Cancer surveys
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The tumour biology of cervical precancer is unusual. A large variety of individually distinct forms crudely divided into slight, moderate, severe dysplasia and carcinoma in situ exist. Virtually all contain genital human papillomavirus (HPV) either as infectious virions or as episomal or integrated DNA. ⋯ Target cells within the transformation zone have the capacity for bidirectional (squamous and/or glandular) differentiation. HPV types seem to drive cells preferentially in different directions after infection/transformation. Low risk types are almost always associated with squamous differentiation, HPV 16 usually also with squamous differentiation and HPV 18 with adenosquamous or adenomatous differentiation. (ABSTRACT TRUNCATED)
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The molecular genetic changes reported in bladder tumours can be classified as primary and secondary aberrations. Primary molecular alterations may be defined as those directly related to the genesis of cancer. These are frequently found as the sole abnormality and often associated with particular tumours. ⋯ Molecular analyses utilizing well characterized preneoplastic lesions, including dysplasia samples, need to be pursued. This in turn may provide the needed information to realise the clinical relevance of detecting genetic instability, as well as molecular or epigenetic alterations, in otherwise morphologically normal appearing urothelium and preneoplastic lesions. The need now is to translate the newly developed scientific information into diagnostic and prognostic strategies, which in turn will prolong patient survival and quality of life.
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In summary, our current understanding of the therapeutics of dyspnoea is inadequate and leaves plenty of room for improvement. Rationalization of the management of this symptom has the potential to improve the quality of life of countless patients with both malignant and non-malignant disease. To date, research studies addressing this issue are sparse. ⋯ The pharmacological treatment of breathlessness deserves further investigation, and clinical studies should be conducted in parallel with appropriate laboratory studies. Drug therapy is, however, but one aspect of the overall management of any symptom, and a thorough assessment of the role of non-drug interventions for dyspnoea is also essential. Well designed multicentre studies are urgently required to evaluate the symptomatic treatment of breathlessness, but such studies must be preceded by the development of valid and sensitive patient rated tools to assess this distressing and common symptom.