Skin Cancer Pill
The choice of treatment for basal cell carcinoma includes surgical removal of the affected area by excision, cryosurgery or radiation therapy. The contemporary method of treatment introduced is through the administration of skin cancer pills called as Erivedge approved by United States food and drug administration society. Erivedge pills are designed to treat advanced levels of basal cell carcinoma. This drug was designed to prevent surgical or radiation associated intervention in sensitive areas such as the nose regions of the face where the carcinoma predominantly occurs.
Erivedge
Erivedge the revolutionary pill for the treatment of advanced basal carcinoma is chemically known as vismodegib. This oral medicine is associated with the prevention of overactive signaling of the Hedgehog pathway by binding to a trans membrane protein occurring in basal cell carcinoma. The continuum of the Hedgehog pathway may result in the metastases of the carcinoma.
Vismodegib (erivedge) is highly permeable and has low aqueous solubility. The plasma protein binding in patients is very high. It binds to albumin and alpha- 1acid glycoprotein. The metabolic pathways associated are oxidation, glucouronidation and also pyridine ring cleavage. The excretion of the drug predominantly happens through the hepatic route. The absorption and retention of the drug occurs in feces and urine.
Dosage and administration
The recommended dosage of erivedge is 150mg taken orally once a day. The duration of medication has to continue until the complete prophylaxis of the disease. Discontinuation of erivedge is only advisable under the incidence of drug toxicity. Additional doses of erivedge are not recommended in case of missing a dose; the next dose has to be resumed. Erivedge intake does not depend upon food intake.
Contraindications and adverse effects
Erivedge is considered as teratogenic, embryo toxic and fetotoxic drug and hence it is not recommended for pregnant women. If administered, the effects include severe birth defects such as craniofacial anomalies, absent or fused digits and also open perineum. Erivedge is also not advisable for nursing mothers as it may be excreted in the milk.
Erivedge consuming patients are advised not to donate blood for a period of seven months. Many adverse effects were reported in the clinical trials conducted on erivedge some of which are muscle spasms, arthralgia, fatigue, diarrhea, weight loss, alopecia, constipation and also decreased appetite. Erivedge intervenes with other drugs such as clarithromycin etc. in leading to adverse reactions.
Erivedge usage is not recommended in children as it intervenes in the epiphyseal growth plate affecting the bones; causing damage to the teeth by necrosis, cysts in the dental pulp and also ossification of the root canal.
Geriatric use of erivedge is also not recommended. The other conditions under which the use of erivedge is not recommended is in patients having hepatic and renal impairments.
Hepatocarcinoma
Malignant hepatoma, which is primary cancer of the liver is termed hepatocarcinoma. Hepatocarcinoma is secondary in about 20% to either a viral hepatitide infection (hepatitis B and C) and about 80% to cirrhosis. In some cases, it is metastasis of cancer, spread from elsewhere in the body. It is also associated with chronic alcohol abuse. Hepatocellular carcinoma is relatively rare in the United States but quite common in the African and Southeast Asian countries. Infact, this is the fifth most common tumor worldwide. In some African countries the disease onsets between late teens and 30s although the normal occurrence is in patients over age 50. Hepatocarcinoma is more common in males than females.
Hepatocarcinoma patients are put under surveillance with ultrasound. Possibly the best method of diagnosis involves a CT scan of the abdomen. This is done using intravenous contrast agent and three phase scanning, enabling the radiologist to detect subtle tumors as well. Another possible alternative to a CT imaging is MRI, using contrast agents which is used to detect the presence of a tumor capsule. Diagnosis is further confirmed by percutaneous biopsy and histopathological parameters.
Treatment for hepatocarcinoma depends especially on the size of the tumor and staging. Some of the treatment options are liver transplantation, which is to replace the liver with a cadaver liver or a live donor lobe; surgical resection wherein the tumor is removed if diagnosed early; Percutaneous ethanol injections in case of solitary tumors and transcatheter arterial chemoembolization for large tumors.
Sometimes sealed source radiotherapy is used to destroy the tumor from within. Here, the radioactive particles are deposited to the area of interest using a catheter. Radiofrequency ablation uses high frequency radio waves to ablate the tumor. As an adjuvant therapy in resected patients, intra-arterial-iodine-131-lipiodol administration is performed. High intensity frequency ultrasound is a relatively new but powerful technique used to treat the tumor. Hormonal therapy and adjuvant chemotherapy are other treatment modalities adopted. Cryosurgery is yet another new technique that can destroy tumors in a variety of sites, in the brain, breast, kidney, prostrate and liver.
Electrosurgery
Electrosurgery is a surgical procedure where high-frequency electric current is used to cut, coagulate tissue or remove lesions. Typically electrosurgery is suited for dermatological conditions such as warts, benign skin tumors, Seborroeic keratosis and skin tags. With limited blood loss, electrosurgery allows precision cuts so as to burn tissue and fulgurate it. While it is not very painful for small lesions, local anasthesia is used for larger lesions. Electrosurgery is an alternative to laser surgery and cryosurgery.
Bibliography / Reference
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