Evaluating health utility in patients with melanoma,breast cancer,colon cancer,and lung cancer: a nationwide,population-based assessment

BACKGROUND: The Rapid Deployment Hemostat (RDH) Bandage has been designed in collaboration with the Office of Naval Research for the treatment of bleeding because of extremity trauma. It is intended as both a battlefield and civilian severe trauma wound dressing. It consists of a specific formulation of Marine Polymer Technologies' proprietary hemostatic polymer poly-N-acetyl glucosamine, and has received FDA clearance. This study compares the hemostatic capabilities of the RDH Bandage with the standard U.S Army First Aid Field Bandage (AFAFB), utilizing a controlled lethal aortotomy model of hemorrhage. MATERIALS AND METHODS: Aortic punch wounds 4 mm in diameter were made in the abdominal aortas of female Yorkshire White swine, and were allowed to bleed for 5 s before application of test materials. Test hemostats were applied to the wound with manual compression for 10 min. Total loss of blood was determined in each experiment. Bandages were removed at the end of 2 h, for those animals that survived, and the onset of re-bleeding was observed. Animals were monitored for an additional 30 min to assess survival following bandage removal. Hemostatic efficacy was judged by the total loss of blood, and the survival of the animals. RESULTS: Eighty percent of the animals treated with the RDH Bandage survived the study through the entire protocol, whereas only 40% of those treated with the Army First Aid Field Bandage survived the removal of manual compression step, and none survived following the removal of bandage after the 2 h observation/monitoring period. The average blood loss for the RDH Bandage treated animals was 234 ml, and the average blood loss for the Army First Aid Field Bandage treated animals was 1071 ml, through the observation/monitoring period. CONCLUSIONS: The RDH Bandage is significantly superior to the standard issue U.S. Army First Aid Field Bandage in the control of hemorrhage in a lethal swine abdominal aortotomy hemorrhage model, resulting in decreased blood loss and increased survival.     

Bone scintigraphy in patients with breast cancer, pulmonary cancer, uterine cervix cancer, and prostatic cancer. Statistical study of spinal accumulation cases

This is a review of bone scintigraphy performed in patients with breast cancer, pulmonary cancer, uterine cervix cancer, and prostatic cancer from 1980 to 1985. The incidence of accumulation in the spine was 25.0% in breast cancer, 29.5% in lung cancer, 24.3% in cervical cancer, and 47.0% in prostatic cancer. The predominant location of the accumulation was the lumbar vertebra (68.9%), followed by the thoracic vertebra (45.0%), sacral vertebra (37.5%), and cervical vertebra (23.6%). The survivability after spinal accumulation was determined by the Kaplan-Meyer survival curve. The 1-year survival rate of breast cancer, pulmonary cancer, cervical cancer, and prostatic cancer was 88%, 19%, 74%, and 90%, respectively, the record of pulmonary cancer being significantly lower. Hence, in the treatment of patients with metastatic spinal tumors, the therapeutic method should be selected according to the underlying disease.     

Synchronous triple urogenital cancer (renal cancer,bladder cancer,prostatic cancer): a case report

A case of synchronous triple urogenital cancer, which was comprised of renal cell carcinoma of the left kidney, transitional cell carcinoma of the urinary bladder, and adenocarcinoma of the prostate, is reported. A 72-year-old Japanese male patient was referred to our outpatient clinic with the complaint of asymptomatic hematuria. At that time, his serum of level of PSA was elevated to 20 ng/ml. Cystourethroscopy showed a papillary bladder tumor and coagula through the left urinary orifice. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass lesion measuring about 6 cm by 5 cm in the left kidney. Angiography showed a hypervascular lesion measuring about 6 cm by 5 cm at the same site. Double cancer, consisting of renal cell carcinoma and transitional cell carcinoma of the urinary bladder, was suspected and we performed left total nephroureterectomy, hilar lymphadenectomy, and transurethral rection of the bladder tumor, one month later. At the same time, we performed a biopsy of the prostate. Histological diagnosis was renal cell carcinoma, clear cell carcinoma and transitional cell carcinoma of urinary bladder. Histological diagnosis of the prostate biopsy was moderately differentiated adenocarcinoma. Since this case fulfilled the criteria of Warren and Gates, it was classified as synchronous triple urogenital cancer. A review of the literature revealed 17 authentic cases of triple urogenital cancer, of which 14 and 10 cases were reported as a combination of renal cancer, bladder cancer and prostatic cancer, in the world and in Japan, respectively. Furthermore, he had been exposed to the atomic bomb explosion in Hiroshima in 1945. This carcinogenic precursor may be related to the development of the triple cancer.     

Pain in the cancer patient--mechanisms, diagnosis, therapy

Pain is the most relevant symptom for many cancer patients, therefore treatment is of great importance. Improved knowledge about the mechanisms involved in cancer pain might help to improve therapy. Peripherally acting analgesics should be used when inflammatory mechanisms contribute to the pain (e.g., prostaglandin release). Analgesics acting in the central nervous system (opiates) can be given over longer periods via the oral route; the risk of side effects then is fairly low. Analgesics have to be administered at regular intervals. Severe states of pain can be managed with peridural administration of opitates.     

Lumpectomy and breast radiotherapy in breast cancer patients with a family history of breast cancer,ovarian cancer,or both

This article presents an outcomes review of breast cancer patients identified from the cancer registries of four area hospitals. These patients had family histories of breast cancer, ovarian carcinoma, or both and were treated with conservative surgery and radiation to the involved breast. Patients were as follows: group 1, one first-degree relative ( n = 165, one synchronous bilateral breast cancer); group 2, ≥2 first-degree relatives ( n = 21); group 3, one second-degree relative ( n = 20); and group 4, ≥2 second-degree relatives ( n = 18). The total of patients and breast cancer events was 224 and 225, respectively. Group 5 was a subgroup of 53 patients with a substantial risk (>10%) of a BRCA1 or BRCA2 mutation. After a median follow-up of 3.9 years, 5 patients had local failure (2%), and 5 developed a contralateral breast cancer (2%). There were no significant differences in local failure rates between groups (p = 1.0): group 1, 5 of 166 (3%); group 2, 0 of 21 (0%); group 3, 0 of 20 (0%); and group 4, 0 of 18 (0%). Local failure for group 5 was 2% (1 of 53). Four of 143 patients (3%) with a minimum 3 years of follow-up (median, 5.6 years) had local failure, and 5 (4%) developed a contralateral breast cancer. A univariate analysis was statistically significant for differentiation only (well, 0 of 67; moderately, 1 of 57 [1.8%]; poor, 3 of 26 [11.5%], p = 0.008). Overall survival for groups 1–4 did not differ significantly. Although follow-up has been relatively short, we have not found that breast cancer patients with various degrees of family histories of breast/ovarian carcinoma have had a detrimental outcome when treated with conservative therapy.     

Breast cancer in Zaria, Nigeria.

A retrospective analysis of the clinical records of 129 women with breast cancer seen at the Ahmadu Bello University Teaching Hospital, Zaria has been carried out. The patients were young (median age 38 years), 64% were premenopausal and 89% were parous and had practised prolonged breastfeeding. Patients typically presented with massive breast tumour (median diameter 10 cm) with matted axillary lymph nodes in 57%. Eighty-eight per cent of patients had stage III or IV disease, and in 85% the histological tumour type was infiltrating ductal carcinoma. Mastectomy was the main mode of treatment and the default rate both before and after treatment was high. The median crude survival period for our patients was only 1.5 years. The survival disadvantage is probably the result of the combined effect of delayed presentation by the patients, the preponderance of biologically very aggressive tumours and our grossly limited therapeutic modalities.     

Induced mammary cancer in rat models: pathogenesis,genetics, and relevance to female breast cancer

Mammary cancer, or breast cancer in women, is a polygenic disease with a complex etiopathogenesis. While much remains elusive regarding its origin, it is well established that chemical carcinogens and endogenous estrogens contribute significantly to the initiation and progression of this disease. Rats have been useful models to study induced mammary cancer. They develop mammary tumors with comparable histopathology to humans and exhibit differences in resistance or susceptibility to mammary cancer depending on strain. While some rat strains (e.g., Sprague-Dawley) readily form mammary tumors following treatment with the chemical carcinogen, 7,12-dimethylbenz[a]-anthracene (DMBA), other strains (e.g., Copenhagen) are resistant to DMBA-induced mammary carcinogenesis. Genetic linkage in inbred strains has identified strain-specific quantitative trait loci (QTLs) affecting mammary tumors, via mechanisms that act together to promote or attenuate, and include 24 QTLs controlling the outcome of chemical induction, 10 QTLs controlling the outcome of estrogen induction, and 4 QTLs controlling the outcome of irradiation induction. Moreover, and based on shared factors affecting mammary cancer etiopathogenesis between rats and humans, including orthologous risk regions between both species, rats have served as useful models for identifying methods for breast cancer prediction and treatment. These studies in rats, combined with alternative animal models that more closely mimic advanced stages of breast cancer and/or human lifestyles, will further improve our understanding of this complex disease.

     

Laparotomy, laparoscopy, cancer, and beyond

The fate of laparoscopic methods for the treatment of cancer remains uncertain. Published middle-range oncologic results from nonrandomized studies demonstrate that laparoscopic methods are associated with an outcome comparable with results after open resection. The world awaits the 3- and 5-year oncologic results of the ongoing randomized and prospective trials. There is a possibility that laparoscopic methods may be associated with a survival benefit. Port tumors remain a concern. However, results at this writing suggest that these recurrences take place at a frequency similar to that of incisional recurrences following open cancer resection. Port tumors currently are viewed as local recurrences. Traumatization of the tumor at the time of resection is thought to be the most important surgery-related risk factor. The demonstration of a survival benefit in a randomized trial would likely have a tremendous impact on the surgical world. Avoidance of laparotomy-related immunosuppression and tumor stimulation, both of which have been well demonstrated in animal studies, theoretically, might account for differences in cancer outcome. The early postoperative period may be a critical time during which the fate of many cancer patients is determined. It is possible that this may be an ideal time frame for antitumor immunotherapy because the tumor burden is at its lowest, and because immunotherapy, unlike conventional chemotherapy, is unlikely to have a negative impact on wound and anastomotic healing. Perioperative nonspecific upregulation of immune function via pharmacologic means may improve long-term oncologic results. Similarly, preoperative tumor vaccines might provide patients with a specific means of combating any remaining tumor cells after curative resection. The results of several recently completed murine studies support both of these ideas. Finally, early postoperative administration of monoclonal antitumor antibodies might provide patients with specific means of combating any remaining tumor cells after curative resection. The introduction of advanced minimally invasive techniques nearly a decade ago has led to new methods of approaching malignant tumors that have the potential to have an impact on the oncologic outcome of cancer patients. This decade-long journey also has led to new insights regarding the impact of surgery on the patient. It also has alerted us concerning the importance of the immediate postoperative period in the patient's ongoing struggle against the tumor. These insights hopefully will lead to better surgical methods and new perioperative adjuvant therapies that will increase the rate of survival and reduce the recurrence rates for cancer patients.     

Penile cancer – Incidence,mortality, and survival in Saxony,Germany

Objective

Penile cancer is a rare disease in Europe and North America. Cancer registry data were used to estimate the incidence, mortality, and survival of penile cancer in Saxony, Germany.

Inflammation, infection, and prostate cancer

PURPOSE OF REVIEW: Recent evidence suggesting that inflammation and infection play a role in the etiology of prostate cancer, and the discovery of a novel virus in men with a genetic susceptibility to prostate cancer is reviewed. RECENT FINDINGS: Almost 20% of visceral cancers worldwide have proven infectious causes. There is substantial histologic, molecular genetic, and epidemiologic evidence that infections and inflammation are also important in the pathogenesis of prostate cancer. The R462Q allelic variant in RNASEL, an antiviral gene important in the innate immune response to viral infections, increases susceptibility to prostate cancer while resulting in vitro in deficient antiviral defenses, suggesting that prostate cancer could be caused by a virus. The study of R462Q carriers led to the discovery and biologic characterization of a novel retrovirus, xenotropic murine leukemia-related virus, isolated and cloned from prostate tissue of affected men. Biologic studies of this virus show that it is sensitive to inhibition by interferon and its downstream mediator, RNaseL, and that its DNA has integrated into the DNA of some men with prostate cancer. SUMMARY: Inflammation triggered by infection and other causes underlies the development of prostate cancer, and xenotropic murine leukemia-related virus is a candidate etiologic agent. Ongoing studies seek to define its oncogenic potential and pathogenesis.