Second malignancy after gastrectomy for early gastric cancer-is there any evidence that adjuvant chemotherapy for early gastric cancer causes a second malignancy ?

The common causes of post-operative death in early gastric cancer are other diseases and second malignancy. In Japan, adjuvant chemotherapy using oral administration of 5-fluorouracil is widely accepted in spite of no statistical evidence until the presentation by Kinoshita in 2005. In 1999, Fujimoto mentioned that adjuvant chemotherapy and chemo-immune-therapy cause a second malignancy. Adjuvant chemotherapy was once the standard treatment for early gastric cancer patients. So, we investigated the relation between adjuvant chemotherapy and second malignancy for early gastric cancer patients. As a result, adjuvant chemotherapy using 5-fluorouracil(Tegafur)did was not cause second malignancy under multivariate analysis. The most important factor in second malignancy with post-operative early gastric cancer patients was heredity(cancer within first-degree relatives). From this point of view, early gastric patients after gastrectomy and endoscopic treatment are necessary in regular examinations to detect other organ cancers and remnant gastric cancer, especially in patients with hereditary factors.     

Extrathoracic castleman’S disease — presenting as a neck mass

Castleman’s disease, also known as angiofollicular hyperplasia, is a disease of unsettled complexity and morbidity, usually occurs in the mediastinum and less frequently in the neck as a solitary mass and is often associated with other illnesses. Two variants have been recognized, the hyaline vascular type which is mare common and the less common plasma cell type with a third hybrid or intermediate type that shares features with both. It has been described with AIDS and Kaposi’s sarcoma as well as follicular dendritic cell tumours. We report a case of Castleman’s disease of the hyaline vascular type arising in the left supra-clavicular region in 41 year old male without any associated systemic illness. The neck is an uncommon location for this rare disease.     

“Care and self-care” “god as a mirror of the self”

A group of physicians of different ages and background gathered together to express their hope for a person-based medicine. The inescapable conclusion of their encounter is that care begets more care, whereas lack of care is contrary to one’s sense of mission and self-worth and generates the need for escapes from oneself. The translation of this concept into clinical practice lies in our ability to communicate our experience in our most common seat of encounter: when we are with another human being in need.     

Bilateral sudden sensorineural deafness with vertigo as the sole presenting symptoms of diabetes mellitus — a case report

This Paper reports a late uncontrolled diabetic presenting to an otolaryngologist with sudden severe sensorineural hearing loss of immediate origin with vertigo and tinnitus as the symptoms. Appropriate investigative and treatment measure resulted in deterioration of hearing in the right ear and mild improvement of hearing in the left ear, with no recovery of imbalance.     

FAT4 functions as a tumour suppressor in gastric cancer by modulating Wnt/β-catenin signalling

Background:

FAT4, a cadherin-related protein, was shown to function as a tumour suppressor; however, its role in human gastric cancer remains largely unknown. Here, we investigated the role of FAT4 in gastric cancer and examined the underlying molecular mechanisms.

Methods:

The expression of FAT4 was evaluated by immunohistochemistry, western blotting, and qRT–PCR in relation to the clinicopathological characteristics of gastric cancer patients. The effects of FAT4 silencing on cell proliferation, migration, and invasion were assessed by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium) assay, and migration and invasion assays in gastric cancer cell lines in vitro and in a mouse xenograft model in vivo.

Results:

Downregulation of FAT4 expression in gastric cancer tissues compared with adjacent normal tissues was correlated with lymph-node metastasis and poor survival. Knockdown of FAT4 promoted the growth and invasion of gastric cancer cells via the activation of Wnt/β-catenin signalling, and induced epithelial-to-mesenchymal transition (EMT) in gastric cancer cells, as demonstrated by the upregulation and downregulation of mesenchymal and epithelial markers. Silencing of FAT4 promoted tumour growth and metastasis in a gastric cancer xenograft model in vivo.

Conclusions:

FAT4 has a tumour suppressor role mediated by the modulation of Wnt/β-catenin signalling, providing potential novel targets for the treatment of gastric cancer.     

Commentary: Implications of Cancer Managed as a “Chronic Illness”

In an increasing number of settings it is appropriate to consider cancer as a very serious but also a chronic disease process. This commentary discusses a number of highly clinically relevant implications of this important evolution in the management of malignancies.     

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

Background and aim

The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 µm) and invasive submucosal (SM2: depth of 500 µm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The “non-extension sign” relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign.

Methods

This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard.

Results

We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0–97.0 %), a specificity of 97.7 % (95 % CI, 96.7–98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7–92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0–99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8–98.1 %).

Conclusion

The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.

     

Extracellular acidity,a “reappreciated” trait of tumor environment driving malignancy: perspectives in diagnosis and therapy

Tumors are ecosystems which develop from stem cells endowed with unlimited self-renewal capability and genetic instability, under the effects of mutagenesis and natural selection imposed by environmental changes. Abnormal vascularization, reduced lymphatic network, uncontrolled cell growth frequently associated with hypoxia, and extracellular accumulation of glucose metabolites even in the presence of an adequate oxygen level are all factors contributing to reduce pH in the extracellular space of tumors. Evidence is accumulating that acidity is associated with a poor prognosis and participates actively to tumor progression. This review addresses some of the most experimental evidences providing that acidity of tumor environment facilitates local invasiveness and metastatic dissemination, independently from hypoxia, with which acidity is often but not always associated. Clinical investigations have also shown that tumors with acidic environment are associated with resistance to chemotherapy and radiation-induced apoptosis, suppression of cytotoxic lymphocytes, and natural killer cells tumoricidal activity. Therefore, new technologies for functional and molecular imaging as well as strategies directed to target low extracellular pH and low pH-adapted tumor cells might represent important issues in oncology.     

A clinical study of docetaxel with or without 5′DFUR as a second-line chemotherapy for advanced gastric cancer

We conducted a clinical pilot study to evaluate the efficacy and safety of the combination of docetaxel and 5′DFUR as a second-line chemotherapy for gastric cancer. Twenty-four patients were divided into two groups by simple randomization: group A (60 mg/m² of docetaxel, every 3 wk) and group B (regimen A + 600 mg/body of 5′DFUR). The response rate was 17% and 42% in group A and B, respectively (p<0.05). The MST from the start of the first-line was 17 mo in group B. The major adverse event was leukopenia in both groups.