In the EMC, choosing a drug for cancer treatment based on a genetic analysis of the tumor has become the norm. All types of molecular genetic tests are performed in the laboratory that can predict the effectiveness of therapy, help the doctor choose the drug necessary for a given patient and, by prescribing "targeted" (targeted) treatment, cure the patient, or, if the disease is already at a late stage, increase his life expectancy.
Cancer is often referred to as a "genome disease", thereby emphasizing that this disease is based on various genetic "breakdowns" of cells. Unfortunately, anyone can get cancer, and the genetic defects in the tumor will vary from person to person. This means that for successful cancer treatment, it is necessary to conduct a genetic analysis of cancer cells, as it is commonly said today, to study the molecular "portrait" of the tumor, since the personification of cancer treatment can significantly increase the effectiveness of the fight against this disease.
At the European Medical Center, choosing a drug for cancer treatment based on a genetic analysis of the tumor has become the norm. All types of molecular genetic tests are performed in the laboratory that can predict the effectiveness of therapy, help the doctor choose the drug necessary for a given patient and, by prescribing "targeted" (targeted) treatment, cure the patient, or, if the disease is already at a late stage, increase his life expectancy.
Targeted treatment differs favorably from chemotherapy in that it practically does not damage healthy cells and tissues of the body, affecting only a given "pathological" gene. This type of treatment is also very convenient because medications can be taken at home, as these medications are often available in tablet form.
For example, for the treatment of breast cancer, it is necessary to know whether sex hormone receptors are present in the tumor (analysis for the expression of estrogen and progesterone receptors). If the receptors are detected, the patient needs hormone therapy. In addition, a special HER2 receptor is detected in the tumor, which makes breast cancer sensitive to the drug herceptin, and such patients must necessarily be treated with this medication.
For the treatment of lung cancer, it is necessary to examine the tumor in our laboratory for EGFR, ALK receptors. These are small molecules that deliver intracellular signals that cause tumor cells to divide and grow rapidly. To block these receptors, we can use a whole arsenal of new drugs – afatinib, cetuximab, erlotinib, crizotinib, pemetrexed.
For the successful treatment of other types of tumors, such as intestinal cancer, head and neck tumors, stomach cancer, and melanoma, pathomorphologists at the EMC Histological Laboratory will also compile a molecular "portrait" of the tumor, which will help clinicians choose the only correct type of treatment for this patient.
Thus, the EMC implements an individual approach to treatment, which increases its effectiveness. The molecular portrait of a tumor in each patient is its own unique set of genes and their mutations.
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Questions and answers
Lump in my breast
I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I
do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?
...more The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we
recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.
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Benign disease
I have a benign lump in one breast size of 12.0*9.9 mm. Puncture or a biopsy will be done next week. I was told by mammologist that surgery is needed. As far as I know, concerning the surgery, axillary lymph nodes are to be removed together with the tumor. I also know that in Europe lymph nodes are testes for
specific markers and only affected ones should be removed; if lymph nodes are no affected, they are not to be dissected and the surgery is minimally invasive. So what is your approach? Does it make sense to do it or you have the same methods and the same equipment?
...more If histological examination of the sample reveals fibroadenoma of basic type or tissue hyperplasia without atypia, or nodular type fibrocystic condition of the breast tissue, the question of surgical treatment should not arise. If biopsy reveals giant fibroadenoma sectoral resection is indicated, i.e. mass excision
within the healthy tissues and lymph nodes will be removed. In case of non- benign histological result, i.e. carcinoma is detected, subsequent immunohistochemical examination is required as well as a clinical oncologist and surgeon consultation; and the decision on complex treatment will be taken by case management team. With regard to the diagnosis and treatment methods in our center, each case is addressed individually. Sometimes we remove a benign area (for example, the area of hyperplasia with atypia) using the vacuum-needle technique through 3-4 mm incision. As for the surgical procedure protocols for benign breast tumors, benign simple fibroadenoma is not removed in America, Europe, Israel, etc. I would like to discuss your case with you in more details and perform some additional tests if needed, so I would be glad to see you at EMC’s Breast center.
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Melanoma
My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is
it possible to make re-excision and subsequent histology in your hospital? If so, how soon?
...more We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to
this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel.
You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!
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A spot on the back and chest
I have a spot on the back and chest, what could it be?
A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will
examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.
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Batkaeva Nadezhda
07 September 2016
Uterine cancer
My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed.
Is it really so that this surgery is only possible for young and relatively healthy persons?
...more It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible,
but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment
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Vladimir Nosov
07 September 2016
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