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ANMCO POSITION Papers: Role of intra-aortic mechanism pump motor inside sufferers with serious superior cardiovascular failure along with cardiogenic jolt.
The oncological management of head and neck tumours is well known and standardized. Radiotherapy is one of the effective tools. However, it induces major changes in healthy tissues teeth, gums, mucous membranes, salivary glands and bones. Some, like mucositis, are immediate and often reversible; others, like hyposialia or fibrosis, are late effects and often irremediable. These changes greatly affect oral health and make its management more complex. Dental management also becomes a capital element of the care path but, unfortunately, often remains neglected by the patient but also by some practitioners. Nor-NOHA It concerns all the stages of the clinical course initial assessment, cancer treatment itself and long-term follow-up. If neglected, the patient's quality of life will be affected and complications, sometimes serious, such as osteoradionecrosis, may occur. Specific care recommendations for maintaining oral health are mentioned, especially for those patients requiring oral cavity irradiation.Treatments for oral cancer can seriously impair the function and the aesthetic, and thus contribute to a significant reduction in the quality of life of affected patients. The role of prosthetic dentists in the multidisciplinary management of these patients is essential both in oral rehabilitation and in prosthetic planning and subsequent rehabilitation. Therefore, these dentists should be involved in the care pathway in order to shape and design the further oral rehabilitation prior to reconstructive surgery and ultimately make the patient smile again.The number of people with cancer is constantly increasing. Thanks to new screening techniques and treatment protocols, the number of survivors is also increasing. However, treatments cause some undesirable side effects that usually persist over time. The level of physical activity of these patients tends to decrease with the diagnosis of cancer and does not usually increase before the end of the treatments or even beyond. However, physical activity is beneficial not only in terms of preventing the progression or recurrence of the disease but also in the fight against side effects related to the disease and its treatments. There are various physical activity recommendations for cancer survivors that will be developed in this article. The project «Sport après cancer. Citoyen sportif, j'agis pour ma santé», developed by the University and the University Hospital of Liège, aims to promote adapted physical activity after cancer, creating a link between outpatient rehabilitation in a hospital setting and the practice of physical activity in a sporting and associative context.More and more patients surviving cancer consult again their general practitioner for various reasons. The aim of this article is to consider ways to reinforce the role of the general practitioners in the follow-up protocol. Two candidates for general practice synthetized, based on literature review, cancer follow-up information of childhood cancer, breast and colorectal cancers. Their concise presentations are examples of useful documents for their colleagues. The general practitioner must receive all information concerning the cancer disease, the treatment and the agenda of the follow-up examinations to guarantee continuity of care. Collaboration between general practitioners and cancer specialists is necessary to provide best care to the patients, to share clear and relevant information and to train future general practitioners.During the past 50 years, the mortality due to childhood cancers decreased dramatically thanks to improvements in supportive care and the use of multimodal approaches. In this context, the long-term follow up after childhood cancer has become a main concern for pediatric oncologists. The SALTO programme was developed in 2012 at the CHR Citadelle in Liège in order to organize a multidisciplinary long-term follow-up for the patients previously treated in our department for a childhood cancer. The aim of the present study was to review, for the most frequent childhood cancers, the long-term sequellae and the second cancers developed by the patients participating to the SALTO programme in order to define the follow-up needed. Our data confirm the importance of a multidisciplinary long-term follow-up, based on the treatments received and following international guidelines.Esophageal cancer is the 19th most common cancer in the European Union. Its prognosis remains poor with a 5-year survival rate estimated between 15 % and 25 %. Accurate diagnosis and pre-therapeutic assessment are essential and should allow a rapid start of therapy. Current treatment is based on multimodal management of which surgery remains the cornerstone. Since 2019, Belgium has started an agreement to centralize esophageal surgery in order to improve surgical outcomes. One year after implementation of centralization, our centre shows a low rate of severe complications (Clavien-Dindo classification IIIb-V) of 20 % and a 0 % mortality rate at 30 and 90 postoperative days. Our patients have benefited from a full minimally invasive or hybrid surgical procedure, contributing to those positive results. In the future, all our efforts must be done to improve collaboration between hospitals in order to provide best medical and surgical treatments.The incidence of pancreatic cancer has doubled during the past three decades. Pancreatic cancer is projected to become the second leading cause of cancer-related death by 2030. Overall 5-year survival is less than 10 %. It is thus of paramount importance to identify patients at risk to develop pancreatic cancer. The "pancreatic emergency route" and the weekly-organized complex surgery consultations are essential for fast and coordinated investigations for patients diagnosed of a pancreatic lesion. Pancreatic surgery, often preceded by neoadjuvant therapy, remains the only curative treatment if applicable. Implemented to decrease surgical morbidity and mortality, current centralization limits pancreatic resection surgery to a restricted numbers of expert centres in Belgium. Thanks to a close collaboration with the CHR of Liège, the CHR of Huy, the CHR of Bois de l'Abbaye, the Clinique André Renard and Vivalia, the reference centre of the CHU of Liège offers surgical, intensive, anaesthetic, oncological, gastroenterological, radiological and paramedical cares as part of a multidisciplinary approach characterized by expertise in the treatment of adenocarcinoma of the pancreas, 24 hours a day and 7 days a week.In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma.Currently, the standard management of locally advanced adenocarcinoma of the middle and lower rectum consists in first intention of pre-operative radio-chemotherapy. This treatment is then usually followed by rectal surgery with removal of the mesorectum. The local recurrence rate is quite low, but at the cost of a non negligible morbidity (urinary, anal and sexual functional sequelae). This raises the question of a possible sparing of surgery and therefore organ preservation in well selected patients with a complete response after radio-chemotherapy. The Brazilians are pioneers in this field. Already in 2004, their publications suggested that the «Watch and Wait» strategy was safe and effective in patients with a complete clinical response. Other publications have followed and tend to confirm that there is no oncological risk in proposing a «watch and wait» strategy for these well selected patients in complete clinical, endoscopic and iconographic remission on the basis of magnetic resonance imaging (MRI). In these conditions, an attentive surveillance strategy allows to avoid operative morbi-mortality without oncological compromise. Monitoring is therefore multi-modal, clinical and endoscopic, but also based on MRI.Cervical cancer is the fourth most common cancer in women and is linked in over 95 % of cases to papillomavirus infection, the incidence of which has fallen in recent years due to screening and vaccination. Almost half of these cancers are diagnosed at a locally advanced stage with an overall 5-year survival of around 65 %. In recent decades, the management strategy of these locally advanced cancers has changed considerably and has allowed the improvement of survival but above all of local control as well as the reduction of toxicity, due to the implementation of imaging. Standard treatment consists of external beam radiation therapy combined with concomitant chemotherapy followed by intrauterine brachytherapy. The role of neo-adjuvant and adjuvant chemotherapy is still being evaluated. New therapeutic approaches (particularly immunotherapy) in addition to standard treatment are also being studied.Breast cancer is the leading cause of neoplastic death in women around the world. In the era of personalized medicine, legitimately awaited by our patients, the future of breast cancer screening will depend on an individual-based risk assessment, making it possible to better adapt the age of onset, frequency and the type of examinations useful for this screening. This article reviews the three broad categories of highest risk factors available to establish a risk score appropriate for each patient.In Belgium, 12 % of patients present with upfront metastatic hormone-naive prostate cancer. Surgical or medical castration has been the only approved treatment for decades. Since 2014, several randomized trials have demonstrated that survival could be significantly improved in patients who are deemed fit enough to cope with the potential added side-effects. Docetaxel chemotherapy and androgen receptor axis-targeted next generation hormonal agents such as abiraterone, enzalutamide and apalutamide have been shown to improve overall survival when given within 12 weeks after castration initiation. Similarly, prostate radiotherapy, in the absence of urological contraindications, might also improve overall survival in patients presenting with less than 5 bone metastases. How these strategies can be combined remains a matter of debate and is currently under investigation.The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient's care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.
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