Cervical cancer screening strategies: not the test you take, but the decision you make

Starting from May 1, 2017 in Australia the National Cervical Screening Program will shift from cervical cytology every two years, to HPV DNA testing as the sole primary screening test every five years in women aged 25 to 74 years, together with the implementation of an active HPV vaccination program.

Conversely in Japan cervical screening using cytology every two years is still being recommended for population-based and opportunistic screening. While Canadian guidelines also recommend cervical screening with cytology every 3 years, in Europe cervical cytology is recommended for women under 30-35 years, and HPV testing as the sole primary screening test every 5-10 years for women above 30-35 years. Actually, guidelines do not represent the real situation in each European country.

In the Netherlands, screening is well organized and relies on primary HPV testing every 5 years until 40 years of age and every 10 years for women aged 40 and beyond: no screening is provided for women under 30, nor over 60 years of age.

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Review of Leakage from a Linear Accelerator and Its Side Effects on Cancer Patients

Radiation therapy using external beam radiation therapy (EBRT) is playing an important role for effective treatment of all kinds of tumors. Peripheral dose is the result of leakage and scatter from multileaf collimators devices (MLCs), counts for 2-10% of the maximum dose given to the patient, depending on the machine used and type of treatment.

The present review reveals that despite of the recent advancements in linear accelerators (LINAC) and MLC design and technology, the remaining small amount of leakage (peripheral dose) of these devices still has significant side effects on patient’s life span and quality of life after treatment.

Based on the findings in this review, it is suggested that introduction of additional effective and patient-specific shielding techniques would have great impact on reducing risk of radiating healthy cells and hence adversely side effects on cancer patients.

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Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) will be unexpectedly present in approximately 10% of colorectal cancer patients having primary cancer resection. In the past this was considered to be an incurable condition with a terminal outcome.

In patients determined to have peritoneal dissemination at the time of resection, the intervention was considered palliative. Recently, long term benefit from definitive treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a reality. These treatments are now appropriate for primary appendiceal and colorectal cancer determined to have PM at the time of resection.

Modifications of the initial management of colorectal cancer patients found upon exploration to have PM are explored in this manuscript. In these patients, not only the primary cancer but also the PM must be optimally treated.

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Experimental and Computational Approaches in Leveraging Natural Compounds

Cancer is caused by the complex interplay between various non-genetic (carcinogens, tobacco, chemicals, radiations and infectious organisms), and genetic factors (inherited mutations, hormones, immune conditions and mutations that occur from metabolism).

These causal factors may act together, or in sequence to initiate or promote carcinogenesis. At a molecular level, it starts with the activation of oncogenes in the cells leading to subsequent inactivation of tumor suppressor genes.

The genes involved in the development of cancer can be grouped under two categories, viz. (i) Oncogenes and (ii) Tumor suppressor genes (TSGs). Oncogenes are responsible for transforming normal cells into their cancerous counterparts. Oncogenes are mutated form of otherwise normal genes known as proto-oncogene. These proto-oncogenes carry out critical functions like cell cycle regulation, and differentiation.

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Osteoblastic Changes During Non-Small Cell Lung Cancer (NSCLC) Treatment

Recently, we published an article reporting an example of the potential misinterpretation in the evaluation of osteoblastic changes during tyrosine-kinase inhibitor treatment in metastatic ALKrearranged non-small cell lung cancer.

Bone metastases are common in disseminated NSCLC, occurring in approximately 30% to 40% of patients. In the majority of cases, they present an osteolytic imaging pattern, even though osteoblastic or mixed-type patterns have also been reported in nearly 8% of cases. Generally, in the assessment of objective response to anticancer agents, bone metastases are classified as non-target lesions and therefore “not evaluable” for response.

However, according to the revised Response Evaluation Criteria in Solid Tumors guideline, the appearance of new non-target lesions, including lytic or osteoblastic bone metastases, is a criterion for defining progressive disease. Sometimes, the evaluation of bone lesion response may be challenging and misinterpreted.

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Development of Thulium-170 Brachytherapy Sources and Application in Rats Treatment

Experimental work where Tm-170 LDR seeds and one HDR source were used to treat cancer on rats is described. Experiments were done with Lewis rats, carrying tumor developed from implantation of CNS-1 Rat Brain Tumor Astrocytoma cells, under the thigh skin. 75% of both HDR and LDR treated rats were completely cured.

I-125 seeds experiments were done as a control, only 8.3% were cured with a similar photon dose. The dose due to beta radiation is very significant and was the main reason for the treatment success.

Tm-170 seeds and a source were developed and tested for brachytherapy. The two common brachytherapy methods were used in the present work; permanent implantation, or low dose rate, LDR, where low activity seeds are implanted and remain inside the tumor, and temporary implantation of a high dose rate (HDR) source, where a high activity source stays inside the tumor for a short time and then removed

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Mammographic Surveillance after Breast Reconstruction-is Imaging Necessary?

There is no consensus in regards to surveillance of women after mastectomy and reconstruction for breast cancer. Mammographic detection rates are low for surveillance after reconstruction and whilst there is insufficient evidence to support annual mammography in these women, there is widespread variation in its use.

We aimed to investigate the mode of detection of recurrent disease and comment on the use of surveillance mammography in our population of women undergoing mastectomy and reconstruction.

Data were retrieved from the Auckland Breast Cancer Registry (ABCR). All women with recurrence after mastectomy and reconstruction between 2000 and 2013 were identified from the database. Clinical records were reviewed for type of reconstruction, site of recurrence and mode of detection.

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EPIGENETICS – ROLE AS BIOMARKER IN CANCER DIAGNOSIS

Cancer is a disease either caused by genetic mutation or epigenetic modifications at the transcription level. Disease diagnosis at the early stage is a challenging step to be taken care for improving the outcome of patient survival.

Latest advances has renewed interest and ended in the development of different potential biomarkers. Biomarkers of cancer include DNA, RNA, proteins, lipids, sugars, small metabolites, cytokinetic and cytogenetic parameters and the entire tumour cells found in the body fluid.

Biomarkers should be thoroughly investigated for diagnosing the disease accurately, and to aid in the selective targeted therapies to improve the disease outcome. This review gives a brief description on various biomarkers for diagnosis, prognosis and therapeutic purposes, and how the epigenetic biomarkers act as cancer biomarker effectively

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Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) will be unexpectedly present in approximately 10% of colorectal cancer patients having primary cancer resection. In the past this was considered to be an incurable condition with a terminal outcome.

In patients determined to have peritoneal dissemination at the time of resection, the intervention was considered palliative. Recently, long term benefit from definitive treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a reality.

These treatments are now appropriate for primary appendiceal and colorectal cancer determined to have PM at the time of resection.Modifications of the initial management of colorectal cancer patients found upon exploration to have PM are explored in this manuscript. In these patients, not only the primary cancer but also the PM must be optimally treated.

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Should Centralized Histopathological Review in Prostate Cancer be the Gold Standard?

To assess the potential impact of centralized histopathological review on prostate cancer management. Methods: Biopsy slides of 277 men with newly diagnosed prostate cancer between January 2010 and March 2014 from 22 centers were referred to our tertiary referral center for centralized histopathological review.

The biopsy Gleason score and D’Amico prognostic risk group were compared between those of the referring pathologists and those after assessment by a centralized histopathological review committee consisting of two specialized uro-pathologists.

Alterations in biopsy Gleason score and D’Amico prognostic risk group between referring pathologists and centralized histopathological committee were subdivided into treatment changes (i.e., lymph-node dissection, nerve sparing surgery, or active surveillance) and diagnostic changes (bone scintigraphy).

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Review of Leakage from a Linear Accelerator and Its Side Effects on Cancer Patients

Radiation therapy using external beam radiation therapy (EBRT) is playing an important role for effective treatment of all kinds of tumors. Peripheral dose is the result of leakage and scatter from multileaf collimators devices (MLCs), counts for 2-10% of the maximum dose given to the patient, depending on the machine used and type of treatment.

The present review reveals that despite of the recent advancements in linear accelerators (LINAC) and MLC design and technology, the remaining small amount of leakage (peripheral dose) of these devices still has significant side effects on patient’s life span and quality of life after treatment.

Based on the findings in this review, it is suggested that introduction of additional effective and patient-specific shielding techniques would have great impact on reducing risk of radiating healthy cells and hence adversely side effects on cancer patients.

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Hyaline-Vascular Variant Castleman Disease

A 48 year old male without any previous medical history had abdominal discomfort. On ultrasonography (US) and contrast enhanced computed tomography (CT), intra-abdominal mass located in between liver and stomach was founded.

Tumour markers including AFP, CEA, CA 19-9, CA 125, and NSE were within normal range. To figure out regional relationship between mass and adjacent structures, endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) were performed.

EUS revealed a mass separated from serosa of stomach, suspicious for gastrointestinal stromal tumour (GIST). MRI revealed a lobulated contour calcification containing solid mass, suspicious for carcinoid, hemangioma, or GIST.

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Quality of Life and Sexual Activity after Stereotactic Hypofractionated Radiotherapy of Prostate Cancer Patients

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.

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