Childhood Cancer Care in Developing Countries

Dealing with children who have cancer in developing countries is a great human experience not only for the patient and the family but also for persons who are caring them.The diagnosis of a child as a cancer case is really a great shock to all family members and it is a moment of a dramatic change in their life. First reaction is usually a combination of sadness and denial.

They will start a new style of life with a plenty of investigations, appointments and different treatments decisions and plans. Different negative emotional reactions are the classic feelings of the parents every time they meet the treating physician. As caring doctors our role is not only treatment, but to help parents to overcome these initial shock stage and these negative emotions to support them to focus on what they should do to help and support their child through this hard time.

One of the hardest parts of caring for such kids is knowing what to say and how much information to give, as children might be frightened and uncertain of many things, they might be frightened of being died, and here we must assure them. Comforting them is very essential in treatment, although for us it's always heartbreaking.

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Life in The Time of Opioids

Just as HIV forever changed the way we approached every aspect of patient care, the pervasive use of opioids for chronic non-cancer pain is now altering the way we care for the patient suffering from acute and chronic pain of malignant origin and has made the care of this important patient population much more challenging.

It seems that it was but a very few years ago that the alleviation of pain in cancer patients seemed within our reach. As clinicians began to understand the nature of cancer pain and how to treat it, the number of patients with uncontrolled cancer pain began to decrease. This was accomplished in large part by the widespread implementation of the World Health Organization Three Step Therapeutic Ladder.

While the Ladder has been subsequently modified to add a fourth step to include interventional pain management modalities and a fifth step to include reversible neuroaugmentation modalities, the mainstay of the Ladder’s efficacy in the management of cancer pain remains the rational use of opioid analgesics.

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Life and Sexual Activity

Prostate cancer is the most prevalent solid tumor diagnosed in men in developed countries. The standard treatment for early stage prostate cancer is surgery (prostatectomy) or radiotherapy. To improve local control, the radiation dose should be escalated.

Three dimensional conformal radiation treatment (3DCRT) increases local control rates while decreasing toxicity rates. Recent data suggest that, to achieve high local control of prostate cancer with acceptable toxicity, hypofractionated radiotherapy (HRT) could be used. Short-duration HRT  is an attractive option compared with a 7-to-8-week course of standard radiotherapy in terms of logistics; the patient’s job, daily activities, and emotions; the availability of accelerators, and the cost of prolonged treatment.

Quality of life (QoL) has become one of the most significant issues in treatment decisions in prostate cancer. In the case of QoL measurement after radical prostatectomy, brachytherapy, or external beam radiotherapy, all types of prostate cancer treatment were shown to be associated with changes in the QoL domains related to urinary, bowel, and sexual functions.

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Association of Promoter Polymorphisms in Xrcc2 Gene Involved in DNA Double Strand Break Repair and Increased Susceptibility to Thyroid Cancer Risk in Pakistani Population

Thyroid cancer is the most prevalent endocrine malignancy with increasing incidence rate in recent years. Females are more likely to have thyroid cancer at a ratio of 3:1. The main risk factors of thyroid cancer are genetic factor, environmental factors and exposure to ionization radiations at childhood.

Exposure to ionization radiations cause single strand and double strand breaks and can produce chromosomal damage and release of reactive oxygen species that causes genomic instability. In human there are many pathways to repair this DNA damage, out of which double strand break repair (DSBR) pathway is an important and preferred pathway to repair such lesion.

This pathway has two types, non-homologous end joining (NHEJ) and homologous recombinant repair (HRR) pathway. HRR is an error prone pathway which is template specific and considered to play a significant role in the repair of DNA double strand damage produced by ionization radiations. HR encompasses many genes, but major role is performed by RAD51 and RAD51-like genes such as XRCC2 and XRCC3.

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An Additional risk of Lung Cancer from Recurrent Exposure to Ethyl Carbamate

Ethyl carbamate  urethane is the ester of carbamic acid. It has been found mainly as a by-product of fermented foods and beverages. EC is widely distributed in fermented foods and beverages, such as spirit, wine, beer, bread, soy sauce, and yoghurt, due to unintentional fermentation during production or storage process of fermented foods or beverages.

EC has been formed from substances like urea, hydrogen cyanide, citrulline, and N-carbamyl compounds during foods and beverage fermentations. Earlier studies reported that unrecorded wine is rich with EC due to reaction between ethyl alcohol and hydrogen cyanide or urea wine.

The Joint Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) Expert Committee on Food Additives (JECFA) reported that EC increase the probable health risk of carcinogenicity of certain types of alcoholic beverages for regular drinkers, especially in unrecorded alcohol. EC exhibits carcinogenic activity on different sites such as the liver, ovary, and skin in a dose dependent manner due to its potential genotoxic activity.

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Male Breast Cancer

Breast is made up of glands called lobules that can make milk and thin tubes called ducts that carry the milk from the lobules to the nipple. Breast tissue also contains fat and connective tissue, lymph nodes, and blood vessels.Bosom tumor for the most part begins off in the inward covering of milk pipes or the lobules that supply them with milk.

A harmful tumor can spread to different parts of the body.The main indication of bosom growth regularly is a bosom protuberance or an anomalous mammogram. Bosom disease stages range from right on time, treatable bosom malignancy to metastatic bosom growth.

Breast cancer is one of the most common malignancies in women but is relatively rare in men with an incidence rate of 0.5% compared to female breast cancer. The risk of breast cancer in male increases with age and men usually present with later stage of disease those results in a worse outcome.

Radio sensitization of Colon Cancer Cells Mediated by Gemcitabine through Cell Cycle Synchronization

Colon cancer is the third most common malign neoplasm worldwide. For the last 10 years, mortality rate from colon cancer has declined by 3%, and the largest drops occurred in adults aged 65 and olde. This decline can be attributed to the increase of screening, which detects and allows the removal of precancerous polyps.

In contrast, rates increased during this time period among adults younger than 50 years. In Brazil this type of cancer is ranked in third place among other incidences of cancer and it is the third cause of deaths from cancer. In general, the most affected age range is of 40-70 years. The conditions associated to increase a risk to develop colon cancer include a personal history of colorectal cancer or adenomatous polyps.

A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease); a strong family history of colorectal cancer or polyps; a known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer.

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The Prognostic Role of Tumor-Infiltrating Lymphocytes CD8 and Foxp3 and their Impact on Recurrence in Breast Cancer Patients

The presence of tumor-infiltrating lymphocytes (TILs) either within the tumor stroma or tumor epithelium reflects the immune response of the host against the tumor, defined as cancer “immunoediting”. Large tumors are in the “escape” phase during which immune cells are not able to stop tumor growth but their presence at least denotes standby immunocompetency which can be reactivated by treatment.

Many TILs have been recognized. Of those, fork head box P3- positive (Foxp3+) regulatory T cells (Tregs), CD8+ T cells, and CD4+ T cells are known to be the main keys for immune surveillance and tolerance, respectively [4]. CD8+ T cells are mediators of antitumor immunity and can lyse tumor cells directly. The clinical importance of CD8+ T cells has been suggested by many recent studies that reported a survival benefit in correlation with an increase in CD8+ T cells in large cohorts of various human cancer patients.

CD4+ T cells have an important role in antitumor immunity that was implicated by their helper or memory cell functions. CD4+ T cells may have several effector functions, such as priming tumor-specific cytotoxic T cells or macrophages that are involved in clearance of tumor cells. In contrast, Tregs are known to have a very important role in escape of antitumor T-cell response in cancer cells [13], due to their ability to potently suppress immune reaction against tumors in vivo.

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Rectal Cancer Following Neoadjuvant Radiochemotherapy

The prognosis of patients with rectal cancer is generally assessed using the TNM staging system, which stages lymph node involvement according to the absolute number of involved lymph nodes. Positive lymph nodes affect the prognosis of patients. Some research has indicated that the survival of patients with positive lymph nodes is much poorer. The 7th AJCC staging system divide patients with rectal cancer into four stages (N1a, N1b, N2a, N2b) which is more accurate than the 6th staging system, suggesting patients with more positive lymph nodes have unfavorable prognosis.

TNM staging system suggests more than 12 lymph node harvest is the premise of accurate N stage. However, adequate lymph nodes could be harvested in only approximate 1/3 patients of rectal cancer. Moreover, most of the patients with positive lymph nodes receive neoadjuvant radiotherapy which will reduce the number of lymph nodes harvest. It is difficult for the patients who have received preoperative radiotherapy to get adequate lymph nodes. The reduction of lymph node harvest may decrease patients’ prognosis and may not be reflected in TNM staging system. It affects prognosis value of N stage for these patients. Some researchers are searching for a more effective indicator to evaluate the situation of lymph nodes.

The lymph node ratio (LNR), the number of metastatic lymph nodes divided by the total number of examined nodes, might be a suitable staging system. LNR doesn’t depend on the absolute number of positive lymph nodes. It treats the ratio of positive lymph node as the indicator of lymph node metastasis. Although it has many drawbacks such as different cutoff values and inconsistent pathological evaluation, researchers focus on it as a valuable prognosis indicator.

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EGFR-Signaling and Autophagy: How they Fit in the Cancer Landscape

Key consequence of an overachieving Epidermal Growth Factor Receptor (EGFR)- signaling in cancer  forcefulness and poor prognosis is very much perceived. In accordance, EGFR is either enhanced or changed in greater part of the malignancies of epithelial beginning, and thusly has been perceived as a primary focus for anticancer treatment.

However, in spite of introductory clinical adequacy of the anti-EGFR treatment in tumor treatment, long term endeavor to quiet the growth boosting impacts of EGFR-dependent signaling meets resistance in malignancy cells. Quite, impacts of EGFR enactment are pleotropic. Additionally, under conditions of anti-EGFR treatment in malignancy cells, criticism initiation of the expert survival motioning by enactment of other development variable receptors can happen. However, a basic part of autophagy in the resistance against anti-EGFR treatment is quick developing. Intresetingly, EGFR controls autophagy in a context-dependent way.

Besides, EGFR deregulated tumors exhibit differential reliance upon autophagy for their survival and development. Additionally, restraining EGFR-signaling advances autophagy. These interesting contemplations are confounded further by discoveries that EGFR manages autophagy in kinase-dependent or independent way. Hence, for effective clinical tumor treatment utilizing anti-EGFR regimen, it is important that we understand molecular details of the nexus between the EGFR-Signaling and autophagy.

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Small Cell Carcinoma of the Rectum, A Systematic Literature Review and Case Series

Small cell carcinomas (SmCC) are malignancies that derive from neuroendocrine cells. The World Health Organisation (WHO) in 2010 classified SmCC as a subgroup of neuroendocrine carcinoma (NEC) which accounts for approximately 0.6 percent of all colorectal cancers. NEC has two histologic subgroups, namely large cell carcinoma (LCC) and small cell carcinoma (SmCC). LCC can be difficult to distinguish from poorly differentiated adenocarcinoma.

Despite the fact that the gastrointestinal tract (GI) has the largest number of neuroendocrine cells in the body it is unusual for such malignancies to occur here. First described in 1952, nearly 650 cases of gastrointestinal SmCC have been reported in the literature until 2007. The oesophagus is the commonest site of incidence of GI SmCC (53%) followed by the colon (13%), stomach (11%), gallbladder (8.4%) and rectum (7.3%). The aggressive neoplastic nature of SmCC is characterised by rapid growth, high mitotic proliferation rate (>20 mitotic figures per 10 high-power fields [HPF] or a Ki-67 index >20%), early dissemination and poor prognosis.

SmCC of the rectum is an extrapulmonary small cell carcinoma (EPSmCC) entity, which morphologically resembles pulmonary small cell carcinoma (PSmCC). SmCC was originally thought to derive from amine-precursor uptake and decarboxylase cells (APUD). However, the pluripotent stem cell, with its potential for variable differentiation, is now the most widely accepted theory [6-9]. Although it is important to rule out a PSmCC as the primary tumour the treatment paradigm for EPSmCC is extrapolated form the platinum based therapy used to treat PSmCC .

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Malignant Transformation in Potentially Malignant Lesions

Breast Cancer is the most frequent cancer among the women now a day. It is most reported cancer globally. By far Breast cancer is the most spotted cancer among women. Globally, more than 20% enhancement in breast cancer since 2008 with a newly diagnosed cases of 1.7 million in 2012; and there are 6.3 million women alive with breast cancer with 14% increase in mortality rate in preceding 5 years.

In Asia, mostly breast cancer occursin women in their forties. In Africa it is also usually around 48 years in which two third cases are premenopausal whereas in Europe majority cases happens in postmenopausal stage. Normal human women breast consists of milk producing lobules, tiny ducts that carry milk from lobule to the nipple and stroma which contains fatty tissues and connective tissues surrounding ducts, lobules, blood vessel and lymphatic vessels. Breast cancer is an assemblage of very diverse group of diseases. The Basis of classification of breast cancer was started with histological features, then based on estrogen receptor(ER) expression and later according to presence of Human Epithelial Growth Factor receptor (HER2).

Breast cancer in specifically begin in lobules (lobular cancer) or ducts (ductal cancer). Keeping in mind the metastatic capability, breast cancer can either be in situ/non invasive or invasive. in situ breast cancer can have different origin and grouped accordingly as Ductal carcinoma in situ (DCIS) or Lobular carcinoma in situ (LCIS). DCIs are the most common type of in situ carcinoma while LCIS can be termed as pre cancer. There is some other in situ type of breast cancer having characteristics of both ductal and lobular carcinomas and have an unknown origin.

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Epidemiology of Thyroglossal Duct Cysts in an Eastern Caribbean Nation

Cystic lesions of the neck include branchial cleft cysts, thyroglossal duct cysts, lymphangioma, dermoid cysts, epidermoid cysts, infections/inflammatory masses, cystic lesions of the thyroid, thymic cysts, laryngoceles, ranulas, cystic lesions of salivary glands, cystic metastatic lymph nodes, neurogenic tumours, rare vascular lesions and cervical bronchogenic cysts. The thyroglossal duct cyst accounts for 70% of all congenital neck masses.

The thyroid gland descends from the base of the tongue at the level of the foramen caecum into the anterior neck through the thyroglossal duct. This duct usually undergoes involution but in seven percent of patients it remains patent. The ducts have an epithelial lining which - in the presence of infection or inflammation produces excess secretions that cause ductal dilatation and cyst formation. The patient may seek medical attention for cosmetic concerns regarding an asymptomatic cyst or when the cyst becomes symptomatic.

In this small case series, the statistics reported in the age groups less than fifty years compared favorably to international statistics. Ahura et al. and Fischer et al. also reported a greater percentage of patients over fifty years that developed cysts. No particular reason was found to account for this.

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Small Cell Carcinoma of the Rectum, A Systematic Literature Review and Case Series

Small cell carcinomas (SmCC) are malignancies that derive from neuroendocrine cells. The World Health Organisation (WHO) in 2010 classified SmCC as a subgroup of neuroendocrine carcinoma (NEC) which accounts for approximately 0.6 percent of all colorectal cancers. NEC has two histologic subgroups, namely large cell carcinoma (LCC) and small cell carcinoma (SmCC). LCC can be difficult to distinguish from poorly differentiated adenocarcinoma.

Despite the fact that the gastrointestinal tract (GI) has the largest number of neuroendocrine cells in the body it is unusual for such malignancies to occur here. First described in 1952, nearly 650 cases of gastrointestinal SmCC have been reported in the literature until 2007. The oesophagus is the commonest site of incidence of GI SmCC (53%) followed by the colon (13%), stomach (11%), gallbladder (8.4%) and rectum (7.3%). The aggressive neoplastic nature of SmCC is characterised by rapid growth, high mitotic proliferation rate (>20 mitotic figures per 10 high-power fields [HPF] or a Ki-67 index >20%), early dissemination and poor prognosis.

SmCC of the rectum is an extrapulmonary small cell carcinoma (EPSmCC) entity, which morphologically resembles pulmonary small cell carcinoma (PSmCC). SmCC was originally thought to derive from amine-precursor uptake and decarboxylase cells (APUD). However, the pluripotent stem cell, with its potential for variable differentiation, is now the most widely accepted theory.

Malignant Transformation in Potentially Malignant Lesions

Early detection and prompt treatment of precancers as well as early detection of any malignancy in these precancers is of equal importance for the successful reduction of morbidity and mortality rates of oral cancers. An inexpensive, noninvasive, and accessible diagnostic methodology to detect the malignant conversion of oral premalignant lesions is required.

Early detection and prompt treatment of precancers as well as early detection of any malignancy in these precancers is of equal importance for the successful reduction of morbidity and mortality rates of oral cancers. An inexpensive, noninvasive, and accessible diagnostic methodology to detect the malignant conversion of oral premalignant lesions is required.

The goal of a cancer-screening program is to detect tumors at a stage early enough that treatment is likely to be successful.

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