Cancer is only skin-deep

从本期起《医学英语》栏开辟“笔译征文”,2～3期刊登一次。下面刊出的“Cancer is only skin-deep,一文。译文欢迎寄来我刊《医学英语》栏(请自贴邮票),我们将选译得较好的数篇在第10期本栏发表,并对寄来的译文中较普遍的误译和不妥之处,作一综合分析,以提高大家的笔译水平。译文较好而未能采用的,选50名公布名单并酌发学习资料。来稿不论采用与否,均不退稿。读者所提的问题,如有普遍意义则公开解答,对其他问题,因人力所限,恕不一一作复。     

Gynecological Issues for Cancer Survivors

The development of sexual morbidity in survivors of female cancers is a multifactorial problem encompassing psychological, physiological, and sociological elements. Often patients are embarrassed to discuss sexual function, and it is rarely addressed in clinical practice. Cancer treatments, such as surgery, chemotherapy, radiation, and endocrine therapies, greatly influence sexual health. Of import, pelvic floor dysfunction plays a significant role in women’s ability to enjoy sexual intercourse and to tolerate the medical pelvic examination. Nurse practitioners and physical therapist specialists can offer a thoughtful, comprehensive assessment of the pelvic floor with a structured treatment program to significantly affect sexual satisfaction.     

Oligometastatic Non-Small Cell Lung Cancer: A Significant Entity outside of Specialized Cancer Centers?

Objective

To report the incidence, patterns of care, and outcomes of oligometastatic non-small cell lung cancer (NSCLC) in a rural practice setting in Norway.

Materials and Methods

A retrospective analysis was conducted of all patients with stage IV NSCLC at the initial diagnosis who received active treatment in the central part of Nordland, a rural county in northern Norway, during the period of 2006–2012. We analyzed overall survival and prognostic factors.

Results

The initial study population included 113 patients with stage IV disease who received active therapy; of these, 23 (20%) had oligometastatic spread (a maximum of 3 metastases to 1 organ). The median age was 71 years. Of the 23 patients, 16 (70%) did not receive radical or at least moderately aggressive local treatment for their thoracic disease. Of the remaining 7 patients, 4 (17.4%) did not receive systemic therapy. The median actuarial survival was 5.6 months in patients with more advanced metastases and 11.7 months in those with oligometastases (p = 0.03). Significant differences were also seen between the 2 oligometastatic patient groups with and without more intense thoracic treatment (median 19.7 vs. 7.6 months, p = 0.004). Further significant predictors of survival in patients with oligometastases were nodal stage (p = 0.028) and weight loss (p = 0.045). Trends were seen for T stage (p = 0.058) and performance status (p = 0.07).

Conclusion

Oligometastatic NSCLC was diagnosed in a relevant proportion of patients; therefore, warranting prospective studies are recommended. Such studies are also needed to confirm the treatment-dependent survival differences observed in our patient population.Key Words: Non-small cell lung cancer, Disease stage, Staging, Metastases, Oligometastases     

Cancer vaccines: prospects and problems

Cytokines provided locally at tbe tumor site mayinitiate an effective anti-tumor immune responsewhich leads to rejection of a tumor which otherwisegrows progressively. Experimentillly, this can betested by gene transfer into cultured tumor cellsfollowed by the analysis of the tumorigenicity of suchgenetically engincered cells. This approach allows to     

Hereditary Cancer Syndromes—A Primer on Diagnosis and Management: Part 1: Breast-Ovarian Cancer Syndromes

Cancer is the second leading cause of death in both men and women in the United States, with colorectal cancer and breast cancer being two of the most frequent cancer types. Hereditary causes occurring due to pathogenic sequence variants and defects in certain genes makes up roughly 5% of all colorectal cancers and breast-ovarian cancers. High-risk hereditary predisposition syndromes have been associated with a substantially increased lifetime risk for the development of colorectal cancers and breast-ovarian cancers depending on the genetic syndrome, and many people also carry an increased risk of several other cancers compared with the general population. The aim of this review was to provide comprehensive literature on the most commonly encountered hereditary predisposition syndromes, including Lynch syndrome, familial adenomatous polyposis, MUTYH-associated polyposis, hamartomatous polyposis, and breast-ovarian cancer conditions. This will be presented as a 2-part series: the first part will cover the breast-ovarian cancer syndromes, and the second will focus on the inherited colorectal cancer and polyposis conditions.     

Cancer is only skin-deep(续)

Early treatment is vital Treatment, by way of surgery, of this cancer is mandatory in the early stages. Melanoma, the most dangerous skin cancer, almost always develops in an immature mole, with a surface flat to touch. These moles can become darker in colour, and even bleed in the initial stages. The teal threat with this form of cancer is that it can metastasise very early and quickly.     

Second Primary Malignancies in Cancer Survivors

Advances in early detection and treatment of cancer have resulted in a growing population of cancer survivors across the United States. Cancer survivors may be at increased risk for the development of a second primary malignancy as a result of environmental factors, genetic predisposition, or as a late effect of the cancer treatment they received. This review examines the risk for second primary malignancy and necessary screening in the six cancers with the highest 5-year survival rates, including: breast cancer, Hodgkin's lymphoma, melanoma, prostate, testicular, and thyroid cancer.     

Cervical Cancer: Who's At Risk?

Cervical cancer is not just a women's health issue, but a public health issue of which we all need to be aware. It can be prevented through primary and secondary prevention strategies, and it can be effectively treated when caught early. This article discusses risk factors for cervical cancer using the BEINGS epidemiologic model, and discusses the important role nurses can play in helping patients understand their individual risk factors and how to modify them.     

Hereditary Cancer Syndromes—A Primer on Diagnosis and Management,Part 2: Gastrointestinal Cancer Syndromes

Hereditary causes due to mutations and defects in certain genes account for roughly 5% to 10% of all colorectal cancers. These inherited syndromes have been associated with a 60% to 100% lifetime risk for development of colorectal cancer, depending on the genetic syndrome, and many also carry an increased risk for multiple extracolonic malignancies. In this second part of a review series on hereditary cancer syndromes, the focus will be to provide guidance on the features and management of the most commonly encountered hereditary colorectal cancers and polyposis conditions including Lynch syndrome, familial adenomatous polyposis, MUTYH-associated polyposis, and hamartomatous polyposis.     

Using Neuroleptics to Treat Delirium in Dying Cancer Patients at a Cancer Center in Saudi Arabia

Neuroleptics are commonly used for treating delirium as a common problem in terminally ill cancer patients. However, prescribing patterns are believed to substantially vary among health professionals. The aim of this study is to determine the pattern of prescribing neuroleptics for treating delirium in cancer patients dying in a palliative care unit in Saudi Arabia. We reviewed the medical records of adults with advanced cancer who died in the palliative care unit over 23 months. In addition to patients’ demographics, data collection included the pattern of prescribing neuroleptics for the treatment of delirium during the last week of life. For the 271 patients included (57.6% females), the median age was 54 years. Although 62% of patients were on around-the-clock (ATC) neuroleptics to treat delirium, about two thirds of these were requiring rescue doses (PRN [pro re nata]) as well. The ATC neuroleptics included haloperidol alone (89.3%), levomepromazine alone (2.4%), or both (8.3%). All neuroleptics were administered via the parenteral route. On average, the maximum daily doses of the ATC neuroleptics were 4 mg for haloperidol and 15.5 mg for levomepromazine. Patients with primary or metastatic brain cancers were less likely to be on neuroleptics (P < .0001). The authors conclude that in their palliative care unit, haloperidol is by far the most commonly used neuroleptic, followed by levomepromazine, to treat the common problem of delirium in patients dying with advanced cancer. The generally low doses of neuroleptics required may be attributed to several factors in this population, including cultural motives.     

Is Early Detection of Ovarian Cancer Possible?

Advances in medical technology have led to potentially useful techniques for the early detection of epithelial ovarian cancer. Early detection of ovarian cancer is crucial for survival as women found to have Stage I or II disease have a 5-year survival of 90% and 70%, respectively, whereas those with advanced disease (Stage III and IV) have a survival of approximately 20%. The circulating tumour marker CA-125 has been extremely useful in following women known to have epithelial ovarian cancers. It has been employed in differentiating benign tumours from malignancies, and is now being tested in a variety of programmes for its role in the early detection of ovarian cancer. The application of endovaginal ultrasound and colour Doppler flow techniques to early detection of ovarian cancer have resulted in several large series identifying ovarian cancer in 1: 1000 to 1: 2000 postmenopausal women screened. However, a high false positivity rate persists using CA-125 and ultrasound techniques alone or in sequence. Developments in molecular genetics may be extremely useful in evaluating women with inherited susceptibilities for this disease, but this probably represents only about 3% of the population of the women who develop epithelial ovarian cancer. The cost-benefit analysis of isolated screening for epithelial ovarian cancer using CA-125 and ultrasound techniques, even in women at high risk for the disease, would suggest that such screening is not cost-effective at this time.     

Cancer mortality in Austria: 1970–2002

PURPOSE: The aim of this study is to assess the overall progress against cancer in Austria by analyzing changes in age-adjusted mortality rates from 1970 to 2002. METHODS: For the years 1970 through 2002, age-adjusted rates for all malignant neoplasms together and for selected cancers individually were calculated for men and women according to year and age. The data were obtained from Statistik Austria. RESULTS: Age-adjusted mortality rates of all cancers decreased in men by 22% and in women by 27%. The annual decrease of cancer mortality was 0.8% per year in the time period analyzed and 1.7% per year from 1993 to 2002 in both sexes. Among older persons (> or = 55 years) the mortality decreased by 21% in men and by 25% in women; among younger persons (< or = 54 years) by 25% and 40%, respectively. In individual cancer sites, the highest mortality rates are observed before the year 1995 in both sexes, except for liver and brain cancer in men (with the most recent peaks in the year 2001) and lung and brain cancer in women (with the most recent peaks in the year 2002). CONCLUSIONS: The observed changes in cancer mortality are primarily related to changes in incidence and, in the last decade, to improved treatment and early detection, but neither of these contributions can be quantified. The strengthening of prevention research (primary and secondary prevention) and further implementation of preventive knowledge is urgently needed.     

Cancer stem cells - A therapeutic target?

Cancer stem cells (CSCs) form a highly tumorigenic core in most human tumors. Although there is no consensus regarding CSC phenotype from different tumor types, CSCs from different cancers share a primitive undifferentiated nature, including a capacity to expand and differentiate, albeit aberrantly, into the major cell types observed in the corresponding tumor. This review focuses on the development of therapeutics targeting CSCs, for which new assays that replace those reporting the inhibition of cell division and rapid tumor shrinkage will be required to account for the quiescent nature and properties of CSCs. The inhibition of signaling pathways related to the stem cell nature of the CSCs may appear an attractive target for novel therapeutics, but these targets could result in significant unwanted off-target effects against essential healthy tissue stem cells. Instead, the ideal therapies targeting CSCs will be directed against functions that contribute to the oncogenic nature of CSCs relative to healthy stem cells, an altogether more challenging task.