1) What is MRgFUS ?

Imagine your doctor being able to see inside your body, find your tumor and treat it without incisions . This is the idea behind a procedure called Magnetic resonance guided focused ultrasound .

MRgFUS uses a combination of high intensity ultrasound waves and magnetic resonance imaging to provide a novel treatment alternative for tumors .MRgFUS focuses the ultrasound energy to a small spot about the size of a peanut inside the tumors. MRgFUS focuses the ultrasound energy to a small spot about the size of a peanut inside the tumor and heats that spot sufficiently to cause cell death .

During treatment , Magnetic resonance images enable the physician to “see” the tumor and surrounding organ in 3 D , obtain real time feedback about temperature changes in the treated areas , and observe what has been treated , in a totally non -invasive manner .

History :
The first investigations of HIFU for non-invasive ablation were reported by Lynn et al. in the early 1940s. Extensive important early work was performed in the 1950s and 1960s by William Fry and Francis Fry at the University of Illinois and Carl Townsend, Howard White and George Gardner at the Interscience Research Institute of Champaign, Ill., culminating in clinical treatments of neurological disorders. In particular High Intensity ultrasound and ultrasound visualization was accomplished stereotaxically with a Cincinnati precision milling machine to perform accurate ablation of brain tumors. Until recently, clinical trials of HIFU for ablation were few (although significant work in hyperthermia was performed with ultrasonic heating), perhaps due to the complexity of the treatments and the difficulty of targeting the beam noninvasively. With recent advances in medical imaging and ultrasound technology, interest in HIFU ablation of tumors has increased.

The first commercial HIFU machine, called the Sonablate 200, was developed by the American company Focus Surgery, Inc. (Milipitas, CA) and launched in Europe in 1994 after receiving CE approval, bringing a first medical validation of the technology for benign prostatic hyperplasia (BPH). Comprehensive studies by practitioners at more than one site using the device demonstrated clinical efficacy for the destruction of prostatic tissue without loss of blood or long term side effects. Later studies on localized prostate cancer by Murat and colleagues at the Edouard Herriot Hospital in Lyon in 2006 showed that after treatment with the Ablatherm (EDAP TMS, Lyon, France), progression-free survival rates are very high for low- and intermediate- risk patients with recurrent prostate cancer (70% and 50% respectively) HIFU treatment of prostate cancer is currentlyan approved therapy in Europe[, Canada, South Korea, Australia, and elsewhere.As of 2012, clinical trials for the Sonablate 500 in the United States are ongoing for prostate cancer patients and those who have experienced radiation failure.

Use of magnetic resonance-guided focused ultrasound was first cited and patented in 1992. The technology was later transferred to InsighTec in Haifa Israel in 1998. The InsighTec ExAblate 2000 was the first MRgFUS system to obtain FDA market approval in the United States.

What are the advantages of MRgFUS?
MRgFUS is a procedure designed to reduce your tumor related symptoms , resulting in significant improvement in your qualityof life . It is a non invasive alternavtive to surgery or hormonal treatments . Only over night hospital stay is required and most patients are able to return to everyday life the very next day .

Procedure details:
During the procedure , you lie on your back or tummy , on the MRgFUS table inside MRI scanner . Conscious Sedation or rarely anesthesia is given to help you relax . You are awake throughout the procedure and your doctor communicates with you during the treatment .

First the doctor obtains MR images and uses these to see the exact location ans size of your tumor and to plan your treatment . Then individual pulses of focused ultrasound energy , called soncations each lasting about 20 seconds are used to heat the lesion , one planned spot at a time, until your doctor is satisfied with the treatment . Afterwards , MR images with contrast are taken to determine how effective the treatment was .

What happens to the patient after the procedure?
Following the treatment , patients will generally require 1-2 hrs of rest while the conscious sedation wears off . you may experience some abdominal pain , cramping or nausea. If necessary , your doctor will provide instructions for medication to keep you comfortable upon discharge . Usually , only over the counter pain relief medication is required . Most patients are able to return to work and normal activity the next day .

what are the risks of the treatment ?
As with any medical procedure , there are risks involved with the MRgFUS treatment .These risks could include back or leg pain , mild skin burns ,abdominal cramping, nausea , fever , vaginal discharge , and urinary tract infection . The incidence of these complications is relatively low .

Who is the right patient for MRgFUS?
Your physician will help you decide if you are a candidate . Baseline MRI with contrast study is done on every patient to determine if they are a candidate for the procedure .

Where can we use MR -Guided Focused Ultrasound surgery ?
Utrerine Fibroids : 25-30% of Indian female patients suffer from Uterine Fibroids . These patients have symptoms like heavily bleeding , abdominal pain, increased urinary frequency , constipation and infertility . MRgFUS is FDA approved modality for treatment of these uterine fibroids . Jaslok hospital is the only centre in India where this modality is available .
Adenomyosis : Patients suffer from heavy bleeding , abdominal pain and infertility due to adenomyosis . MRgFUS is a CE approved modality for treatment of focal Adinomyosis.
Bone Metastasis : Excruciating pain is the main symptom in patients with bone metastasis. MRgFUS helps us to achieve : a) pain palliation b) local tumor control c) skeletal stabilization .
Prostate Cancer : Patients with T1- T2 tumors ( low and intermediate risk) are ideal candidates for treatment with MRgFUS .
Future applications :
liver / brain tumors : Research work is going on for treatment of liver and brain tumors with MRgFUS.

Functional brain surgery : Research work is on to perform MRgFUS in functional brain surgery like STN etc . Increase drug response to cancer , osteoporosis, Arthritis , Thrombolysis, Embolisation of tumors


What is a smart inhaler and how does it work?

‘Smart’ inhalers are inhalers with extra digital features – they link to an app on your phone or tablet to help you and your doctor manage your asthma better.

At the moment there are lots of products in development, but you can’t get them from your GP just yet.

Some smart inhalers have sensors which can work out if you’re in a high pollution or high pollen area, some can send you handy reminders, and some can tell if you need to check your inhaler technique. They’re all designed to automatically track how often you’re using your inhaler, so you don’t need to keep your own records.

Some trials have suggested that if you use a smart inhaler it can make it easier to stick to taking your medicine. That means you get fewer symptoms.

How could using a smart inhaler help me?

Here are just some of the ways using a smart inhaler could make life a bit easier:

  • Getting an alert on your smartphone when you hit a high pollen or high pollution area – helping you decide whether to avoid it
  • Helping you prove to your doctor or asthma nurse that you’ve been taking your inhaler regularly, so they can better understand if your care needs changing
  • Letting you know if you’ve used your inhaler correctly, helping to make sure you get more of the medicine into your lungs, and reducing possible side effects.

Where can I get a smart inhaler?

If you’re in the UK, you can’t buy smart inhalers at the moment, because they’re still being tested in clinical trials.

Asthma UK has been lobbying for the last few years for wider testing of smart inhalers, and we’re pleased to see this now being recommended in the NHS Long Term Plan.

There’s more to do before smart inhalers are widely available, but they could be an exciting development. Our own research has shown that nearly 9 in 10 people with asthma would be interested in using a smart inhaler if they were available through the NHS. There’s also potential that the data collected through smart inhalers could be used to better detect the early warning signs of asthma attacks, and help reduce them for everybody.

Are smart inhalers anything to do with being on a SMART regime?

No. Maintenance and Reliever Therapy – sometimes known as SMART or MART – is a specific treatment regime where people are prescribed a combination inhaler.



Metastasis is responsible for most cancer mortality. The process of metastasis is complex, requiring the coordinated expression and fine regulation of many genes in multiple pathways in both the tumor and host tissues. Identification and characterization of the genetic programs that regulate metastasis is critical to understanding the metastatic process and discovering molecular targets for the prevention and treatment of metastasis. Genomic approaches and functional genomic analyses can systemically discover metastasis genes. In this review, we summarize the genetic tools and methods that have been used to identify and characterize the genes that play critical roles in metastasis.Keywords: Metastasis, Genomic screen, Functional genomics, Next-generation sequencing.

1 Introduction

Metastasis is the formation of tumors at distant sites following the spread of cancer from a primary site . When cancer is detected before it has spread, it can often be treated successfully with surgery or local and systemic adjuvant chemoradiation therapy. However, when it is detected after it has metastasized, treatments are much less successful . Furthermore, due to the lack of diagnostic tools, many patients in whom there is no evidence of metastasis at the time of initial diagnosis develop metastases later . Metastatic lesions, rather than the primary tumor, are responsible for most cancer deaths and have consequently become the most feared aspect of cancer . Hematogenous metastasis occurs via multiple steps starting with cancer cells escaping from the primary tumor and entering the blood stream (intravasation). Cells that are able to survive in the circulation come to rest in capillaries at a new site, then exit from capillaries into surrounding tissues (extravasation), initiating the formation of micro-metastases. The development of new blood vessels (angiogenesis) then enables the formation of secondary tumors . The metastatic process is also very inefficient and only an extremely small percentage of tumor cells are able to complete all the steps in this complex process and survive at secondary organs . Completion of this journey requires fine coordination among the genes involved at each step of the process . The dissemination of cancer cells and growth of metastases depend on the balance between genetic programs in tumor cells and host’s genetic background that promote or suppressor metastasis . Identification and understanding genome-wide alterations associated with this pathological process are vital to elucidating the complexity of the metastatic process. The recent development of genomics approaches allows the identification of metastasis genes at the genome-wide level.

Genetic Testing for Cancer Risk

Approved by the Cancer.Net Editorial Board, 08/2018

Genetic testing helps estimate your chance of developing cancer in your lifetime. It does this by searching for specific changes in your genes, chromosomes, or proteins. These changes are called mutations.

Genetic tests are available for some types of cancer. These include:

  • Breast cancer
  • Ovarian cancer
  • Colon cancer
  • Thyroid cancer
  • Prostate cancer
  • Pancreatic cancer
  • Melanoma 
  • Sarcoma
  • Kidney cancer
  • Stomach cancer

Genetic testing may help:

  • Predict your risk of a particular disease
  • Find if you have genes that may pass increased cancer risk to your children
  • Provide information to guide your health care

No genetic test can say if you will develop cancer for sure. But it can tell you if you have a higher risk than most people.

Only some people with a gene mutation will develop cancer. What does this mean? A woman may have a 45% to 65% chance of breast cancer. But she may never develop the disease. Meanwhile, a woman with a 25% chance may develop breast cancer.

Risk factors for hereditary cancer

A hereditary cancer is any cancer caused by an inherited gene mutation. An inherited gene means it is passed from parent to child within a family. The following factors suggest a possible increased risk for hereditary cancer:

Family history of cancer. Having 3 or more relatives on the same side of the family with the same or related forms of cancer.

Cancer at an early age. Having 2 or more relatives diagnosed with cancer at an early age. This factor may differ depending on the type of cancer.

Multiple cancers. When one relative develops 2 or more types of cancer.

Rare cancers. Some types of cancer, such as ovarian cancer, adrenocortical cancer, or sarcoma, are linked to inherited genetic mutations.

Reasons to consider genetic testing for cancer

Genetic testing is a personal decision made for different reasons. It is also a complex decision best made after talking with your family, health care team, and genetic counselor.

ASCO recommends considering genetic testing in the following situations:

  • A personal or family history suggests a genetic cause of cancer.
  • A test will clearly show a specific genetic change.
  • The results will help with diagnosis or management of a condition. For example, you may take steps to lower your risk. Steps may include surgery, medication, frequent screening, or lifestyle changes.

ASCO also recommends genetic counseling before and after genetic testing.