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Other types and Hodgkin combined) and esophageal carcinoma including Yolk Sac tumor (14 cases, 13. The females (32% of all malignancies in females) and it was decade wise breakup is shown in Table 3. A total of 237 cases of prostatic adenocarcinoma were In males, colorectal and gastric carcinomas rounded off diagnosed in the study period. Average tumor volume top fve while colorectal carcinoma, ffth overall in both was 60 to 65%. Cervical cancer accounted for over 45% ninth place overall in our series, and ninth and eleventh of all cancers in females, while Kaposi sarcoma accounted place in males and females respectively. Even in females, the urinary bladder was at tenth place overall, eighth Kaposi sarcoma comprised over 21% of all malignancies. Carcinomas of Surprisingly, the incidence of breast carcinoma was very endometrium and cervix occupied the eighth and ninth low in Malawi (4. Cancer of larynx and vocal cord occupied eleventh carcinoma of cervix was among the top most malignancies, place overall, eleventh in males and twelfth in females. Across Asia, low incidence of carcinoma cervix may refect low sexual the incidence rates vary greatly and there are signifcant promiscuity in Pakistani women. In females, breast and bladder cancers were the commonest in males, while cervical cancer were the most common while oral and breast, colorectal, uterine and thyroid cancers were the pharyngeal cancers were also extremely common in both commonest cancers in females. This variability in the incidence of various types of overall cancer incidence in Cyprus was lower compared cancers even within different regions of the same country to the other countries in the region. Prostate breast cancers showed a statistically signifcant increasing and lung cancer were the commonest cancers in Italian trend in the 1990s while incidence rates of other cancers males while breast cancer accounted for about one-fourth remained sTable. Mortality from and esophagus were the predominant cancer types in cancer is decreasing in the developed world. It will go on increasing at least up to 2020 and that the noted that the existing diagnostic and treatment facilities number of hospital days and sickness costs will increase. The is unfortunate that in Pakistan, there is not even a regional study highlighted genetic and environmental factors cancer registry, what to say of a national one. Our situation important in specifc types of cancer for example cigarette is identical to India in terms of rising cancer burden and smoking and tobacco abuse (in cancer of lung, oral cavity, grossly inadequate diagnostic /treatment facilities but larynx, esophagus, pancreas, urinary bladder, kidney), tragically, we do not have the data to determine the exact young black women (breast), black men (lung & prostate), magnitude of an undeniably grim situation. Past and recent young whites with excessive sun exposure (malignant attempts to develop regional cancer registries were not melanoma), and the elderly (colorectal cancer). Cancer of cervix was the commonest statistics compiled by the American Cancer Society followed by kaposi sarcoma, cancers of esophagus, breast based on the most recent data on cancer incidence and and non-Hodgkin lymphoma. In males, Kaposi sarcoma mortality demonstrated that incidence and mortality rates was the commonest followed by cancer of esophagus, from all cancer sites continued to decrease from 2000 Asian Pacifc Journal of Cancer Prevention, Vol 17, 2016 1069 Zubair Ahmad et al onwards in males.
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Grenman R, Pekkola-Heino K and Kinnala P (1996): the incidence of laryngeal cancer by anatomical site in south-western Finland (letter). Guenel P, Engholm G and Lynge E (1990): Laryngeal cancer in Denmark: a nationwide longitudinal study based on register linkage data. Hirabayashi H, Koshii K, Uno K, Ohgaki H, Nakasone Y, Fujisawa T, Syouno N, Hinohara T and Hirabayashi K (1991): Extracapsular spread of squamous cell carcinoma in neck lymph nodes: prognostic factor of laryngeal cancer. Hirvikoski P (1999): A clinicopathological study on survival in laryngeal squamous cell carcinoma. Hasanen E, Pohjola V, Pyysalo H and Wickstrom K (1983): Polycyclic aromatic hydrocarbons in the Finnish wood-heated sauna. Iro H, Waldfahrer F, Altendorf-Hofmann A, Weidenbecher M, Sauer R and Steiner W (1998): Transoral laser surgery of supraglottic cancer: follow-up of 141 patients. Kleinsasser O (1992): Revision of classification of laryngeal cancer, is it long overdue? Krecicki T, Zalesska-Krecicka M, Jagas M, Szajowski K and Rak J (1998): Laryngeal cancer in Lower Silesia: descriptive analysis of 501 cases. Laccourreye H, Laccourreye O, Weinstein, G, Menard M and Brasnu D (1990a): Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma. Laccourreye H, Laccourreye O, Weinstein, G, Menard M and Brasnu D (1990b): Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas. Laccourreye O, Bassot V, Brasnu D and Laccourreye H (1999a): Chemotherapy combined with conservation surgery in the treatment of early larynx cancer. Leon X, Quer M, Agudelo D, Lopez-Pousa A, De Juan M, Diez S and Burgues J (1998): Influence of age on laryngeal carcinoma. Merletti F, Faggiano F, Boffetta P, Lehmann W, Rombola A, Amasio E, Tabaro G, Giordano C and Terracini B (1990): Topographic classification, clinical characteristics, 66 and diagnostic delay of cancer of the larynx/hypopharynx in Torino, Italy. Mustakallio S (1944): Uber das Larynx und Hypopharynxkarzinom, ihre Rontgenbehandlung und die Ergebnisse der Therapie. Martensson B (1975): Epidemiological aspects on laryngeal carcinoma in Scandinavia. Makitie A, Pukander J, Raitiola H, Hyrynkangas K, Koivunen P, Virtaniemi J and Grenman R (1999): Changing trends in the occurrence and subsite distribution of laryngeal cancer in Finland. Pedersen E, Magnus K, Mork T, Hougen A, Bjelke E, Hakama M and Saxen E (1969): Lung cancer in Finland and Norway: an epidemiological study. Pernu J (1960): An epidemiological study on cancer of the digestive organs and respiratory system. Pollan M and Lopez-Abente G (1995): Wood-related occupations and laryngeal cancer. Pradier R, Gonzalez A, Matos E, Loria D, Adan R, Saco P and Califano L (1993): Prognostic factors in laryngeal carcinoma.
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A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. Clinical response to thyroxine sodium in clinically hypothyroid but biochemically euthyroid patients. Symptoms and Signs of Thyroid Dysfunction Hypothyroidism Hyperthyroidism Symptoms Coarse, dry skin and hair Nervousness and irritability Cold intolerance Heat intolerance Constipation Increased frequency of stools Deafness Muscle weakness Diminished sweating Increased sweating Physical tiredness Fatigue Hoarseness Blurred or double vision Paraesthesias Erratic behavior Periorbital puffiness Restlessness Heart palpitations Restless sleep Decrease in menstrual cycle Increased appetite Signs Slow cerebration Distracted attention span Slow movement Tremors Slowing of ankle jerk Tachycardia Weight gain Weight loss Goiter Goiter 48 Table 2. Quality of Randomized Trials of Thyroxine Replacement Therapy Eligibility Outcome Study, Random Allocation Groups Similar at Criteria Assessors Care Provider Year Assignment? Quality of Randomized Trials of Thyroxine Replacement Therapy (continued) Reporting of Attrition, Differential Loss to Score Patient Intention-to-Maintenance of Crossovers, Follow-up or Overall Statistical (Good/ Study, Unaware of Treat Comparable Adherence, and High Loss to Follow-Analysis Fair/ Year Treatment? Poor) Cooper et al, Yes, not No the number of Partially Unclear, probably not Yes, except it Good 1984(75) verified patients randomized did not address appears to be 41; 33 dropouts patients were analyzed. Description and Results pf Randomized Trials of Thyroxine Replacement Therapy (continued) Quality Adverse Rating Study, Effects (Good/Fair/ Relevance Year Assessed? No known history or not stated Jaeschke et al, Only through 1 case of atrial Fair Fair Description of Were patients referred 1996(15) dropouts fibrillation and 1 case recruitment was from family practitioners? Summary of Findings of Systematic Review Overall Level and Type of Evidence for Arrow* Question Evidence the Link Findings 1 Is there direct None N/A No controlled studies links screening directly to health evidence from outcomes. It also detects unsuspected subclinical hyperthyroidism in 5-20 per 10,000 adults. Subclinical hypothyroidism is found in 5% of women and 3% of men; the yield varies with age and is highest in elderly women. In an overview of observational studies thyroxine population not reduced total cholesterol by 0. Cross-sectional Good (for Replacement doses of levothyroxine have not been shown adverse effects of studies (for osteoporosis to have any serious long-term adverse effects. Evidence regarding the incidence of serious only incidental short-term complications of levothyroxine therapy (ie, atrial findings from fibrillation, angina, myocardial infarction) is poor. Use of more than one molecular profile test in an individual with a thyroid nodule is unproven and not medically necessary due to insufficient evidence of efficacy. Hematological Cancer Molecular profiling using chromosomal microarray analysis. Use of a Next Generation Sequencing profile test to assess minimal residual disease. Due to insufficient evidence of efficacy, molecular profiling using gene expression profiling, Chromosome Microarray multi-gene cancer panels are unproven and not medically necessary for all other indications, including but not limited to:? The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. Chromosome Microarray: A laboratory analysis that identifies genome wide copy number variations at the chromosome level, such as aneuploidies, microdeletions and duplications, rearrangements, and amplification. Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions Page 3 of 41 UnitedHealthcare Commercial Medical Policy Effective 04/01/2020 Proprietary Information of UnitedHealthcare.
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The patient may have noticed it incidentally or someone else may have pointed out a swelling in the neck. The swelling may be slowly growing over months or years or rapidly growing over weeks. The general approach to the diagnosis of a solitary thyroid nodule is described in later section and will not be repeated here. Thyroid cancer, usually of the follicular variety may arise in a long standing multi-nodular goitre. A patient with recurrence of disease following treatment may also complain of swelling in the neck in the thyroid bed. Lymph node enlargement: Although microscopic metastasis can be found in up to 50% of cases, palpable lymph node enlargement is much less common though of extreme clinical significance from the points of view of staging and treatment. Nodes in the anterior triangle are more clinically significant than those in the posterior triangle. Findings due to loco-regional spread Invasion in the surrounding structures, which is recurrent laryngeal nerve, trachea, strap muscles of the neck, or oesophagus, may occur. The patient may present with hoarseness of voice, difficulty in breathing or strider, or dysphagia. Superior Vena Cava Syndrome may arise due to spread along the blood vessels in follicular cancer or due to external compression in the case of anaplastic cancer. Bone metastasis: Thyroid cancer may spread to appendicular skeleton, skull including base of skull, spine or pelvis. The patient may present with a swelling or a pathological fracture in the case of appendicular skeleton metastasis. In a patient with a pathological fracture of the humerus or femur with an unknown cause, thyroid gland must be carefully examined. A patient may present with diplopia, proptosis or difficulty in swallowing due to base of skull metastasis. Widespread skeletal metastasis can be extremely painful needing significant attention to pain palliation therapy. Brain Metastasis: Though rare, a patient with brain metastasis from thyroid cancer may present with or develop features of raised intracranial tension that is, persistent headache, early morning vomiting, diplopia and papilledema [3. Also, in a patient with brain metastasis from an unknown primary, thyroid gland must be carefully examined as it makes the disease potentially treatable. One should remember small intracranial metastases may not have any clinical feature. A high index of clinical suspicion is required to identify brain metastasis in a known case of thyroid cancer. Iatrogenic features Complications due to surgery: Patients may complain of generalized body aches, tetany, and paraesthesias due to hypocalcemia resulting from hypoparathyroidism.
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