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PubMedDate not supplied

Pattern of head and neck cancers among Nigerians in Lagos.

Three hundred and eight-one cases of head and neck cancers were studied over a 10 year period (1988 - 1998) at the Lagos University Teaching Hospital, Lagos. The aim was to assess the various sites of primary lesion, gender and age distribution and histopathological types. The International Classification of Diagnosis Oncology's (ICDO) 9TH version was used to categorize sites of primary lesion. A yearly incidence of 38 cases was noted with an overall male preponderance. Forty-five percent of the patients with head and neck cancers were in their forth and fifth decades of life. The nasopharynx was the commonest site of primary lesion (16.8%) followed by the nose, paranasal sinuses and middle ear (ICDO - 160) with 13.6%. Laryngeal cancer ranked third accounting for 12.1% of the cases. Other common sites of primary lesion were: the skin (9.2%), the salivary glands (7.6%), the mandible (7.3%) and the thyroid gland (7.3%). Metastatic cancer in the neck with unknown primary lesion was seen in 2.9% of the patients. Cancers associated with heavy tobacco use e.g. laryngeal cancers, lip and tongue cancers showed a very high male predilection with M:F ratios of 10.5:1, 8:1 and 6:1 respectively. 91% of the head and neck cancers were of epithelial tissue origin while sarcomas accounted for only 6.6% of the cases. The results show that head and neck cancers affect Nigerians especially males at the prime of their working life. The devastating psychosocial effects on the individual, the family and the society are enormous. Emphasis on cancer prevention is recommended.

Adult↗
PubMed2006

[A case of carcinoma with sarcomatoid elements in the middle mediastinum].

We describe a 63-year-old man who, while under treatment as an outpatient for adult onset Still's disease (AOSD), developed edema of the extremities and mediastinal tumor was observed on a chest X-ray film and a chest CT scan. He was not pathologically diagnosed at first and received radiation therapy with a total dose of 30 Gy. Transbronchial biopsy was carried out because the tumor enlarged, and the tumor invasion was observed in the left lumen of the main bronchus. Histological findings suggested a diagnosis of carcinoma with sarcomatoid elements (CSE). Further radiation therapy with a dose of 20 Gy was unsuccessful; his condition gradually worsened and the patient died. The autopsy findings demonstrated that CSE developed in the middle mediastinum, and the other organs were not involved. From an embryologic standpoint, there seemed to be some possible differential diagnoses, such as a pleomorphic carcinoma as a subtype of lung cancer, and CEA as a metastatic mediastinal lymph node cancer of unknown origin or a primary mediastinal lymph node cancer. Like the present case, tumors developed in the middle mediastinum with rapid progression are rare. We report a case, that was difficult to diagnose and treat.

Carcinoma↗
PubMed1994

[A suspected case of T0N1M0 small cell carcinoma of the lung].

A 51-year-old man was admitted to our hospital with a chief complaint of cough. His chest X-ray and CT scan revealed enlargement of a left hilar lymph node. However, no primary lesion was apparent in the rest of the lung. Bronchofiberscopic findings were essentially normal. At surgery the mass was determined to be an enlarged lymph node (No. 11). No apparent malignant lesion was identified in the lung. Postoperative pathological examination showed small cell carcinoma in a part of the No. 11 lymph node. Despite a thorough systemic examination, no primary foci were detected. We have been following up this patient with chemotherapy for the approximately 2 year period since the operation, but no primary lesions have been detected as yet. Therefore, we speculate that this patient is a very rare case of primary unknown T0N1M0 lung cancer.

Carcinoma, Small Cell↗
PubMed2005

[An autopsied case of metastatic endocrine carcinoma of the pancreas with primary site difficult to identify].

A 40-year-old man suffering from right cheek swelling was first diagnosed with ameloblastoma or anaplastic poorly-differentiated carcinoma of the head and neck region. He received 2 courses of CDDP/TXT chemotherapy (cisplatin 75 mg/m2, docetaxel 80 mg/m2) and achieved a partial response, but his carcinoma of the pancreas recurred. He also achieved a partial response with 2 courses of CBDCA/TXL regimen (carboplatin AUC=6, paclitaxel 200 mg/m2), but later died from his progressive disease. The autopsy revealed a pathological diagnosis of metastatic endocrine carcinoma of the pancreas. This case was close to a cancer with an unknown primary (CUP) site, and several favorable sub-sets of CUP have been identified, which are responsive to systemic chemotherapy. Poorly-differentiated neuroendocrine carcinomas like this case are highly sensitive to chemotherapy, and a careful pathological diagnosis may clarify its sensitivity to chemotherapy and the prognosis.

Adult↗
PubMed1998

[Management of hematologic systemic diseases and rare tumor entities with manifestations in the oromaxillofacial area].

Malignant lymphomas, hematological malignancies, sarcomas, occult head and neck primaries, Merkel cell carcinomas and malignant melanomas are among the tumors that are rarely seen in the head and neck region. Almost 20% of patients with acute leukemia initially present with symptoms of the oral cavity (ulcerations, gingival hypertrophy, etc.). If a malignant lymphoma is suspected, the lymph node should be removed in toto to ascertain diagnosis. Furthermore, in order to make sure that the immunohistological work-up or electron microscopic analysis is adequate, the pathologist should be informed prior to extirpation of the suspicious lymph node. The same diagnostic procedure is indicated for metastases from undifferentiated or small cell cancer of an unknown primary. Metastatic squamous cell or undifferentiated carcinoma to a solitary cervical lymph node from an unknown primary can be cured by multimodal therapy (extirpation, radical neck dissection and adjuvant radiation) in 30% of the cases. Following polychemotherapy, long-term survival may also be achieved in disseminated stages of undifferentiated carcinoma or poorly differentiated adenocarcinoma in an occult primary. When osteosarcoma of the jaw is suspected, core biopsy has to be planned carefully: in order to prevent tumor seeding, the needle track has to be excised during definitive surgery. Most authors propose (neo-)adjuvant chemotherapy (or chemoradiation) for head and neck osteosarcoma, especially when additional risk factors, i.e. a large primary or poorly differentiated sarcoma, are present. Patients with positive margins should receive adjuvant radiotherapy in soft tissue sarcoma. Local control of angiosarcoma is possible exclusively by radiation. Adjuvant radiation is also indicated in Merkel cell carcinoma. Because this tumor spreads in a "cascade" fashion, elective node dissection may also provide a chance for cure. Excision with wide margins is the principal therapeutic step in malignant melanoma. Due to the anatomic localization, adequate resection may not be possible in mucosal melanoma of the head and neck. When regional lymph nodes are involved, radical lymph node dissection and adjuvant radiation have to be added to the therapeutic concept. There is an emerging role for adjuvant interferon alpha in intermediate and high-risk melanoma.

Combined Modality Therapy↗
PubMed1982

An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy.

Metastatic adenocarcinoma in the axillary lymph nodes of a female patient often originates from a primary tumor in the ipsilateral breast. Mastectomy may be recommended if adenocarcinoma is found in the axillary nodes even when the primary tumor is not clinically detectable. In these circumstances, the recommendation for mastectomy should be based on the firm histologic diagnosis of adenocarcinoma. In the present report, five female patients are discussed who presented with axillary lymphadenopathy without clinically evident breast masses or mammographic evidence of malignancy. Axillary lymph node biopsies, performed in each patient, were inconclusive after conventional light microscopic examination. Electron microscopy established the diagnosis of adenocarcinoma. These findings were complemented by sex steroid analyses of the tumors where possible. Each patient underwent ipsilateral mastectomy, and in each specimen an occult breast carcinoma was found. The necessity of making a precise tissue diagnosis in all cases of metastatic cancer from an unknown primary is stressed, and special techniques to accomplish this must be considered preoperatively. This is particularly important in the female patient with metastatic breast carcinoma in an isolated axillary lymph node, since ipsilateral mastectomy may be curative.

Aged↗
PubMed1994

Estrogen-replacement therapy in younger women with breast cancer.

Approximately 25% of breast cancers occur in premenopausal women. In addition to local therapy, surgery or surgery plus irradiation, systemic chemotherapy administration has become the standard of care for all node-positive and many node-negative patients. Systemic adjuvant chemotherapy can result in ovarian dysfunction or failure. This renders many women prematurely estrogen deficient. The consequences of menopause, genitourinary atrophy, bone loss, and increased risk of cardiovascular disease, have not been routinely assessed in clinical trials. The risks of estrogen deficiency have not been assessed in comparison to improved disease-free and overall survival benefits of adjuvantly treated premenopausal breast cancer patients. Estrogen-replacement therapy in postmenopausal women has been shown to prevent osteoporosis and reduce fracture risk. The majority of studies also show a marked reduction in cardiovascular disease and mortality. Estrogen-replacement therapy has been considered a disease-prevention strategy rather than a therapeutic intervention. The risks and benefits of estrogen-replacement therapy in women with primary breast cancer are unknown. It is unknown how the well-known benefits accrued from reduction in skeletal and cardiovascular morbidity/mortality compare with the potential risks of increased breast cancer morbidity/mortality. Carefully designed prospective clinical trials with well-defined objectives and endpoints are required to learn if more harm than good is done by the withholding of estrogen therapy in breast cancer patients.

Adult↗
PubMed1992

Delay by internists in obtaining diagnostic biopsies in patients with suspected cancer.

OBJECTIVE: To investigate the degree and type of delays in performing diagnostic biopsies in medical patients with suspected malignancy. DESIGN: Retrospective survey of clinical histories of patients referred between January 1985 and March 1989. SETTING: Inner city teaching hospital internal medicine (non-oncologic) services. PATIENTS: Patients with gastrointestinal and lung cancers, adenocarcinoma of unknown primary site, and lymphomas were referred as inpatients by internists. Two hundred fifty-five patients were eligible, and 177 were evaluable. MAIN OUTCOME MEASURES: The number, type, and results of tests done before and after biopsy were analyzed. RESULTS: In 67% of patients the biopsied lesion was detected by the second day of evaluation; however, there was an 8- to 10-day delay before a biopsy was done. This delay was consistent across the four malignancy groups studied. Although logistic and other unavoidable delays occurred in 40% of the cases, in 60% delays could only be attributed to continued, frequently low yield, noninvasive tests. An average of 3.3 tests were made per patient, with only 24% leading to a definitive biopsy. CONCLUSION: Because of the performance of many other tests, a substantial delay exists in proceeding to biopsy during the diagnosis of cancer by internists.

Adenocarcinoma↗
PubMed2002

Breast MR imaging in a patient with unilateral axillary lymphadenopathy and unknown primary malignancy.

Bilateral invasive breast cancers were detected on MR imaging in a patient with left unilateral axillary lymphadenopathy and normal findings at physical examination, mammography, and ultrasound of both breasts. One spiculated and a second ill-defined enhancing lesion in the left breast as well as a superficial circumscribed lesion in the right breast were proven to be invasive malignancies. In patients with isolated axillary lymph nodes and occult primary malignancy, breast MRI can identify or exclude the breast as primary site, which proves the superiority and diagnostic benefit of this imaging method and also its contribution to the therapeutic approach.

Adult↗
PubMed1998

Multiple primary cancers in families with Li-Fraumeni syndrome.

BACKGROUND: Li-Fraumeni syndrome is a dominantly inherited disorder characterized by early-onset breast cancer, sarcomas, and other cancers in children and young adults. Members of families with this syndrome also develop multiple primary cancers, but the frequency is unknown. To approach this issue, we quantified the incidence of second and third primary cancers in individuals from 24 Li-Fraumeni kindreds originally diagnosed with cancer during the period from 1968 through 1986. METHODS: The relative risk (RR) of subsequent cancers and 95% confidence intervals (CIs) were calculated by use of population-based incidence data from the Connecticut Cancer Registry. Kaplan-Meier analysis was used to determine the cumulative probability (+/- standard error) of subsequent cancers. RESULTS: Among 200 Li-Fraumeni syndrome family members diagnosed with cancer, 30 (15%) developed a second cancer. Eight individuals (4%) had a third cancer, while four (2%) eventually developed a fourth cancer. Overall, the RR of occurrence of a second cancer was 5.3 (95% CI = 2.8-7.8), with a cumulative probability of second cancer occurrence of 57% (+/- 10%) at 30 years after diagnosis of a first cancer. RRs of second cancers occurring in families with this syndrome were 83.0 (95% CI = 36.9-187.6), 9.7 (95% CI = 4.9-19.2), and 1.5 (95% CI = 0.5-4.2) for individuals with a first cancer at ages 0-19 years, 20-44 years, and 45 years or more, respectively. Thirty (71%) of 42 subsequent cancers in this group were component cancers of Li-Fraumeni syndrome. CONCLUSIONS: Compared with the general population, members of Li-Fraumeni syndrome families have an exceptionally high risk of developing multiple primary cancers. The excess risk of additional primary cancers is mainly for cancers that are characteristic of Li-Fraumeni syndrome, with the highest risk observed for survivors of childhood cancers. Cancer survivors in these families should be closely monitored for early manifestations of new cancers.

Adolescent↗
PubMed1983

Intensive 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), NSC #4366650 and cryopreserved autologous marrow transplantation for refractory cancer. A phase I-II study.

One hundred forty-three patients with refractory cancer were treated with intensive BCNU (600-2850 mg/m2) and autologous marrow transplantation to determine the maximum tolerated dose and antitumor effects of this regimen. Recovery from severe pancytopenia in less than 4 weeks after transplantation occurred in 92.8% of evaluable patients, suggesting the efficacy of the autologous marrow in limiting the prolonged myelosuppression anticipated with intensive BCNU. Serious extramedullary toxicity was encountered at BCNU 1200 mg/m2, where a 9.5% incidence of fatal interstitial pneumonitis and a 3.0% incidence of fatal hepatic necrosis was observed. Higher BCNU doses, 1500 to 2850 mg/m2, were associated with a 35.3% incidence of fatal hepatotoxicity. Fatal encephalomyelopathy was encountered in two patients given BCNU 2250 and 2850 mg/m2. One patient who received the highest cumulative dose of BCNU (3450 mg/m2 in 2 courses) died of cardiac necrosis. Other serious extramedullary toxicities were not encountered, even in the 14 patients who survived from 1 to nearly 5 years after BCNU therapy. Antitumor responses occurred in 40.0% of evaluable patients; a dose effect could not be evaluated due to patient heterogeneity. The BCNU doses associated with acceptable toxicity, 600 to 1200 mg/m2, produced a 37.5% total and an 11.3% complete response (CR) rate, including five patients with prolonged CRs of 1 to nearly 5 years. Notable among the CRs was the 25.0% CR rate in previously untreated metastatic melanoma, and the production of CRs in malignant disease in the central nervous system (CNS) including melanoma, lung cancer, adenocarcinoma of unknown primary, acute leukemia and glioblastoma multiforme. It is concluded that augmented doses of BCNU can be given when autologous marrow transplantation is used to limit myelosuppression. Lung and liver toxicity prevent the use of BCNU doses greater than 1200 mg/m2; neurotoxicity, and perhaps cardiotoxicity, are manifestations of the highest doses used in this study. The antitumor activity of BCNU 600 to 1200 mg/m2 remains to be determined for most neoplasms; these results suggest improved results in melanoma and CNS malignancy compared to conventional-dose BCNU therapy.

Adolescent↗
PubMed2000

Multiple genetic alterations cause frequent and heterogeneous human histocompatibility leukocyte antigen class I loss in cervical cancer.

The nature and frequency of human histocompatibility leukocyte antigen (HLA) class I loss mechanisms in primary cancers are largely unknown. We used flow cytometry and molecular analyses to concurrently assess allele-specific HLA phenotypes and genotypes in subpopulations from 30 freshly isolated cervical tumor cell suspensions.Tumor-associated HLA class I alterations were present in 90% of the lesions tested, comprising four altered pheno/genotype categories: (a) HLA-A or -B allelic loss (17%), mostly associated with gene mutations; (b) HLA haplotype loss, associated with loss of heterozygosity at 6p (50%). This category included cases with additional loss of a (third) HLA-A or -B allele due to mutation, as well as one case with an HLA class I-negative tumor cell subpopulation, caused by a beta2-microglobulin gene mutation; (c) Total HLA class I antigen loss and retention of heterozygosity (ROH) at 6p (10%); and (d) B locus or HLA-A/B downregulation associated with ROH and/or allelic imbalance at 6p (10%). Normal HLA phenotypes and ROH at 6p were observed in 10% of the cases. One case could not be classified (3%). Altered HLA class I antigen expression occurs in most cervical cancers, is diverse, and is mainly caused by genetic changes. Combined with widespread tumor heterogeneity, these changes have profound implications for natural immunity and T cell-based immunotherapy in cervical cancer.

Adenocarcinoma↗
PubMed1998

[CT findings of calcified liver metastases].

OBJECTIVE: To observe the CT findings of 13 cases with calcified liver metastases. METHODS: The primary tumors were 10 cases of colonic carcinoma and 3 cases of rectal carcinoma. CT and ultrasonic examinations of these 13 cases revealed calcified liver metastases. One case had laparotomy and biopsy, pathological diagnosis was liver metastases with necrosis and focal calcifications. RESULTS: There were 3 types of CT findings of calcified liver metastases: (1) sand-like calcifications conglomerate into a mass or circular clump, (2) irregular patchy calcifications, (3) small punctate calcifications. These calcifications were either in the center or the periphery of a single or multiple low density masses. CONCLUSION: Calcified liver metastases are uncommon. The primary tumor is usually colon carcinoma. Calcification can also be seen in carcinomas of the ovary, stomach and breast metastasized to the liver and primary carcinoma of the liver. When calcified liver metastasis is revealed by CT in patient with unknown primary tumor, colon cancer may be suggested.

Adult↗
PubMed1984

Guidelines for detection of breast cancer: an update on investigative methods. A report of the ad hoc committee on mammography of The Canadian Association of Radiologists.

The high incidence of breast cancer and its mortality make it imperative that women over 25 years of age have a clinical examination of their breasts at least every three years up to age 40 and annually thereafter. Before the age of 25, mammography is seldom indicated and then it should usually be limited to a spot film of a potential lesion. After 25, mammography is indicated for any woman with breast symptoms, women with metastases from cancer of an unknown primary site, and before any breast surgery. Women with a strong family history and those with large breasts should also have a mammogram between the ages of 25 and 35. Between the ages of 35 and 39 we recommend a baseline mammogram for asymptomatic women. After 39 and up to age 50, women should consult their physicians yearly to determine if, and how often, mammography should be performed. Finally, after age 50, annual mammography is suggested. In each of the above contexts, the radiologic examination should be coupled with clinical palpation of the breasts. A trained and experienced mammographer should recommend biopsy when mammograms show a typical spiculated mass; an ill-defined or even well defined mass that cannot be said to be benign; a suspicious distortion of local architecture; or a cluster of suspicious microcalcifications. Any cyst the nature of which is uncertain after puncture, or abnormal ducts on a galactogram also should make a biopsy mandatory. On the other hand, a normal mammogram should not prevent biopsy of a lesion of the nipple or of a lump detected clinically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Human tumor stem cell assay].

Human tumor stem cell assay is an in vitro colony-forming technique. Double soft agar layers are used for culture tumor cells and cell lethality is judged by the numbers of colony formation in this assay. Single-cell suspension made from various malignant materials in cancer patients is placed in culture after exposing to various anticancer agents for one hour and incubated for two weeks. Antitumor effects of various anticancer agents against individual patients are evaluated by % inhibition of colony formation. Of 57 tumor specimens 42 (74%) formed at least five colonies per plate (per 0.5 x 10(6) cells). The colony-forming rates of various malignancies are as follows: breast cancer 14/15 (93%), ovarian cancer 8/10 (80%), stomach cancer 5/13 (38%), sarcoma 4/5 (80%), lung cancer 1/4 (25%), colon cancer 3/3, each of pancreas cancer, leukemia and primary unknown adenocarcinoma 2/2, malignant lymphoma 1/1. The median plating efficiency (number of colonies/number of nucleated cells plated) is 0.02% (range: 0.001-0.3%). High correlation between human tumor stem cell assay results and response of an individual patient's tumor to chemotherapy is reported by Salmon and Von Hoff. Human tumor stem cell assay is useful tool for the high prediction of chemosensitivity response.

Antineoplastic Agents↗
PubMed1994

[Atypical symptoms in patients with germinal testicular tumors].

The cardinal syndrome of a testicular germ cell tumour is typically scrotal enlargement. The present paper compares the group of patients with typical scrotal presentation and those who present with atypical symptoms caused by metastases. Among 284 retrospectively studied patients, 34 (12%) presented with extrascrotal symptoms. The most important were abdominal pain (n = 16) and pulmonary symptoms (n = 10). The group of patients with extrascrotal symptoms was characterized by the following parameters: percentage of pure seminoma in 35% (versus 56% in the patients with typical presentation), elevation of alpha-feto-protein in 47% (versus 27%), and elevation of beta-HCG in 61% (versus 29%). The outcome was lethal in 35% of the patients with atypical presentation, as opposed to 6% of those with typical presentation. In 22 patients with extrascrotal presenting signs a palpable testicular mass was found on clinical examination. Occult testicular tumour proved to be present in 9 patients, and burned-out tumours in 3. Unawareness of testicular cancer is a significant factor in diagnostic delay. Scrotal palpation should be part of every clinical examination in younger male patients with cancer from an unknown primary.

Adult↗