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Old 03-05-2008, 10:51 AM
Dross Dross is offline
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Default Kidney Cancer Surgery Often Determined By Surgeon's Abilities

A new study reveals that the type of surgery a patient with kidney cancer receives depends more on the surgeon's preference than on the patient's tumor size, demographic characteristics, or general medical health. The findings indicate that patients with kidney cancer often may not be receiving the most appropriate surgical care. The study is published in the April 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

Open radical nephrectomy is the standard surgical treatment for patients with localized kidney cancer, but partial nephrectomy and laparoscopic surgery have emerged as attractive alternatives that are less invasive but equally effective. However, many physicians have not adopted these surgical techniques despite their benefits.

To investigate the potential barriers to adoption of partial nephrectomy and renal laparoscopy, David Miller, MD of the University of California Los Angeles and colleagues reviewed data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program and the Centers for Medicare and Medicaid Services (CMS). They identified 5,483 Medicare beneficiaries diagnosed between 1997 and 2002 with localized kidney cancer, determined the type of surgery received by each patient, and identified the primary surgeon for each case.

The researchers assessed the use of radical nephrectomy, partial nephrectomy, and laparoscopy among these patients, noting surgeon- and patient-based factors that may have contributed to decisions about which type of surgery was used. A total of 611 patients underwent partial nephrectomies and 4,872 underwent radical nephrectomies, 515 of which were performed laparoscopically. After taking into consideration factors including patient demographics, comorbidity, tumor size, and volume of surgeries done by each surgeon, there was considerable variation among surgeons in the type of surgery they performed, an 18.1% variance for partial nephrectomy and a 37.4% variance for laparoscopy. Factors based on surgeons practice style contributed more to these variances than did patient characteristics.

The authors concluded that for many older patients with kidney cancer, the surgery provided may depend more on their surgeon's practice style than on the characteristics of the patient and his or her disease.¯ They added that the timely dismantling of residual barriers to surgeons adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care provided to patients with kidney cancer.

Article: Diffusion of Surgical Innovation Among Patients With Kidney Cancer. David C. Miller, Christopher S. Saigal, Mousumi Banerjee, Jan Hanley, Mark S. Litwin, and the Urologic Diseases in America project. CANCER; Published Online: March 10, 2008 (DOI: 10.1002/cncr.23372); Print Issue Date: April 15, 2008.

According to Dr. David Y.T. Chen, attending surgeon at Fox Chase Cancer Center, being seen and evaluated by a urologist/urologic oncologist is typically the initial step to kidney cancer treatment, and consultation with other cancer specialists, such as medical oncologists or radiation oncologists, is commonly not needed or of benefit, in the majority of cases when only the kidney is involved.

Since surgical removal of kidney cancer is recognized as the most effective treatment, —complete surgical removal of kidney cancer results in roughly a 90-95% cure rate— once a suspected kidney cancer is identified, the next step should be to see a surgeon.

Since most kidney cancers today are found as early stage tumors, as long as the kidney cancer can be surgically removed, other cancer treatments such as chemotherapy or radiation treatment are not applied.

Since surgery is usually the critical component of successful kidney cancer treatment, being seen and cared for by a urologic oncologist and at an experienced cancer center can often optimize the outcome of kidney cancer surgery.

Especially today, as there are several different options for kidney cancer surgery: open or minimally invasive surgery; total kidney removal (radical nephrectomy) or partial kidney removal (partial nephrectomy); laparoscopic or robotic-assisted surgery—these different choices can be appropriately discussed and reviewed with a patient by an experienced urologic oncologist.

Last edited by gdpawel : 03-25-2013 at 11:50 AM. Reason: additional info
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Old 02-19-2011, 10:27 AM
gdpawel gdpawel is offline
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Default Surgical Specimen Is the Personalized Part of Personalized Cancer Medicine

In this dawning era of molecular medicine, surgeons and pathologists are playing a more pivotal role in cancer medicine. They are the custodians of the specimens and therefore the molecules that represent the personalized part of personalized cancer medicine. Surgeons will continue to cure cancer with greater success rates through earlier detection and excision, but as the custodiams of the tissue, they will also be central to improving cancer management through molecularly targeted interventions.

Ann Surg Oncol. 2009 August; 16(8): 2079–2080.
Published online 2009 May 27. doi: 10.1245/s10434-009-0526-1. PMCID: PMC2711907

© Society of Surgical Oncology 2009

The Surgical Specimen Is the Personalized Part of Personalized Cancer Medicine

Carolyn C. Compton, MD, PhD

Office of Biorepositories and Biospecimen Research, National Cancer Institute, Bethesda, MD USA
Carolyn C. Compton, Email: [email][/email]

Received March 15, 2009

As a pathologist, I have been evaluating cancer resection specimens throughout my career and have come to have a deep appreciation of the challenges of surgical oncology. Happily for patients, surgeons cure cancer on a fairly regular basis by excising it with expert technique and detailed knowledge of human anatomy and tumor biology. The tissue resected by the surgeon and analyzed by the pathologist is the source of crucial information that, in turn, informs the decisions and actions of our medical oncology colleagues.

As cancer medicine looks forward to a new era of molecularly defined cancer subtypes and targeted therapies, however, the role of both surgeon and pathologist is evolving to require an ever greater degree of professional attention towards the surgical resection specimen. It is the surgically resected tissue that possesses the molecular information needed to define the specific molecular characteristics of the patient’s tumor, the specific therapies to which the tumor would be expected to respond, and even the specific risks of adverse reactions to given therapies predicted by the patient’s genetic make-up. This molecular information forms the basis of the “personalized” approaches envisioned for cancer patients in an age of molecular medicine. The professional responsibility to assure that the specimen’s molecular composition and integrity are safeguarded is shared by both the surgeon and the pathologist. Current momentum towards molecular medicine is rapidly elevating this professional responsibility to one of the most important aspects of cancer patient care.

Currently, however, safeguarding the molecular integrity or documenting surgical variables that impact the molecular composition of the resection specimen is not widely considered to be primary aspects of the surgeon’s professional responsibility. Manipulations of the tissue within the surgical procedure itself may have dramatic effects on the molecular make-up of that tissue. However, these manipulations are neither recorded nor controlled when and where possible. Variables such as anesthesia type and duration, drugs administered preoperatively and intraoperatively, and devascularization/ischemia time for the resected tissue may dramatically alter molecular profiles and/or molecular integrity. Once successfully resected, the specimen may spend varying amounts of time at room temperature in the surgical suite and/or holding unit before being delivered to Pathology, which may further alter the molecular composition and quality of the tissue.

Without the surgeon’s extension of professional responsibility to the resected tissue to control, when feasible, and track such variables, the advantages of personalized adjuvant approaches may be lost to the patient. In molecular medicine, the resected tissue becomes the major determinant of all downstream therapy. Therefore, the care of the specimen must be addressed co-equally with the care of the patient. This elevated bar for ensuring tissue integrity and molecular quality also must be addressed by pathologists. The fresh specimen will need to be overseen by the pathologist with the same immediacy and professional attention. More than ever, surgeons and pathologists will be required to work together closely to achieve the goal of meeting the new standards of “specimen care” required for molecular analysis.

Our knowledge about the affects of iatrogenic variables such as surgical manipulation, intraoperative drug delivery, and pathological handling on the molecular profiles that reflect the biology in resected tissues is growing rapidly.1–5 Postoperative tissue ischemia time, for example, has been shown to alter gene and protein expression profiles within minutes following surgical excision in colectomy specimens and prostatectomy specimens.1–3 Not surprisingly, even before resection has been completed, intraoperative manipulations have been shown to markedly alter gene transcription levels during radical prostatectomies.4 The effects of different peri- and intraoperative variables on molecular profiles in different types of tissues are just beginning to be understood, but it is clear that surgeons and pathologists alike contribute significantly to the final molecular composition and integrity of the resected tissue.5

Procedures that maximize specimen quality respect the fact that resected tissues are vital and biologically reactive. Until they are fixed or frozen, biospecimens are viable and capable of reacting to physiological stress. They are a living part of the patient from which they come and are responsive to changes in temperature, perfusion, oxygenation, and other physiological and biochemical variables, both pre- and intraoperatively as well as postoperatively. Typically, once a tumor is successfully resected, the surgeon’s attention turns to patient and relatively little is directed towards the specimen. Unless an intraoperative consultation such as a frozen section is requested and the specimen is immediately addressed for this purpose, it may sit unattended for varying periods of time before being prepared for delivery to the pathology laboratory. The conditions of delivery itself may vary, as may the immediacy of the specimen handling once it has arrived in the pathology laboratory. Furthermore, some of the newer surgical techniques, such as robotically assisted prostate resections, may further compromise the quality of the resection specimen if it is allowed to remain in the operative site at body temperature for significant amounts of time after devascularization.

In this emerging age of molecular medicine, a new level of awareness of and attention to “the state of the specimen” will be required by surgeons, operating room staff, pathologists, and pathology staff. All play essential roles in the series of events leading up to stabilization of the tissue that impact its molecular make-up and molecular integrity. Surgeons are the initiators and controllers of many of these events and therefore represent the “gatekeepers.” The powerful molecular analysis technologies now at our disposal and the increasingly sensitive and specific analysis platforms under development provide us with unprecedented abilities to define the molecular features of cells and tissues. However, they also pose new risks by providing us with the ability to derive the wrong answer with even greater speed and accuracy unless the analytes are of high quality and are derived from high-quality specimens. It is our joint professional responsibility to follow procedures that will ensure the quality of the biospecimen and to document the specimen handling history for the patient’s record.

In this dawning era of molecular medicine, where a hard-won understanding of the molecular details of cancer is leading to more powerful and accurate diagnostics and therapeutics, I foresee surgeons and pathologists playing a new and more pivotal role in cancer medicine. They are the custodians of the specimens and therefore the molecules that represent the personalized part of personalized medicine. Surgeons will continue to cure cancer with greater success rates through earlier detection and excision; but as the custodians of the tissue, they will also be central to improving cancer management through molecularly targeted interventions.


1. Spruessel A, Steimenn G, Jung M, Lee SA, Carr T, Fentz A-K, et al. Tissue ischemia time affects gene and protein expression patterns within minutes following surgical excision. BioTechniques. 2004;30:1030–7.

2. Dash A, Maine IP, Varambally S, Shen R, Chinnaiyan AM, Rubin MA. Changes in differential gene expression because of warm ischemia time of radical prostatectomy specimens. Am J Pathol. 2002;161:1743–8.

3. Lin DW, Coleman IM, Hawley S, Huang CY, Dumpit R, Gifford D, et al. Influence of surgical manipulation on prostate gene expression: implications for molecular correlates of treatment effects and disease prognosis. J Clin Oncol. 2006;23:3763–70.

4. Schlomm T, Näkel E, Lübke A, Buness A, Chun FK-H, Steuber T, et al. Marked gene transcript level alterations occur early during radical protatectomy. Eur Urol. 2008;53:333–46.

5. Signoretti S, Bratslavsky G, Waldman FM, Reuter VE, Haaga J, Merino M, et al. Tissue-based research in kidney cancer: current challenges and future directions. Clin Cancer Res. 2008;14:3699–705.
Gregory D. Pawelski
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Old 02-19-2011, 10:28 AM
gdpawel gdpawel is offline
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Default Personalized Cancer Medicine Is Here, Now

As we enter the era of "personalized" medicine, it is time to take a fresh look at how we evaluate treatments for cancer patients. More emphasis is needed matching treatment to the patient. Patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.

Findings presented at the 41st Annual Meeting of the European Society for Clinical Investigation in Uppsala, Sweden and the Annual Meeting of the American Assoication for Cancer Research (AACR) in San Diego, CA concluded that "functional profiling" with cell-based assays is relevant for the study of both "conventional" and "targeted" anti-neoplastic drug agents (anti-tumor and anti-angiogenic activity) in primary cultures of "fresh" human tumors.

Cell-based Assays with "cell-death" endpoints can show disease-specific drug activity, are useful clinical and research tools for "conventional" and "targeted" drugs, and provide unique information complementary to that provided by "molecular" tests. There have been more than 25 peer-reviewed publications showing significant correlations between cell-death assay results and patient response and survival.

Many patients are treated not only with a "targeted" therapy drug like Tarceva, Avastin, or Iressa, but with a combination of chemotherapy drugs. Therefore, existing DNA or RNA sequences or expression of individual proteins often examine only one compenent of a much larger, interactive process. The oncologist might need to administer several chemotherapy drugs at varying doses because tumor cells express survival factors with a wide degree of individual cell variability.

There is a tactic of using biopsied cells to predict which cancer treatments will work best for the patient, by taking pieces of live "fresh" tumor tissue, applying different chemotherapy treatments to it, and examining the results to see which drug or combination of drugs does the best job killing the tumor cells. A cell-based assay test with "functional profiling," using a cell-death endpoint, can help see what treatments will not have the best opportunity of being successful (resistant) and identify drugs that have the best opportunity of being successful (sensitive).

Funtional profiling measures the response of the tumor cells to drug exposure. Following this exposure, they measure both cell metabolism and cell morphology. The integrated effect of the drugs on the whole cell, resulting in a cellular response to the drug, measuring the interaction of the entire genome. No matter which genes are being affected, functional profiling is measuring them through the surrogate of measuring if the cell is alive or dead.

For example, the epidermal growth factor receptor (EGFR) is a protein on the surface of a cell. EGFR-inhibiting drugs certainly do target specific genes, but even knowing what genes the drugs target doesn't tell you the whole story. Both Iressa and Tarceva target EGFR protein-tyrosine kinases. But all the EGFR mutation or amplificaton studies can tell us is whether or not the cells are potentially susceptible to this mechanism of attack. They don't tell you if Iressa is better or worse than Tarceva or other drugs which may target this. There are differences. The drugs have to get inside the cells in order to target anything. So, in different tumors, either Iressa or Tarceva might get in better or worse than the other. And the drugs may also be inactivated at different rates, also contributing to sensitivity versus resistance.

As an example of this testing, researchers have tested how well a pancreatic cancer patient can be treated successfully with a combination of drugs commonly used to fight lung, pancreatic, breast, and colorectal cancers. The pre-test can report prospectively to a physician specifically which chemotherapy agent would benefit a cancer patient. Drug sensitivity profiles differ significantly among cancer patients even when diagnosed with the same cancer.

The funtional profiling technique makes the statistically significant association between prospectively reported test results and patient survival. It can correlate test results that are obtained in the lab and reported to physicians prior to patient treatment, with significantly longer or shorter overall patient survival depending upon whether the drug was found to be effective or ineffective at killing the patient's tumor cells in the laboratory.

This could help solve the problem of knowing which patients can tolerate costly new treatments and their harmful side effects. These "smart" drugs are a really exciting element of cancer medicine, but do not work for everyone, and a pre-test to determine the efficacy of these drugs in a patient could be the first crucial step in personalizing treatment to the individual.

Literature Citation:

Functional profiling with cell culture-based assays for kinase and anti-angiogenic agents Eur J Clin Invest 37 (suppl. 1):60, 2007

Functional Profiling of Human Tumors in Primary Culture: A Platform for Drug Discovery and Therapy Selection (AACR: Apr 2008-AB-1546)
Gregory D. Pawelski
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Old 09-13-2011, 04:09 PM
gdpawel gdpawel is offline
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Default The Surgical Oncologist

Surgeons are trained not only in the evaluation and management of patients with malignancy, but in the evaluation and management of patients with benign disease as well. Many surgeons have a large number of patients in their practice with benign conditions (i.e. cysts). Many patients will never need an operation.

The role of the surgeon is to perform the workup, often an ultrasound and/or needle biopsy, and then determine if cancer is present or not. Once cancer is diagnosed, the surgeon will work with the medical oncologist and radiation oncologist as a team to decide in a multidisciplinary fashion what the best adjuvant treatment is, if needed.

For decades, any surgeon was considered competent to exercise all surgical skills, including cancer surgery. Indeed, while most surgeons may be acceptably competent, the specialty of surgical oncology is increasingly important. The surgical oncologist is most often the first specialist to see a patient before other oncologic specialists.

Surgical procedures for cancer are often complex and technically demanding. Studies have shown that patients have better outcomes, the lowest complications and death rates when they are treated by experienced surgical oncologists. In addition, cutting-edge techniques can often provide superior results over tried-and-true methods that have been around for many years.

Surgical oncologists are clinical scientists with knowledge of and experience in cancer surgery that come from additional training, limitation of the scope of general surgical practice, familiarity with the biology and natural history of cancers, and the role of the other oncologic specialties in their diagnosis and management.

Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.

Surgery is an integral part of the multimodality treatment of many cancers.

The line of reasoning frequently used to explain the value of surgery included five points.

First, surgery is thought to remove resistant clones of tumor cells and thus decrease the likelihood of the early onset of drug resistance.

Second, the removal of large masses likely to be associated with poorly vascularized areas of tumor improves the probability of delivering adequate drug doses to the remaining cancer cells.

Third, the higher growth fraction in better vascularized small masses enhanced the effect of chemotherapy.

Fourth, smaller masses required fewer cycles of chemotherapy and thus decreased the likelihood of drug resistance.

Fifth, removal of bulky disease enhances the immune system. Patients who present with a large mass are suffering because of that mass and they need that tumor out to relieve symptoms and to save life due to symptoms. It's important to deal with the bulk.

Mayo Clinic
American Board of Surgeons
Society of Surgical Oncology

Surgery is the "gold standard" against which other treatments are measured. There is no better way to eliminate a cancer than total removal.
Gregory D. Pawelski

Last edited by gdpawel : 02-21-2013 at 02:16 PM. Reason: additional info
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Old 07-24-2012, 04:34 PM
gdpawel gdpawel is offline
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Default Laboratory Oncology

Larry Weisenthal, M.D., PhD.
Medical and Laboratory Director
Weisenthal Cancer Group
Huntington Beach, California

The tumor holds the key to a patient's clinical outcome and survival. Each specimen must be individualized. Performing cell function analysis deserves the same degree of professional time and attention as major extirpative or debulking surgery or radiotherapy.

All sorts of specimens, from nice, sterile, viable sugar-cubed size pieces of tumor tissue from a sterile site to mucinous, contaminated low viability specimens from inside the colon lumen to several liters of bloody fluid to fried liver (from electrocautery biopsies of liver tumors) to small needle biopsies to bone marrow and blood specimens.

For solid tumors, testing is done with three-dimensional (3D) clusters (microclusters). It takes a lot of work to glean viable tumor cells and get a quantitative yield and separate tumor cells from normal and dead cells and get rid of mucin and what is called "brain matrix" from specimens of glioblastoma, and then to isolate the viable cell clusters from the discohesive, single cells and so on. Two specimens are seldom alike.

Not infrequently though, patients have a fairly major, invasive surgery primarily to get tumor for testing, so failure (an inevaluable assay) is not an option. Going after a surgical/biopsy specimen has a role in eliminating ineffective agents and avoid unnecessary toxicity and in directing "correct" therapy.

There would be a huge advantage to the patient to receive a "positive/sensitive" drug, compared to a "negative/resistant" drug. The time and energy required to conduct an excisional biopsy pales in comparison to the time, energy and lost opportunities associated with months of ineffective, toxic therapy.

Reliable, sensitive and specific cell-death endpoints are needed in a functional cytometric profiling assay. At least three different cell-death endpoints are used for every specimen (of the five that are immediately at disposal). You've got to make sure that the signal that is being measured is really from tumor and not normal cells and different endpoints have different advantages and disadvantages, depending on the type of specimen.

In certain instances, one cell-death endpoint is biologically more valid than another. When you get the same result with multiple endpoints, there is confidence in the results. When there is disagreement, and there is no readily understandable reason for the disagreement, much more caution is done in using this information for treatment recommendations.

Functional cytometric profiling is not a simple, turn-key solution. It is more a professional service, more than a simple laboratory test. It is sometimes thought of as a practicing the specialty of "Laboratory Oncology." I am an early member of an emerging new medical specialty, which I refer to as Laboratory Oncology. The function of the laboratory oncologist is to utilize available forms of laboratory testing of tumor biopsies to best individualize (personalize) cancer treatment with drugs, radiation, and/or surgery.

These forms of laboratory testing are based on multiple approaches, including traditional anatomic pathology, molecular genetics, and cell biology (typically through the application of cell culture methodologies). The importance of Laboratory Oncology is that there is an exploding growth in the number of anti-cancer drugs, which tend to be of only partial and unpredictable efficacy, which are often toxic, and which are extremely expensive. There is a huge need for existing and improved methodologies to best match treatment to the patient.
Gregory D. Pawelski
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Old 05-17-2013, 04:28 PM
gdpawel gdpawel is offline
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Default What's all involved in kidney (renal cell) cancer surgery?

William Huang, M.D.
Surgical Oncologist

A variety of factors are taken into account when treating Stage I kidney cancer. The term "stage I" refers to a localized kidney tumor (kidney tumor confined to the kidney) less than 7 cm in size. For smaller tumors (< 4 cm) surgical options include removal of the tumor bearing portion of the kidney (partial nephrectomy) or removal of the entire kidney (radical nephrectomy). Ablation or destruction of the tumor without surgical excision is also considered an option for some patients with smaller tumors. As kidney tumors get larger, particularly over 7 cm, many surgeons favor radical nephrectomy over partial nephrectomy. Benefits of partial nephrectomy include preservation of renal function without compromising cancer control, however, partial nephrectomy exposes patients to a greater risk of surgical complications. Ultimately, the type of surgical treatment is dependent on the size and location of the tumor as well as the overall health of the patient and the presence of other medical conditions such as pre-existing chronic kidney disease.

A variety of factors are taken into account when contemplating surgery for patients with metastatic kidney cancer. Surgical treatment of metastatic RCC (renal cell carcinoma) can include removal of the primary kidney tumor as well as surgical resection of metastasis. Prior to the era of targeted therapies for metastatic kidney cancer, removal of the primary kidney tumor (also known as cytoreductive nephrectomy) demonstrated benefit over cytokine therapy alone. It remains unclear, at this time, if a similar benefit of surgery will be seen in patients treated with the current targeted therapies. The decision to surgically treat patients with metastatic RCC are frequently based on: the volume and location of metastatic disease, the patient’s risk status, performance status (overall health), symptoms from the primary tumor (such as pain or bleeding) and the response to systemic treatment (if treated up front prior to surgery). If metastases occur after removal of the kidney tumor, surgical resection can be performed based on the time to metastasis and the location and volume of metastatic disease.

Cytoreduction or removal of the primary tumor was frequently performed in the era of cytokine therapy as it demonstrated improvement in survival (for metastatic renal cell cancer). The role of cytoreduction is not as clear in the era of target therapies. Indications for cytoreductive nephrectomy include: small volume of metastatic disease; good performance status or risk status and symptoms from the primary tumor.

For patients with localized kidney cancer, risk refers to the likelihood of developing metastatic disease and dying of disease. For newly diagnosed localized kidney cancer, the greatest clinical “risk factors” are size and symptoms. The current staging systems for localized RCC are based primarily on size. Since most localized kidney cancers are now found accidentally on imaging for unrelated reasons, most kidney cancers are small and do not cause symptoms and are generally felt to be low risk. It has been shown, however, that greater size is a risk factor for developing metastatic disease. Some studies also suggest that location, characteristics on imaging (such as necrosis) and growth rate are predictors of higher risk cancers. If the cancer has been biopsied or surgically removed, risk can be also assessed on the size, the histologic subtype (the type of kidney cancer such as clear cell, papillary, chromophobe, etc), tumor grade and pathologic findings such as fat involvement or vascular involvement.

Following surgery, pathologic stage, grade and histologic subtype are used to stratify risk. Staging of localized kidney tumors is dependent on size and occasionally characteristics such as involvement of vascular structures or surrounding fat or other organs.

Currently, local ablative treatment options include cryotherapy (freezing) and RFA (radiofrequency ablation - heating). Ablative therapies are used to destroy kidney tumors and preserve the surrounding unaffected kidney tissue. Ablative therapies can be performed laparoscopically or percutaneously (through the skin). Ablative therapies have been shown to carry a greater risk of tumor recurrence than surgical removal and are therefore considered by many to be an option reserved for older and sicker patients with smaller kidney tumors.

HIFU is high-intensity focused ultrasound. HIFU is a device, which uses ultrasound waves to create heat and destroy tissue. HIFU is being investigated in a variety of other solid organ malignancies including prostate cancer, breast cancer and liver cancer. HIFU is considered an ablative therapy such as cryotherapy or RFA since it destroys the tumor while preserving the normal surrounding organ tissue. HIFU is still considered investigational, as there is little long-term data on outcomes following treatment with HIFU.
Gregory D. Pawelski
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Old 05-17-2013, 04:31 PM
gdpawel gdpawel is offline
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Default What is High Intensity Focused Ultrasound (HIFU)?

High intensity focused ultrasound, or HIFU, is a new type of cancer treatment. It is administered by directing a high frequency sound beam at a specific part of a cancerous tumor. HIFU was first proposed as a treatment for cancer over 50 years ago but it is only in the past few years that the medical establishment has been seriously investigating its use in treating different types of cancer. One advantage of this type of treatment is that it only uses sound waves to kill the cancer cells. This means that it doesn't have as many side effects as other types of cancer treatments already in use. Doctors hope to use HIFU to kill cancer cells without damaging healthy cells. Chinese researchers are the pioneers in using this treatment. They have done trials treating nearly 5,000 people with many different types of cancers. Researchers in Europe are now conducting trials to find out if HIFU can be used for people unable to have surgery to remove their cancer.

When Can HIFU be Used?

HIFU is only useful to treat a single tumor or part of a large tumor; it cannot be used to treat tumors that are more widespread. This means that HIFU is not suitable for people with cancer that has spread to more than one place in their body. HIFU cannot pass through solid bone or air, meaning that it is not suitable to treat every type of cancer. It has been used to treat some patients with pancreas, liver, and prostate cancers, and it has achieved quite encouraging results. It is becoming one of the safest and most effective approaches to control pancreatic tumors locally besides surgery, which is not a viable procedure for many pancreatic cancer patients. Combined with systematic therapies, HIFU has shown great potential for controlling pancreatic cancer and extending the survival of the patients, while inducing minimal side effects.

What Types of Cancer Might HIFU be Effective in Treating?

Below is a list of several types of cancers that HIFU has been tested on:

Breast Cancer
Pancreatic cancer
Kidney cancer
Prostate cancer
Primary and secondary liver cancer
Ovarian cancer
Metastatic abdominal cancer

HIFU is not a suitable treatment for:

Brain tumors
Lung cancer and cancers in the pelvic area
Skin cancers

Bladder Cancer

Doctors in China have used HIFU to treat people with bladder cancer. Recurrent tumor appearance necessitates the use of surgery as the standard follow-up treatment.

Side Effects of HIFU

People who have been treated with HIFU so far have had very few side effects. It may cause some pain for 3 to 4 days afterwards. In rare cases, there are complaints of sore skin in the area treated.

Thus far, Chinese medical institutions mainly use HIFU to treat pancreatic, metastatic colorectal, liver, and ovarian cancers. In clinical trials carried out in China, HIFU displays the ability to destroy the cancer cell and reduce the tumor size, and even destroy the whole tumor when it is less than 3 cm in diameter. In Chinese treatment regimens, HIFU is combined with unique systematic cancer therapy in the targeting of pancreatic cancer.


1. Therapeutic Effect of High-Intensity Focused ultrasound to Treat 115 Cases of Primary or Metastatic Carcinoma of liver, NIU Li, CHU Yumin, et al., Chinese Modern Medical & Clinical,2005, 2: 14-15

2. A Clincical Study of Thermotherapy of HIFU in Combination with Chemotherapy in Treatment of Advanced Pancreatic Cancer, GAO Yuan, FENG Jun, et al., Suzhou University Journal of Medical Science, 2006, 26: 428-30

3. A Clinical Study on High Intensity Focused Ultrasound Treating 17 Cases with Advanced Pancreatic Carcinoma, YE Xinmin, ZHOU Chenhua, et al., J Med Res, 2007, 36: 114-16

4. Clinical Study of Treating Advanced Pancreatic Carcinoma by High Intensity Focused Ultrasound, Military Medical Journal of South China, 2004: 18: 17-18

5. The Efficacy of High-Intensity Focused Ultrasound (HIFU) in Advanced Pancreatic Cancer, Bo Xie, Jiajun LIANG, et al., Clin Oncol Cancer Res, 2008, 5: 183-6

6. Trealment of Unresectable Pancreatic Carcinoma by High Intensity Focused Ultrasoun, CAI Mao-huai, YANG Shu-cheng, et al., Chin J Med Ultrasoun, 2004, 1: 260-62

7. High-intensity Focused Ultrasound in Patients with Late-stage Pancreatic Carcinoma. Wang X, Sun J. Chin Med J(Engl), 2002, 115(9):1332-5

8. Control of Prostate Cancer by Transrectal HIFU in 227 Patients, Poissonnier L, Chapelon JY, et al. Eur Urol. 2007, 51(2):381-7

9. First Analysis of the Long-term Results with Transrectal HIFU in Patients with Localised Prostate Cancer. Blana A, Murat FJ, et al., Eur Urol. 2008 Jun;53(6):1194-201

10. High-intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: 5-year Experience. Blana A, Walter B, Rogenhofer S, Wieland WF. Urology.2004,63(2):297-300

11. Short and Long Term Efficacy of High Intensity Focused Ultrasound Therapy for Advanced Hepatocellular Carcinoma. Li YY, Sha WH, Zhou YJ, Nie YQ. J Gastroenterol Hepatol, 2007, 22(12): 2148-54

12. High Intensity Focused Ultrasound (HIFU) Therapy for Local Treatment of Hepatocellular Carcinoma: Role of Partial Rib Resection. Zhu H, Zhou K, et al. Eur J Radiol. 2008, Aug 14
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