Delay in diagnosis and treatment of breast cancer in northern Norway

The delay in diagnosis and treatment of 173 breast cancer patients admitted for radiotherapy at the University Hospital of Tromso is presented. The median delay from symptom to diagnosis was 2.4 months (0-98.6 months), from histological/cytological diagnosis to operation 7 days (range 0-523 days) and from operation to start of radiotherapy 47 days (range 24-102 days). There were no correlations between delay and age, tumour size, estrogen receptor status, breast involved, relapse or death of disease. A prolonged diagnostic delay (p=0.041) was revealed in the county (Finnmark) having the worsed prognosis. Delay should be minimised to reduce anxiety and unnecessary suffering and improve survival.     

Delay of diagnosis and treatment of colorectal cancer—A population-based Danish Study

Background: Recently, the authors have shown a doubled risk of having an advanced rectal cancer (RC) (Dukes’ stage C or D) at the time of treatment, if the interval between onset of symptoms and start of treatment (treatment delay) was >60 days [Korsgaard M, Pedersen L, Sorensen HT, Laurberg S. Treatment delay is associated with advanced stage of rectal cancer but not of colon cancer. Cancer Detect Prev 2006;30(4):341–6]. The authors examined the treatment delay for colorectal cancer (CRC), as influenced by the patients, the general practitioners (G.P.), and the hospitals. Method: Population-based prospective observational study based on 743 Danish CRC-patients. Treatment delay was determined through questionnaire interviews. We examined the patient delay, the G.P. delay, and the hospital delay, and thereby the frequency of patients for whom the Danish fast-track recommendations of a maximum of 14 days to diagnose CRC, and 14 days from the diagnosis to start the of treatment, were met. Colon cancer (CC) and RC-patients were analyzed separately. Results: Patient delay, in particular, was long, and longest for RC-patients (median 44 days vs.18 days). Median G.P. delay was short, but 25% of the CC-patients had a G.P. delay of 59 days or more, and 25% of the RC-patients had a G.P. delay of 53 days or more. The fast-track recommendations were poorly met; 53% of the CC-patients and 39% of the RC-patients waited >14 days after referral for the diagnosis. 29% of the CC-patients, and 53% of the RC-patients waited >14 days before the start of treatment. Conclusion: The total delay was too long, and can be shortened by optimizing all delay intervals.     

Results of specialization in the surgical treatment of gastric cancer in Peru

Background The best results in the surgical treatment of gastric cancer are those obtained by the Japanese surgical school that emphasizes D2 lymphadenectomy as a fundamental principle for obtaining better local control of the disease. However, this technique has not gained wide acceptance in the West, owing to the fact that the results of Japanese studies have not been reproduced frequently in Western countries. In recent years, a series of studies have recommended the centralization of gastric cancer treatment in specialized surgical units in order to obtain results similar to those achieved by Japanese centers. The objective of this study was to describe the specialization process and to show the short-term results obtained in the surgical treatment of gastric cancer in the Specialized Unit of the Rebagliati National Hospital, the largest general referral hospital in Lima, Peru. Methods In the year 2000 a specialized service was created for the surgical treatment of gastric cancer, initiating a process that included the establishment of surgical treatment guidelines, training in the Japanese surgical technique, and progress along the learning curve for D2 lymphadenectomy. Clinical, surgical, and pathological data were recorded prospectively in a fixed format, considering that strict documentation of cases was also an important step within this process. Results Between January 1, 2004, and December 31, 2005, 243 consecutive patients with a proven diagnosis of gastric adenocarcinoma were admitted to the operating theater for surgical treatment. During this study period, morbidity was 22.7% and hospital mortality, 2.8%. The numbers (mean ± SD) of resected lymph nodes for distal gastrectomy and total gastrectomy were 37.3 ± 12.4 and 45.3 ± 14.5, respectively. Hospital stay was 13 days for distal gastrectomy as well as for total gastrectomy. Conclusion According to our results, adequate training in the Japanese surgical technique, progress along the learning curve for D2 lymphadenectomy, and the establishment of specialized units are highly recommended for the surgical treatment of gastric cancer in Western referral hospitals. Calle Guatemala 165 — Dpto. 101, Urb. Santa Patricia, La Molina, Lima, Perú     

Delay between the initial symptoms, the diagnosis and the onset of specific treatment in elderly patients with lung cancer

IntroductionThe proportion of elderly patients with lung cancer is increasing. The objectives of this study were to describe the initial symptoms in elderly patients (≥ 70 years) with lung cancer and to describe the diagnostic and treatment delays.Patients and MethodsWe reviewed all consecutive patients with lung cancer that were diagnosed between 2006 and 2008 in our department. The initial symptoms and delays in the diagnosis and treatment in elderly patients were compared with those of younger patients.ResultsOne hundred ninety-three patients were included (26 small-cell cancers and 167 non–small-cell lung cancers [NSCLCs]). Ninety-two patients (47.7%) were ≥ 70 years old. No statistical differences were identified between the 2 groups concerning initial symptoms. In elderly patients, the delay between the initial symptoms and the first visit with a thoracic oncologist (median 1.6 months [IQR 23 days-3.3 months]), the delay between the first visit and the specific treatment (median 1.1 months [IQR 18 days-1.8 months]), and the delay between initial symptoms and the specific treatment (median 3 months [IQR 2-5.7 months]) were similar to those in the younger patients (P = .101, P = .084, and P = .671, respectively). Eighty-four percent of the elderly patients were actively treated vs. 98% of the younger patients (P = .001).ConclusionWe identified no differences regarding the initial symptoms in elderly patients with lung cancer compared with those in younger patients. The delays in diagnosis and treatment were similar between the 2 groups.     

Delay in the diagnosis and outcome of colorectal cancer: a prospective study.

AIMS: The aim of this study was to examine the incidence of the delay in the diagnosis of colorectal carcinoma, possible causes of this delay and its effects on outcome. METHODS: A prospective study was performed on 100 patients affected by colorectal cancer. Duration of symptoms was calculated from the date of onset of symptoms to the date of surgery. RESULTS: Sixty-nine patients suffered delays in treatment of more than 12 weeks from the onset of symptoms. In patients with symptoms of less than 12 weeks' duration there was a higher incidence of radical surgery and none of these patients presented, at the time of surgery, a neoplastic dissemination. Multivariate analysis, however, showed that the only factors with an independent effect on 5-year survival and disease-free survival were Dukes' stage and the presence of pre-operative complications. CONCLUSIONS: The results of this study suggest that, independent of the diagnostic delay, the outcome of the colorectal cancer is only conditioned by tumour stage and by complicated cancer.     

纳米技术在肿瘤诊断和治疗中应用的现状与展望

恶性肿瘤是人类的一大杀手,如何对其有效的诊疗一直是医学界努力攻克的难题,具有独特性能的纳米材料为肿瘤早期诊断和治疗带来了新机遇.现就纳米技术在肿瘤诊断和治疗领域的研究进展作一回顾,并展望其发展前景.     

Delay in diagnosis of cancer. Possible effects on the stage of disease and survival

A total of 2299 new cancer patients were referred to the Northern Israel Oncology Center in 1974 and in 1980. The stage of disease, delay in diagnosis, the responsibility for the delay, and the survival of those referred in 1974 were investigated. At the time of diagnosis, 39% of the patients had localized disease, 34% had locally advanced disease, and 23% had metastatic disease. In 52% of the patients there was no delay in diagnosis. No correlation was found in the group as a whole between the stage of disease and delay in diagnosis. Only in the breast cancer group without delay in diagnosis, however, were there significantly more patients at an early stage than at an advanced stage of disease. At each stage of disease, responsibility for the delay was shared about equally between the patients and the physicians, except in advanced breast cancer, where the patients were more often responsible for the delay. The survival rate was higher in patients in whom the disease was diagnosed earlier. It was also higher at each clinical stage (Stages I and II) in patients who had no delay than in those with delay in diagnosis. The survival rate was higher in patients who were themselves responsible for the delay in diagnosis than in patients whose physicians were responsible for the delay. In 1980, less diagnosis were delayed in fewer patients than in 1974 (42% versus 65%). Responsibility for the delay in 1980 lay equally with the patients and with the physicians, but when compared to 1974, the physicians' responsibility and administrative delay were less. Campaigns for early diagnosis are advocated.     

Delay of diagnosis and treatment of colorectal cancer--a population-based Danish study

Background: Recently, the authors have shown a doubled risk of having an advanced rectal cancer (RC) (Dukes’ stage C or D) at the time of treatment, if the interval between onset of symptoms and start of treatment (treatment delay) was >60 days [Korsgaard M, Pedersen L, Sorensen HT, Laurberg S. Treatment delay is associated with advanced stage of rectal cancer but not of colon cancer. Cancer Detect Prev 2006;30(4):341-6]. The authors examined the treatment delay for colorectal cancer (CRC), as influenced by the patients, the general practitioners (G.P.), and the hospitals. Method: Population-based prospective observational study based on 743 Danish CRC-patients. Treatment delay was determined through questionnaire interviews. We examined the patient delay, the G.P. delay, and the hospital delay, and thereby the frequency of patients for whom the Danish fast-track recommendations of a maximum of 14 days to diagnose CRC, and 14 days from the diagnosis to start the of treatment, were met. Colon cancer (CC) and RC-patients were analyzed separately. Results: Patient delay, in particular, was long, and longest for RC-patients (median 44 days vs.18 days). Median G.P. delay was short, but 25% of the CC-patients had a G.P. delay of 59 days or more, and 25% of the RC-patients had a G.P. delay of 53 days or more. The fast-track recommendations were poorly met; 53% of the CC-patients and 39% of the RC-patients waited >14 days after referral for the diagnosis. 29% of the CC-patients, and 53% of the RC-patients waited >14 days before the start of treatment. Conclusion: The total delay was too long, and can be shortened by optimizing all delay intervals.     

Errors in the diagnosis and treatment of thyroid cancer

The analysis of the data on 744 patients with thyroid tumors showed inadequate examination to be the main cause of untimely diagnosis of cancer of the organ. Cytologic examination of tumor punctate proved most effective for diagnosis since it confirmed cancer in 92.3% of cases. Adequate examination and extrafascial surgical procedure with intraoperative contrasting of the thyroid assured five-year survival rate of 95.9% and a decrease in the risk of injury to n. recurrens by 23%.     

PET技术在肺癌诊断治疗中的应用

正电子发射体层扫描 (positronemissiontomogra phy ,PET)技术是近年来开发应用的新技术。该技术将影像学检查和细胞功能检测结合起来 ,其临床应用为肺癌的诊治开辟了新途径。最近在加拿大温哥华召开的第十届世界肺癌大会上 ,有多篇文章报道了PET技术在肺癌诊治中的应用 ,显示其广泛的临床应用前景。但即使是在医学相对发达的英国 ,PET技术也尚未得到广泛应用[1] 。本文对本次大会交流的论文以及近期发表的有关PET技术在肺癌诊断治疗中的应用进展 ,简要评述如下。1　原理概述正电子是放射性核素衰变过程中释放出的带正电荷的阳离子 ,其…     

Livin基因在恶性肿瘤诊断和治疗中的研究

Livin是凋亡抑制蛋白家族最新的成员,通过抑制半胱氨酸天冬氨酸蛋白酶、激活丝裂原激活蛋白激酶等途径参与细胞凋亡的调节.Livin在多种恶性肿瘤中高表达,并且在肿瘤的发生、发展中发挥重要作用,为肿瘤的诊断及治疗提供了新的研究方向.     

肿瘤的基因靶向检测和治疗

 随着分子靶向药物和个体化治疗的研发和临床使用,肿瘤的基因靶向检测和治疗已成为肿瘤治疗的热点。尤其是针对表皮生长因子受体（EGFR）信号通路相关基因、DNA复制相关基因、纺锤体形成相关基因、细胞代谢过程相关基因等分子靶向检测和治疗,靶点分子的基因多态性决定了靶向药物治疗的有效性。     

New developments in the diagnosis and treatment of thyroid cancer

Answer questions and earn CME/CNE Thyroid cancer exists in several forms. Differentiated thyroid cancers include those with papillary and follicular histologies. These tumors exist along a spectrum of differentiation, and their incidence continues to climb. A number of advances in the diagnosis and treatment of differentiated thyroid cancers now exist. These include molecular diagnostics and more advanced strategies for risk stratification. Medullary cancer arises from the parafollicular cells and not the follicular cells. Therefore, diagnosis and treatment differs from those of differentiated thyroid tumors. Genetic testing and newer adjuvant therapies have changed the diagnosis and treatment of medullary thyroid cancer. This review will focus on the epidemiology, diagnosis, workup, and treatment of both differentiated and medullary thyroid cancers, focusing specifically on newer developments in the field. CA Cancer J Clin 2013;63:373‐394. ^©2013 American Cancer Society, Inc.     

MicroRNAs in the diagnosis, prognosis and treatment of cancer

MicroRNAs (miRNAs) are small non-coding RNAs that regulate critical cell processes such as cell proliferation, apoptosis and differentiation by modulating gene expression. MiRNAs deregulation has been observed extensively in cancer. Elegant studies have demonstrated that miRNAs are involved in the initiation and progression of several malignancies. In this review we will address the role of miRNAs in the diagnosis and prognosis of cancer. The development of new drugs mimicking or blocking miRNAs will be discussed.     

Review on diagnosis and treatment in cancer of the uterus

Diagnosis and treatment for the uterine cancer since 1949 were reviewed. During the period of 1949 to 1975, a total of 6986 cases of cervical cancer, including stage 0, were treated. Whereas the five year survival rate for the first five years was 56.3%, it rose 80.8% for the latest five years. This improvement depends mainly on the marked increase in stage 0 cases. There is not so much difference in survival rate between surgery and radiotherapy. Adequate therapy for the recurrent diseases, which were found by the follow-up examinations after the primary treatments, contributed to 2.24% raise in five year survival rates. This fact shows the important role of the periodical follow up examinations for all patients previously treated. As the endometrial cancer has been gradually increasing in Japan, the necessity for paying attention to the early detection were pointed out.     

Recent progress in the diagnosis and treatment of ovarian cancer

Epithelial ovarian cancer is the most lethal of the gynecologic malignancies, largely due to the advanced stage at diagnosis in most patients. Screening strategies using ultrasound and the cancer antigen (CA) 125 tumor marker are currently under study and may lower stage at diagnosis but have not yet been shown to improve survival. Women who have inherited a deleterious mutation in the BRCA1 or BRCA2 gene and those with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have the highest risk of developing ovarian cancer but account for only approximately 10% of those with the disease. Other less common and less well-defined genetic syndromes may increase the risk of ovarian cancer, but their contribution to genetic risk is small. A clear etiology for sporadic ovarian cancer has not been identified, but risk is affected by reproductive and hormonal factors. Surgery has a unique role in ovarian cancer, as it is used not only for diagnosis and staging but also therapeutically, even in patients with widely disseminated, advanced disease. Ovarian cancer is highly sensitive to chemotherapy drugs, particularly the platinum agents, and most patients will attain a remission with initial treatment. Recent advances in the delivery of chemotherapy using the intraperitoneal route have further improved survival after initial therapy. Although the majority of ovarian cancer patients will respond to initial chemotherapy, most will ultimately develop disease recurrence. Chemotherapy for recurrent disease includes platinum-based, multiagent regimens for women whose disease recurs more than 6 to 12 months after the completion of initial therapy and sequential single agents for those whose disease recurs earlier. New targeted biologic agents, particularly those involved with the vascular endothelial growth factor pathway and those targeting the poly (ADP-ribose) polymerase (PARP) enzyme, hold great promise for improving the outcome of ovarian cancer.