Endoscopic ultrasound in the staging of gastrointestinal luminal malignancies

Endoscopic ultrasound (EUS) is an important tool in the staging of gastrointestinal cancers. This review highlights the use of EUS in the staging of gastrointestinal luminal malignancies and compares the performance of EUS with other imaging modalities (CT, MRI and PET-CT) in the staging of these malignancies. Management algorithms in the staging of these malignancies are also presented.peer-reviewe

Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act: a national database study

The Affordable Care Act (ACT) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes

EPIDEMIOLOGICAL STUDY ON HEAD AND NECK MALIGNANCIES - A STUDY OF 150 CASES

OBJECTIVE: In the present study we investigate the head and Neck Malignancy cases presenting to the ENT department of our Hospital, and analyze the same to give inputs as to the incidence of head and neck malignancies, the symptoms and stage of presentation, lifestyle and habits as contributory risk factors, identify ENT primary in neck secondaries, histopathological types and selection of best treatment.METHODS: Prospective analysis of 150 patients with newly diagnosed malignancies of nasopharynx, oropharynx, larynx, hypopharynx and ear.RESULTS: Most malignancies are common in patients greater than 40 years of age. 88% of cancer occur in males. Oropharynx cancer is the most common cancer in our study, with the commonest subsite as base of tongue. Supraglottic and pyriform fossa tumours are the commonest tumour in laryngeal and hypopharyngeal cancers  respectively. The most common presentation is dysphagia. Synergistic effect of smoking and alcohol is seen in 50% of patients. Most of the cases were seen in stage III and IV except glottis cancer which is predominantly seen in stage I, almost all cases were squamous cell carcinoma.CONCLUSION:The results of our study were in conformity with other similar studies. In larynx, Supraglottic was more common as opposed to glottis in certain western studies. Analysis of various factors helps in early diagnosis and management.KEYWORDS:Cancer, Head and Neck Malignancy, Larynx, pharynx, Nasopharynx, Neck secondaries.

A Case of Bowen’s Disease and Small-Cell Lung Carcinoma: Long-Term Consequences of Chronic Arsenic Exposure in Chinese Traditional Medicine

Chronic arsenic toxicity occurs primarily through inadvertent ingestion of contaminated water and food or occupational exposure, but it can also occur through medicinal ingestion. This case features a 53-year-old lifetime nonsmoker with chronic asthma treated for 10 years in childhood with Chinese traditional medicine containing arsenic. The patient was diagnosed with Bowen’s disease and developed extensive-stage small-cell carcinoma of the lung 10 years and 47 years, respectively, after the onset of arsenic exposure. Although it has a long history as a medicinal agent, arsenic is a carcinogen associated with many malignancies including those of skin and lung. It is more commonly associated with non–small-cell lung cancer, but the temporal association with Bowen’s disease in the absence of other chemical or occupational exposure strongly points to a causal role for arsenic in this case of small-cell lung cancer. Individuals with documented arsenic-induced Bowen’s disease should be considered for more aggressive screening for long-term complications, especially the development of subsequent malignancies

Pelvic floor disorders in gynecological malignancies. An overlooked problem?

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors

Acute kidney injury in critically ill cancer patients : an update

Patients with cancer represent a growing group among actual ICU admissions (up to 20 %). Due to their increased susceptibility to infectious and noninfectious complications related to the underlying cancer itself or its treatment, these patients frequently develop acute kidney injury (AKI). A wide variety of definitions for AKI are still used in the cancer literature, despite existing guidelines on definitions and staging of AKI. Alternative diagnostic investigations such as Cystatin C and urinary biomarkers are discussed briefly. This review summarizes the literature between 2010 and 2015 on epidemiology and prognosis of AKI in this population. Overall, the causes of AKI in the setting of malignancy are similar to those in other clinical settings, including preexisting chronic kidney disease. In addition, nephrotoxicity induced by the anticancer treatments including the more recently introduced targeted therapies is increasingly observed. However, data are sometimes difficult to interpret because they are often presented from the oncological rather than from the nephrological point of view. Because the development of the acute tumor lysis syndrome is one of the major causes of AKI in patients with a high tumor burden or a high cell turnover, the diagnosis, risk factors, and preventive measures of the syndrome will be discussed. Finally, we will briefly discuss renal replacement therapy modalities and the emergence of chronic kidney disease in the growing subgroup of critically ill post-AKI survivors

Dermatological Malignancies at a University Teaching Hospital in north-western Tanzania: A Retrospective Review of 154 Cases

Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in North-western Tanzania. Data were collected from patients’ files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi’s sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies “chronic ulcers” and all suspected lesions should be biopse

Laddering Through Pedigrees: Family History of Malignancies in Primary Breast Cancer Patients

A family history (FH) of breast cancer (BC) is a long recognized risk factor for developing the disease. Also, there ‍have been some reports of links between an FH and some other malignancies (mostly uterus, ovary, and prostate ‍cancers), and an increased risk of developing BC. In this paper we present descriptive report of the occurrence ‍pattern of malignancies in families of BC afflicted patients through 4 generations. Patients included 542 Iranian ‍primary BC cases, presenting at an outpatient clinic for treatment and follow-up. Detailed pedigrees were drawn for ‍each patient, and data for a total of 6220 relatives were gathered. Among the probands, 29.9% and 53.9% had a ‍positive FH of BC and other malignancies (OM) respectively. Mean number of breast cancers was nearly double in ‍maternal-lines versus paternal-line relatives. Also, occurrence of brain, uterus, and colorectal cancers was significantly ‍higher in maternal-line relatives, but conversely, liver cancer showed a tendency toward paternal-line relatives (1st ‍degree relatives excluded). The highest frequency of BC involvement was noted in 2nd degree/2nd generation, and 3rd ‍degree/3rd generation relatives. For OMs, although gastric cancer was by far the most frequent OM across pedigrees, ‍uterus cancer, and hematopoeitic system lesions (leukemia) predominated over gastric cancer through the 3rd and 4th ‍generations respectively. We did not find any relation between having a positive FH of BC, and developing earlyonset ‍BC. The findings discussed in this paper were partially presented at the 18th UICC International Cancer ‍Congress, Oslo-Norway, 30 June-5 July 2002

Expression of LDL receptor-related proteins (LRPs) in common solid malignancies correlates with patient survival

LDL receptor-related proteins (LRPs) are transmembrane receptors involved in endocytosis, cell-signaling, and trafficking of other cellular proteins. Considerable work has focused on LRPs in the fields of vascular biology and neurobiology. How these receptors affect cancer progression in humans remains largely unknown. Herein, we mined provisional data-bases in The Cancer Genome Atlas (TCGA) to compare expression of thirteen LRPs in ten common solid malignancies in patients. Our first goal was to determine the abundance of LRP mRNAs in each type of cancer. Our second goal was to determine whether expression of LRPs is associated with improved or worsened patient survival. In total, data from 4,629 patients were mined. In nine of ten cancers studied, the most abundantly expressed LRP was LRP1; however, a correlation between LRP1 mRNA expression and patient survival was observed only in bladder urothelial carcinoma. In this malignancy, high levels of LRP1 mRNA were associated with worsened patient survival. High levels of LDL receptor (LDLR) mRNA were associated with decreased patient survival in pancreatic adenocarcinoma. High levels of LRP10 mRNA were associated with decreased patient survival in hepatocellular carcinoma, lung adenocarcinoma, and pancreatic adenocarcinoma. LRP2 was the only LRP for which high levels of mRNA expression correlated with improved patient survival. This correlation was observed in renal clear cell carcinoma. Insights into LRP gene expression in human cancers and their effects on patient survival should guide future research

Determinants of hospital death in haematological cancers: findings from a qualitative study

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. Objectives: Current UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases.Methods: The study was set within the Haematological Malignancy Research Network (HMRN-www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data. Results: Five themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred. Conclusions: Hospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death