Frontiers of ovarian carcinosarcoma

Ovarian carcinosarcoma (OCS), also known as a malignant mixed Müllerian tumour (MMMT), is a rare and aggressive form of cancer that accounts for less than 5% of ovarian cancers. It is characterized by high morbidity and mortality rates, with a median overall survival (OS) of less than 2 years. Several factors, including advancing age, nulliparity, reduced lactation rates, decreased use of oral contraceptive pills, genetic mutations in BRCA (breast cancer) genes, and the use of assisted reproductive technology, may increase the risk of OCS. Poor prognostic factors include an advanced stage at diagnosis, older age, lymph node metastasis, suboptimal surgical cytoreduction, the presence of heterologous features on histopathology, and increased expression of vascular endothelial growth factor (VEGF), tumour protein p53, and p53 alongside Wilms tumour 1 (WT1). The main treatment approach for OCS is cytoreductive surgery followed by platinum-based chemotherapy, although immunotherapy is showing promise. Homologous recombination deficiency (HRD) testing may enhance outcomes by enabling personalized immunotherapy and targeted therapies for specific patient groups, thereby reducing unnecessary side effects and healthcare costs. However, there is currently a lack of standardised treatment regimens for OCS patients, with most studies consisting of case reports and a shortage of suitable comparator groups. This article aims to provide clinicians with information on the epidemiology, risk factors, prognostic factors, and latest therapeutic advancements in OCS

Frontiers of molecular biology of cancer

Cancer is rooted in genetic background, with the expression of oncogenesis playing a pivotal role in the early stages of tumor formation. Acquired mutations in somatic cells primarily contribute to the development of most common cancers, while specific germline mutations are responsible for rare hereditary cancer syndromes. Within the realm of cancer-associated genes, oncogenes undergo activation, exhibiting phenotypic dominance, whereas tumor suppressor genes experience inactivation, displaying phenotypic recessiveness. The ongoing effort to improve our knowledge about molecular mechanisms involves defining pathways influencing cancer therapy. Technological advancements have made it possible to identify genes integral to cancer development and have significantly contributed to the growing success of precision medicine in oncology, with targeted therapies directed against tumors and components of the tumor microenvironment. This Special Issue, titled “Molecular Biology of Cancer—Implications for Diagnosis and Treatment”, comprises a total of eight contributions. These include five original articles and three reviews, offering fresh insights into cancer biology, molecular genetics, and innovative therapeutic approaches

Prostate cancer - what about oligometastatic disease and stereotactic ablative radiotherapy? - a narrative review

Background and Objective: Oligometastatic prostate cancer (OMPC) encompasses a heterogenous group of clinical entities defined by the timing of the development of metastases. These include de novo oligometastatic, oligorecurrent and oligoprogressive prostate cancer (PrCa). We describe the evidence supporting the use of stereotactic ablative radiotherapy (SABR) to the oligometastases to improve patient outcomes in each of these settings. Methods: Published clinical trials relevant to ‘OMPC’ and ‘SABR’ where used for this narrative review. Key Content and Findings: The driving force behind this narrative review is the constantly evolving field of OMPC with an increasing number of salvage radiotherapy options changing the current treatment paradigm. We now have evidence to support that disease control can be optimised with SABR as shown in several practice changing trials including ‘ORIOLE’, ‘STOMP’ for PrCa and ‘SABR-COMET’ showing a survival advantage with a tumour agnostic salvage approach. We also describe the challenges with data interpretation and cost implications. Challenges include the small sample size for most reported trials, in combination with a lack of cost-efficiency analysis. Conclusions: SABR is a promising treatment approach for OMPC with a proven clinical benefit in some clinical settings and its use will expand in the future

HPV and cervical cancer: A review of epidemiology and screening uptake in the UK

Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS

Precision medicine based in epigenomics: the paradigm of carcinoma of unknown primary

Epigenetic alterations are a common hallmark of human cancer. Single epigenetic markers are starting to be incorporated into clinical practice; however, the translational use of these biomarkers has not been validated at the 'omics' level. The identification of the tissue of origin in patients with cancer of unknown primary (CUP) is an example of how epigenomics can be incorporated in clinical settings, addressing an unmet need in the diagnostic and clinical management of these patients. Despite the great diagnostic advances made in the past decade, the use of traditional diagnostic procedures only enables the tissue of origin to be determined in ∼30% of patients with CUP. Thus, development of molecularly guided diagnostic strategies has emerged to complement traditional procedures, thereby improving the clinical management of patients with CUP. In this Review, we present the latest data on strategies using epigenetics and other molecular biomarkers to guide therapeutic decisions involving patients with CUP, and we highlight areas warranting further research to engage the medical community in this unmet need

A Pedagogic Information System (APIS) in a Web-Based Statistics Classroom

This study investigated the potential application of web-based pedagogy for teachers of elementary statistics, using A Pedagogical Information System (APIS), in order to explore ways in which teachers can enhance instruction via technology in the classroom. This information system would provide new opportunities for practical teacher education, given that the literature on statistics pedagogy and web-based teaching and learning is sparse. The purpose of the study was to examine issues of efficacy, efficiency, and effectiveness of the use of Internet websites in the instruction of introductory statistics at the college level. The design of the study was qualitative and used a phenomenological interpretive method. The participants in this study were four instructors of introductory statistics courses at the undergraduate level of higher education in a northeastern state in the United States. They were interviewed individually for approximately 60 minutes in a semi-structured format in which they discussed their experiences and perceptions about using Internet sources for instruction of students in Introductory Statistics. The results of the study indicated that teachers welcomed incorporating technology into their classrooms. Participants found that having students with different learning styles, allocating time to deal with details, and having difficulty managing the interplay between topics as being key problems that could arise in the organization of a web-based introduction to an elementary statistics course. Although all participants agreed that there is a lack of uniformity among statistical topics, most wanted to emphasize descriptive statistics, distributions, probability, inference, confidence intervals, and regression. They acknowledged that web-based learning would radically alter student and teacher roles, so that the teacher would become a mentor and students would become active learners. Instruction would be geared more to practical applications than to theory. Instructors would have to make decisions about how much web-based information they would use and would have to become knowledgeable about web content

Immunotherapy combined with standard therapies in head and neck squamous cell carcinoma - a meta-analysis

Head and neck squamous cell carcinoma (HNSCC) is a deadly disease with a poor prognosis due to late diagnosis and limited treatment options. Immunotherapy (IT) is emerging as a promising approach, especially after the failure of standard of care therapies (STs). The objective of this systematic review and meta-analysis was to evaluate whether the addition of IT to STs improves outcomes for patients with HNSCC, including overall survival (OS), progression-free survival (PFS), and quality of life (QoL). This review employed the Population Intervention Comparison and Outcome (PICO) framework to identify relevant search terms in electronic databases, and also included supplementary hand searches. Six primary research articles were selected using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) flow chart, and were critically appraised. Data extraction from these studies was conducted, and a meta-analysis was performed to aid in the generation of forest plots. The addition of IT to standard anticancer therapies was found to enhance patient outcomes, such as OS, PFS, and QoL. The toxicity profile of IT was acceptable, with minimal treatment-related deaths. The most frequently observed adverse events (AE) were related to the skin, followed by hematological toxicities. Based on our analysis, the addition of IT to STs is a suitable treatment option and is supported by current research. However, further studies are needed to investigate factors that influence treatment effectiveness and to develop optimal therapies. To achieve this, we recommend a comprehensive treatment approach that involves the multidisciplinary team (MDT) and patient assessment tools. [Abstract copyright: Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Prostate cancer - what about oligometastatic disease and stereotactic ablative radiotherapy? - a narrative review

Oligometastatic prostate cancer (OMPC) encompasses a heterogenous group of clinical entities defined by the timing of the development of metastases. These include de novo oligometastatic, oligorecurrent and oligoprogressive prostate cancer (PrCa). We describe the evidence supporting the use of stereotactic ablative radiotherapy (SABR) to the oligometastases to improve patient outcomes in each of these settings. Published clinical trials relevant to 'OMPC' and 'SABR' where used for this narrative review. The driving force behind this narrative review is the constantly evolving field of OMPC with an increasing number of salvage radiotherapy options changing the current treatment paradigm. We now have evidence to support that disease control can be optimised with SABR as shown in several practice changing trials including 'ORIOLE', 'STOMP' for PrCa and 'SABR-COMET' showing a survival advantage with a tumour agnostic salvage approach. We also describe the challenges with data interpretation and cost implications. Challenges include the small sample size for most reported trials, in combination with a lack of cost-efficiency analysis. SABR is a promising treatment approach for OMPC with a proven clinical benefit in some clinical settings and its use will expand in the future

Constrictive pericarditis–a cloak camouflaging lymphoma

Non-Hodgkin’s lymphoma presenting as a primary cardiac lymphoma (PCL) is extremely unusual. Having a predilection for the right side of the heart and accounting for 1% of all cardiac tumours, the difficulty in diagnosing the lesion, owing to the location and vague presenting symptoms and signs, often leads to delayed diagnosis and poor prognosis. In our case report, a middle-aged male was diagnosed with PCL presenting as pyrexia of unknown origin with the help of F18-fluorodeoxyglucose positron emission tomography (18 FDG-PET). PET-CT is an invaluable tool in patients with pyrexia of unknown origin (PUO), especially caused by neoplasms as it helps in localizing the target lesion, aiding in selecting the appropriate intervention for rapid tissue diagnosis. This case serves to sensitize the physicians of PCL presenting with PUO and mimicking a relatively common cardiac tumour such as atrial myxoma

Frontiers of Molecular Biology of Cancer

Cancer is rooted in genetic background, with the expression of oncogenesis playing a pivotal role in the early stages of tumor formation [...