TUMOR SPECIFIC IMMUNO-THERAPY PROCEDURE: * 1st step after drawing peripheral blood we separate the surface of tumor-cells and

tumor antigen-loaded macrophages. * 2nd step we remove about 60 to 80 % of their outer cell membrane. * 3rd step we present to immunological active cells of peripheral blood in vitro these removed parts of cell membrane and in addition the "nude" cancer-cells. -With this procedure immune-active cells express in the laboratory antibodies and cytokines towards this removed camouflage on the one hand, and on the other hand to nude tumor-cells. * 4th step we harvest these tumor-specific antibodies and cytokines and use it for treatment. Immune-active cells in vivo cannot express antibodies and cytokines towards cancer-cells, since protection by mimicries in vivo is done. In vitro antibodies and cytokines can be expressed, since by laboratory-procedure mimicries is removed. So in vitro immune-active cells express antibodies and cytokines specific towards the tumor-cells. Bringing back these patients own tumor specific antibodies and cytokines (signal-transducers) in patients system, white blood cells in vivo "read" this message and find all the immunologically hidden tumor-cells in patients organism. Since antibodies and in special cytokines are signal-transducers, comparison is allowed with a wanted paper, that is expressed in vitro and given back therapeutically in vivo to support patient's immune-active cells. CLINICAL ASPECTS Under this treatment clinically appears natural immunological defense anywhere tumor order metastases are located in form of inflammation. This inflammation is the beginning of the therapeutic effect and is followed by tumor-decrease. Naturally these reactions are depending on tumor- or metastases-size, -location, and dependant on the activity of patients immunesystem. Very important is that this expression of cytokines is controlled. So first of all documentation is done of tumor necrosis factor a, Interleukin 2- and Interleukin 6-receptor from the native serum. Under the described laboratory procedure cytokines will be expressed more or less. If laboratory procedure is stopped, second examination of the upon mentioned cytokines is done. So beginning on 200 % or more of the basic serum-cytokines are expressed, the therapy will be started. Otherwise, if less than 200 % of cytokines are expressed, no specific antitumor-effect will be expected, and no therapy will be done. The laboratoryprocedure has to be repeated. So this technique also allows predicting any therapeutic effect, what is just in oncology very important. This technique also is suitable for Early Cancer Detection. More than half of all patients with RCC have blood in the urine (hematuria). Often this blood is present in small amounts or diffused in the urine so that it cannot be seen with the naked eye (called microscopic hematuria). To detect hematuria, a chemical test of the urine is performed. On occasion, cells found in the urine are examined under a microscope for abnormalities. This procedure is called urine cytology.

Kidney Cancer- treatment BLOOD TESTS Another laboratory procedure typically used in the diagnosis of RCC involves microscopic examination and/or chemical analysis of the patient's blood. These tests screen for the following conditions which may indicate the presence of cancer: Anemia (too few red blood cells; caused by internal bleeding, a common cancer symptom) Polycythemia (too many red blood cells; sometimes caused by cancerous tumors in the kidney that trigger the release of erythropoitin [EPO], a hormone that increases red blood cell production in bone marrow) Hypercalcemia (high blood calcium levels) and elevated liver enzymes

Cystoscopy Blood in the urine can result from other health problems, such as kidney stones or traumatic kidney injury, so the doctor may order a cystoscopy to determine precisely where the internal bleeding is occurring. In cystoscopy, a long, thin, rigid or flexible optical scope is inserted through the urethra and into the bladder. The practitioner then makes a visual examination of the urethra, bladder, and kidneys to locate the site of bleeding. Fine Needle Aspiration RCC tumors are made up of cancerous (malignant) cells that grow into a mass. If a tumor is found through imaging or other procedures, a cell sample may be taken for microscopic examination. Physicians usually avoid performing needle biopsies of suspected kidney tumors because of the risk for bleeding or other complications. Some tumors contain a fluid-filled cyst. A small amount of this fluid can be drawn out of the cyst for examination by a pathologist, who will look for and identify the cancer cells. This can help the physician determine an appropriate treatment plan. While no longer common, a similar technique can be used to collect a sample of solid tissue from a non cystic tumor.

Surgery and Other Procedures for Cancer Treatment Breast Reconstruction Surgery, the oldest form of treatment for cancer, is the initial procedure in the diagnosis and/or treatment of many solid cancers. There are many cancers where the role of surgery is limited to a biopsy for diagnosis, since other therapies (chemotherapy and/or radiation therapy) are more effective and less debilitating. Freeing surgery from pain and infection enabled its extensive use in the treatment of tumors.

How Do Surgery and Other Procedures Work and do? Surgery and other invasive procedures work by removing cancerous tissues. The goal is to remove or reduce the total body tumor burden. When surgery is used to make a cancer diagnosis, the surgeon removes a tissue sample and sends it to a laboratory for examination and identification. In addition, how aggressively the tumor is capable of growing and whether or not it has already metastasized is considered. Finally, your doctor will assess your general health and how to best preserve your quality of life. Preventive or Prophylactic Surgery This procedure involves removing body tissue that is not cancerous but is likely to become cancerous. An example is using cryosurgery (using the extreme cold temperatures) to destroy and remove precancerous cells on the cervix. Diagnostic Surgery In diagnostic surgery, a tissue sample is removed and used to identify a specific cancer and make a diagnosis. The removed tissue is examined under a microscope to confirm the diagnosis and determine various features of the cancer that can be used to predict prognosis. Staging Surgery Staging surgery is used to determine the extent of the cancer in the body. While the physical exam, laboratory tests, and imaging studies are also used to stage a cancer, surgical staging often allows a more accurate assessment of how far the cancer has spread. Curative Surgery Attempting to remove the entire tumor when it appears to be in one area is known as curative surgery. It is thought of as a primary treatment for cancer, but it may be used with chemotherapy or radiation therapy. Debulking or Cytoreductive Surgery When it is not possible to safely remove the entire tumor, debulking surgery is often done. In so doing, the surgeon attempts to remove as much of the tumor as possible, which can make the tumor more susceptible to radiation or chemotherapy. Palliative Surgery Palliative surgery is not intended to cure cancer. It is used to manage pain and treat complications of advanced cancer, such as a life-threatening obstruction or bleeding.

Supportive or Combination Surgery Supportive surgery is used to support other types of treatment. For example, surgery can be used to place a catheter into a vein, which then allows for the administration of chemotherapy. Restorative or Reconstructive Surgery This procedure is used to restore your appearance after primary surgery. It can also be used to restore the function of an organ or body part. An example of this type of procedure is breast reconstruction after mastectomy . Types of Surgery and Other Procedures *Biopsy In a biopsy, your doctor removes a sample of tissue for diagnostic tests. It is not possible to make the diagnosis of cancer without a tissue biopsy. There are a variety of biopsy procedures, some require surgery and are performed by surgeons. Others are done in the doctor's office with little anesthesia. Usually, a biopsy removes just a sample of the affected tissue. Occasionally, the entire tumor is removed during the biopsy. Regardless of how much tissue is removed, it must be examined in a laboratory for an accurate diagnosis. The following are some of the more common tissue biopsy procedures. *Incisional Biopsy In an incisional biopsy, your surgeon cuts through your skin to remove a small part of a larger tumor. This is usually done with local or regional anesthesia, which is numbing medication used in the area of the biopsy. General anesthesia, which puts you to sleep, may be needed if your tumor is in the chest or abdomen. *Excisional Biopsy In an excisional biopsy, your surgeon cuts through your skin to remove the entire tumor. This is usually done with local or regional anesthesia. General anesthesia may be needed if your tumor is in the chest or abdomen. *Fine Needle Biopsy In a fine needle biopsy, your doctor removes tissue or fluid samples through a very thin needle. Imaging techniques like ultrasound or CT scan can be used to help guide the needle to the tumor. The procedure does not require hospitalization and can be done with local anesthesia. An advantage to this procedure is that it does not require a large incision through the skin. However, in some cases, the needle cannot remove enough tissue for a definitive diagnosis.

*Needle Core Biopsy A needle core biopsy is much like a fine needle biopsy, but the needle is slightly larger. This allows for removal of a larger sample of tissue. *Endoscopy In an endoscopy, the doctor uses a flexible tube with a video camera or a viewing lens and a fiber optic light source on the end to view areas in the body. Using this procedure, your doctor can see the tumor directly and get an idea of its size and location. In addition, a biopsy can be taken through the scope for diagnostic purposes. The procedure usually does not require an open surgical incision or general anesthesia. However, you will be given medication that will make you sleepy and more relaxed before the procedure. An endoscope can be passed through natural body openings and into the following areas:

Esophagus Stomach Small intestine Rectum and colon Bladder Respiratory tract

*Laparoscopy Laparoscopy is done to view and possibly perform surgery on the organs in your abdomen, such as the intestines, stomach, gallbladder, and pelvic organs. Your surgeon inserts a laparoscope (a long, thin tube with a fiber optic light source and video camera) into your abdomen, which allows viewing of abdominal organs. Several small (half inch) incisions are made just above or below the navel and carbon dioxide gas is injected through the incision to inflate the abdomen. This creates a larger space for your doctor to work. The laparoscope is inserted through one of the incisions and the camera transmits images of your organs on a video monitor. Your doctor may make additional small incisions in which other instruments can be inserted to move the organs around for better viewing and to perform any procedures, such as a tissue biopsy. Because the incisions are very small, there is less pain associated with the procedure and recovery is faster than an open abdominal surgery. Laparoscopy may be performed under a local or general anesthetic and is usually done at a hospital.A similar procedure involving the chest is called a thoracoscopy or mediastinoscopy. *Electrosurgery Electrosurgery uses high-frequency electrical current applied by needles, blades, or electrodes to eliminate cancer cells. This procedure can be done in a doctor's office and with a local anesthesia. It is used for some cancers of the skin, oral cavity, anus, and rectum.

*Cryosurgery In cryosurgery, your doctor uses temperatures below -166.2F to freeze and kill abnormal cells. Carbon dioxide, Freon, and nitrous oxide are the three most common gaseous freezing agents. Or, your doctor can use a very cold probe, called a cyroprobe. This procedure can be done in a doctor's office and may involve local anesthesia. Cyrosurgery is used to treat surface lesions, like skin cancer and precancerous and cancerous gynecologic conditions. Newer innovations have enabled this technique to treat areas deep within the body, like metastatic liver cancer and prostate cancer . The use of cryosurgery for the definitive or curative management of prostate cancer is investigational. *Laser Surgery Laser surgery uses a powerful beam of light energy to kill and remove cancerous tissue. Because the beam is so highly focused, it can be used for precise surgical work, like repairing the retina of an eye. Lasers are used to remove tumors in difficult-to-access areas or to minimize blood loss in highly vascular (containing many blood vessels) tissue. Laser surgery is also called photocoagulation or photo ablation. In photocoagulation, tissues are heated to temperatures above 932F, which immediately destroys the tissue. This process is used to prevent blood loss when surgery is performed in an area with numerous blood vessels. Photo ablation occurs at temperatures above 1,832F, a temperature at which tissue water boils. This results in a "vaporization" of the tissue. This procedure is used for incision and removal of diseased tissue. *Mohs Surgery Mohs surgery, a procedure used with skin cancer, is a microscopically controlled surgery. After you are given local anesthesia, a specially trained surgeon shaves off the suspect tissue, layer by layer. After removal, each layer is examined under a microscope. The procedure ends when the excised tissue looks normal.Chemosurgery is the combined use of layer-by-layer surgical resection of tissue and topical application of chemical agents. *Open Surgery When a less invasive procedure cannot provide adequate treatment, your surgeon may opt for open surgery. Open surgery always takes place in a hospital and with anesthesia (either general or local depending on the situation). In open surgery, an incision is made to remove part or all of the cancerous tissue. Adverse Effects Can Occur With Surgery and Invasive Procedures Advances in surgical techniques, anesthesia, and the management of postoperative infections have greatly reduced the danger associated with surgery. However, there are some risks involved.

*During Surgery Complications can include any of the following: Bleedingthis may require blood transfusions. The doctor will try to minimize your risk, but you may want to consider banking some of your own blood in the weeks before surgery in case you need it during your operation. Damage to internal organs or blood vesselsyour doctor will try to minimize this complication as much as possible. Reactions to anesthesia or other medicinesalthough this complication is rare, it can be very serious. All your vital signs will be monitored throughout the procedure to watch for any signs of a reaction. Problems with other organs, such as the heart or kidneysthese are also very rare, but can be life-threatening. This type of complication is more likely to happen to a person who already has problems with these organs.

*After Surgery Painalmost every person who undergoes surgery experiences some level of pain. Although some pain is normal, it should not interfere with your recovery. While there are many effective medications for pain, usually it is the method of their administration that matters most. Infection at the incision siteDoctors take many precautions to minimize the risk of infection at the site of the wound, but it can occur. Antibiotics are usually given to treat these infections. It is important to let your doctor know if you detect signs of a possible infection at your incision site, such as increasing or thickening discharge, spreading redness, swelling, or increasing pain.

Pneumonia You are at a greater risk for this complication if you are a smoker, have compromised lung function, or had surgery done to your chest. To help minimize your risk, start deep breathing exercises and get out of bed as soon as possible after surgery. Other infections within the bodyThis is especially the case if your digestive tract was opened during surgery. Your doctor will take great care to prevent this effect from happening, and strong antibiotics are given if it does occur. BleedingThis can occur either internally or externally, and can occur if a blood vessel was not sealed off during surgery or if a wound reopens. Blood clotsThese can form in the deep veins of the legs after surgery, especially if you remain in bed for a long time. This can be a serious problem if the clot breaks off and travels to your lung. Try to get out of bed and sit, stand, and walk as soon as possible. Slow recovery of normal body functionsAn example is movement in the intestines, which can result in constipation.

Cervical Cancer - Treatment

Cauterization Cauterization (also called diathermy) involves burning off abnormal cervical cells using heat, electricity, or chemicals. The procedure is most commonly used on patients with pre-cancerous cervical conditions. Cauterization can be performed in a physicians office or outpatient section of a hospital with minimal discomfort. However, in some instances, cauterization may cause scarring that could interfere with future Pap smear interpretation. Cryosurgery Cryosurgery is performed by inserting a special metal probe called a cryoprobe through the vagina so that it directly touches the cervical lesion. Once the probe is properly positioned, liquid nitrogen is sent through the probe. The temperature of liquid nitrogen is approximately 256 degree Fahrenheit or 160 degrees Celsius, cold enough to freeze and destroy the desired cervical tissue. Cyrosurgery is commonly used to treat pre-cancerous cervical conditions (such as cervical neoplasia) before they have a chance to develop into cervical cancer. The procedure may also be used to treat early-stage cervical cancer. Cryosurgery can be performed in a physicians office (typically by a gynecologist). The most common side effect of cyrosurgery is mild cramping; severe discomfort does not usually occur. Women are typically able to resume normal activities immediately after the procedure, although they are usually advised to refrain from sexual intercourse and douching for several weeks after surgery. During the weeks following surgery, most women who undergo cryosurgery experience a watery discharge in which the dead cervical tissue is expelled. Laser Surgery Laser surgery involves using a focused laser beam to burn off abnormal cervical cells or to remove a sample of cervical tissue for examination in a pathology laboratory. Laser surgery is a quick procedure that does not usually damage the surrounding tissue. The procedure can be performed in a physicians office or outpatient section of a hospital. Recovery time is usually very fast. Laser surgery is usually performed on patients with pre-cancerous or non-invasive forms of cervical cancer. Cone Biopsy A cone biopsy removes a piece of tissue which is cylindrical or cone shaped. The procedure is usually performed to diagnose cervical cancer but can also be used as a treatment if the cancer is small enough to be completely removed during biopsy. After the tissue is removed, it is analyzed in the pathology laboratory to determine whether cancer is present. There are two main methods used to perform cone biopsy. The LEEP (also called LLETZ) method, short for loop electrosurgical excision procedure, removes tissue by using a wire that is heated by an electrical current.. Another method of cone biopsy involves using a surgical scalpel or laser to remove the tissue. This procedure typically requires general anesthesia and may be performed in a hospital or outpatient facility. However, an overnight hospital stay is not usually required.

The most common side effects of cone biopsy include cramping/discomfort and moderate or mild bleeding for a few weeks after the procedure. Patients should avoid sexual intercourse, tampons, and douching until the incision is completely healed, which may take several weeks. Patients should also discuss other possible side effects of cone biopsy treatment prior to the procedure. The advantages of cone biopsy are that it provides a large sample of tissue for analysis and it can sometimes completely remove the cancer so the patient does not need additional surgery. If a cone biopsy is recommended after abnormal Pap smear results, a patient may wish to ask if a colposcopy (looking at the cervix with magnification) or cervical biopsy would be an appropriate alternative (if they have not already been performed), based on her individual case.