Staging of cancer of the colon and cancer of the rectum.

A retrospective analysis of 1,826 cases (924 colon, 902 rectal) from ten institutions provided the basis of this study on the staging of cancer of the colon and rectum. The general rules of the American Joint Committee on the relationship between times and the staging of cancer have been followed. These represent modifications of the originally formulated TNM system of the Union Internationale Contre Le Cancer (UICC) which has been designed as a clinical-diagnostic classification, not applicable to cancer of inaccessible sites or structures requiring postsurgical treatment pathologic assessment of therapeutically removed specimens. Inadequacies of the clinical data requested for our study required adoption of the pTNM evaluation method of classification. Multiple regression analysis of the data demonstrated a relationship between survival and the following: depth of penetration (T), status of regional lymph nodes (N), and presence or absence of distant metastasis (M). This was similar for both sites. Basically, for the rectum it was in consonance with the original Dukes' classification (A, B, and C), and was remarkably applicable to the colon. The survival data for the two sites were so similar as to suggest the use of one set of pTNM categories not only for the postsurgical-treatment pathologic evaluation, but also for the stage grouping definitions. Strongly recommended for cancer of all sites is the development of General Oncology Data Forms to be included in the clinical charts and records of all patients with cancer.     

Exploiting the hallmarks of cancer: the future conquest of breast cancer

What separates a malignant from a normal cell? This question has occupied scientists for decades. Although a simple answer remains elusive, several hallmarks of malignancy have been identified. These critical features include uncontrolled proliferation, insensitivity to negative growth regulation, evasion of apoptosis, lack of senescence, invasion and metastasis, angiogenesis and genomic elasticity. Existing therapies predominantly target proliferation either with cytotoxic agents, ionising radiation or more targeted attacks on growth factor signalling pathways. Our most successful therapies to date inhibit proliferation via the oestrogen receptor (ER) and HER2 pathways. Further improvements in therapy must attack the other hallmarks of malignancy and will undoubtedly be accompanied by a better means of individual patient selection for such therapies. Indeed, each of these hallmarks presents a therapeutic opportunity. To believe otherwise would be to assume that a feature is both biologically crucial, yet therapeutically unimportant, an unlikely paradox. Here, we suggest the hallmarks of malignancy as a conceptual framework for understanding novel breast cancer therapies.     

Progress of imaging diagnosis for the cancer therapy--breast cancer

As two main modalities for the breast cancer, ultrasonography (US) and mammography (MMG) were discussed about the efficacy and limitation of qualitative diagnosis. The accuracy rate of US and MMG for the breast cancer were 90.0% and 92.7% at the Aichi Cancer Center Hospital during these 2 years (1986-1988). The number of patients with the breast cancer is increasing recently in Japan. This cancer, however, is one of the curable cancer at the early stage. Therefore, it is very important thing to detect a small malignant mass less than 1cm in a diameter by using these modalities. In addition, the establishment of the mass screening system for breast cancer is desired. In order to make a precise diagnosis, it is necessary to add some devices on the ordinary modalities. For examples, mechanical improvement of the Moribuden tube with 0.1mm focus, operation of ductgraphy and cystography by double contrast method in MMG and application of 10MHz transducer in US. Furthermore, needle biopsy under US or X-ray is expected positively to make a fast diagnosis. On the other hand, DMR (Digital Mammo-Radiography) system has a bright prospect for the mass screening of the breast cancer in the respect of efficacy, cost and radiation hazard. DMR system has many advantages as follows, 1. The system is capable of bringing out clearly very minor differences of contrast. 2. Tumor shadows can be easily displayed. 3. The lateral projection only is sufficient (allowing examination of the chest wall also). 4. The X-ray dose is small: 0.03-0.05mSv. 5. The equipment is inexpensive to use. 6. Patient positioning is simple, and examinations take little time. 7. Long operator training programs are unnecessary. 8. The system uses digital signals, and so automatic diagnosis is possible. 9. Theoretically, at least, tumors as small as 0.2 mm in diameter can be detected.     

Implications of cancer stem cells in the treatment of cancer

Identification of cancer stem cells (CSCs) in both hematological and solid malignancies suggests that CSCs may be a common phenomenon for most malignancies. Similarly to normal stem cells, CSCs can self-renew and differentiate into progeny cancer cells. Almost all current therapy against cancer targets differentiated cancer cells. CSCs are more resistant to therapy secondary to quiescence, increased expression of antiapoptotic proteins and drug efflux transporters. In this article, we review the current status of CSC research and propose the targeting of CSC cell-surface molecules, signal transduction pathways, the stem cell niche, stem cell differentiation and drug resistance.     

Attitudes towards cancer. Development of the cancer attitudes questionnaire

A questionnaire evaluating attitudes towards cancer (the Cancer Attitudes Questionnaire) was constructed to compare the attitudes of first-year medical students before and after taking a clinical oncology program with those of students who did not participate in the program. A factor and reliability analysis revealed five underlying factors that explained 42% of the variance and reliabilities ranging from 0.55 to 0.79. An analysis of covariance revealed that students who participated in the clinical oncology program were more positively predisposed toward the outpatient functioning of cancer patients (P less than 0.04) at the conclusion of the year than students who did not take the course; the participating students were also somewhat less pessimistic toward the disease (P less than 0.07). Women (regardless of whether they had taken the course) assigned significantly greater importance to the patient's and family's attitudes in relation to outcome of disease (P = 0.03) than did male students. It appears that an early medical educational oncology experience emphasizing contact with ambulatory cancer patients can appreciably alter the attitudes of first-year medical students towards cancer.     

食管癌伴发其它脏器重复癌23例报告

本文收治食管癌伴发其它脏器重复癌２３例，异时性９例，并时性１４例。继发癌包括贲门癌４例，胃癌６例，结肠癌２例，肺癌６例，皮肤癌２例，甲状腺癌２例，喉癌、鼻咽癌、膀胱癌各１例。食管癌放疗１７例，手术４例，化疗２例，中药治疗２例。１、３、５、年生存率各为３４，８％、８．７％及６．３％。预后与首发癌及继发癌发生的间隔时间、继发癌的发病部位及食管癌本身因素有关。     

Revisiting the concept of cancer stem cells in prostate cancer

The cancer stem cell (CSC) model proposes that cells within a tumor are organized in a hierarchical lineage relationship and display different tumorigenic potential, suggesting that effective therapeutics should target rare CSCs that sustain tumor malignancy. Here we review the current status of studies to identify CSCs in human prostate cancer as well as mouse models, with an emphasis on discussing different functional assays and their advantages and limitations. We also describe current controversies regarding the identification of prostate epithelial stem cells and cell types of origin for prostate cancer, and present potential resolutions of these issues. Although definitive evidence for the existence of CSCs in prostate cancer is still lacking, future directions pursuing the identification of tumor-initiating stem cells in the mouse may provide important advances in evaluating the CSC model for prostate cancer.     

Breast cancer survivors' beliefs about the causes of breast cancer

Objective: To explore the beliefs held by breast cancer (BC) survivors about the factors that contribute to the development of their BC. Methods: The BUPA Health Foundation Health and Well‐being after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive BC. Participants completed an enrollment questionnaire (EQ), first follow‐up questionnaire (FQ1) and a second follow‐up questionnaire (FQ2), 12 months and 24 months post‐EQ, respectively. In the FQ2, women were asked whether they believed anything contributed to the development of their BC and whether they had made lifestyle changes since the FQ1. Well‐being was assessed at the FQ2 using the Psychological General Well‐being Index (PGWB). Results: In total, 1496/1684 women completed the FQ2 and 43.5% reported belief in a factor that may have contributed to their developing BC. These women were more likely to be younger (p<0.0001) and educated beyond high school (p<0.0001). Stress (58.1%) was the most common reason given, followed by previous use of hormone therapy (17.0%) and a family history of any cancer (9.8%). Women who believed stress contributed to their BC had lower PGWB scores than other study participants (70.9 ± 16.1, n = 361 versus 77.3 ± 14.9, n = 1071, mean difference = 6.4, 95% CI: 4.6–8.2 p<0.0001) and were more likely to have made lifestyle changes since their BC diagnosis. Conclusions: Many women with BC believe that stress has contributed to their condition. Women who held this belief were more likely to adopt strategies to reduce stress than those who did not. Copyright © 2011 John Wiley & Sons, Ltd.     

Risk of cancer of the prostate and of the kidney parenchyma following bladder cancer

AIMS AND BACKGROUND: A registry-based cohort study of male patients with bladder cancer was conducted to determine the relative risk of second primary cancer of the prostate and kidney, the uni-/multivariate differences in relative risk according to patient characteristics, the cumulative risk by duration of the follow-up, and the prevalence:incidence ratio of prostate and kidney cancer cases detected in the first 6 months after the diagnosis of bladder cancer. METHODS: The complete case records of all male patients (n = 2025) diagnosed with bladder cancer between 1986 and 2002 were extracted from the database of the Romagna Cancer Registry: 1539 patients were eligible for analysis of the incidence of following prostate and kidney cancers, of the relative risk and the standardized incidence ratio specific for the time interval of follow-up. RESULTS: A total of 108 prostate cancer cases and 23 kidney cancer cases were observed during the follow-up. The relative risk of second primary cancer of the prostate and kidney was respectively 3.52 (95% CI, 2.89-4.25) and 3.90 (95% CI, 2.47-5.85). The absolute excess risk was 11.8 x 1000 for prostate cancer and 2.5 x 1000 for kidney cancer. The number of prevalent cases of prostate and kidney cancer detected was approximately 10 times greater than the expected number based on incidence rates from the general population. During the follow-up, incidence of prostate cancer stabilized at a level that was 3- to 4-fold greater than that expected. Despite fluctuations, a decrease was also observed for incidence of kidney cancer. CONCLUSIONS: In summary, our study showed the relatively constant high incidence of prostate and kidney cancers in bladder cancer patients over time. The possibility of subsequent cancer implies that an appropriate long surveillance is required. The pertinence depends on the duration of the follow-up as well as the degree of surveillance.     

Impact of radiotherapy in the risk of esophageal cancer as subsequent primary cancer after breast cancer

PURPOSE: To assess the risk of esophageal cancer as second cancer among breast-cancer patients treated with radiotherapy. METHODS AND MATERIALS: The records of the Finnish Cancer Registry from 1953 to 2000 were used to assess the risk of esophageal cancer as second cancer among 75,849 breast-cancer patients. Patients were treated with surgery (n = 33,672), radiotherapy (n = 35,057), chemotherapy and radiotherapy (n = 4673), or chemotherapy (n = 2,447). The risk of a new primary cancer was expressed as standardized incidence ratio (SIR), defined as the ratio of observed to expected cases. RESULTS: By the end of 2000, the number of observed cases esophageal cancers was 80 vs. 72 expected cases (standardized incidence ratio (SIR) = 1.1, 95% Confidence Interval (CI) = 0.9 to 1.5). Among patients followed for 15 years and treated with radiotherapy, the SIR for esophageal cancer was 2.3 (95% CI = 1.4 to 5.4). No increase in risk was seen for patients treated without radiotherapy. The risk of esophageal cancer was increased among patients diagnosed during 1953 to 1974, although age at the treatment did not have marked effect on the risk estimate. CONCLUSION: Increased risk of second cancer in the esophagus was observed for breast-cancer patients in Finland, especially among patients with over 15 years of follow-up and treated in the earliest period, which may relate to the type of radiotherapy.     

Testicular cancer: the challenge for cancer control

The effect of the discovery of a curative treatment regimen for testicular cancer is apparent in countries with declining national mortality rates. The introduction of centralised treatment in Slovakia has been maintained, and the decline seen in the former country referred to as East Germany after rapid economic change is also clear and continuing. However, mortality remains higher in all countries of central and eastern Europe, compared with western European countries. Testicular cancer could almost be eliminated as a cause of death worldwide if the political will, adequate finance, and the necessary training and logistics to deliver appropriate treatment were implemented. The resources required to eliminate death from testicular cancer are resource-based, rather than dependent on the outcome of further research. The aim of all cancer research is to benefit the patient with cancer or those who are at risk of developing the disease. Testicular cancer control would be the finest illustration of this process and, simultaneously, would be a model for implementation as new, successful therapeutic modalities for other cancers are developed.     

Validation of the functional assessment of cancer therapy esophageal cancer subscale

BACKGROUND: To develop and validate a quality of life subscale for patients with esophageal cancer to be used with the Functional Assessment of Cancer Therapy-General (FACT-G). METHODS: Prospective cohort study of patients with esophageal cancer treated with surgery alone or neoadjuvant chemoradiotherapy and surgery evaluating the validity, internal consistency, and responsiveness to change of the FACT-Esophageal (FACT-E) when comparing it with the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ 30) and esophageal (OES 24) as well as clinical factors. RESULTS: The FACT-E demonstrated very good convergent and divergent validity when compared with the EORTC QLQ30 and OES 24 and clinical variables. Internal consistency was also good with coefficient alpha > 0.70 for all subscales and individual items. Stability coefficients were > 0.80. Changes in clinical status were reflected in changes in FACT-E scores demonstrating responsiveness to change, particularly in patients receiving neoadjuvant chemoradiotherapy before surgery. CONCLUSIONS: The FACT-E met or exceeded all standards for validity, providing an option to measure health-related quality of life for different treatment strategies for esophageal cancer.     

Comprehensive cancer centres and the war on cancer

Comprehensive Cancer Centres are now recognized as an important weapon in the war on cancer, but they had to fight a very different battle to become accepted by the academic community. Why were these centres developed? How do they contribute to cancer research? Have they achieved the aims for which they were set up? And how should they be improved? It is important to answer these questions because we believe that cancer centres, though in need of improvement, are vital parts of our anticancer strategy.     

肿瘤患者知晓肺癌和肾癌防治知识的调查分析

目的探讨肿瘤患者对肺癌和肾癌防治知识的知晓情况。方法采用非随机自愿参与问卷调查方式对2018年10月在成都参加肺癌和肾癌宣教活动的肿瘤患者进行调查,对肺癌和肾癌防治知识应答量化,统计平均知晓分、知晓评分和知晓率。结果患者对肺癌和肾癌知识的知晓总分平均为6. 90分,知晓评分49. 28分。不同性别和年龄患者对肿瘤防治相关知识知晓总分和评分比较,差异无统计学意义(P> 0. 05)。肺癌防治知识知晓评分为51. 73分,不同性别和不同年龄患者对肺癌防治和肾癌防治知识的知晓总分和知晓评分比较,差异无统计学意义(P> 0. 05)。肺癌防治知识的知晓率为0. 0%～87. 4%,肾癌防治知识的知晓率为9. 6%～85. 4%。知晓率最高的是刺激性干咳是早期最主要临床症状,最低的是早期发现肺癌最恰当的方法是胸部低剂量CT;各项肾癌防治知识知晓率为9. 6%～81. 3%,知晓率最高的是肥胖人数增多与近来肾癌发病率迅速上升有关,最低的是简单通过尿液检测、血液检测体格检查都不能发现早期肾癌。结论肿瘤患者对肺癌和肾癌防治知识的认知普遍不足,尤其缺乏对早期肿瘤临床检查方法的认知。     

Disrupting the networks of cancer

Ecosystems are interactive systems involving communities of species and their abiotic environment. Tumors are ecosystems in which cancer cells act as invasive species interacting with native host cell species in an established microenvironment within the larger host biosphere. At its heart, to study ecology is to study interconnectedness. In ecologic science, an ecologic network is a representation of the biotic interactions in an ecosystem in which species (nodes) are connected by pairwise interactions (links). Ecologic networks and signaling network models have been used to describe and compare the structures of ecosystems. It has been shown that disruption of ecologic networks through the loss of species or disruption of interactions between them can lead to the destruction of the ecosystem. Often, the destruction of a single node or link is not enough to disrupt the entire ecosystem. The more complex the network and its interactions, the more difficult it is to cause the extinction of a species, especially without leveraging other aspects of the ecosystem. Similarly, successful treatment of cancer with a single agent is rarely enough to cure a patient without strategically modifying the support systems conducive to survival of cancer. Cancer cells and the ecologic systems they reside in can be viewed as a series of nested networks. The most effective new paradigms for treatment will be developed through application of scaled network disruption.     

Telling the diagnosis of cancer

Although a concensus has emerged in this country that patients should be told when cancer is discovered, no data is available to indicate how and where patients are currently told that they have cancer. Fifty-five patients undergoing anticancer therapy were therefore interviewed to learn how this process occurs. The majority of patients were told by surgeons (74%) and only a minority by primary care physicians (11%). Most were told in a traditional medical setting (42% in the doctor's office, 17% in a hospital room), but 23% were told over the telephone and 19% in the recovery room. Two indicators of patient satisfaction with the telling process suggested that different sites of telling were not equivalent. Patients told over the telephone or in the recovery room were more likely to describe the telling in negative terms and less likely to describe their doctors as being helpful in understanding their illness than those told in a doctor's office or in their hospital bed. This pilot study indicates considerable variation in this aspect of patient care and suggests directions for future research. To determine whether interviews that explore these issues with cancer patients are unpleasant or stressful, patients' reactions to being subjects in this study were sought. Patients asked directly at the completion of the interview or surveyed 2 to 4 months later said the interview had been helpful and/or a positive experience. None expressed negative feelings about participating. Concerns about the psychological harm resulting from such study of this patient group do not appear to be warranted and should not impede future research.