สงสัยว่า First line ทำไมไม่ใช้ Carboplatin ทางอังกฤษถือว่า Carboplatin อย่างเดียว เป็น First line โดยไม่จำเป็นต้องใช้ร่วมกับ Taxol ก็ได้ Taxol อย่างเดียวไม่ถือเป็น First line ราคาของ Carboplatin ก็ไม่แพงมาก generic brand ก็หลักพันเท่านั้น
หมอนรินทร์ เป็น medical oncologist เชี่ยวชาญทางการให้ยาฃึ่งสามารถให้คำปรึกษาได้ แต่ถ้าเป็นตามโรงพยาบาลแพทย์ในเมืองไทยแล้ว ภาควิชามะเร็งนรีเวชจะเป็นผู้ทำการรักษาทั้งผ่าตัดและให้ยาเคมีบำบัด และจะมี case study มากกว่าทางอายุรกรรมมะเร็ง
อยากทราบว่าจากระยะที่ 1 C เข้าสู่ระยะที่ 2 a b c เข้าสู่ระยะที่ 3 a b c และยะระที่ 4 สุดท้าย เป็นอย่างไรช่วยอธิบายได้มัยครับเพราะแฟนกังวลใจมาก ๆๆๆๆ ถ้าได้คำตอบจะได้สบายใจมากขึ้น ขอให้ทุกคนสุขภาพแข็งแรงนะครับ
กวางว่า บล็อกนี้ ที่มีพี่ๆ เพื่อนๆ ร่วมอุดมการณ์... คือมองดูมะเร็งพร้อมกับดำเนินชีวิตไป กวางลอกฝรั่งเขามา เรียกว่า Living with Cancer ทำให้บล็อกสมบูรณ์ขึ้นมาก ก็เนื่องด้วยผู้สนใจมาอ่าน จะได้รับรู้ความรู้สึกและรู้ภาวะของแต่ละคน
เคล็ดลับในการต่อสู้กับมะเร็ง มีคำพูดนึง จาก หนังสือ The Last Lecture - We cannot change the cards we are dealt, just how we play the hand- เราไม่สามารถเปลี่ยนไพ่ในมือได้ แต่เราหาวิธีเล่นได้
Decide if youre a Tigger or an Eyeore -เราตัดสินใจได้ว่าเราเลือกจะเป็นทิกเกอร์ (ผู้สนุกสนานร่าเริง) หรืออียอร์(ผู้ชอบทุกข์ระทม) อันนี้จากการ์ตูนวินนี่ เดอะพู คนพูดมองเรื่องนี้ได้ลึกซึ้งดีแฮะ
จริงด้วย บล็อกอันนี้ไม่ค่อยเหมือนบล็อกคนป่วย เมื่อดูจากการเมาท์ของพวกเรา...555 ถ้าพี่เล็กสังเกตให้ดี โลโก้ด้านซ้ายมือของเวปกวาง จะเป็น Health and Travel by Meena ค่ะ
Keep up, Life is just a play. Just walk on your path... and share love & kindness to all living being... You would feel peaceful of inner self insted of the chaotic world.
This is Nuch (P'kob friend Ja). As we have talked about natural therapy. I have started last week, and I rather share with you guys in your blog than just email you personally.
Introducing me symptom, - 2005 i have 12cm Fibroids, It was removed, and the surgeon reported endrometriosis on the left ovary. - 2006 laparoscopy to remove endrometriosis (Chocolate cysts). But Doctor reported that he found nothing, ??????. Yes, i still have lots of pain and waste my energy and time for surgury. - 2007 laparoscopy to remove endrometriosis + scares tissues.
I don't have cancer yet but Endometriosis + scar tissue make me in pain almost everyday, very very bad when i have period and ovulation time. Can't walk, can't sit, can't sleep, can't eat.
My specialist have given me Endep to block nave and control pain, 1 tablet/day (I was given that pills on the day i saw Kwang at Coogee beach). It was good, i had my life back again. After 4-5 months, those ugly pain come back again. I also did IVF procedure (wasn't successful), which make my worse. Now i'm kinda crezy and suffering with pain. I'm taking Chinese medicine, try to do natural therapy and order enzyme from internet and hope that one of them would help.
Now, about natural therapy. What i do is not the full version of natural therapy. I do just try to eat right and follow their (Kwang's) instruction as much as i can. Let's have a look how i go; - Stop eating meat but may be 1 prawn in soup or veggies (just for favor). - Fruits for breakfasts and breaks. - Tofu soup or stir-fire veggies for lunch/dinner - 1 serve of brown rice/day sometime a corn - Still use fish, soy, sesame sauce and brown sugar - 1 black Decaf coffee/ no sugar - Morning walk for 30 mins before go to work - Try not to take pill killer for 2-3 days, but it was too painful. So, i used it when necessary, but i'm back to Endep again.
Well, that's all i am trying to do so. Today it is day 5. I lose 1-2 kg from first 2-3 days. I don't feel tried, just some pain still with me like shadow. I will see my specialist again tomorrow and we will see what is her opinion.
Ok, long story. Thanks you na ka Kwang for your advised. I can't make it all bout if my pain reduced, i may can do more.
++ คำถามของพี่สาว เมื่อ 5 พฤศจิกายน Response : Delay of OVCA treatment should be due to patient physical condition. Once her physical condition is improved, OVCA treatment should be started. -->> แปลกันเองนะ งึม งึม
สรุปให้ค่ะว่า ถึงตอนน้อง M ไปให้คีโมครั้งแรกเรียบร้อยแล้ว ก็แปลว่า สุขภาพโดยรวมดี ก็เลยให้คีโมได้...ไม่งั้นหมอจะคอยจนกว่าสุขภาพดีขึ้นพอจะรับฤทธิ์ยาไหว จึงจะให้ยาค่ะ เพราะมันเป็น Strong Medicine
++ คำถามของคุณแม่แตน วันที่ 2 พฤศจิกายน response : Despite symptoms not indicated OVCA culprint, she can visit and consult with Gyn Doctor. TUV ultrasound and CA125 blood test can be performed. กวางลองแปลดูนะ-->> แม้ว่าไม่มีอาการบ่งชี้ว่าเป็นมะเร็งรังไข่ แต่ก็ไปพบหมอสูตินรีเวชได้ อาจจะทำการตรวจอัลตร้าซาวน์และตรวจเลือด CA125 หาความผิดปกติ
พี่แม่นก, เรื่องอาหารการกิน ใช่เลยค่ะ ทางสายกลาง...สำหรับแต่ละคน เป็นปัจเจกค่ะ เดินตามทางที่เป็นของเราค่ะ... :) Walk on your path. Create your own path, do not just follow others.
Thank you Kwang, Aunt Ped for your support. I have been busy with moving from last few week. So, i didn't come to this blog for a while.
During moving, I went back to normal food because of we had so many guesses and many functions ( for 2 weeks). Now i'm back to my strictly natural food again .
I have seen a specialist last 3-4 weeks. She said that there are 2 choices. First, operation again but it would come back again. Just like a circle. Second, long term contraception call "Mirena®". Mirena is a small tool that place inside a womb where slowly release hormone (20microgram/day) for over 5 years. On another hand, I won't be pregnant if I'm on Mirena. I still have some hope that i can have a baby one day, so this option is not an idea at the moment .
Well, last circle. I still had bad pain, I had a day off from work. Then i took Naprogesic (//www.naprogesic.com.au). That make me feel better. So, We will see how i go next circle.
All for now, i will keep in touch with you guys na ka.
โดย: Nuch Ja (Mrs MC ) วันที่: 27 พฤศจิกายน 2551 เวลา:8:04:47 น.
ใกล้ปีใหม่แล้ว ใครมี plan ไปเที่ยวที่ไหนกันบ้างคะ ...ตอนแรกพี่หน่องว่าจะไปวังน้ำเขียว แต่ประเมินแล้ว ผู้คนอาจจะเยอะแยะมากมาย อาจจะหลบไปช่วงหลังปีใหม่ แล้วพอดี ต้องให้คีโมครั้งที่ 4 ในวันคริสมาสต์พอดี คงได้ร้องเพลง เมอรรี่คริสต์มาส บนเตียงให้คีโม...we wish you a merry christmas and a happy new year..r..r
คริสต์มาสปีที่แล้ว ตอน 2 ทุ่มครึ่งนกก็ไปนอนจิงเกิลเบลล์กับซานตาครอสในชุดขาว 3 ท่าน ก่อนจะให้ยาสลบยังเปิดเพลงคริสต์มาสให้ฟังแก้ความกลัวอีกด้วย...Santa Clauses are coming to me...หลังจากนั้นก็ทำการผ่าหน้าท้องเลาะรังไข่กับต่อมน้ำเหลืองออกมา จะเป็นคริสต์มาสที่ไม่มีวันลืมเลย....It's my White Christmas...Ho Ho Ho...
แล้วมันก็ผ่านไปด้วยดี... Wish you have a very happy christmas สู้สู้ค่ะพี่หน่อง
เอากลอนเพราะๆ มาฝากค่ะ คงคุ้นเคยกันบ้างนะคะ
What Cancer Cannot Do ~ Cancer is limited Cancer cannot cripple love Cancer cannot shatter hope Cancer cannot erode faith Cancer cannot destroy peace Cancer cannot kill friendship Cancer cannot destroy memories Cancer cannot silence courage Cancer cannot invade the soul Cancer cannot steal eternal life Cancer cannot conquer the spirit Cancer is limited.....
First of all, Congratulation to Kwang for a book which is coming soon. I will keep an eye on it and get it when i come back to Bangkok na. It is good to have more information about Woman's deceases in Thai (most of them, you have to look on internet (English version). Also, Khun Niranam info is pretty useful too.
Well, i have seen my IVF doctor last few weeks. He has apologized me for my extremely pain after IVF procedure. Because of my ovary was pull up and stuck with something by scar and tissue. That made it hard to correct eggs and it might bleeding when he proceed egg correction procedure.
Then, he did ultrasound my internal uterus to see what was cause of ovary wrong position and pain. he found my cysts are getting bigger, one of them is 5 cm. I knew it, it is gonna happen, oh dear....not again.
Now, i will go back to see my specialist and seek for his opinion. Should i do another operation then IVF, don't do any more IVF or just get rip of ovary. So, scar and tissues will have more space in my tammy.. hahaha..
by the way, Chinese medicine didn't work for me too.
Anyway, we are coming back to Thailand in Feb, and we may visit Kwang in Lang Pra Bang.
ขออณุญาติตอบเรื่อง CA-125 โดยเอา paper ของ Maurie Markman ฃึ่งเป็น guru ทางด้านมะเร็งรังไข่ ยาวหน่อยแต่ให้ความกระจ่างมาก โดยสรุป CA-125 ใช้ในการติดตามผลการตอบสนองการรักษามะเร็งรังไข่ แต่ไม่ใช่ตัวคัดกรองมะเร็งรังไข่ ควรที่จะสังเกตุอาการอื่นร่วมด้วย
The Role of CA-125 in the Management of Ovarian Cancer Maurie Markman The Cleveland Clinic Cancer Center, Department of Hematology/Medical Oncology The Cleveland Clinic Foundation, Cleveland, Ohio, USA Correspondence: Maurie Markman, M.D., Department of Hematology/Medical Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. Telephone: 216-445-6888; Fax: 216-444-9464.
ABSTRACT
Over more than a decade of clinical use, CA-125 has proven itself to be one of the most useful tumor markers in cancer medicine. The major clinical utility of this serum marker is in following the clinical course of women with known ovarian cancer. Other potential uses of CA-125 include the evaluation of the effectiveness of new antineoplastic agents in this malignancy, and in the modification of treatment strategies in individuals whose CA-125 levels fail to decline at an acceptable rate following the institution of therapy. At the present time, the use of CA-125 as a method to screen for ovarian cancer should be considered investigational.
Cancer Care Ontario Practice Guidelines Initiative Sponsored by: Cancer Care Ontario Ontario Ministry of Health and Long-Term Care Screening Postmenopausal Women for Ovarian Cancer Evidence Summary Report # 4-6a
Report Date: March 17, 2003
An evidence summary report is a systematic overview of the best evidence available on a specific clinical question when there is insufficient high-quality evidence on which to base a practice guideline.
SUMMARY Question Is there a role in Ontario for screening asymptomatic postmenopausal women in the general population for ovarian cancer? Outcomes of interest were the performance of screening tests assessed in terms of predictive values, sensitivity and specificity, the stage of screen-detected disease at diagnosis, and survival.
Target Population This evidence summary applies to the general population of postmenopausal women who are not at increased risk of ovarian cancer (e.g. women who do not have of a positive family history of disease).
Methods Entries to MEDLINE (1966 through October 2002), CANCERLIT (1983 through October 2002), and Cochrane Library (2002, Issue 4) databases and abstracts published in the proceedings of the annual meetings of the American Society of Clinical Oncology from 1997 to 2002 were systematically searched for evidence relevant to this evidence summary report.
Evidence was selected and reviewed by two members of the Cancer Care Ontario Practice Guidelines Initiatives Gynecology Cancer Disease Site Group and methodologists. This evidence-summary-in-progress report has been reviewed and approved by the Gynecology Cancer Disease Site Group, which comprises gynecologic oncologists, medical oncologists, radiation oncologists, an oncology nurse, a pathologist, and community representatives. External review by Ontario practitioners was obtained through a mailed survey. Final approval of the evidence summary report was obtained from the Practice Guidelines Coordinating Committee. The Cancer Care Ontario Practice Guidelines Initiative has a formal standardized process to ensure the currency of each evidence summary report. This process consists of periodic review and evaluation of the scientific literature and, where appropriate, integration of this literature with the original evidence summary.
Key Evidence One systematic review of seventeen prospective cohort studies, in addition to five cohort studies and one randomized controlled pilot study, met the inclusion criteria for this evidence summary. Three randomized controlled trials that are evaluating the effects of screening are currently underway. Cancer antigen 125 and ultrasounds were the primary screening tests evaluated. Ultrasound and cancer antigen 125 have low positive predictive values, resulting in 12% of healthy women being recalled for more testing, and a false positive rate of 0.1% to 0.6%. The harms of unnecessary surgery include the complications of the surgery itself and the onset of premature menopause. The results from a randomized controlled trial led to the conclusion that of every 10,000 women participating in an annual screening program with cancer antigen 125 for three years: 800 (8%) will have an ultrasound scan because of an elevated cancer antigen 125, 30 (.3%) will undergo a surgical investigation because of an abnormal ultrasound, 6 (.06%) will have ovarian cancer detected at surgery (approximately half of these will be early-stage disease and stand a chance of a cure) 24 (.24%) undergoing surgery will be found not to have ovarian cancer, 10 (.1%) will have ovarian cancer detected over the next eight years.
Currently, there is no screening strategy available for ovarian cancer in women in the general population. In addition, there is a lack of evidence to justify a population-screening tool for ovarian cancer.
Opinions of the Gynecology Cancer Disease Site Group There is insufficient evidence currently to support the introduction of screening in the asymptomatic, general-risk, postmenopausal population. Screening is associated with increased rates of surgery and patient anxiety. The benefits of screening in terms of lives saved, decrease in health costs, pain, and suffering do not appear to be outweighed by the costs of screening and investigation and the social costs of unnecessary investigations and treatments. Detection of early-stage cancers may not lead to increased survival rates. No optimal interval for screening can be defined. The positive predictive value of the screening tests needs to be improved. Any further recommendations regarding screening for ovarian cancer in this group of women must await the conclusions of the three major ongoing trials. Efforts to impact ovarian cancer-related mortality rates should in the meantime focus on prevention, including:
a) Identifying women at high risk followed by genetic counselling and BRCA1 and BRCA2 identification (Appendix 2). The use of prophylactic oophorectomy in identified BRCA1 or 2 carriers needs to be further explored.
b) Making available to both patients and health care providers information about the benefits of oral contraceptive use and tubal ligation in prevention.
Related Evidence Summaries The Gynecology Disease Site Group is also reviewing the evidence for screening women at high risk for developing ovarian cancer and will present their findings in a separate document. In contrast to this present report, which focuses on women in the general population, the benefits of screening may outweigh the risks of surgical intervention in false positive cases for women with an increased risk of ovarian cancer (e.g. women who have of a positive family history of disease).
Prepared by the Gynecology Cancer Disease Site Group For further information about this evidence summary report, please contact: Dr. Michael Fung Kee Fung, Chair, Gynecology Cancer Disease Site Group, Ottawa General Hospital, 50 Smyth Road, Ottawa, Ontario; TEL 613-737-8560; FAX 613-737-8828.
ขออวยพรปีใหม่ล่วงหน้า เพราะจะไม่ได้เข้ามาชมหลายวันค่ะ ปีใหม่นี้ขอให้ทุกท่านรวมทั้งครอบครัวมีความสุข และสมหวังในทุกสิ่งที่ปราถนา ให้ชีวิต...มีสุขสดใส ให้ทุกวันใหม่...มีโลกสุดสวย ให้ทรัพย์สินเพิ่มพูน...รำรวย ให้ผลบุญคอยตามช่วยทั้งปีเทอญ. Merry Christmas and Happy New Year
++น้า M ขา วันนี้คงดีขึ้นแล้วนะค่ะ ถึงได้มาทักทายได้ ฟ้าเห็นแต่ พี่สาวระยองมา เห็นว่าน้า M ไม่ค่อยแข็งแรง พี่สาวเลยมาทักทายกันแทน ฟ้งแล้วฟ้าสงสารน้า M จัง ทานซาลาเปาไม่ได้อุ่นยังท้องเสียเลยแย่จังเลยนะค่ะ ยังไงฟ้าก็เอาใจช่วยอยู่ค่ะ และ ขอบคุณคำอวยพรดีๆขอน้า M ขอส่งกลับให้น้า M เหมือนกันค่ะ
Carboplatin hypersensitivity: a 6-h 12-step protocol effective in 35 desensitizations in patients with gynecological malignancies and mast cell/IgE-mediated reactions
Chyh-Woei Leea, Ursula A. Matulonisb and Mariana C. Castellsa
Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
Received 5 March 2004. Available online 17 September 2004.
Abstract Objectives
The incidence of hypersensitivity reactions (HR) is increased in patients treated with multiple courses of carboplatin. The purposes of this investigation were to evaluate the effectiveness of a 12-step desensitization protocol and to characterize the immune mechanism of carboplatin HR. Methods
We analyzed 10 consecutive patients who had documented HR to carboplatin and in whom continued treatment with carboplatin was considered advantageous. The patients were treated with carboplatin using a 6-h, 12-step desensitization protocol with a 30-min premedication regimen. Skin tests were performed on five patients. Results
Ten patients successfully completed 35 planned courses of desensitizations to carboplatin, 31 of which were without reactions. Four patients had symptoms during their first (n = 3) and third (n = 1) desensitizations but tolerated the re-administration of infusions without further reactions. For subsequent courses, the protocol was modified for two patients who had extracutaneous symptoms during desensitization and was unchanged for the patient who had mild urticaria. These three patients tolerated subsequent courses of desensitizations without reactions. The fourth patient with symptoms during desensitization no longer required carboplatin due to progressive disease. Of the five patients who were skin tested to carboplatin, four had positive wheal and flare reactions. In one patient, the skin test response to carboplatin became negative after desensitization. Conclusion
The 6-h, 12-step desensitization protocol is safe and effective for treating patients with carboplatin HR. Positive skin tests to carboplatin suggest a mast cell/IgE-mediated mechanism. Conversion of the positive skin test to a negative response after desensitization supports antigen-specific mast cell desensitization.
The Role of CA-125 in the Management of Ovarian Cancer Maurie Markman The Cleveland Clinic Cancer Center, Department of Hematology/Medical Oncology The Cleveland Clinic Foundation, Cleveland, Ohio, USA Correspondence: Maurie Markman, M.D., Department of Hematology/Medical Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, ------------------------------------------
High-Risk cisplatin: For all patients receiving cisplatin, a corticosteroid (หรือ Dexamethasone บางทีพยาบาลจะเรียกสั้นๆ ว่า dexa) plus metoclopramide (ตัวนี้ brand name ที่ใช้จะเรียก Plasil) or plus a 5-HT3 antagonist (มีหลายตัวในกลุ่มนี้แต่ส่วนใหญ่จะใช้ Ondansetron หรือ brand name คือ Zofran) is recommended for the prevention of delayed emesis.
High-Risk noncisplatin: A prophylactic corticosteroid as a single agent, a prophylactic corticosteroid plus metoclopramide, and a prophylactic corticosteroid plus a 5-HT3 antagonist are regimens suggested for the prevention of delayed emesis.
Intermediate/Low Risk: No regular preventative use of antiemetics for delayed emesis is suggested for patients receiving these chemotherapeutic agents.
EXPERT PANEL DISCUSSIONS Recognizing and Overcoming Challenges in the Treatment of Recurrent Ovarian Cancer Course Director and Moderator Maurie Markman, MD 2008-06-06
1) Current Therapeutic Options and Clinical Issues in Recurrent Ovarian Cancer: Where Do We Stand? Maurie Markman, MD University of Texas M. D. Anderson Cancer Center Houston, Texas
William Patrick McGuire, MD Franklin Square Hospital Center Baltimore, Maryland
Robert L. Coleman, MD University of Texas M. D. Anderson Cancer Center Houston, Texas
2) Looking Ahead: Emerging Options in Treatment of Ovarian Cancer Maurie Markman, MD University of Texas M. D. Anderson Cancer Center Houston, Texas
William Patrick McGuire, MD Franklin Square Hospital Center Baltimore, Maryland
Robert L. Coleman, MD University of Texas M. D. Anderson Cancer Center Houston, Texas
How are you ka Kwang? I have seen you on You tube, which remind me that i should keep in touch especially about these woman disease.
Update my story first na ka.
After came back from Thailand. I had a laparocopy surgery. It was not very good. There were some water leaking into my lung after surgery 12 hr. So, I have to have lung insertion for sucking water out, stay in hospital for 3 more days.
Before that drama, Dr. told me after surgery that my Endometriosis (will call Endo na ka) was very very bad. It grow on ovary, outside, inside uterus and every where. It almost on liver too. No wonder, i had so much.
He said that i will need to have hysterectomy ( remove uterus) by next 2 months otherwis all scar tissues and cysts will come back, fast. But we will talk in detail today.
Well, cross finger. If i can try my last chance to get pregnant in 2 months. If i can, would my baby be healthy? Have to think about that too
Anyway, talk to doctor first.
P'Kob and Mika were very kind to me ka. They came to the hospital almost every day while i was admit there. Luckily, P' Kob had many days off. She is usually very busy.
Now, K Thomas turn to be a framer so you can have all fresh vegies growing by your husband na ka. Very luck you.