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Tag: Melanoma

Rethinking Cancer Guidelines

Universal treatment standards will be the basis of future medical care.  In oncology, a leading organization for the development of such guidelines is the National Comprehensive Cancer Network (NCCN).  This national consortium of 21 National Cancer Institute designated cancer centers publishes state of the art recommendations.  Modified continuously, these are internationally respected guidelines and cover more then 97% of cancers.

The 17th Annual NCCN Conference was held in Hollywood, Florida last month. Cancer guidelines were updated in several significant ways.

The general movement of the last 20 years has been to reduce the amount of surgery for breast cancer. The NCCN recommends that during breast saving surgery (lumpectomy) the surgeon test the first lymph node (“sentinel”).  If there is no cancer in the first one or two nodes, then no more nodes need to be removed.  The NCCN also stated, that if breast cancer patients have small cancers and normal blood tests, they do not need a bone scan, or CT scan.

In lung cancer patients, several procedures received new support.  It is recommended that doctors use ultrasound-guided biopsy to sample lymph nodes in the middle of the chest (mediastinum) instead of surgery.  The new guidelines also support the use of non-invasive surgery (Video Assisted Thorascopic Surgery, VATS) instead of open surgery to treat lung cancer.  The use of VATS for lung cancer has increased more than 300% in recent years.  The pathologic name for an increasingly common form of lung cancer was changed.  Formally, called “bronchioalveolar”, it will now be called “adenocarcinoma in situ.”   Finally, the NCCN emphasized the need for accurate genetic testing for  “ALK”, before using the drug that targets this mutation, crizotinib.

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Using An App to Confront Your Metastatic Melanoma

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If you or anyone else you know has had a malignant melanoma, you and that other person, and your respective physicians, should click http://therapy.collabrx.com to access the Targeted Therapy Finder–Melanoma (ttf-melanoma). It is free and does not require registration.

Collabrx of Palo Alto has developed this first of its kind application (app) under the leadership of noted internet entrepreneur and melanoma survivor Marty Tenenbaum.

The app is based upon the science of the original Melanoma Molecular Disease Model (MMDM) in Cancer Commons built by David Fisher and Keith Flaherty of Harvard Medical School and Smruti Vidwans and colleagues on our staff.

Over decades, medicine has developed a comprehensive approach to diagnosing, grading, and staging malignant melanoma and many physicians follow that knowledge to deliver treatment at the “standard of care”. Thus, of the 70 000 melanomas diagnosed in the USA each year, approximately 90% are cured, mostly by surgery. The problem comes with those 7000 per year that progress “beyond standard of care”. Most of these patients have metastases to organs far from the site of the primary melanoma and its related lymph nodes. This clinical circumstance has long been considered hopeless for most patients, since no therapy has been consistently successful.

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