A pilot study to determine support during the pre-treatment phase of early prostate cancer

While we know about physicians' involvement in the diagnosis and treatment of prostate cancer, little is known about others who assist men in dealing with the diagnosis and treatment choices, once they are diagnosed with early prostate cancer, but not yet treated. This pilot study explores if men use other sources of support and the roles and functions of support providers. We conducted separate individual interviews with 21 men diagnosed with prostate cancer and 18 persons identified by the diagnosed men as their support provider. Some of the men diagnosed with prostate cancer reported not relying on a support provider, others identified other men already treated for prostate cancer, others' their partner. The provided support consisted of informational and emotional support. Men already treated for prostate cancer provided informational support. Spousal support depended on the diagnosed partner's willingness to accept emotional and/or informational support. Due to the variation in diagnosed men's support, we recommend that physicians inquire about patients' sources of and interest in support. This will reveal which patients rely almost exclusively on physicians, when deciding on a certain treatment.     

Intrahepatic cholangiocarcinoma diagnosed preoperatively as hepatocellular carcinoma

BACKGROUND: Some cases of mass-forming intrahepatic cholangiocarcinoma (ICC) are diagnosed as hepatocellular carcinoma (HCC) based on preoperative imaging and clinical findings. We investigated the backgrounds of such cases. METHODS: Sixty-seven patients with mass-forming ICC underwent surgery from 1980 to 2002. Twenty-four of these patients received a diagnosis of HCC preoperatively. We compared the group diagnosed as HCC and that diagnosed as ICC. ICC was diagnosed histopathologically in all 67 patients. RESULTS: The specific clinical findings included high rates of associated hepatitis C virus infection, high levels of serum alpha fetoprotein, lower levels of serum CA19-9, small dimension of the tumor, hypervascular staining on angiography or computed tomography, lower rates of lymph node metastasis, and high rates of HCC occurrence in the group diagnosed as HCC. None of the patients underwent extrahepatic bile duct resection and most patients did not undergo lymph node dissection in the group diagnosed as HCC. The rates of mucus secretion and the ductal expression of mucin core protein-1 (MUC1) were significantly different between the subgroups. The cumulative survival rates were significantly better in the group diagnosed as HCC than in the group diagnosed as ICC. CONCLUSION: Patients with ICC given a preoperative diagnosis of HCC had distinct clinical features and could be treated with the same operation as HCC patients.     

US-guided 14G Core Needle Biopsy: Comparison Between Underestimated and Correctly Diagnosed Breast Cancers

Background: The purpose of study was to evaluate radiologic or clinical features of breast cancer undergoingultrasound (US)-guided 14G core needle biopsy (CNB) and analyze the differences between underestimated andaccurately diagnosed groups. Materials and Methods: Of 1,898 cases of US-guided 14G CNB in our institute,233 cases were proven to be cancer by surgical pathology. The pathologic results from CNB were invasive ductalcarcinoma (IDC) (n=157), ductal carcinoma in situ (DCIS) (n=40), high-risk lesions in 22 cases, and benign in14 cases. Among high-risk lesions, 7 cases of atypical ductal hyperplasia (ADH) were reported as cancer and 11cases of DCIS were proven IDC in surgical pathology. Some 29 DCIS cases and 157 cases of IDC were correctlydiagnosed with CNB. The clinical and imaging features between underestimated and accurately diagnosed breastcancers were compared. Results: Of 233 cancer cases, underestimation occurred in 18 lesions (7.7%). Amongunderestimated cancers, CNB proven ADH (n=2) and DCIS (n=11) were diagnosed as IDC and CNB provenADH (n=5) were diagnosed at DCIS finally. Among the 186 accurately diagnosed group, the CNB results wereIDC (n=157) and DCIS (n=29). Comparison of underestimated and accurately diagnosed groups for BI-RADScategory, margin of mass on mammography and US and orientation of lesion on US revealed statistically significantdifferences. Conclusions: Underestimation of US-guided 14G CNB occurred in 7.7% of breast cancers. Betweenunderestimated and correctly diagnosed groups, BI-RADS category, margin of the mass on mammography andmargin and orientation of the lesions on US were different.     

Season of diagnosis has no effect on survival from malignant melanoma

Diagnosis in summer had been shown to be associated with better survival from some cancers, but such studies on malignant melanoma where sun exposure is a risk factor for disease are rare. We evaluated seasonality in melanoma diagnosis and its effect on survival in Victoria, Australia using 26,060 cases reported to the population‐based Victorian Cancer Registry during 1986–2004. To estimate the amplitude of the seasonal variation, we calculated the ratio of the number of melanoma cases diagnosed in summer to that in winter. Linear regression was undertaken to assess the variation in thickness, the main prognostic indicator for melanoma, by season of diagnosis adjusting for sex, anatomical site, year of diagnosis and age at diagnosis. We modeled excess mortality using Poisson regression controlling for possible confounders in order to study the effect of season of diagnosis on survival. An overall 46% summer diagnostic excess was evident (summer‐to‐winter ratio 1.46; 95% CI 1.41, 1.52). Results of linear regression showed that melanoma diagnosed in winter were thicker than those diagnosed in any other season (percentage difference in thickness ?2.01, ?6.97 and ?10.68 for spring, summer and autumn, respectively; p < 0.001). In the Poisson regression model of relative survival, cases diagnosed in spring, summer or autumn had slightly lower excess mortality than those diagnosed in winter before adjustment for other variables, but after adjustment the excess mortality ratios were close to unity. Our findings do not support the hypothesis that melanoma cases diagnosed in winter have worse prognosis than cases diagnosed in other seasons. © 2009 UICC     

Cholecystocolonic fistula diagnosed with CT‐intravenous cholangiography

Cholecystoenteric fistulas are often not diagnosed preoperatively and delineation of fistula can have an influence on surgical planning. We report a case of cholecystocolonic fistula diagnosed preoperatively using CT‐i.v. cholangiography and review the published reports.     

Disparities in quality of care for colon cancer between hospitals in the Netherlands

BackgroundAim of this study was to describe treatment patterns and outcome according to region, and according to hospital types and volumes among patients with colon cancer in the Netherlands.MethodsAll patients with invasive colon carcinoma diagnosed in the period 2001–2006 were selected from the Netherlands Cancer Registry. Logistic regression analyses were performed to examine the influence of relevant factors on the odds of having adequate lymph node evaluation, receiving adjuvant chemotherapy and postoperative mortality. Relative survival analysis was used to estimate relative excess risk of dying according to hospital type and volume.ResultsIn total, 39 907 patients were selected. Patients diagnosed in a university hospital had a higher odds (OR 2.47; 95% CI 2.19–2.78) and patients diagnosed in a hospital with >100 colon carcinoma diagnoses annually had a lower odds (OR 0.70; 95% CI 0.64–0.77) of having ≥10 lymph nodes evaluated. The odds of receiving adjuvant chemotherapy was lower in patients diagnosed in teaching hospitals (OR 0.85; 95% CI 0.73–0.98) and university hospitals (OR 0.56; 95% CI 0.45–0.70) compared to patients diagnosed in non-teaching hospitals. Funnel plots showed large variation in these two outcome measures between individual hospitals. No differences in postoperative mortality were found between hospital types or volumes. Patients diagnosed in university hospitals and patients diagnosed in hospitals with >50 diagnoses of colon carcinoma per year had a better survival.ConclusionsVariation in treatment and outcome of patients with colon cancer in the Netherlands was revealed, with differences between hospital types and volumes. However, variation seemed mainly based on the level of the individual hospital.     

Prognosis of pregnancy-associated breast cancer

Conventionally, breast cancer diagnosed during pregnancy and within the years following have been referred to collectively as pregnancy-associated breast cancer. However, increasing evidence suggests that breast cancer diagnosed during pregnancy is a different entity from that diagnosed postpartum, both in terms of prognosis and biology. Given the increasing number of women who find themselves diagnosed with breast cancer during or following a pregnancy, future research and discussion should separate these two into distinct groups: breast cancer diagnosed during pregnancy and breast cancer diagnosed postpartum in an effort to enhance our understanding to inform and improve clinical management and counseling.     

A correlative histocytological study of carcinoma and epithelial atypia of the palate among Indian reverse smokers

A correlative histocytological study was made of 6 patients with palatal carcinomata and 342 patients with palatal lesions (primarily leukoplakias) associated with reverse smoking from the Srikakulam district of Andhra Pradesh. Among 6 histologically diagnosed carcinomata only 2 showed cytological findings typical of carcinoma. Of the 46 atypias diagnosed histologically among the other palatal lesions, only 6 (13%) were diagnosed cytologically. Our findings show that cytological examination of precancerous and cancerous lesions located on the hard palate, which is a highly keratinized area of the oral cavity, may not be reliable enough for revealing premalignant or malignant changes.     

Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing?

BACKGROUND: The 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines recommend that women who have Papanicolaou (Pap) smears diagnosed as atypical squamous cells (ASC), cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H) should be referred for immediate colposcopic examination. The objective of this pilot study was to evaluate whether reflex human papillomavirus (HPV)-DNA testing performed on smears diagnosed as ASC-H may obviate the need for immediate colposcopic examination. METHODS: All ThinPrep Pap smears that were diagnosed as ASC-H or atypical squamous metaplastic cells (ASMT) between 2001-2003 and that had HPV-DNA testing and subsequent histologic and/or cytologic follow-up were evaluated. Those smears that were diagnosed as ASMT were reviewed and reclassified under the 2001 Bethesda System as either ASC of undetermined significance (ASCUS) or ASC-H. Smears that were diagnosed as ASCUS were excluded from the study. RESULTS: The study included of 48 smears that were diagnosed as ASC-H. All patients with biopsy-proven HSIL had positive high-risk (HR)-HPV results (100% negative predictive value). Approximately 80% of patients with ASC-H who had biopsy-proven, low-grade intraepithelial lesion on follow-up had positive HR-HPV results. Among the patients who had ASC-H with negative follow-up, 50% had positive HR-HPV results, and 50% had negative HR-HPV results. CONCLUSIONS: Among patients with ASC-H, a negative HR-HPV result was found to be an excellent predictor of the absence of HSIL. The results of this pilot study suggested that HPV-DNA testing may serve as a means to better select which patients with ASC-H on Pap smear should undergo colposcopic examination. This approach potentially may reduce medical costs and eliminate the need for routine colposcopic examination among patients with ASC-H Pap smears.     

Cytologic analysis of renal angiomyolipoma: a comparison of radiologically classic and challenging cases.

BACKGROUND: Angiomyolipoma is a benign kidney tumor with distinctive pathologic and clinical features. Because the prognosis differs from many other renal and retroperitoneal tumors, accurate diagnosis on cytologic material may be important for appropriate management. METHODS: A retrospective analysis of cytologic material from eight patients with histologically confirmed angiomyolipomas was performed. The findings are described. RESULTS: Three cases were diagnosed radiologically as angiomyolipoma, three were diagnosed as renal cell carcinoma, one was diagnosed as a "renal mass," and one was diagnosed as a fat-containing adrenal tumor. Compared with the tumors that were suggestive radiologically of angiomyolipoma, tumors that were suspicious radiologically for renal cell carcinoma tended to contain less fat on cytologic examination. One fat-containing tumor was not diagnosed as angiomyolipoma because the tumor was believed to be adrenal in origin. Cytologically, cohesive stromal fragments were comprised of cells ranging from epithelioid to elongate. Stromal atypia was present in 7 of 8 cases (88%) but was marked in only 2 cases (25%). Thick-walled vessels were noted in 3 of 8 cases (38%). CONCLUSIONS: The cytologic diagnosis of angiomyolipoma is difficult in cases in which the radiologic diagnosis is not clear. The liberal use of immunostains is advised in the evaluation of stromal renal tumors.     

Improvements in survival for women with breast cancer in Scotland between 1987 and 1993: impact of earlier diagnosis and changes in treatment

We investigated changes in survival, and their causes, in women with early breast cancer diagnosed in Scotland. The Scottish Cancer Registry identified 1617 and 2077 such women, without metastases at diagnosis who underwent surgery as part of their primary treatment, diagnosed in 1987 and 1993, respectively. There was a statistically significant 11% improvement in 8-year survival between 1987 and 1993. Survival improved across almost all clinical/pathological, treatment and health care delivery/deprivation categories; improvement was not limited to those women diagnosed through the screening programme. In a multivariate model, improved survival appeared to be explained largely by screening and clinical/pathological prognostic factors. Deprivation also had an adverse effect on survival; however, the geographical variation in survival observed for women diagnosed in 1987 was not apparent by 1993. We did not demonstrate a significant independent effect of surgical caseload on survival. We conclude that survival has increased partly as a consequence of screening and earlier diagnosis, but also due to improvements in the organisation and delivery of care.     

The visibility of cancer on earlier mammograms in a population-based screening programme

The aim of this study was to examine how frequently the later-round screen-detected and interval breast cancers were visible in earlier screening mammograms by retrospective review and to compare their radiological and clinicopathological features with those diagnosed by primary screening. In a population-based mammography screening programme 63 731 women aged 50–59 years were invited and 56 158 examinations were carried out in the period 1987–1992 in the Tampere area in Finland. A total of 276 breast cancers were detected, of which 131 were diagnosed on later screening rounds or were interval cancers. A retrospective review of previous screening mammograms was carried out in 130 cases by the radiologist who diagnosed the breast cancer and thus knew the exact location of the tumour, no blinded review was carried out. 43 (33%) cancers were visible, 84 (65%) were not visible and 3 (2%) not included on the mammogram in a retrospective review. Later round screen-detected cancers were statistically significantly more often visible in earlier screening mammograms (43%) than interval cancers (19%) (P=0.002). Tumours missed by screening mammography but which were visible on retrospective review were often histologically well-differentiated and were more often diagnosed in the subsequent screening round than by clinical diagnosis as interval cancers. If all retrospectively visible interval cancers had been diagnosed by screening 19% (10/54) of the interval cancers could have been avoided. If all retrospectively visible cancers had been diagnosed at the time of false-negative screening or assessment 65% (84/130) of all patients would have benefitted from an earlier diagnosis compared with the actual figure of 31% (41/130).     

Improved survival for patients with de novo metastatic prostate cancer in the last 20 years

IntroductionDuring recent years, several new life-prolonging therapeutic options have been introduced for patients with metastatic prostate cancer (mPCa). The aim of the present study was to evaluate the changes in the survival of patients diagnosed with mPCa prior to and in the early period of the implementation of these new agents.Patients and methodsThe study population consisted of 207 men diagnosed in 1997 and 316 men diagnosed in the period 2007–2013 with de novo mPCa and managed with initial endocrine therapy. Men were followed for overall survival and PCa-specific survival.ResultsAt the time of diagnosis, men diagnosed in the period 2007–2013 had less co-morbidity, lower prostrate-specific antigen levels and lower clinical tumour categories than men diagnosed in 1997. A significantly higher proportion of men diagnosed in 1997 were managed with surgical castration (57% versus 9%). Only one patient diagnosed in 1997 received second-line therapy compared with 81 men (26%) diagnosed in the period 2007–2013. The median overall survival was significantly longer for men diagnosed between 2007 and 2013 compared with men diagnosed in 1997 (39.4 months versus 24.2 months, p < 0.0001). Likewise, the cumulative incidence of PCa-specific death was higher among men diagnosed in 1997 compared with men diagnosed between 2007 and 2013, with 5-year cumulative incidences of 72% and 47%, respectively (p < 0.0001).ConclusionSurvival in men diagnosed with metastatic PCa has improved significantly over time. The improved survival can in part be explained by lead-time bias, but also by the introduction of new life-prolonging treatments.     

Impact of cancer service centralisation on the radical treatment of men with high-risk and locally advanced prostate cancer: A national cross-sectional analysis in England

In many countries, specialist cancer services are centralised to improve outcomes. We explored how centralisation affects the radical treatment of high-risk and locally advanced prostate cancer in the English NHS. 79,085 patients diagnosed with high-risk and locally advanced prostate cancer in England (April 2014 to March 2016) were identified in the National Prostate Cancer Audit database. Poisson models were used to estimate risk ratios (RR) for undergoing radical treatment by whether men were diagnosed at a regional co-ordinating centre (‘hub’), for having surgery by the presence of surgical services on-site, and for receiving high dose-rate brachytherapy (HDR-BT) in addition to external beam radiotherapy by its regional availability. Men were equally likely to receive radical treatment, irrespective of whether they were diagnosed in a hub (RR 0.99, 95% CI 0.91–1.08). Men were more likely to have surgery if they were diagnosed at a hospital with surgical services on site (RR 1.24, 1.10–1.40), and more likely to receive additional HDR-BT if they were diagnosed at a hospital with direct regional access to this service (RR 6.16, 2.94–12.92). Centralisation of specialist cancer services does not affect whether men receive radical treatment, but it does affect treatment modality. Centralisation may have a negative impact on access to specific treatment modalities.     

The presence of human papillomavirus type 16 in squamous cell carcinoma of the proximal finger and reconstruction with a bilobed transposition flap.

In a 71 year old white female a clinically diagnosed keratoacanthoma on the dorsum of the right third finger was removed using Mohs micrographic surgery and histologically diagnosed as a squamous cell carcinoma. It was shown by dot blot hybridization to have HPV type 16 DNA in the tumor. The wound was reconstructed with a bilobed transposition flap.     

Screening mammography and breast cancer treatment patterns in older women

Objective.To examine the impact of mammography screening on treatment options received by a cohort of older breast cancer patients. Setting and population.We studied 718 newly diagnosed breast cancer patients, 67 years and over, diagnosed with TNM Stage I and II disease between 1995 and 1997 at 29 hospitals in five regions. Methods.Data were collected from patients, surgeons, and medical records. A breast cancer diagnosis was considered to have been by screening mammography if so reported by both patient and medical records. Bivariate and logistic regression were used to identify predictors of a women having her cancer detected by screening mammography and the relationships between mode of detection, stage of disease at diagnosis, and local treatment. Results.Women with high school or greater education were 1.75 times (95%, CI 1.11–2.75) more likely to have their cancers diagnosed by screening mammography than women who had not completed high school, controlling for other factors. Screening found earlier stage disease: 96% of women with mammographically diagnosed cancer had T1 lesions, compared to 81% of women diagnosed by other means (p=0.001). Women with mammography detected lesions were more likely to have ductal cancer, and to be referred to radiation oncologists more than women diagnosed by other means. Controlling for stage and histology, screening remained associated with a higher likelihood of receiving breast conserving surgery (BCS) with radiation (RT) (OR 1.56, 95%, CI 1.10–2.22) than other local therapies. Conclusions.Beyond the impact on stage, ductal cancers were more likely to be diagnosed by screening. Mammographically detected lesions were associated with referrals to radiation oncologists and higher rates of BCS and RT. Research is needed to explain the residual independent effects of mammography screening on breast cancer treatment.     

Ruptured Triceps Tendon Diagnosed Radiographically

The authors present two cases involving rupture of the triceps tendon that was initially diagnosed on radiographs. Tendon ruptures have been radiographically diagnosed before but only once by a fractured osteophyte of the triceps tendon, to our knowledge. The first case demonstrated this while the other showed an avulsion fracture at the tendon's insertions which has been described previously (seven times) on radiographs.     

Primitive Neuroectodermal Tumor Presenting with Diffuse Leptomeningeal Involvement in a 55-Year-Old Woman: A Case Report and Brief Summary of Current Diagnostic Tests and Treatment

Primitive neuroectodermal tumors (PNETs) are typically present as masses in children and adolescents, but rarely in adults. Diagnoses, management strategies, and prognostication factors are not well established in adult cases of PNETs. We describe the case of a central nervous system PNET diagnosed in a 55-year-old woman presenting with a sudden onset of symptoms consisting of increased intracranial pressure and findings of diffuse leptomeningeal enhancement and a small medullary lesion seen on MRI. Amongst the small database of PNETs diagnosed in adults, our case report stands out as one of few cases describing a primarily leptomeningeal PNET diagnosed on biopsy. We also review the literature on PNETs presenting with diffuse leptomeningeal disease and the treatment of PNETs in the adult population.Key words: Primitive neuroectodermal tumor, Leptomeningeal involvement, Adult primitive neuroectodermal tumor     

窄带成像放大内镜诊断早期食管癌的临床价值研究

目的 探讨窄带成像放大内镜(NBI-ME)诊断早期食管癌的临床价值.方法 选取2018年1月至2021年1月间上海市金山区亭林医院收治的经病理证实的200例高级别上皮内瘤变或早期食管癌患者,采用随机数表法分为普通内镜组、超声内镜组、NBI-ME组和窄带成像(NBI)-碘染色内镜组,每组50例.普通内镜组患者采用普通内镜...     

Estimating the referral rate for cancer genetic assessment from a systematic review of the evidence

To estimate the optimal proportion of new patients diagnosed with cancer who require assessment and evaluation for familial cancer genetic risk, based on the best evidence available. We identified evidence of the patients who require assessment for familial genetic risk when diagnosed with cancer through extensive literature reviews and searches of guidelines. Epidemiological data on the distribution of cancer type, presence of a family history, age and other factors that influence referral for genetic assessment were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiological data to calculate the optimal proportion of patients who should be referred. We identified 'high probability' and 'moderate probability' groups for having a genetic susceptibility. The proportion of patients diagnosed with cancer in Australia who have a high probability of having a genetic predisposition and who should be referred for genetic assessment is 1%. If the moderate probability group is also assessed this proportion increases to 6%. This model has identified the proportion of new patients diagnosed with cancer who should be referred for genetic assessment. This data is the first step in determining the resources required for provision of an adequate cancer genetic service.