Risk factors and primary prevention of lung cancer. Cessation of cigarette addiction

Despite the huge knowledge about the risk factors associated with lung cancer, this disease remains the leading cause of cancer deaths in highly developed countries. The reason for this phenomenon is the increasing pollution of the natural environment and, above all, the difficulties in eliminating the addiction to smoking. In large Polish urban agglomerations, the exposure to particulate matter containing hydrocarbons on its surface, to free hydrocarbons, nitrogen and sulphur oxides is constantly increasing. Moreover, almost 25% of the Polish population smoke cigarettes and the elimination of smoking addiction through psychotherapy, nicotine replacement therapy and pharmacotherapy are sometimes ineffective. This article presents that the use of tobacco-burning products other than cigarettes (e.g., cigars or pipes) and products containing marijuana are as dangerous to health as classical cigarettes. Other nicotine-containing products have also appeared: e-cigarettes and tobacco heating systems. These products are highly addictive to nicotine, but the aerosols, that are produced by them, contain fewer toxic substances than cigarette smoke. Therefore, there are reasons to use these products instead of traditional cigarettes in people who are highly addicted to nicotine (after exhaustion of other treatment options) to reduce health risks, including lung cancer risk. However, it must be evoked that only a complete smoking cessation and the use of nicotine-containing products could be effective in reducing the risk of lung cancer

Skuteczność chemioterapii u chorej na drobnokomórkowego raka płuca z mutacją genu BRCA2 i zespołem Schwartza-Barttera

Drobnokomórkowy rak płuca (SCLC) stanowi obecnie 15–20% wszystkich nowotworów płuca. Cechuje się szybkim wzrostem i wczesnym pojawianiem się przerzutów odległych. Jest ściśle związany z paleniem tytoniu. Charakterystyczną cechą tego typu nowotworu jest częste współistnienie zespołów paraneoplastycznych (ok. 50% chorych). Zespoły paraneoplastyczne są klinicznie istotne, ponieważ mogą stanowić pierwszy objaw choroby nowotworowej. Wczesna diagnostyka niepokojących objawów jest istotnym czynnikiem zwiększenia skuteczności leczenia i szansy chorego na dłuższe przeżycie. Częstymi i klinicznie istotnymi zespołami paraneoplastycznymi w przebiegu SCLC są przede wszystkim zespół nieprawidłowego wydzielania hormonu antydiuretycznego (SIADH), paranowotworowe zwyrodnienie móżdżku i miasteniczny zespół Lamberta-Eatona. W niniejszej pracy przedstawiono przypadek chorej, która zgłosiła się do szpitala z objawami hiponatremii. Podczas wyjaśniania przyczyny hiponatremii stwierdzono występowanie SIADH (zespół Schwartza-Barterra) w przebiegu SCLC. Istotny okazał się również fakt, że chora jest obciążona genetycznie rodzinnym występowaniem raka piersi i jest nosicielką mutacji w genie BRCA2. Zgodnie z najnowszymi badaniami mutacja w genie BRCA2 istotnie wpływa na chemiowrażliwość komórek nowotworowych, a w konsekwencji zwiększa odpowiedź organizmu na leczenie. Chora otrzymała chemioterapię z udziałem karboplatyny i etopozydu, uzyskując częściową remisję choroby nowotworowej po dwóch cyklach leczenia

Current dietary recommendations for patients with cystic fibrosis

Cystic fibrosis (CF) is classified as metabolic and multisystem disease with autosomal recessive inheritance caused by mutations in the gene located on chromosome 7 encoding cystic fibrosis transmembrane conductance regulator (CFTR) protein. CFTR is a transmembrane chloride channel of epithelial cells and affects the activity of the mucous membrane of the sweat glands, airway epithelium, pancreatic ducts, vas deferens, bile ducts and intestines. In CF, increased concentration of chlorides in the sweat, pancreatic insufficiency and impaired absorption are observed as well as changes in the respiratory system related to, among others, impaired airway patency, weakening of the mucociliary clearance mechanism and the development of bacterial infections. CF is a chronic condition requiring comprehensive therapy. Nutritional treatment is an essential element of CF therapy. Malnutrition is a common complication in patient with CF and eating disorders. The majority of patients with CF have higher energy, protein and fat needs. In addition, supplementation with enzyme preparations, vitamins, sodium chloride, as well as the use of high-energy nutrients is recommended. The aim of the study was to evaluate current nutritional recommendations of patients with CF

The effectiveness of chemotherapy in small cell lung cancer patients with BRCA2 gene mutation and Schwartz-Bartter syndrome

Small cell lung cancer (SCLC) currently comprises 15–20% of all lung cancers. It is characterised by rapid growth and early appearance of distant metastases. It is closely related to smoking. A characteristic feature of this type of cancer is the frequent coexistence of paraneoplastic syndromes (about 50% of patients). Paraneoplastic syndromes are clinically important because they can be the first sign of cancer. Early diagnosis of disturbing symptoms is an important factor in increasing the effectiveness of treatment and the patient’s chance for longer survival. The most frequent and important paraneoplastic syndromes in the course of SCLC are primarily the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), paraneoplastic cerebellar degeneration, and Lambert-Eaton syndrome. This paper presents the case of a patient who came to the hospital with symptoms of hyponatraemia. Looking for the causes of hyponatraemia, the syndrome of abnormal secretion of antidiuretic hormone (Schwartz-Bartter syndrome) in the course of small cell lung cancer was confirmed. The fact that the patient was genetically burdened with the family history of breast cancer and was a carrier of the BRCA2 gene mutation was also significant. According to the latest research, mutation in the BRCA2 gene significantly affects the chemosensitivity of cancer cells, and thus increases the body’s response to treatment. The patient received chemotherapy with carboplatin and etoposide, resulting in partial remission of cancer after two treatment cycles

Place of residence does not significantly influence radiological morphology of cervical cancer

Introduction and objective Cervical squamous cell carcinoma is one of the most common malignancies of women. Its incidence and morphology was analyzed based on the magnetic resonance (MR) data among rural and urban residents. Material and Methods The study involved 61 Caucasian women (58.26±9.63 years) preliminary diagnosed with a cervical cancer without any previous treatment. Standard MR examination, including diffusion weighted imagining, apparent diffusion coefficient (ADC) value measurement and dynamic contrast enhancement, was performed. Results The rural residents (n=22) were insignificantly older. Their first and last menstruation were observed later and number of pregnancy was higher than in urban women (n=39). However, the incidence of miscarriage was insignificantly rarer. All the tumour linear diameters as well as its volume were insignificantly higher in rural women. The ADC value of the cervical tumor was insignificantly lower, while ADC of lymphatic nodules was higher in rural women. Insignificant changes in tumour grade between both examined groups were found in histological, clinical and radiological examinations. Place of residence did not influence any clinical symptoms nor tumour volume and its ADC. Colporrhoea and colpodynia were insignificantly more often observed in urban women, while parametrium, urinary bladder and rectal infiltrations were more commonly seen in rural residents. Higher risk of lymphatic spread to the internal iliac and parametral lymphatic nodes was reporte[b]d in the rural community. Conclusions Cervical cancer had similar morphology and growth pattern, regardless of the place of residence. However, a insignificantly larger tumour size among rural residents may suggest a higher incidence of lymphatic spread, probably as a result of less aaccess to modern health care

Effectiveness of osimertinib in patients with lung adenocarcinoma in clinical practice — the Expanded Drug Access Program in Poland

Introduction: Osimertinib is a third-generation, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that has demonstrated efficacy in the treatment of EGFR-mutant non-small-cell lung cancer (NSCLC) in prospective clinical trials. Material and methods: This retrospective analysis evaluated the outcomes of 32 pretreated patients with EGFR T790M mutation who received osimertinib in clinical practice at seven centers in Poland within the Expanded Drug Access Program. Osimertinib was used in the second line in 59% of patients and in later lines in 41%. Results: Objective response was attained in 16 patients (50%), and 12 subjects (38%) had stable disease. Median progression -free survival was 11.3 months in the overall population, 12.6 months in patients with EGFR exon 19 mutation and 7.5 months in patients with EGFR exon 21 mutation (p = 0.045). Median overall survival (OS) was 18.3 months. Overall, 58.4% and 45.6% of patients remained in follow-up after 12 and 24 months, respectively. Median OS appeared longer for patients without cerebral metastases than for those with cerebral metastases (27.4 vs 9.4 months, respectively; p = 0.078), and for patients with the Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1 than those with ECOG PS 2 (27.4 vs 11.8 months, respectively; p = 0.189), although neither result reached statistical significance. Median OS of patients with partial response, stable disease and progressive disease was 27.4, 12.7 and 4.5 months, respectively (p < 0.001). Age, comorbidities, line of treatment with osimertinib, and type of activating EGFR mutation did not impact on OS. Adverse events of any grade or grade 3/4 were reported in 38% and 9% of patients, respectively. One person discontinued due to interstitial pneumonia.Conclusion: These results confirm the value of osimertinib in patients with previously treated EGFR T790M-mutant NSCLC. Clinical benefit was evident in patients with cerebral metastases and moderate performance status

Różnicowanie autoimmunologicznego uszkodzenia i makrogruczolaka przysadki mózgowej w trakcie terapii niwolumabem u chorej na niedrobnokomórkowego raka płuca — opis przypadku

W pracy przedstawiono opis przypadku chorej na niedrobnokomórkowego raka płuca z ekspresją PD-L1 na 1% komórek nowotworowych, leczonej za pomocą chemioterapii oraz radioterapii, a w momencie progresji choroby — immunoterapii niwolumabem. W trakcie stosowania immunoterapii u chorej rozwinęły się objawy wieloosiowej niedoczynności przysadki. W badaniach obrazowych przysadki uwidoczniono makrogruczolaka. W rozpoznaniu różnicowym brano pod uwagę autoimmunologiczne zapalenie przysadki w przebiegu terapii niwolumabem. Po wyrównaniu zaburzeń hormonalnych kontynuowano immunoterapię, uzyskując remisję choroby, utrzymującą się przez następne 2 lata

Place of residence does not significantly influence radiological morphology of cervical cancer

Introduction and objective Cervical squamous cell carcinoma is one of the most common malignancies of women. Its incidence and morphology was analyzed based on the magnetic resonance (MR) data among rural and urban residents. Material and Methods The study involved 61 Caucasian women (58.26±9.63 years) preliminary diagnosed with a cervical cancer without any previous treatment. Standard MR examination, including diffusion weighted imagining, apparent diffusion coefficient (ADC) value measurement and dynamic contrast enhancement, was performed. Results The rural residents (n=22) were insignificantly older. Their first and last menstruation were observed later and number of pregnancy was higher than in urban women (n=39). However, the incidence of miscarriage was insignificantly rarer. All the tumour linear diameters as well as its volume were insignificantly higher in rural women. The ADC value of the cervical tumor was insignificantly lower, while ADC of lymphatic nodules was higher in rural women. Insignificant changes in tumour grade between both examined groups were found in histological, clinical and radiological examinations. Place of residence did not influence any clinical symptoms nor tumour volume and its ADC. Colporrhoea and colpodynia were insignificantly more often observed in urban women, while parametrium, urinary bladder and rectal infiltrations were more commonly seen in rural residents. Higher risk of lymphatic spread to the internal iliac and parametral lymphatic nodes was reporte[b]d in the rural community. Conclusions Cervical cancer had similar morphology and growth pattern, regardless of the place of residence. However, a insignificantly larger tumour size among rural residents may suggest a higher incidence of lymphatic spread, probably as a result of less aaccess to modern health care