DNA alone naked DNArecombinant viruses adenovirus, vaccinia, and others A critical component of any immune approach is a consideration of immune escape. Tumors escape destruction by the immune system via a variety of active, regulatory mechanisms. Overcoming these mechanisms is the goal of immunomodulation. These checkpoints all participate to dampen immune responses against cancer.
These include serum albumin and transferrin concentrations and a An analysis of gynecologic malignancies complete blood count. Circulating serum transport proteins reflect the synthetic capacity of the liver, and can be used as markers of nutritional deficit.
Other proteins, such as thyroxine-binding prealbumin and retinol-binding protein have half-lives of 2 days and 12 hours, respectively, but are not measured at most clinical laboratories within a time frame useful for management of nutrition.
The half-lives of these special proteins may be used as approximate indicators of the duration of a patient's nutritional compromise and can be helpful for monitoring recovery of protein synthetic function.
Serum albumin is the most frequently used assay for determining whether a patient is in a state of nutritional deficiency. The half-life of albumin is approximately 19 days, 14 and deficits reflect the duration of the inability of the liver to produce this important protein.
Because of the relatively long half-life of albumin, its concentration is not often used as a marker of recovery. A normal albumin level is usually considered to be greater than 3. Immune reactivity tests, such as the intracutaneous injection of tuberculin or mumps antigen, are also sometimes used as an index of malnutrition.
In a cancer patient, however, anemia, leukopenia, and cutaneous anergy are often due to other cancer-related factors that can cause bone marrow suppression or impair cell-mediated immunity.
More often, a history and physical examination combined with readily available blood tests can help determine which patients will benefit from nutritional support.
In the cancer patient, nutritional requirements can change dramatically. While estimates from population-based studies may be adequate for determining the need for protein and energy requirements in patients with diseases other than cancer, they may be grossly inaccurate in a woman with gynecologic malignancy.
It is important to determine a precise number of kilocalories and the number of grams of nitrogen used in the maintenance of lean body mass.
The stresses related to disease and therapy may accelerate protein wasting and may result in essential nutrient and vitamin deficiencies. These components should be replaced in the proper proportions to avoid excess carbohydrate and nitrogen intake.
Many patients with gynecologic malignancy may be able to take some food by mouth, and in this case, a count of calories and grams of protein should be undertaken to determine how much of the requirement for these nutrients would be met without intervention.
An assessment of nutritional deficits allows tailoring supplementation to the individual patient according to her needs. It is known from many studies, for example, that 1 g of protein and 3—4 kcal are required to maintain 1 kg of lean body mass.
These maintenance figures are calculated with the addition of factors related to specific stresses or deficits resulting from suboptimal oral intake. The Harris-Benedict Equation is a well-known population-based formula for estimating daily energy requirements for men and women.
The utility of this cumbersome gross estimate is hampered by the fact that it derives the number of calories required to maintain homeostasis on the basis of a healthy person at bed rest, and it must therefore be adapted to patients with underlying diseases or energy requirements for protein turnover.
Multiplicative factors must be used to determine specific energy requirements associated with mild, moderate, and severe activity within the normal range, besides the major stress associated with malignancy combined with recovery from surgery. In meeting energy requirements, carbohydrates such as glucose dextrose and lipids, which store energy more efficiently, are the best substrates.Cancer epidemiologist Anne F.
Rositch, Ph.D., of the Johns Hopkins Bloomberg School of Public Health and her colleagues sought to characterize contemporary trends, patterns of disease, adherence to national care guidelines and barriers to treatment of gynecologic malignancies among HIV-positive female patients in an urban clinic population.
Genetics of Breast and Gynecologic Cancers includes information on BRCA1 and BRCA2 variants (breast and ovarian cancer) and Lynch syndrome (endometrial cancer). Get more information about hereditary breast and gynecologic cancer syndromes in this clinician summary. Methods. We present data from the second interim analysis of overall survival and a retrospective, preplanned analysis of data by BRCA mutation status from our randomised, double-blind, phase 2 study that assessed maintenance treatment with olaparib mg twice daily (capsules) versus placebo in patients with platinum .
Gynecologic Malignancies: Endometrial, Ovarian, and Cervical Cancer Online Medical Reference - covering Definition through Treatment.
Authored by Kristine Zanotti of the Cleveland Clinic. This chapter provides insight into gynecological cancer risks, symptoms, outcomes, and treatments. Computed tomography in evaluation of gynecologic malignancies: A retrospective analysis Author links open overlay panel Laurel A.
King M.D. a b O. Eduardo Talledo M.D. a b Donald G. Gallup M.D. a b Taher A.M. El Gammal M.D. a b. Brachytherapy provides patients with gynecologic malignancies a highly conformal dose to treatment volumes and limits irradiation of healthy tissue to an acceptable level.
However, not all patients are able or willing to receive such treatment and require alternative methods for .