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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