Influence of the Application of MRI on the T, N Staging System of Nasopharyngeal Carcinoma

OBJECTIVE To investigate the influence of utilizing MRI on the T, N staging system (the 5th edition, UICC) and on the 1992 China staging systems (Fuzhou-Guangzhou,China) by comparing the results of CT and MRI examinations of nasopharyngeal carcinoma (NPC).METHODS All 56 NPC patients, which were confirmed by histology,accepted both CT and MRI examinations. CT system scans were obtained by using an Elscient CT Twin Flash with the conventional axial scan. Three cases were examined by an additional coronary scan and 16 patients received an enhanced CT. The MR imaging was performed with a 0.5T MR system (Philips T5- II Ultra-Magnetic). The conventional axial, sagittal and coronary sections with SE sequences were obtained. The scan field was from the supra sellar cistern to the inferior border of C2. Most patients (50/56) accepted contrast enhanced MRI.RESULTS The pharyngobasilar fascia can clearly be seen on MRI but not on CT, so MRI can accurately determine the lesion in the nasopharyngeal cavity. MRI is more sensitive for evaluation of tumor involvement of soft tissue such as the Iongus colli muscle (14 cases by CT and 26 by MRI), tensor veli patalini muscle and levator veli palatini muscle (17 cases by CT and 23 by MRI), and skull-base bone marrow invasion (15 cases by CT and 42 by MRI). MRI can also demonstrate the invasion of the carotid sheath area and the enlargement of retropharyngeal lymph nodes more definitely than CT.The involvement of the trigeminal nerve can be detected on MRI, which may influence the clinical staging directly.CONCLUSION Of the 56 cases examined, 16 (28.6%) changed the staging based on UICC staging; while 33.9% (19/56) cases changed based on the 1992 China-stagin9 system. The major influence of MRI examinations on the 1992 staging was to differentiate the involvement of the carotid sheath area from metastasis of the retropharyngeal lymph nodes. There also was a significant difference in finding early invasion of the skull base.     

Cancer, a defect of the psyche?

Patients and families often put forward psychosocial determinants to explain occurring or progression of cancer disease. The idea of a psychogenesis in cancer is widely spread by the surrounding culture. Nevertheless, the scientific research in this field brought very contradictory results, and often rests on debatable methods. Some authors hypothesize that a type C personality predisposes to cancer. But so far, most of prospective studies analysing the association between C traits and this disease have been negative. Results of semi-prospective studies, in which patients are enlisted before a diagnostic investigation, are difficult to interpret, because the starting features can partly result from the stress of this investigation. The same problem interferes with most studies about the association between alexithymia and cancer. The reliable works analysing the impact of depression most often conclude in favour of a non-existent or a weak risk, and do not allow defining it as a well established risk factor. Most of prospective studies about the link between stress and cancer are negative. Moreover, they index stressful life events occurred for a few years before the diagnosis, that is to say during a too short delay to be allowed to incriminate them in the supervening of the disease. The question of the possible impact of coping styles with cancer on its evolution also remains debated. Some studies for instance plead in favour of a beneficial effect of fighting spirit or denial, but they are contradicted by other studies. All this forces us to be very careful when discussing the possible links between psyche and cancer. It is important to underline the hypothetical nature of these relationships. Psychosomatic explanations risk to be used to fill in gaps of knowledge, and to give us the illusion that we can avoid or control a disease which escapes us. They especially risk to make the patients guilty of their cancer or its evolution, through an inadequate point of view which does not take the complexity in stake into account.     

Micro-RNAs,the Cornerstones of the Future of Radiobiology in Head and Neck Cancers?

Even though it is only the 6th most common malignancy at the modal level, head and neck cancers are distinguished by a considerable treatment failure rate, especially by locoregional recurrences, the intrinsic tumor radioresistance being one of the causes of this phenomenon. The efforts of radiobiological research of these cancers are oriented towards the identification of biomarkers associated with radioresistance and radiosensitivity in order to modulate the treatment so that the therapeutic benefit is maximum. Micro-RNAs (miRNAs, miRs), small single-stranded non-coding RNA molecules are currently being extensively evaluated as potential biomarkers in numerous diseases, including cancer. The evaluation of the potential of miRNAs to modulate or predict radiosensitivity or radioresistance, to anticipate the risk of recurrence and metastasis, and to differentiate different tumor subtypes is based on multiple mechanisms by which mRNAs control proliferation and apoptosis and interact with cell cycle phases or act as oncogenes with the potential to influence invasion promotion or tumor suppression. A refinement of radiosensitivity based on miRNAs with clinical and radiobiological application in head and neck cancers can lead to a personalization of radiotherapy. Thus, a miRNA signature can anticipate the risk of toxicity associated with chemoradiation, the possibility of obtaining locoregional control after treatment, and the recurrence and distant metastasis risk. The potential of miRNAs as an intrinsic predictor of sensitivity to chemotherapy may also guide the therapeutic decision toward choosing an escalation or de-escalation of concurrent or sequential systemic treatment. The choice of the irradiated dose, the fractional dose, the fractionation scheme, and the refining of the dose-volume constraints depending on the radiosensitivity of each tissue type estimated on a case-by-case basis by miRNAs profile are possible concepts for the future radiotherapy and radiobiology of head and neck cancers.     

Incidence trends of melanoma of the skin compared with other localisations,in the Norwegian population, 1956–2005

BackgroundIncreasing incidence rates (IRs) of cutaneous malignant melanoma (CMM) have been associated with increased exposure to ultraviolet radiation (UVR). The aim of this study was to compare the changes over time in IRs of malignant melanoma in anatomical localisations exposed to different levels of UVR in the same population.Patients and methodsAll incident cases of melanoma (invasive) diagnosed 1956–2005 were extracted from the database of the Cancer Registry of Norway. The average percentage change of the age-standardised IRs per 5-year period of diagnosis was calculated (loglinear regression) by anatomical localisation (skin, eye, internal organs and external genitalia).ResultsCMM represented 91.7% of the total number of melanomas, while ocular melanoma and melanoma in the internal organs represented 6.2% and 1.2%, respectively. The average quinquennal percentage increase in IRs for CMM and melanoma in internal organs was 23.3% [95% confidence interval (CI) 20.9–25.8] and 14.0% (95% CI 8.2–19.7), respectively. The corresponding analysis for ocular melanoma showed an increase of 1.3% (95% CI -1.5 to 4.2) and a decrease (not significant) for melanoma on male (-8.8%) and female (-2.1%) external genitalia.ConclusionA wide variation in IRs and trends between the four anatomical localisations with unlike levels of UVR exposure suggests different causal pathways for melanoma.     

Cancers of the lung,head and neck on the rise：perspectives on the genotoxicity of air pollution

Outdoor air pollution has been recently classified as a class I human carcinogen by the World Health Organization （WHO）. Cumulative evidence from across the globe shows that polluted air is associated with increased risk of lung, head and neck, and nasopharyngeal cancers--all of which affect the upper aerodigestive tract. Importantly, these cancers have been previously linked to smoking. In this article, we review epidemiologic and experimental evidence of the genotoxic and mutagenic effects of air pollution on DNA, purportedly a key mechanism for cancer development. The alarming increase in cancers of the upper aerodigestive tract in Asia suggests a need to focus government efforts and research on reducing air pollution, promoting clean energy, and investigating the carcinogenic effects of air pollution on humans.     

Sex-Dependent Staging in Non–Small-Cell Lung Cancer; Analysis of the Effect of Sex Differences in the Eighth Edition of the Tumor,Node, Metastases Staging System

Introduction

Non–small-cell lung cancer (NSCLC) has disproportionately negative outcomes in men compared with women. The importance of the relationship between sex and tumor, node, metastases (TNM) staging system remains unknown. The objective of this study was to investigate the effect of sex on NSCLC survival for each stage in the eighth edition of the TNM staging system in NSCLC.

One Case of Pulmonary Chondroma, Rare Benign Tumor of the Lung

Pulmonary chondroma is a rare form of benign neoplasms of the lung, of which the cartilage is the only constituent. Most of the patients with lung chondroma are asymptomatic at the time of diagnosis and the occupying lesion in lung is mostly detected in the routine health examination. The image of pulmonary chondroma is similar to the other benign solitary neoplasms of the lung and the definitive diagnosis can only be established un     

New developments in the lymphocyte micronucleus assay—the effect of diet,genotype and the importance of nucleoplasmic bridges

The cytokinesis-block micronucleus(CBMN)assay is an established method for studying chromosome breakage and loss in human cells both in vitro and in vivo. However, its use in the study of genomic stability could be improved by a better understanding of the impact of (a) micronutrients (b) genetic background and (c) of other associated important nuclear events indicative of chromosome rearrangement (ie nucleoplasmic     

Immune approaches to the treatment of breast cancer,around the corner?

Immunotherapy for the treatment of breast cancer can be categorized as either (a) specific stimulation of the immune system by active immunization, with cancer vaccines, or (b) passive immunization, such as tumor-specific antibodies (including immune modulators) or adoptive cell therapy that inhibit the function of, or directly kill, tumor cells. We will present the current information and the future perspectives of immunotherapy in patients with breast cancer, including the prognostic role of tumor infiltrating lymphocytes, immune signatures, targeted therapies modulating the immune system, and tumor antigen cancer vaccines. Active immunotherapy in breast cancer and its implementation into clinical trials have been largely a frustrating experience in the last decades. The concept that the immune system regulates cancer development is experiencing a new era of interest. It is clear that the cancer immunosurveillance process indeed exists and potentially acts as an extrinsic tumor suppressor. Also, the immune system can facilitate tumor progression by sculpting the immunogenic phenotype of tumors as they develop. Cancer immunoediting represents a refinement of the cancer immunosurveillance hypothesis and resumes the complex interaction between tumor and immune system into three phases: elimination, equilibrium, and escape. Major topics in the field of immunology deserve a response: what do we know about tumor immunogenicity, and how might we therapeutically improve tumor immunogenicity? How can we modulate response of the immune system? Is there any gene signature predictive of response to immune modulators? The success of future immunotherapy strategies will depend on the identification of additional immunogenic antigens that can serve as the best tumor-rejection targets. Therapeutic success will depend on developing the best antigen delivery systems and on the elucidation of the entire network of immune signaling pathways that regulate immune responses in the tumor microenvironment.     

Does the Evidence Support the Use of Concurrent Chemoradiotherapy as a Standard in the Management of Locally Advanced Cancer of the Cervix,Especially in Developing countries?

Locally advanced cancer of the cervix (FIGO stages III and IVA) is one of the most common malignancies in developing countries. Conventional treatment has been a judicious combination of external radiotherapy and intracavitary brachytherapy. However, prompted by the results of five randomised-controlled trials (RCTs) published in close succession, The National Cancer Institute (NCI) alert in 1999, and two meta-analyses, the management of cancer of the cervix has gradually changed. Concurrent chemoradiotherapy with cisplatin alone, or in combination, is gradually being favoured for the treatment of cancer of the cervix. This overview examines whether the published evidence is sufficiently adequate to justify the use of chemoradiotherapy using cisplatin as standard care in the management of cancer of the cervix, especially in developing countries, where most women present with locally advanced cancer of the cervix. A critical review of the various phase III randomised trials and meta-analyses indicates that, although chemoradiotherapy could be a standard form of treatment for early cancer of the cervix, its role in advanced stages needs further exploration before this could be incorporated into routine clinical care.     

Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett’s esophagus

Purpose

Diet is a potentially modifiable risk factor for Barrett’s esophagus (BE). We investigated the associations between intakes of fruits and vegetables and risk of BE.

Methods

We identified study subjects from 1,859 participants who underwent the endoscopy in a single VA Medical Center in the US between 2008 and 2011. Dietary intake in the previous year was elicited using a self-administered Block food frequency questionnaire (FFQ). Logistic regression model was used to estimate odds ratio (OR) and its 95 % confidence interval (CI) for BE.

Results

A total of 151 cases with definite BE and 777 controls completed the FFQ. When highest tertile of intake was compared with the lowest, the OR (95 % CI) was 0.46 (0.26–0.81) for dark green vegetables, 0.52 (0.30–0.90) for legumes, 0.50 (0.28–0.90) for total fiber, 0.45 (0.25–0.81) for isoflavones, 0.52 (0.30–0.67) for total folate, and 0.45 (0.26–0.79) for lutein, adjusting for multiple confounding factors including use of aspirin or proton pump inhibitor, gastro-esophageal reflux symptoms, and physical activity. The association for dark green vegetables was attenuated after adjustment for lutein, total fiber, and total folate (OR = 0.82; 95 % CI 0.30–2.22).

Conclusion

Higher intake of dark green vegetables was associated with a decreased risk of BE in a veteran population. Such an inverse association may be partially mediated by lutein, fiber, and folate. The novel findings on the association between intake of lutein, total folate, or isoflavones and risk of BE need further confirmation.     

Paget’s disease of the breast: the experience of the European institute of oncology and review of the literature

Background Paget’s disease of the breast is an uncommon presentation of breast malignancy, accounting for 1–3% of all the breast tumors and presents in different histopathologic patterns: in association with an underlying invasive or non invasive carcinoma, or without any underlying neoplasia. In the literature, different methods are used for the treatment. Mastectomy with or without axillary dissection has been considered as the standard treatment procedure for many years. Several studies have already shown that breast conservation with radiation therapy is an oncologically safe option. Regarding the axillary approach, several studies have documented the presence of positive sentinel lymph node even in Paget’s disease alone. The objective of this study was to retrospectively analyze outcome of patients affected by Paget’s breast disease and to define our institutional experience. Patients and methods Between May 1996 and February 2003, 114 patients with confirmed Paget’s disease of the breast were retrieved and underwent surgery at the European Institute of Oncology of Milan, Italy. The median age of the patients was 54 years at the time of the diagnosis. In our study, the histopathological examination of the operated specimen revealed one hundred seven patients with Paget’s disease associated with an underlying invasive or non invasive carcinoma, and seven patients without underlying carcinoma. Patients underwent either conservative breast surgery or mastectomy, with or without sentinel lymph node biopsy and/or axillary surgery. Each patient was evaluated after surgery at a multidisciplinary meeting to selecting systemic therapy. Results Seven patients had “pure” Paget’s disease of the breast and one hundred seven had the disease associated with an underlying carcinoma. As surgical techniques 71 mastectomies and 43 breast conserving surgeries have been performed. Complete axillary dissection was done in patients with clinically positive lymph node and/or sentinel lymph node biopsy positive. Sentinel lymph node biopsy was performed in nineteen patients with invasive component and five were positive and underwent axillary dissection. Eleven sentinel lymph node biopsies were done in patients with non invasive component and none of them was positive. Adjuvant systemic therapies were based on the final tumor, node and metastasis stage: thirty patients received adjuvant chemotherapy alone, fourteen received endocrine treatment alone, twenty-six patients were evaluated to receive both chemo and endocrine therapy. The median duration of follow up was 73 months and was updated in the last 6 months. Five patients developed local recurrence, one had regional recurrence, another two had loco-regional recurrences and fourteen had distant metastasis as a first event. Malignancy-related deaths were censored in the statistical analyses cancer for and due to another tumor in eleven patients. Additionally, deaths were not related to malignancy totally in thirteen patients. Conclusions Screening examination and imaging techniques are fundamental. Breast conserving surgery combined with breast irradiation for patients with invasive and non invasive breast carcinoma has become the treatment of first choice. All surgical conservative approaches should include the complete nipple–areolar complex and margins of resected specimen free of tumor. Thanks to the evolution of the conservative approach, good cosmetic result can be obtained. To be informed about the axillary lymph node status and to avoid the patient to have a second surgical approach, sentinel lymph node biopsy should be performed.     

Mortality Report of Malignant Tumors in SheXian,Hebei Province,China, from the 1970’s to the Present

Background: Investigations into mortality from malignant tumors were initiated in the 1970’s in Hebei Province, ‍China, and especially for esophageal cancer the rates were high, Shexian county ranking in first place of the towns ‍that were surveyed. ‍Methods: Since the 1970’s, a register system for all causes of death has been in place. Data for the decades of the ‍1970’s, 1980’s, 1990’s and 2000’s century were here checked and analyzed by SPSS software. ‍Result: From the decades of the 1970’s onward, the mortality rates of malignant tumors/100,000 were 272.0, ‍260.1, 211.7 and 180.1, respectively, with significant differences over time (x2 =240.5, P<0.001). The main malignant ‍tumors were esophageal, gastric, liver, lung and cervix cancers. The sum of their percentages of all cancer deaths ‍were 92.1% in the 1970’s, 91.6% in the 1980’s, 92.1% in the 1990’s and 93.9% in the 21st century. The sex ratios ‍(male vs female) were 1.5, 1.5, 1.7 and 2.0 respectively, with an ascending trend. Mortality rates of malignant tumors ‍increased with age, with an obvious geographic distribution. The highest mortality of malignant tumors was evident ‍in the area where the Qingzhang and Zhuozhang rivers join. ‍Conclusion: From 1970’s to the beginning of the 21st century, the mortality rate of malignant tumors has shown ‍a declining trend. The main responsible cancers are in the esophagus, stomach, liver, and lung. Through great ‍efforts for prevention, obvious decrease for esophageal cancer and cervix cancer has been achieved, but the mortality ‍rate for gastric cancer remains high.