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The role of removing lymph nodes as part of standard surgery for endometrial cancer

Cancer arising from the lining of the womb, known as endometrial carcinoma, is now the most common gynaecological cancer in western Europe and North America. Most women (75%) still have their tumour confined to the body of the womb at diagnosis and three‐quarters of women with endometrial cancer will survive for five years after diagnosis. Lymph node metastases can be found in approximately 10% of women, who clinically have cancer confined to the womb at diagnosis, and removal of all pelvic and para‐aortic lymph nodes is widely advocated, even for women with presumed early stage cancer. Lymph node removal is part in the international staging sytem (FIGO) for endometrial cancer. This recommendation is based on non‐randomised studies that suggested improvement in survival following removal of pelvic and para‐aortic lymph nodes. However, treatment of pelvic lymph nodes may not be directly therapeutic and may just indicate that a woman has a more aggressive cancer and therefore a poorer prognosis. Results of a systematic review and meta‐analysis of RCTs of routine radiotherapy to treat possible lymph node metastases in women with early‐stage endometrial cancer, did not improve survival, which was contrary to previously recommended treatment, based on evidence from non‐randomised studies. Hence, more treatment to lymph nodes might not necessarily be better treatment, especially as surgical removal of pelvic and para‐aortic lymph nodes has serious potential short and long‐term harmful effects and most women will not have positive lymph nodes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Yoga in addition to standard care for people with blood or lymph node cancer

Blood and lymph node cancers are referred to as haematological malignancies. These are types of cancer that affect the blood, bone marrow and other parts of the lymphatic system. The most common ones are lymphomas, leukaemias and myelomas. Depending on the kind of cancer and how far it has spread, there are a lot of different options to manage the disease. Usually chemotherapy, radiotherapy or a combination of both is used to treat the disease. If the cancer is widespread, a transplantation of the patients’ own bone marrow cells combined with an aggressive chemotherapy can be a treatment option.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The lymphatic system

Lymph travels around the body through a network of vessels in much the same way that blood travels around the body through the blood vessels. Whereas the blood carries nutrients and other substances into our tissues, the lymph vessels drain fluid from the tissues and transport it to the lymph nodes. These small gland-like masses of tissue filter out and destroy bacteria and other harmful substances. The bigger lymph vessels then carry the cleaned fluid back to the vein called the superior vena cava, where it enters the blood stream.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 6, 2008

What are the organs of the immune system?

The defense system of the human body is made up of entire organs and vessel systems like the lymph vessels, but also of individual cells and proteins. The inner and outer surfaces of the body are the first barriers against pathogens (germs). These surfaces include the skin and all mucous membranes, which form a kind of mechanical protective wall. Several things support this protective wall:

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 7, 2011

The defense mechanisms of the adaptive immune system: An alliance of antibodies, T cells and soluble proteins

T lymphocytes, or just T cells for short, play a central role in fighting against pathogens (germs) in the tissue. They are produced in the bone marrow and migrate through the blood to the thymus, where they then specialize to identify and destroy foreign (non-self) cells. This is why they are called T cells.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 4, 2012

Lymphedema (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of lymphedema, a condition in which lymph fluid builds up in tissues and causes swelling.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 12, 2013

Fact sheet: Treating lymphedema

After breast cancer treatment your arm might feel heavy and prickly or tight, and the rings on your fingers might get tighter: these could be signs of lymphedema. Early diagnosis and action to reduce the swelling can be critical because the symptoms may get worse over time.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 21, 2013

Breast cancer: What treatments have been shown to offer relief for lymphedema after breast cancer?

Self-management with compression bandaging can help reduce lymphedema after breast cancer. Professional manual lymphatic drainage might help as well. Because lymphedema often gets worse and harder to treat over time, early recognition of the problem is important.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 21, 2013

AIDS-Related Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of AIDS-Related Lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 2, 2014

Merkel Cell Carcinoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of Merkel cell carcinoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 5, 2014

Breast Cancer Treatment and Pregnancy (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of breast cancer during pregnancy.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 23, 2014

Childhood Hodgkin Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood Hodgkin lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 11, 2014

Adult Hodgkin Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of adult Hodgkin lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 23, 2014

Breast Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of ductal carcinoma in situ, lobular carcinoma in situ, and invasive breast cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 23, 2014

Cancer: What do the codes in the doctor’s letter mean?

There is an international system for the classification of cancerous tumors. This helps to describe cancers and compare the results of medical tests and examinations. Doctors and researchers all use what is known as TNM classification.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 27, 2012

Penile Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of penile cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 14, 2013

Vulvar Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of vulvar cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 2, 2013

Adult Non-Hodgkin Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of adult non-Hodgkin lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 25, 2014

Male Breast Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of male breast cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 23, 2014

Childhood Non-Hodgkin Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood non-Hodgkin lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 25, 2014