FACTS ABOUT TOBACCO ADDICTION, DISEASES, CANCER & DEATH
Posted by on Sunday, 12th June 2011
FACTS ABOUT TOBACCO ADDICTION, DISEASES, CANCER & DEATH
TOBACCO APPEARS TO BE AS OLD AS HUMAN CIVILIZATION. CULTIVATION OF THE TOBACCO PLANT PROBABLY DATES BACK 8000 YEARS. THE TWO SPECIES OF THE PLANT ARE NICOTIANA RUSTICA AND NICOTIANA TABACUM,
CONTENTS OF TOBACCO --
ADDICTION FACTOR----NICOTINE.
TOXIC AND CARCINOGENIC CHEMICALS.---TOBACCO-SPECIFIC NITROSAMINE, POLYCYCLIC AROMATIC HYDROCARBONS, CARBON MONOXIDE, TAR.
CIGARETTES CONTAINS---- » 4,000 CHEMICAL COMPOUNDS, 200 KNOWN POISONS, 60 CANCER CAUSING AGENTS.
WHEN A SMOKER INHALES, THE NICOTINE REACHES THE BRAIN IN AROUND 8 SECONDS. REGULAR SMOKERS SAY IT HELPS THEM RELAX AND FEEL LESS HUNGRY.
NICOTINE –(ADDICTIVE CHEMICAL ) ---- SMOKERS CAN GET HOOKED VERY QUICKLY AND IT CAN TAKE YEARS AND A HUGE EFFORT TO KICK THE HABIT. NOT MANY PEOPLE ARE ABLE TO REMAIN OCCASIONAL SMOKERS.
GLOBALLY TOBACCO RELATED DEATHS —
DEATH OF 1 IN 10 ADULTS (ABOUT 5 MILLION DEATHS EACH YEAR) .
WITH 2.41 MILLION DEATHS IN DEVELOPING COUNTRIES . 2.43 (2.13.2.78) MILLION IN DEVELOPED COUNTRIES. 3.84 MILLION DEATHS WERE IN MEN.
THE LEADING CAUSES OF DEATH FROM SMOKING ----
• CARDIOVASCULAR DISEASES (1.69 MILLION ),
• CHRONIC OBSTRUCTIVE PULMONARY DISEASE (0.97 MILLION )
• LUNG CANCER (0.85 MILLION ).
• FIFTY PER CENT OF UNNECESSARY DEATHS DUE TO TOBACCO OCCUR IN MIDDLE AGE (35.69 YEARS),
• ROBBING AROUND 22 YEARS OF NORMAL LIFE EXPECTANCY.
• THE ATTRIBUTABLE MORTALITY IN MALES (13.3%) / FEMALES (3.8%).
• 12% FOR VASCULAR DISEASE.
• 66% FOR CANCER OF THE TRACHEA, BRONCHUS AND LUNG CANCERS
• 38% FOR CHRONIC RESPIRATORY DISEASE.
• PRESENTLY, MORE THAN 10 MILLION PEOPLE GLOBALLY ARE DIAGNOSED WITH CANCER EVERY YEAR. IT IS ESTIMATED THAT BY 2020, THERE WILL BE 15 MILLION.
CANCER CAUSES 6 MILLION DEATHS EVERY YEAR, OR 12% OF DEATHS WORLDWIDE.
• THE TOBACCO-RELATED CANCERS REPORTED BY THE POPULATION-BASED CANCER REGISTRIES OF BANGALORE, BARSHI (RURAL), BHOPAL, CHENNAI, DELHI AND MUMBAI CONSTITUTE 56.4% AND 44.9% OF CANCERS.
• IN MALES TOP FIVE OR SIX CANCERS ARE ALL TOBACCO-RELATED ---CANCERS: OF THE LUNG, ORAL CAVITY, LARYNX, OESOPHAGUS AND PHARYNX.
• IN WOMEN, THE LEADING CANCER SITES INCLUDE THOSE RELATED TO TOBACCO: CERVIX, ORAL CAVITY, OESOPHAGUS AND LUNG.
• OTHER CANCERS---CANCERS OF OESOPHAGUS, STOMACH, LIVER, PANCREAS, CANCERS OF LARYNX, NASOPHARYNX, NASAL CAVITY AND NASAL SINUSES, CANCERS OF URINARY BLADDER, KIDNEY , CANCERS OF CERVIX, AND MYELOID LEUKAEMIA.
SECOND HAND TOBACCO SMOKE HAS ALSO BEEN CONCLUSIVELY SHOWN TO BE CARCINOGENIC TO THE LUNGS.
• MORE THAN 55 LAKH PEOPLE WORLDWIDE DIE EACH YEAR FROM TOBACCO USE.NEARLY 8 LAKH INDIANS DIE FROM TOBACCO USE EVERY YEAR, WHICH IS MORE THAN THOSE KILLED BY AIDS, TUBERCULOSIS, AND MALARIA COMBINED. MORE THAN 2,200 INDIANS DIE EVERY DAY DUE TO TOBACCO USE.
• 40 OUT OF 100 CANCER CASES IN INDIA ARE TOBACCO-RELATED. NEARLY 95% OF ALL ORAL CANCERS OCCUR AMONG TOBACCO USERS.
• TOBACCO USE ALSO CAUSES STROKE, HEART ATTACK, LUNG DISEASE, BLINDNESS AND OTHER ILLNESSES.
• TOBACCO USERS FEEL TEN YEARS OLDER AND DIE TEN YEARS YOUNGER THAN PEOPLE WHO DO NOT USE TOBACCO.
• 50 OUT OF 100 TEENAGERS WHO SMOKE TODAY WILL EVENTUALLY DIE OF TOBACCO RELATED DISEASE UNLESS THEY QUIT.
WHEN YOUNG PEOPLE SMOKE OR CHEW TOBACCO THEY:
• EXPERIENCE LOSS OF STAMINA DURING AND AFTER EXERCISE.
• FACE DIFFICULTY IN BREATHING, RUNNING AND SPORTING ACTIVITIES.
• GET TIRED EASILY.
• YOU MAY BELIEVE SMOKING MAKES YOU LOOK TRENDY AND COOL, BUT YOU CAN BECOME IMPOTENT/INFERTILE.
• SMOKING AND TOBACCO USE CAUSES TEETH STAINS AND BAD BREATH.”
• SMOKING AND TOBACCO USE DRIES OUT YOUR SKIN AND HAIR. IT IS LIKELY TO CAUSE WRINKLES.” QUITTING MAKES YOU FEEL BETTER AND YOU START TASTING FOOD BETTER.
EFFECTS OF QUITTING TOBACCO----
2 HOURS AFTER QUITTING: NICOTINE IS OUT OF THE SYSTEM.
12 HOURS: CARBON MONOXIDE IS OUT OF THE SYSTEM AND LUNG FUNCTION BEGINS TO IMPROVE.
2 DAYS: SENSE OF SMELL IMPROVES; PHYSICAL ACTIVITY BECOMES EASIER AND MORE AIR GETS INTO THE LUNGS.
2 MONTHS: LUNGS WORK MORE EFFICIENTLY AND ARE ABLE TO REMOVE MUCOUS; BLOOD FLOW TO THE LIMBS IMPROVES.
12 MONTHS: RISK OF HEART DISEASE IS HALF THAT OF A CONTINUING SMOKER.
10 YEARS: RISK OF LUNG CANCER IS LESS THAN HALF THAT OF A CONTINUING SMOKER.
15 YEARS: RISK OF HEART ATTACK AND STROKE IS ALMOST THE SAME AS A PERSON WHO HAS NEVER SMOKED.
DR NITIN KHUNTETA
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CERVIX CANCER--PRESENT SCENRIO. DR NITIN KHUNTETA
Posted by on Friday, 12th March 2010
CERVIX CANCER ---PRESENT SCENRIO DR Nitin Khunteta
There has been tremendous change in the demographic profile of India over time, as both vital rates-birth and death rates-have gradually declined. The life expectancy at birth has increased to 65 years. Noncommunicable diseases like cancer have become a major cause of morbidity and mortality in the midst of already existing communicable diseases. According to National Cancer Registry Program of India, cancers of the uterine cervix and of the breast are the leading malignancies seen in Indian women. In view of the well-defined natural history and long detectable preclinical phase, the cancer of uterine cervix gets priority in terms of control program through mass screening. An important reason for higher cervical cancer incidence in our country is lack of effective screening programs aimed at detecting precancerous conditions before they progress to invasive cancer.
Cervical cancer is the most common cancer in Indian women. According to WHO estimates, every year 132,082 women are diagnosed with cancer and 74,118 women die from this disease. Currently there are about 365.71 million aged over 15 years and each one of them is at the risk of developing this cancer. Globally it affects 500,000 women and a fifth of them reside in India. Statistics indicate Cervical Cancer kills eight women every waking hour in India.
Worldwide, it was the second-most common cancer after breast cancer.
"It is the commonest cancer in India and all sexually active women are at a risk of contracting this disease. But it's mostly seen in woman aged between 50 to 55 years. If detected at a pre-cancerous stage, this cancer is 100 per cent curable." says Dr Nitin Khunteta, a consultant in Bhagwan Mahaveer Cancer Hospital, Jaipur.
Main cause
HPV (Human papillomavirus infection) is the virus for this cancer. It is a sexually transmitted virus . Most people never even know they have HPV, or that they are passing it to their partner.
Risk factors:
Having sex at an early age , Having many sexual partners , Having many pregnancies , Using birth control pills for 5 or more years
Consuming any form of tobacco .
Symptoms
Pelvic pain or pain during intercourse, bleeding between periods, post-menstrual bleeding and discharge from the vagina .
Prevention Strategies--
1-Cervical cancer vaccine: Is the first vaccine ever designed to prevent cancer. It is recommended to girls aged 11 to 12 years as it allows a girl's immune system to be activated before she's likely to encounter HPV.
2-Delay sex
3-Limit number of sexual partners and to avoid having sex with someone who has had many other sexual partners.
4-Use condoms: Condoms when used correctly can lower the HPV infection rate by about 70%. They can't protect one completely because they don't cover every possible HPV-infected area of the body, such as the skin of the genital or the anal area.
Important Tests
Pap test: Cells are collected from the surface of the cervix and checked on a slide.
HPV test: Doctors take DNA cells by swabbing the cervix. "The HPV test is ideal for the detection of cervical cancer. It is slightly more accurate than the Pap test.
Colposcopy test: It enlarges the image of the cervix and the cells can be then seen clearly. This test is available at Bhagwan Mahaveer Cancer Hospital, Jaipur.
Treatment
The three main treatments available today are surgery, radiotherapy and chemotherapy.
Seeing the present scenario we all need to be aware about this disease, which is preventable to a large extent, can be cured if diagnosed in early stage.
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Cervix cancer—cervical cancer vaccine. DR NITIN KHUNTETA
Posted by on Sunday, 25th October 2009
Cervix cancer—cervical cancer vaccine
In India, Cervical Cancer is the most common cancer in women. Every year, in India, 132,000 new
cases are diagnosed and 74,000 women die due to this cancer. Globally, Each year, nearly 500,000 new cases are diagnosed of which nearly 270,000 women actually die.
Cervical Cancer is caused by the Human Papillomavirus (HPV).These are classified into 'high-risk' (oncogenic) and 'low-risk' types . 15 oncogenic HPV types have been linked to Cervical Cancer . Low-risk HPV types, such as HPV 6 and 11, are not known to cause cancer,but are responsible for benign genital warts . Globally, HPV 16, 18, 45 and 31 are 4 most common oncogenic HPV types. HPV 16 and 18 together account for 70%.
Together,HPV 16, 18, 45 and 31 are responsible for 80% of Squamous cell carcinomas of the cervix.These same 4 HPV types are also responsible for 90% of Adenocarcinomas of the cervix.
Oncogenic HPV can spread via skin-to-skin genital contact and does not necessarily require penetrative sexual intercourse. Men act as a reservoir of infection, capable of passing on the virus to their female partners who are then at risk of developing Cervical Cancer.
Yes! Cervical Cancer can now be prevented through vaccination.
Cervical cancer vaccine composed of HPV 16 and 18 antigens in the form of VLPs (Virus like particles) combined with a novel adjuvant system called AS04. Adjuvants play a key role in enhancing the immune response elicited by a vaccine. They are used in almost all commercially available vaccines.The most commonly used adjuvant is Aluminium hydroxide. The novel adjuvant system AS04 which combines traditional Aluminium hydroxide with MPL (i.e. Monophosphoryl Lipid A). MPL binds to a novel receptor called the TLR 4 on Antigen presenting cells.This interaction results in a better memory B cell response. Memory B cells are long-lived cells, which then constantly produce a sustained level of antibodies over a long period of time.
Cervical vaccine has been licensed for use in girls and women aged 10-45 years. Antibodies are an important correlate of long-term protection. It is believed that antibody levels that are consistently high over a period of time and are likely to stay high, would provide long term protection against Cervical Cancer.
It is recommended that subjects who receive a first dose of Cervical cancer vaccine complete the three-dose vaccination. If flexibility in the vaccination schedule is necessary, the second dose can be administered between 1 month and 2.5 months after the first dose. Vaccination should be postponed until after completion of pregnancy.
Cervical cancer vaccine is generally safe and well tolerated. The most frequently reported solicited symptoms after administration of vaccine are injection site reactions including pain, redness and swelling. The majority of the solicited local and general symptoms reported are mild to moderate in intensity.
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BREAST HEALTH-BREAST CANCER
Posted by on Monday, 5th October 2009
BREAST CANCER –BREAST HEALTH--------
DR NITIN KHUNTETA
MBBS, MS ( GEN. SURGERY),
M Ch (SURGICAL ONCOLOGY),
DNB (SURGICAL ONCOLOGY).
CONSULTANT SURGICAL ONCOLOGIST, Bhagwan Mahaveer Cancer hospital & Research Centre, Jaipur
The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females pushing the cervical cancer to the second spot.
The rise is being documented mainly in the metros. It is reported that one in 22 women in India is likely to suffer from cancer during her lifetime, while the figure is definitely more in America with one in eight being a victim of this deadly cancer.
Breast cancer is the most common form of cancer among women. According to a study by International Agency for Research on Cancer (IARC), there will be approximately 250,000 new cases of breast cancer in India by 2015. At present, India reports around 100,000 new cases annually.
Globally, every three minutes a woman is diagnosed with breast cancer in the world, amounting to one million cases annually. The incidence could go up by 50 percent to 1.5 million by 2020, says the World Cancer Report.
The chances of survival and cures for breast cancer is as high as 90 percent after complete treatment.
Breast cancer will become an epidemic in India in near future. Before it becomes the epidemic we should take appropriate measures to prevent development of breast cancer.
AVOIDING THE RISK FACTORS DECREASES THE CHANCE OF DEVELOPMENT OF BREAST CANCER ---
The rise in the incidence of breast cancer is due to changing lifestyles, i.e marrying late, the average child bearing age has increased to 30 and sometimes even beyond that, early weaning from breast feeding, the use of combined estrogen and progestin hormone replacement therapy (HRT) , obesity & lack of physical activity.
THE SMALLER THE CANCER IN BODY THE HIGER CHANCE OF CURE------ There are four stages of breast cancer. Stage 1 to 4. For to diagnose at earlier stage the following recommendation should be followed—
Screening mammography---mammography is so far the only screening method that has been consistently proven to reduce deaths from breast cancer. It is considered the gold standard of screening, while breast self examination is, at best, a supplement to regular mammograms and breast exams by a doctor.
RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
• Schedule the mammogram when the breasts are not tender or swollen to help reduce discomfort and to assure a good picture. Try to avoid the week just before the menstrual period.
• On the day of the exam, don’t wear deodorant or antiperspirant; some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray film as white spots.
• Discuss any new findings or problems in your breasts with your doctor or nurse before having a mammogram.
• To bring previously done mammograms so that they can be compared to the new ones.
Breast self examination-------Goal- to report any breast changes to a doctor or nurse right away.
• Systematic step-by-step approach to examining the look and feel of one’s breasts.
• What to look-- lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, a discharge other than breast milk, or a change in the size of one breast,
• Best time for a woman to examine her breasts is when the breasts are not tender or swollen.
• Women who are pregnant, breast feeding, or have breast implants can also choose to examine their breasts regularly.
• Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Clinical breast examination.---- Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.
ACS RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
The treatment protocol for breast cancer depends on the stage of the cancer & general physical condition of the patient.
Surgery is the main modality for early & locally advanced breast cancer.
The two types of surgery to treat breast cancer are:
1--Surgery to remove the entire breast & axillary lymph nodes i.e radical mastectomy.
2--Surgery to remove just the area of the breast that contains cancer & axillary dissection (breast-conserving surgery) followed by radiation treatment.
Studies now show that breast-conserving surgery followed by radiation therapy is as good as mastectomy in treating early-stage breast cancer (Breast Conservation Trials, NSABP B-06).
Breast conservation surgery is not recommended in patients with---
Two or more tumors in separate areas of breast, H/O prior therapeutic irradiation to the breast, Pregnancy, Women with certain connective tissue diseases. e.g systemic scleroderma, lupus erythematosus, polymyositis, dermatomyositis, and mixed-connective tissue disorders. Women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with chemotherapy in small & medium size breast.
After breast conserving cancer surgery & subsequent radiotherapy, up to 50 to 60 % of woman have a residual deformity that requires surgical correction, by performing immediate remodelling of the breast at the same time as cancer removal. Plastic surgical techniques (oncoplastic & flap surgery ) should be integrated with the original operation .
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VENOUS THROMBOEMBOLISM & CANCER--- THE PRESENT PERSPECTIVE
Posted by on Saturday, 3rd October 2009
The association of VTE with underlying malignancy was first reported by Armand Trousseau in 1865.
VTE includes both deep venous thrombosis (DVT) and pulmonary embolism (PE).
DVT is divided into 4 categories---
1--Upper extremity; 2--Distal lower extremity (e.g., calf);
3--Central/proximal major veins 4--Central Venous Catheter patients with VTE.
FACTS ABOUT VTE------
• Cancer accounts for 20%, patients receiving chemotherapy accounting for as much as 13 of total VTE cases...2,3(The reported rates of VTE in patients with cancer are believed to be underestimated, given that autopsy rates of VTE can be as high as 50% compared with clinical rates of 4% to 20%.4,5
• Venous thromboembolism (VTE) is a major complication of cancer, occurring in 4% to 20% of patients, and is one of the leading causes of death in patients with cancer.1
• Hospitalized patients with cancer and those receiving active therapy seem to be at the greatest risk for development of VTE.
• VTE A RISING TREND IN CANCER PATIENTS. In a recent analysis of more than 66,000 patients with cancer hospitalized at 120 US academic medical centres, 5.4% developed VTE per hospitalization, increasing by 36% from 1995 to 2002 (P < .0001 for trend).1
• Vascular toxicity, particularly thromboembolism, is a specific toxicity of antiangiogenic drugs. Newer cancer regimens that include thalidomide, lenalidomide, or bevacizumab have reported very high rates of VTE.6,7
• Hospitalized patients with VTE have a greater in-hospital mortality rate (odds ratio, 2.01; 95% CI 1.83 to 2.22; P < .0001), and this is true of patients both with and without metastatic disease.8
• The risk of fatal PE in patients with cancer undergoing surgery is three-fold greater than in patients without cancer undergoing similar surgery.9
• VTE recurs three-fold more frequently in cancer patients than in patients who do not have cancer, and requires long-term anticoagulation with a two-fold greater risk of bleeding complications than in patients who do not have cancer.10 VTE in patients with cancer also consumes health care resources.
Available Anticoagulants--------------
1-----Unfractionated Heparin 2---Vitamin K antagonists--Warferin
3----Low molecular weight heparin--- Dalteparin, Enoxaparin, Fondaparinux
4----Parenteral Direct Thrombin Inhibitors: Lepirudin (recombinant Hirudin), Argatroban
Bivalirudin .
Recommendation for thromboprophylaxis ------
1--- Hospitalized patients with cancer should be considered candidates for VTE prophylaxis with anticoagulants in the absence of bleeding or other contraindications to anticoagulation.
2---Routine prophylaxis with an antithrombotic agent is not recommended in ambulatory patients with cancer during systemic chemotherapy.
3--Patients receiving thalidomide or lenalidomide with chemotherapy or dexamethasone are at high risk for thrombosis and warrant prophylaxis.
4---All patients undergoing major surgical intervention for malignant disease should be considered for thromboprophylaxis.
5---Patients undergoing laparotomy, laparoscopy, or thoracotomy lasting greater than 30 minutes should receive pharmacologic thromboprophylaxis with either low-dose UFH or LMWH unless contraindicated because of a high risk of bleeding or active bleeding.
6---Prophylaxis should be commenced preoperatively, or as early as possible in the postoperative period.
7--- A combined regimen of pharmacologic and mechanical prophylaxis may improve efficacy, especially in the highest-risk patients.
8---Prophylaxis should be continued for at least 7 to 10 days postoperatively. Prolonged prophylaxis for up to 4 weeks may be considered in patients undergoing major abdominal or pelvic surgery for cancer with high-risk features such as residual malignant disease after operation, obese patients, and those with a previous history of VTE. 11
TREATMENT FOR PATIENTS WITH CANCER WITH ESTABLISHED VTE TO PREVENT RECURRENT VTE
1. 1--- LMWH is the preferred approach for the initial 5 to 10 days of anticoagulant treatment of the cancer patient with established VTE.
2. 2---LMWH given for at least 6 months is also the preferred approach for long-term anticoagulant therapy. Vitamin K antagonists with a targeted INR of 2 to 3 are acceptable for long-term therapy when LMWH is not available.
3. 3---After 6 months, indefinite anticoagulant therapy should be considered for selected patients with active cancer, such as those with metastatic disease and those receiving chemotherapy. This recommendation is based on Panel consensus in the absence of clinical trials data.
4. 4---The insertion of a vena cava filter is only indicated for patients with contraindications to anticoagulant therapy and in those with recurrent VTE despite adequate long-term therapy with LMWH.
5. 5---For patients with CNS malignancies, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring is necessary to limit the risk of hemorrhagic complications. Anticoagulation should be avoided in the presence of active intracranial bleeding, recent surgery, pre-existing bleeding diathesis such as thrombocytopenia (platelet count < 50,000/µL) or coagulopathy.
6. 6---For elderly patients, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring and dose adjustment is necessary to avoid excessive anticoagulation and further increase in the risk of bleeding.
References---
1. Khorana AA, et al: Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 5:632-634, 2007.
2. Caine GJ, et al: The hypercoagulable state of malignancy: Pathogenesis and current debate. Neoplasia 4:465-473, 2002.
3. Heit JA, et al: Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med 162:1245-1248, 2002.
4. Gomes MP, et al: Diagnosis of venous thromboembolic disease in cancer patients. Oncology (Huntingt) 17:126-135, 2003; discussion 139-144.
5. Ottinger H, et al: Deep venous thrombosis and pulmonary artery embolism in high-grade non Hodgkin's lymphoma: Incidence, causes and prognostic relevance. Eur J Haematol 54:186-194, 1995.
6. Cavo M, et al: Deep-vein thrombosis in patients with multiple myeloma receiving first-line thalidomide-dexamethasone therapy. Blood 100:2272-2273, 2002.
7. Shah MA, et al: Thromboembolic events in gastric cancer: High incidence in patients receiving irinotecan- and bevacizumab-based therapy. J Clin Oncol 23:2574-2576, 2005.
8. Khorana AA, et al: Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 24:484-490, 2006.
9. Gallus AS et al : Prevention of post-operative deep leg vein thrombosis in patients with cancer. Thromb Haemost 78:126-132, 1997.
10. Prandoni P, et al: Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484-3488, 2002.
11. Gary H. L, et al : American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer. Journal of Clinical Oncology, Vol 25, No 34 (December 1), 2007: pp. 5490-5505.
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