Biomedical subjects
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Three cases of galactocele appeared as breast nodule during lactation are reported. From our experience and the recent literature, ultrasound shows a good reliability for the diagnosis of breast diseases during pregnancy and lactation in spite of oedema and breast turgidity, distinctive of these periods.
The tumor proliferative activity of 74 previously untreated epithelial ovarian carcinomas was evaluated by the thymidine labeling index (TLI) and the primer-dependent alpha DNA polymerase assay (PDP-LI). The median TLI and PDP-LI were 2% (0.1 to 28.0) and 10% (3.0 to 80.0), respectively. The TLI was significantly correlated to tumor grade, International Federation of Gynecology and Obstetrics (FIGO) stage, and residual disease. However, neither the TLI nor the PDP-LI was a predictor of survival. A higher response rate was observed in the case of rapidly proliferating tumors: an objective response (OR) was observed in 38.4% of the patients with a low TLI and in 53.6% of the patients with a high TLI. The advantage of an OR in favor of the high TLI group was significant for patients treated with regimens containing doxorubicin (high TLI, 72.2% OR; low TLI, 40% OR; P = 0.03).
Sixty patients with stage IIIA and IIIB breast cancer have been treated with a combined modality approach including induction chemotherapy, surgery and adjuvant chemotherapy: 74.5% of patients achieved an objective response after 3 cycles of induction chemotherapy, and 98.3% of patients were rendered disease-free after induction chemotherapy and surgery or radiotherapy; at 4 years, actuarial survival and disease-free survival are 71.5% and 43%, respectively. These results are significantly better than our historical control, and locally advanced breast cancer must now be considered a curable disease when treated with an aggressive multimodal approach.
Eighteen cases of endometrial cancer under 45 years were clinically and pathologically reviewed. Epidemiological analysis confirmed obesity as an effective risk factor for this neoplasia. In only three cases the association of adenomatous hyperplasia with endometrial cancer was discovered. These data support the theory that in young women endometrial cancer is not an endocrine related neoplasia.
The authors evaluated the advantages obtained utilizing FNAB with ultrasound in the needle aspiration of breast cysts. Echography can guide the aspiration up to its end in an effective and localized way. Cytologic examination of the cystic fluid confirmed the benign nature of the cyst. The association of needle aspiration and guided echography was related to a low number of relapses (19.8%). Among these relapses some risk factors have been found as well as a correlation between cystic fluid cytologic examination and relapses incidence has been determined.
Nipple discharge, a rare clinical sign, is more frequently determined by benign breast diseases, but it can be associated to breast cancer; for this reason such clinical sign shouldn't be ignored. Cytologic examination together with breast examination and thermography are the correct oncologic approach for nipple discharge, because such way it is possible to select the patients for whom mammography or galactography are recommended as well as and breast biopsy depending on the galactographic data.
In a group of 152 ovarian cancer patients, 11 cases with familial recurrence were investigated (7.23%). Of the families evaluated we found 26 patients with ovarian cancer and twenty two with different cancers in other sites. In ovarian cancer the familial aspect, despite its relatively low frequency, is one of the few factors for identifying "high risk" patients, thus allowing effective secondary prevention.
Adriamycin, one of most effective antitumor drugs, is characterized by high toxicity. The adriamycin-induced alopecia is frequent (80-97% of patients) and rapidly shows itself (already after first treatment). Such toxic effect, so unpleasant particularly to female patients, was largely prevented in our experience (Gynecological Oncology Service) with the utilization of hypothermic caps. These caps, reducing the drug absorption above the scalp, allows limiting the hair loss. The result obtained (reduction of severe alopecia in 34% of patients) encourage the use of such a method to improve the life quality of patients.
The hypothesis of a correlation between diet and cancer is widely supported by several epidemiological and experimental studies. Certainly the exact mechanism of this intervention is still unknown; nevertheless in the tests of a carcinogenesis the direct action of some food is recognised, whereas the indirect action of others should occur through modifications of immune and endocrine systems. Many studies conclude that a high intake of fats and animal proteins appeared to be associated with the etiology of some endocrine related neoplasms, such as the cancer of prostate breast endometrium and ovary. We studied the dietary practices and some constitutional parameters of women affected by endometrial cancer and control women. We did not find a significant difference between the two groups related to height. Conversely the daily intake of lipids and particularly of proteins, glucides and calories turned out much higher in the group of patients. Moreover we found a significant difference related to weight; obese women were more numerous in the group of patient. The above results confirm the importance of a right diet in the prevention of this neoplasm.
Among the toxic effects of antitumor drugs the injury for extravasation occurs too. The kinds of damage which result can achieve dramatic features with serious consequences on the psychophysic activity of patients who once tried other kinds of toxicity following chemotherapy. As the extravasation is caused by way of use and by drug-giving methods, we present this accident: it is necessary to observe rigorous rules of procedure during infusion and, if extravasation occurs, to make use of efficient drugs and physical methods. A recent case of extravasation occurred, at our Gynecological Oncology Service, in a patient who carried out chemotherapy without hospitalization. This case is here proposed and discussed; we think that the rarity of this accident is in our experience, due to the several precautions we observe during the infusion of drug.
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AIM: This phase II trial evaluated the biomodulation of 5-fluorouracil (5-FU) plus folinic acid (FA) with or without ifosfamide (IFO) in chemotherapy-naive patients with colorectal cancer. PATIENTS AND METHODS: Forty-eight patients were randomized to receive: FA (25 mg/m2 iv bolus days 1 to 3), followed by 5-FU (750 mg/m2 iv bolus days 1 to 3), arm A; or FA (25 mg/m2 iv bolus days 1 to 3), followed by 5-FU (750 mg/m2 iv bolus days 1 to 3) plus IFO (2,000 mg/m2 in 1000 mL 5% dextrose in a 2-hr infusion, days 1 to 3), arm B. Mesna was added during and after IFO to prevent hemorrhagic cystitis. Treatment was repeated every 21 days in both arms. RESULTS: Forty-five patients were assessable for response: in arm A, 5 patients achieved a partial response (overall response, 25%), and in arm B, 2 patients achieved a complete and 1 a partial response (overall response, 12%). Time to failure was 3.5 months (range, 1-38) in patients treated with 5-FU plus FA, and 3 months (range, 1-21) in patients treated with the IFO combination. The median survival time was 13.5 months (range, 1-49 months) in arm A and 16 months (range, 1-43 months) in arm B. Diarrhea, stomatitis and vomiting were the most common nonhematologic toxicities in both arms. The most notable hematologic toxicity was leukopenia; 15% and 20% of patients experienced grade 4 in arm A and arm B, respectively. CONCLUSIONS: IFO does not increase the activity of the 5-FU plus FA combination in advanced colorectal cancer.
The increased incidence of hepatocellular carcinoma in patients affected with haemochromatosis has previously been attributed to cirrhosis. However, some cases of hepatocellular carcinoma without cirrhosis have recently been reported in patients with haemochromatosis, leading to reconsideration of the role of iron in the tumorigenesis of hepatocellular carcinoma. We describe a 79 year old male patient affected with haemochromatosis and with a multinodular hepatocellular carcinoma, but without any evidence of cirrhosis. The absence of any other cancer risk factor (alcohol abuse, liver viral infections, heredity) has lead us to reconsider the possible role of iron as a direct carcinogen in the onset of hepatocellular carcinoma in patients with haemochromatosis.
BACKGROUND: Advanced pancreatic cancer (APC) constitutes a poor-prognosis disease with few and disappointing therapeutic options. In recent years chemotherapy has demonstrated a positive effect on disease-related symptoms with the introduction of a novel pyrimidine analogue, gemcitabine. Moreover there is experimental and clinical evidence that endocrine therapy may play a small but unexplored role in the management of APC. Therefore we performed a phase II study to assess whether the combination of gemcitabine and tamoxifen could be an active and safe schedule for the treatment of APC in terms of response rate and clinical benefits. MATERIALS AND METHODS: Twenty-seven evaluable consecutive patients with locally advanced, unresectable or metastatic adenocarcinoma of the pancreas were treated with gemcitabine (1000 mg/mq given as a short infusion once weekly for 3 consecutive weeks out of every 4 weeks) and tamoxifen (20 mg daily starting the second day after gemcitabine). The treatment was continued until progression or unacceptable toxicity. Evaluation of efficacy included response rate, time to progression, survival and clinical benefit, an integrated measurement of pain parameters, weight and performance status. RESULTS: A partial response was achieved in 11% of patients while 48% experienced stable disease, lasting at least 8 weeks; disease progression was documented in 41% of patients. The median time of progression was 4.5 months; the median survival-time was 8 months and one-year survival was 31%. Clinical benefit was documented in 59% of patients with a median duration of 13 weeks. No gastrointestinal or haematological grade 4 toxicity was observed. In general the treatment showed a satisfactory safety profile and tamoxifen-related toxicity was not documented. CONCLUSION: The combination of gemcitabine and tamoxifen appears to be an innovative therapeutic approach in the management of APC with interesting clinical activity and a good profile of toxicity. This novel schedule of treatment deserves further investigation in large randomized trials to assess if the addition of tamoxifen could improve the therapeutic results of gemcitabine in APC, mostly in term of quality of lfe.
Adjuvant chemotherapy is one of the latest and more promising modality of cancer treatment within the multidisciplinary approach to neoplasms. This paper illustrates the biological rationale as well as preliminary evaluation of its effectiveness for bladder carcinoma.
Belonging to the vast family of cytokines, interferons (IFN) have recently been widely investigated concerning their possible clinical applications, both in virology and oncology. In this field results have been quite mixed but definitely encouraging. The best achievements have been obtained in hematology, and particularly in the treatment of hairy cell leukemia and chronic myelogenous leukemia, but new perspectives have also opened in the therapy of solid tumors, especially in the local treatment of superficial bladder cancer and ovarian cancer, AIDS-related Kaposi's sarcoma and malignant melanoma. IFN have in certain cases showed an efficacy comparable to that of classic treatments but with lower toxicity, and in some tumors they have even improved the results obtained so far, especially in combined therapy. We have here gathered the most recent results concerning the use of IFN in the therapy of solid tumors in order to highlight the new therapeutic opportunities available to clinical oncology.
P53 overexpression, detected by immunohistochemical analysis, has been reported in about 50% of gastric cancers whereas scarce data are available on the p53 oncoprotein in precancerous gastric lesions. This study focused on the p53 expression in gastric cancerous and precancerous lesions. One hundred gastric specimens obtained during endoscopy were analyzed: 14 cases of normal gastric mucosa, 53 of chronic gastritis with intestinal metaplasia and/or dysplasia and 33 gastric tumors. An immunoperoxidase technique and monoclonal anti-p53 antibodies were employed. Eleven out of 31 gastric carcinomas overexpressed p53. No correlation was observed between p53-positivity and histological type and grade of tumors. All precancerous lesions were p53-negative. Our results suggest that p53 overexpression is a relatively late event in gastric carcinogenesis.