIS AND TREATMENT

The diagnosis is based on ultrasound, CT scan and biopsy, necessary to confirm the liver.

The treatment is surgical, if possible (removal of the tumor). In the diffuse forms, we use the local or systemic chemotherapy (injection of a catheter into the hepatic artery).

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Overall survival at 1 year of diagnosis is made very low (12%) and even survival at 5 years (0,4-4%), the lowest of all cancers.

Early symptoms of pancreatic cancer are usually nonspecific and are therefore often ignored by the patient and physician. Among these early nonspecific symptoms include: bloating, malaise, diarrhea, vomiting and constipation.

As the disease progresses and is already at an advanced stage the patient presents to the doctor with a painless jaundice and a history of weight loss.

The prevalence of symptoms varies according to location (head, body or tail of the pancreas) and size of the tumor growing within the pancreatic mass.

When the presence of jaundice is associated with a tumor that sits in the body or tail of the pancreas invariably coincides with a clinical presentation very late, which makes the chances of being able to remove the tumor are minimal due to the almost certain existence metastases in the liver and regional lymph nodes.

Surgical removal of the tumor and the organ that sits (whether partial or total) is the treatment that offers the greatest chance of cure, although more than 80% of patients present the physician in an evolutionary phase in which the cancerous disease is already well advanced or unresectable, which explains the very low percentage of cases in which it is possible to remove the tumor, ie the tumor is “unresectable” and, consequently, the disappointing survival rates of this malignancy.

The key to increasing the percentages of cases in which possible removal of the tumor and part of the body where it settles (pancreatoduodenectomy) or the entire pancreas (total pancreatectomy radical) lies therefore in an early diagnosis.

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Treatment depends on the size and type of tumor, the initial site and the person’s general health. The goals of treatment may relieve symptoms, as well as improve performance and welfare. Often used whole-brain radiation to treat tumors that have spread to this organ, especially if more than one tumor.

You can use the surgery for metastatic brain tumors when a single lesion and when there is no cancer elsewhere in the body. Some tumors can be removed completely. In other cases, when tumors are deep or that infiltrate brain tissue, it can carry out surgical Debulking (removal of much of the mass that makes up the tumor to reduce its size). Surgery may reduce pressure and relieve symptoms in cases where no one can remove the tumor. Chemotherapy for brain metastases is not as helpful as surgery or radiation for many types of cancer.

Drugs for some symptoms of brain tumor may include the following:

• Corticosteroids such as dexamethasone to reduce brain swelling
• Osmotic diuretics such as urea or mannitol to reduce brain swelling
• Anticonvulsants such as phenytoin to reduce seizures
• Analgesics
• Antacids or antihistamines to control stress ulcers

When you find multiple metastases (widespread cancer), treatment may focus primarily on relieving pain and other symptoms. Welfare measures and safety, physiotherapy, occupational therapy and other interventions can improve quality of life for patients. Legal advice may help establish advance directives, such as a power of attorney, in cases which are likely to be intellectual or physical deterioration continued.

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An examination reveals neurologic changes that are specific to the location of the tumor. Are also common signs of increased intracranial pressure. Some tumors may not show symptoms until they are large, then suddenly cause rapid deterioration of neurological functioning of the person. The original tumor (primary) and can be known or be discovered after an examination of tumor tissue in the brain indicates it is a metastatic type.

• A CT scan or MRI of the head can confirm the diagnosis of brain tumor and identify its location. MRI is usually more sensitive for finding tumors in the brain.
• Cerebral Angiography may be done occasionally. Doing so may show a mass that occupies space, which may or may not be highly vascular (filled with blood vessels).
• Make an X-ray, mammography and computed tomography of chest, abdomen and pelvis, as well as other tests to find the original tumor site.
• An EEG may reveal abnormalities.
• An examination of tumor tissue removed during surgery or CT-guided biopsy is used to confirm the exact type of tumor. If you can locate the primary tumor outside the brain, this tumor is that he and biopsied rather than the brain tumor.
• Sometimes also performed a lumbar puncture (spinal tap) to examine the cerebrospinal fluid.

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The presence of the above symptoms may lead a physician to suspect brain cancer. A CT scan or magnetic resonance imaging (MRI) are the first examinations to be performed to properly diagnose a brain cancer, whatever the type. These specialized radiological examinations can detect many types of brain tumors and determine their location and size accurately. However, they do not determine whether the tumor is cancerous or not.

We must perform a biopsy to determine if the tumor is cancerous. For this, we take a sample of the tumor during surgery. If the tumor is too deep in the brain, surgeons can use a technique called Stereotactic biopsy or establishment of the needle through three-dimensional approach. This technique uses an MRI to create a three dimensional image of the brain that are then used to guide a needle contained in a special case to the appropriate region of the brain. It sucks and is collected tumor cells in the needle for analysis. Once collected, we analyze the biopsy sample using microscopes and special chemicals to determine the type of tumor. It usually takes several days before obtaining the results of a biopsy.

We may sometimes collect cells of brain tumors in Cerebrospinal fluid (CSF), a special fluid that surrounds the brain and spinal cord. CSF samples are taken using a thin needle that is inserted in the lower back under local anesthesia, this procedure is called a lumbar puncture. We can do this procedure when too much pressure accumulates in the brain. Indeed, the pressure change resulting from the brain drain may cause aspiration of part of the brain tissue at the base of the skull, causing serious complications.

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