Anaplastic thyroid carcinoma

Anaplastic thyroid carcinoma may represent the ultimate dedifferentiation step of thyroid tumorigenesis and is one of the poorest cancers in human. It accounts for less than 2% of thyroid cancers and affects older patients in their sixth to eighth decade. Usual clinical presentation is a rapidly growing thyroid mass invading surrounding structures with compressive symptoms. Cervical lymph nodes enlargement and distant metastases occur frequently. Though cytological results obtained by fine needle aspiration may be suggestive of diagnosis, tissue biopsy for immunohistochemical study can be necessary to exclude lymphoma and to validate aggressive therapies. Patients developing anaplastic thyroid cancer must be referred urgently in cancer centers to plan multimodality therapeutic approach depending on their performance status. The treatment regimen combines surgery when feasible, hyperfractionated and accelerated external beam radiotherapy and doxorubicin based chemotherapy. Such treatment can provide control of locoregional disease but does not impact on overall survival in patients with distant metastases. The prognosis is dismal with a mean survival of four to nine months after diagnosis. Long survivors are patients with emerging disease presenting a resectable tumor and receiving adjuvant radiotherapy and/or chemotherapy. Therapeutic researches investigate redifferenciation strategies and targeted therapies to inhibit EGF receptors and neoplastic angiogenesis. Primary prevention of this lethal disease may consist of adequate treatment of differentiated thyroid cancers and goiters in elderly.     

Pulmonary sarcomatoid carcinoma: Clinical and prognostic characteristics, a case report

Sarcomatoid carcinoma is a rare malignancy in the family of non-small-cell lung cancer. They belong to a mixed group of poorly differenciated neoplasia, including sarcomatous cells or sarcomatoid-like cells with giant or spindle cells. We report the case of a 69-year-old man with sarcomatoid carcinoma. We describe the main characteristics of these tumors. Diagnosis is frequently delayed and lesions are locally advanced. The prognostic is poorer than other non-small-cell lung cancer. Chemotherapy is often not efficient.     

Dyspnea in lung cancer

Dyspnea is a subjective symptom defined as an experience of uncomfortable and difficult breathing which strongly affects the quality of life. It is the most common symptom in lung cancer but its physiopathology remains unclear. Dyspnea is due to cancer itself, specific therapies or comorbidities. To evaluate intensity of dyspnea, analogue visual and verbal rating scales need to be preferred. Diagnosis of underlying cause, based on rational and non invasive strategy is needed to perform effective treatment if possible. Despite its frequency, few therapies are really effective, except nonpharmacologic measures: only morphine can be actually recommend, especially with naive patients. In palliative cases, if dyspnea is uncontrolled, benzodiazepine can be used and may represent ethic approach.     

Anti-angiogenic agents in the treatment of lung cancer: indications and toxicities

Lung cancer is the leading cause of cancer-related death. Targeting the vascular endothelial growth factor (VEGF) pathways in combination with standard chemotherapy can improve response rate and survival in non-small cell lung cancer. Since October 2006, a new class of drugs targeting angiogenesis has been introduced for the treatment of advanced lung cancer. Bevacizumab, an antibody directly targeting VEGF was the first agent to be approved. Other small molecule tyrosine kinase inhibitors targeting the VEGF receptor are also active in the treatment of advanced lung cancer and are currently under development. Most of these new drugs are well tolerated though potentially significant toxicities such as haemoptysis and hypertension have been observed. This article will review these new-targeted anti-angiogenic agents with a focus on their use in lung cancer and on their important side effects.     

Pain and primary lung cancer in the elderly

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P<0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.     

癌症支持治疗中血栓形成的危险因素

癌症的支持治疗在癌症患者的抗癌治疗中有重要意义,但存在血栓形成的风险.癌症患者常见的辅助支持治疗包括输血治疗、红细胞生成刺激因子、孕酮和中心静脉导管.明确支持治疗与血栓形成的关系,有利于癌症患者防治血栓形成.     

Anemia and lung cancer

Erythopoietin (EPO) treatment of anemia during cancer has dramatically improved the tolerance of chemotherapy and quality of life of patients at all stages of the disease. Several surveys have demonstrated a high prevalence and a high incidence of anemia in lung cancer patients. The guidelines updates concerning EPO treatment for these patients are described. They take into account the debate concerning the potential harm of these molecules on the neoplastic disease and the possible role of EPO receptors expressed by several tumors, including non small cell lung cancer.     

Evaluation of the quality of life in patients followed for differentiated cancer of the thyroid

Thyroid cancer often has good prognosis but can impact quality of life. The objective of this study is to evaluate quality of life in patients treated for differentiated thyroid carcinoma and look for associated factors. An observational cross-sectional study with comparison group was conducted in the Endocrinology Department of the Ibn Rochd University Hospital between October 2013 and February 2015. The patient group included 124 adult patients followed for differentiated thyroid carcinoma; the control group comprised 124 healthy subjects of the same age. Quality of life was evaluated by 3 questionnaires validated in Arabic: SF36, Hamilton anxiety and Hamilton depression. Patients’ quality of life was significantly impaired compared to controls on the two Hamilton and all SF36 scores. Factors influencing quality of life were TNM stage, radioiodine therapy and dose, and the presence of metastases. The psychological management of patients with thyroid cancer is an essential point always to be considered, especially in the presence of risk factors for impaired quality of life.     

S-腺苷甲硫氨酸抑制miR-34a依赖的肺癌转移的作用

目的探讨S-腺苷甲硫氨酸抑制miRNA-34a依赖的肺癌转移机制。 方法选取肺癌细胞A549,分别采用0、50、100、200、500 μM的S-腺苷甲硫氨酸(S-adenosylmethionine, SAMe)刺激A549细胞并检测miR-34a以及下游STAT3信号通路的表达情况,同时检测不同刺激条件下A549细胞的侵袭转移情况;实时荧光定量(real-time fluorescence quantification, qPCR)检测miR-34a、E-cadherin、α-catenin、N-cadherin、Vimentin的mRNA表达水平;Western Blot实验检测STAT3、p-STAT3、β-actin的表达水平;Transwell实验检测A549细胞的侵袭能力变化。 结果随着SAMe浓度的增加,miR-34a的表达水平呈梯度增加,与对照组相比,经t检验分析,差异有统计学的意义(P<0.05);Western Blot实验显示,与对照组相比,500 μM SAMe刺激后,下游的p-STAT3蛋白水平下降,总STAT3和内参蛋白β-actin水平不变;qPCR结果显示,随着药物浓度的增加,表皮蛋白E-cadherin、α-catenin的mRNA水平上升,间质蛋白N-cadherin、Vimentin的mRNA水平下降;Transwell实验显示经50、100、200、500 μM的SAMe刺激后,A549细胞的侵袭转移抑制率分别为18.70%、31.24%、47.66%、58.46%,与对照组相比,经t检验分析,差异有统计学的意义(P<0.05)。 结论SAMe可通过抑制miR-34a依赖的下游STAT3信号通路抑制肺癌细胞的侵袭转移,提示SAMe在肺癌侵袭转移过程中发挥重要作用。     

Role of FDG-PET scanning in stage IIIAN2 non-small cell lung cancer

Patients with clinical stage IIIAN2 non-small cell lung cancer (NSCLC) are a heterogeneous subgroup in term of prognosis and therapeutic management. The optimal management of this patient group is a major focus for thoracic oncology research and the concept of multimodality treatment has recently been introduced. This approach combines induction chemotherapy or radiochemotherapy followed by surgery in the case of mediastinal lymph node down-staging. positron emission tomography computed tomography with [18F]-fluorodesoxyglucose (FDG-PET) is a molecular and metabolic imaging modality which combines the metabolic data of PET with morphological data from CT. FDG-PET has become a standard in lung cancer management since the different indications listed in the standards, options and recommendations (SOR) of the FNCLCC. However, the potential specific importance of FDG-PET in IIIAN2 patients needs to be addressed further. In this setting, the authors' objective is to review the potential role of metabolic imaging in stage IIIAN2 NSCLC, taking into account new multimodality treatments. In stage IIIAN2, FDG-PET has performed better than morphoradiological imaging for baseline and postinduction lymph node staging, the identification of distant metastasis, and determining prognosis, as well as assessing the response to treatment.