Clinical characteristics of cancer of unknown primary (CUP)--a summary of 22 cases

Cancer of unknown primary site (CUP) is not a rare entity and accounts for 3-5% of all malignant neoplasias. CUPs are diagnosed with metastatic lesion so they are all in the advanced stage. Systemic chemotherapy is applied in many cases, but the ideal therapeutic strategy has not yet been determined. CUP shows much histological and therapeutic heterogeneity. Histologically, half of CUPs are adenocarcinoma and the rest are undifferentiated carcinomas. We analyzed the clinical and therapeutic characteristics 22 cases of CUP patients. Most CUP patients are found from lymph node swelling. There is no significant tendency as to the site of lymph node metastasis. Bone metastases are frequently encountered. It seems undifferentiated carcinomas are more responsive to chemotherapy. Chemo-sensitive patients are likely to have a longer life expectancy. In our experience all of the chemo-responsive cases are treated with platinum-based chemotherapy. Today several platinum-based combination chemotherapies are reported, but there is no large-scale randomized study. Because of its variety, individualized therapy may be ideal for CUP.     

Provision for the radiation protection of medical personnel in a radiogynecologic department (according to the experience of the Research Institute of Oncology and Medical Radiology of the Ministry of Health of the Belorussian SSR)]

Some aids of collective and individual radioprotection of the medical personnel during a conduction of intracavitary gammatherapy are evaluated. The characteristics of the production equipment (a semi-automatic protection line, a set for radiation following the principle of simple afterloading, remote afterloading) are given, and their operation principles are described. The materials concerning the radiation-hygienic analysis of the medical personnel labour conditions are reported. Measures providing their reliable protection during manipulations with radioactive sources are delineated.     

Neuropathies of monoclonal gammopathies of undetermined significance

Although rare, MGUS neuropathies offer a unique glimpse of some the molecular mechanisms of autoimmunity. For this reason alone, they are important disorders and are being studied vigorously in many research centers around the world. In at least some cases, they are potentially treatable. New, safer, and more effective therapies are needed, however. The neurologist and hematologist must work together to develop these treatments.     

A review of the antimicrobial activity of the fluoroquinolones

The evolution of the fluoroquinolones is described, and structure-activity relationships outlined. The in-vitro antimicrobial activities of ciprofloxacin, enoxacin, norfloxacin, ofloxacin and pefloxacin against a wide range of organisms are critically reviewed. In-vitro factors influencing fluoroquinolone activity are discussed. Reports of the acquisition of resistance to the fluoroquinolones are evaluated. Finally, possible future directions for this group of antibiotics are discussed.     

Proceedings: Carcinoma of the oral cavity--general principles of therapy

Over 90% of malignant tumors of the head and neck are squamous cell cancers. These originate in the epithelium of the upper respiratory and alimentary tracts. Some thirty or more primary sites are recognized. Though there are specific therapeutic problems relative to each of these sites, there are general principles which apply to many. I have attempted to present a general outline of therapy for squamous cell carcinoma of the head and neck. It is hoped that this will help the physician who is not intimately involved with the details of therapy to understand why some patients with malignancy are treated one way while others are directed along other avenues of therapy.     

The significance of assessment of quality of life as a cancer treatment

Now that cancer treatments have advanced and people are surviving longer, considerations of patient QOL are becoming more important. QOL questionnaires are lists of questions taken from more than two domains. The questions are roughly divided into the "general scale" type, which asks people, patients or not, about their level of general QOL, and the "disease specific scale" type, which investigates the level of QOL focusing on the effects of the disease or treatments. Questionnaires of QOL specific to patients suffering from cancer has the former as core questions, with the latter added for type of cancer, treatments, and symptoms. Two questionnaires, EORTC QLQ and FACT, are most often used in clinical research, and Japanese versions are also available. When investigating the change in the level of the QOL with time, the disease specific scale, which better reflects changes due to the disease, is useful. Moreover, using a questionnaire that is easy to complete will minimize deficit values, and raise the accuracy of data. Use of sample questionnaires available on the Internet will be useful in preliminary surveys. Any medical treatment has a detrimental effect on patients' mind and body. We hope that the results of the QOL research are utilized as evidence in deciding which medical treatments to give patients.     

Common toxicities of mammalian target of rapamycin inhibitors

The toxicities of newer targeted therapies are different from those seen with the traditional chemotherapy. Mammalian target of rapamycin (mTOR) inhibitors are evolving into an important class of drugs in oncology, and this class of drugs presents with a variety of different toxicities. Although similar to the toxicities seen in transplantation, these rapamycin analogs have unique side effects when compared to traditional chemotherapy agents. While most of the toxicities are mild, few can be severe and require routine monitoring. Mucositis and rash are the most common side effects. The metabolic toxicities, hyperglycemia, hyperlipidemia, and hypophosphatemia are different from the side effects traditionally seen with chemotherapy. This review will focus on the common toxicities seen with the mTOR inhibitors.     

Treatment of endocrine pancreatic tumors

Endocrine pancreatic tumors are rare with an incidence of 4 per million inhabitants. Most tumors are malignant except for insulinomas that usually are benign. They are slowly growing in the majority of cases but there are exceptions with rapidly progressing malignant carcinomas. Because of the rarity of these tumors large randomized trials are difficult to accomplish. However, most physicians treating these patients agree that surgery should be considered in all cases and that medical treatment with chemotherapy and biotherapy is well established for this group of patients.     

Pathology of pineal region tumors

Various histological types of tumors arise in the pineal region. The most common tumors are pineal parenchymal tumors and germ cell tumors. Pineal parenchymal tumors are divided into pineocytoma, pineal parenchymal tumor with intermediate differentiation and pineoblastoma. Pineocytomas are well-differentiated tumors and retain the morphological and immunohistochemical features of pineal parenchymal cells. Lobular architectures and pineocytomatous rosettes are also typical features. In contrast, pineoblastomas are embryonal tumors resembling primitive neuroectodermal tumors (PNET). However, pineoblastomas are distinct from PNET in other sites due to their exhibiting photosensory differentiation including Flexner–Wintersteiner rosettes and fleurettes. Although pineal cysts are tumor-like lesions, and not true neoplasms, they are occasionally difficult to distinguish from pineocytoma and astrocytoma. From the therapeutic aspect, a precise differential diagnosis is critical.The pineal region is the most common site of the brain in which germ cell tumors occur. Germinoma, teratoma, embryonal carcinoma, yolk sac tumor and choriocarcinoma are encountered, and the latter three types of tumors usually constitute elements of mixed germ cell tumors. The morphological and immunohistochemical features of intracranial germ cell tumors are very similar to those of gonadal germ cell tumors, although there are some differences in germinoma. Pineal germinoma may exhibit carcinomatous differentiation.Other types of tumors are occasionally observed, including fibrillary and pilocytic astrocytoma, glioblastoma, ependymoma, melanoma, meningioma and so on. Metastatic pineal tumors are also rare. The most common site of origin for pineal metastasis is the lung.     

Special techniques of hair transplantation by fusiform grafts and flaps of many types.

There are more and better ways of transplanting scalp hair than merely by punch grafts. Techniques of transplantation by fusiform grafts and flaps are briefly described, advantages are stated, and results are illustrated.     

Current status of surgical treatment of cancer of the esophagus

Treatment modalities for cancer of the esophagus continue to encourage a healthy debate amongst surgeons, radiotherapists, and chemotherapists. This is because overall results by current treatment methods are generally unsatisfactory, though an all-round steady gain is now being reported by many authors. With increasing sophistication in radiotherapy techniques (external and intracavitary) and more effective combination chemotherapy, it is likely that surgical treatment of this cancer may be reexamined. There is little doubt, however, that despite the advent of radiotherapy and chemotherapy, surgery is still the most important treatment method in providing lasting relief of dysphagia and maximum survival. While increasingly low surgical mortality and a high cure rate are now being reported, the type and extent of surgery are still contentious issues. Alternatives ranging from a very radical excision (monobloc total esophagectomy with mediastinal dissection) to a blunt transhiatal esophagectomy are now being advocated. Radiotherapists and chemotherapists are now investigating the feasibility of a nonsurgical treatment for cancer of the esophagus.     

Post Traumatic Osteolysis of the Acromial End of the Clavicle

The mode of presentation and radiological findings in nine cases of post-traumatic osteolysis of the clavicle are discussed. Clinical, radiological and pathological findings are presented, the findings in this series are compared with earlier reports and the differential diagnosis of erosions of the outer end of the clavicle is discussed. The forms of treatment available and prognosis of the condition are enumerated. The entity would appear to be more common than previous reports suggest.     

Classification of Fungi in modern view

Fungi are a heterogeneous jumble coming together from three kingdoms of organisms. The True Fungi represent a kingdom of its own and are positioned closer to the Animalia than to the Plantae. At present the Fungi are divided into five Divisions. Species pathogenic for humans are found in the Divisions Zygomycota, Ascomycota and Basidiomycota. The Pneumocystidales are now classified in the Ascomycota. The Malasseziales are included in the Class Ustilaginomycetes. Essential characteristics for the classification of Fungi are derived from ultrastructure, chemistry, and more recently also from molecular biology of these organisms. None of these methods can stand for its own, all characteristics must be included.     

Biology of tumors of the peripheral nervous system

Tumors of the peripheral nervous system include neuroblastomas, pheochromocytomas, and neuroepitheliomas. Neuroblastomas and pheochromocytomas are adrenergic in origin and share certain genetic features, whereas neuroepitheliomas are thought to be cholinergic and are characterized by distinct genetic features. Neuroblastomas are characterized by deletion of the short arm of chromosome 1 (1p), amplification of theMYCN proto-oncogene, and hyperdiploidy in subsets of tumors. All three of these genetic features have prognostic value in subsets of patients. Allelic loss of 14q also occurs with increased frequency, but the prognostic importance of this abnormality is not known yet. Pheochromocytomas have not been studied as extensively, but allelic loss for 1p appears to be a frequent change, and no clear examples of oncogene activation have been identified to date. Neuroepitheliomas are characterized by translocation between chromosomes 11 and 22. Although they have a characteristic pattern of proto-oncogene expression, it is not clear that any of these oncogenes are activated specifically, and no sites of allelic loss have been identified to date. Thus, cytogenetic and molecular analysis of neuroblastomas, pheochromocytomas, and neuroepitheliomas are useful in distinguishing them from each other and from other tumors in selected cases. Furthermore, certain genetic markers are useful in predicting clinical behavior, especially for neuroblastoma.Abbreviations RFLP Restriction Fragment Length Polymorphism - LOH Loss Of Heterozygosity - dmins Double-minute chromatin bodies - HSR Homogeneously Staining Region - N myc-amplification of MYCN     

Radiological differential diagnosis of early colorectal cancer

Radiological differential diagnosis of early colorectal cancer was described in terms of a set of lesions which are macroscopically similar to early cancer and are present in the continuum of atypicality (adenoma-early cancer-advanced cancer), and those which are macroscopically similar to early cancer, but are not present in the continuum of atypicality (malignant lymphoma, rectal carcinoid). The majority of early colorectal cancers are polypoid lesions. They are classified into three forms; pedunuculated, sessile without central depression, and sessile with central depression. Sessile lesions without central depression which are in 1 cm level are most probably early cancers.     

Alteration of phenotype of 'regressor' avian sarcoma cells following treatment with phorbol ester

Tumor cells which are cultured from the regressor phase of avian sarcoma virus (ASV)-induced tumor growth are deficient with respect to ability to produce progeny transforming virus. In addition, such cells are relatively unreactive with anti-viral antibody and are unable to elaborate, into the medium, antigens which are stimulatory to the sensitized lymphocytes of virus-injected hosts. These deficits can be overcome by treatment of the cells with the tumor promoter, phorbol myristate acetate (PMA).     

Trends of management of carcinoma of the biliary tract

Trends of management of carcinoma of the biliary tract are described. Ultrasonography has made it possible to perform non-invasive and routine examination for biliary disorders and to find early cancer of the gallbladder. Moreover, endoscopic ultrasonography has enabled to make a differential diagnosis and a staging diagnosis. Percutaneous transhepatic cholangioscopy has been used as the most precise diagnostic procedure and peroral cholangioscopy has been introduced as a more convenient endoscopy. Although percutaneous transhepatic biliary drainage is considered to be hazardous and disadvantageous procedure in Western countries, it is essential in Japan where radical and extended operation are frequently performed. In Japan, major hepatectomies, pancreatoduodenectomy and/or combined resections of major vessels are aggressively adopted for advanced gallbladder cancers. However, such operations are still much dangerous and long-term survivors are few. Therefore, application of these extended operation for this advanced disease should be carefully re-examined. Various hepatectomies with caudate loberesection have been performed for patients with carcinoma of the hepatic hilus. Liver transplantation is also attempted for this disease, however, not accepted generally. Pylolus preserving pancreatoduodenectomy is now being accepted for biliary malignancies, which brings excellent quality of life.     

Actions of bisphosphonates in animal models of breast cancer

The skeleton is the most common site of breast cancer metastases. These bone metastases are usually osteolytic and cause significant morbidity. Bisphosphonates, potent inhibitors of bone resorption, reduce skeletal morbidity in breast cancer patients with bone metastases. Animal studies with bisphosphonates are crucial to understanding the mechanisms by which these compounds affect bone and tumor cells in vivo. Such animal models of breast cancer that are used to test the efficacy of bisphosphonates are discussed. These studies may offer insight into the treatment of other tumor types that frequently metastasize to bone.     

Chronology of administration of cytotoxic drugs and combinations of chemotherapy with radiotherapy

Contrarily to that which has been observed in some experimental tumors, the clinical data show that it is not possible to take advantage of the semi-synchronisation of tumor cells induced by the administration of cytotoxic drugs or ionizing radiations, either in combination chemotherapy or during the association between radiotherapy (RT) and chemotherapy (CT). The association of RT and CT has obtained excellent results in those human tumors which are both chemosensitive and radiosensitive such as lymphoma, testicular tumors, embryonal tumors, cancers of childhood. However, even in these favorable types of tumors, high doses of RT and CT are required, not significantly lower than those which are delivered when one of the two modalities is used alone. Therefore, the major problem is that of the possible cumulative toxicity of the two modalities. The toxicity appears to be maximum when the two modalities are administered concomitantly; it can be reduced in sequential administration when there is a sufficiently long interval between the various agents. However, sequential associations may cause long delay in the delivery of one of the two modalities and in rapidly growing tumors this delay might be detrimental. This is why an integrated alternating scheme was proposed in which short radiotherapy courses are interdigitated between the courses of chemotherapy, chemotherapy being administered with the conventional scheduling. Preliminary results of this alternating combination are discussed. In small cell carcinoma of the lung and non-Hodgkin lymphoma of poor histologic types, so far the results are promising.     

Assessment of quality of life in palliative care--psychometric properties of a short questionnaire

The psychometric properties of a short but comprehensive quality-of-life instrument, developed especially for cancer patients in the palliative care setting are presented. Items from physical, psychological, social and existential domains are included. The findings suggest that the AQEL (Assessment of Quality of Life at the End of Life) instrument is both valid and reliable, but further trials with more patients are needed.