ecancermedicalscience最新文献

Cervical cancer is the gynecological malignancy that ranks third worldwide. It consists histologically of multiple subtypes, such as squamous cell carcinoma, which is the most common (65%), then adenocarcinoma (15%) and other types such as neuroendocrine, adenosquamous and carcinosarcoma tumours, which are less common. According to the World Health Organisation, lymphoepithelioma-type carcinoma has been described as an uncommon subtype and a variant of squamous cell carcinoma of the cervix. Its pathogenesis is related to the presence of the human Epstein-Barr virus and human papillomavirus. We present the case of a woman diagnosed with squamous cell lymphoepithelioma-like carcinoma of the cervix that was comprehensively managed with radical hysterectomy alone, presenting a good response and without recurrence.

With the rising incidence of cancer in low and lower-middle-income countries, the burden of pneumonia, which causes disproportionate morbidity and mortality in cancer patients, presents an evidence gap. We conducted a 1-year prospective cohort study in the oncology ICU at Tata Medical Center Kolkata, to determine the incidence, risk factors, etiology and impact of pneumonia on length of stay and mortality. Pneumonia was identified via daily ICU rounds using clinical and radiological features. A 1:1 age and sex matched comparison cohort without pneumonia was included. Etiology of pneumonia was determined using microscopy, culture, ELISA, PCR and cartridge-based nucleic acid amplification tests. Logistic regression was used to study risk factors, Cox regression for mortality and linear regression for hospital and ICU length of stay. There were 2279 ICU admissions. We recruited 711 patients: 355 had pneumonia, 356 did not. The incidence of pneumonia was 15.6% (95% CI: 14.1%-17.1%); 51.8% were community-acquired (CAP) and 48.2% were hospital-acquired (HAP). Seventy percent of CAP patients experienced recent healthcare exposure, with 28% hospitalised. All-cause 90-day mortality (6.4 per 1000 person-days) was 9 times higher in pneumonia patients. Lengths of hospital stay (18.6 days), ICU stay (10.9 days) and mechanical ventilation (2 days) were higher in pneumonia patients. Seventy-three percent of pneumonia patients had positive microbiology from lower respiratory samples. Gram-negative bacilli were frequent in both CAP and HAP. Influenza A/B was frequent in the monsoon and Haemophilus influenzae in the winter. Bone-marrow transplant, hematological malignancies, neutropenia and chronic obstructive pulmonary disease increased pneumonia risk. CAP, hematological malignancies and neutropenia increased the risk of death by day 90. Pneumonia, both CAP and HAP, increased mortality and hospital and ICU length of stay in adults with cancer. Gram-negative bacilli were common in both CAP and HAP. Tailored infection control programmes and an emphasis on adult vaccination are imperative to pneumonia prevention.

Clear cell hidradenocarcinoma (HAC) is a rare and aggressive malignant tumour originating from eccrine sweat glands, accounting for only 0.001% of all tumours. HAC primarily occurs in the head and neck region, with a high propensity for local recurrence and distant metastases. This case report details the unusual presentation of a 66-year-old male with a history of myocardial infarction, hypertension and a significant smoking history, who presented with abdominal pain and progressive shortness of breath. Diagnostic imaging revealed pleural and pericardial effusion and initial workup, including biopsies from pleura, skin and lymph nodes, was inconclusive. Subsequent histopathological examination suggested a diagnosis of HAC with metastases to the pleura, pericardium, lymph nodes, bones and subcutaneous tissues. Despite aggressive diagnostic efforts, the patient succumbed to the disease before chemotherapy could be initiated. This case underscores the diagnostic challenges of HAC, particularly with its atypical presentation and rare metastatic sites, such as the pleura and pericardium. The report emphasises the need for awareness of this rare malignancy and its potential for rapid, fatal progression.

Cancer patients are at a heightened risk of infections due to immunosuppression from chemotherapy, radiotherapy and the malignancy itself, contributing to increased morbidity and mortality. Effective infection management in this vulnerable population requires a systematic and timely approach to diagnosis and treatment. This review addresses ten critical questions concerning the management of infections in cancer patients, synthesising insights from clinical guidelines, expert opinions and current evidence. The review begins by discussing the optimal diagnostic workup for neutropenic patients, including investigations, risk stratification and treatment approaches for various neutropenia-specific syndromes. It further explores the principles of antibiotic escalation and de-escalation for gram-negative infections, emphasising the need for tailored therapeutic strategies. Advances in microbiological diagnostics, such as early detection methods and understanding resistance mechanisms in gram-negative organisms and Clostridioides difficile infections, are analysed in dedicated sections. The role of radiological investigations, which remain the cornerstone for diagnosing infections in immunocompromised patients, has been addressed. Catheter-related blood stream infection and the role of surveillance culture are explored in the final section. By addressing these critical questions, this review provides oncology clinicians with practical, evidence-based guidance for preventing, diagnosing and managing infections in cancer patients. The insights presented aim to enhance clinical outcomes and ensure patient safety in this high-risk population.

Background: Atypical fibroxanthoma is a rare cutaneous tumour of mesenchymal origin, often presenting as a rapidly growing, painless mass in sun-exposed areas. Although historically considered benign, it has an intermediate malignant potential with a risk of recurrence and, in rare cases, metastasis. Treatment primarily involves surgical excision, although recurrence rates can occur. Adjuvant superficial high-dose-rate (HDR) brachytherapy (plesiotherapy) is able to reduce recurrence risk, particularly after local tumour relapses and/or when complete excision with wide margins is unfeasible. It provides excellent local control, cosmetic outcomes and minimal toxicity, making it a promising option in selected cases. This report highlights the utility of customised-mold HDR plesiotherapy for a locally recurrent atypical fibroxanthoma.

Background: The D-TORCH trial demonstrated superiority of 1% topical diclofenac over placebo in preventing capecitabine-induced hand-foot syndrome (HFS). We conducted an exploratory analysis of this study to assess the relationship between HFS and serum levels of the inflammatory marker, cyclooxygenase-2 (COX-2).

Methods: Serum COX-2 levels were measured in patients in the D-TORCH study's experimental and placebo arms at baseline and 12 weeks of capecitabine-based therapy or at the development of HFS (whichever occurred earlier) and in 20 age-matched healthy controls using a human COX-2 ELISA kit (E-EL-H5574).

Results: 233 (88.5%) patients of the D-TORCH cohort (n = 263) underwent serial COX-2 analysis. The population was female predominant (n = 165, 70.8) with a median age of 47 years (range: 19-73), including breast (n = 130, 55.8%) and gastrointestinal cancers (n = 103, 44.2%). 31 (13.3%) patients developed any-grade HFS, with 25 (10.7%) having grade 2 or worse HFS. Mean serum COX-2 levels at baseline and 12 weeks did not show a statistically significant difference (mean + standard deviation, 3.41 + 2.15 ng/ml versus 3.35 + 2.40 ng/ml, p = 0.69); however, baseline levels in patients were significantly higher than healthy controls (p < 0.001). No statistically significant difference was found between serial COX-2 levels by gender, use of topical diclofenac, type of malignancy or severity of HFS.

Conclusion: Serum COX-2 levels did not show a significant change with capecitabine-based therapy, regardless of the use of topical diclofenac possibly reflecting the predominant stromal production of the enzyme. This finding highlights the need to assess HFS-affected tissues for local COX-2 immuno-expression along with further blood-based biomarkers.

The plethora of targetable variants among non-small cell lung cancers is on the rise, making it one of the most important cancer types in the context of precision oncology. Recently, the MET exon14 skipping mutation has emerged as a novel therapeutic target. This mutation results from somatic alterations at the splice junction of exon 14 of the MET gene, leading to constitutive activation of downstream signaling pathways. The approval of targeted therapy for this variation makes it a compelling need to use appropriate testing systems for detection. Utilising a robust next-generation sequencing platform, we have identified this mutation in 5.3% of cases in our cohort. In the absence of information on MET exon 14 skipping from India, this case series will throw some light on this variation in our subcontinent and highlights the fact that the real-world effectiveness of MET inhibitors like Tepotinib and Capmantinib might be lower than expected.

Purpose: This study aimed to identify key aspects of health-related quality of life in women with locally advanced breast cancer (LABC) and analyse their links to factors and treatment modalities.

Method: A cross-sectional study was conducted from August to October 2023 in Ulin Regional Public Hospital, Banjarmasin, Indonesia, involving LABC women whose quality of life (QoL) was assessed using Quality-of-Life Questionnaire Breast Cancer 23. Data were analysed using ANOVA, independent t-tests for parametric data, Kruskal-Wallis and Mann-Whitney tests for non-parametric data and significant variables (p < 0.05) included in a final regression model for identifying predictors.

Results: Of 100 participants (mean age 50 years), most had low education levels (41%), were unemployed (74%) and had stage IIIB cancer. Body image score was the highest, while systemic therapy side effect was the lowest. Better sexual enjoyment was reported in post-menopausal women (p = 0.043), those with higher education (p = 0.036) and married individuals (p = 0.021). Higher economic status was associated with better sexual enjoyment (p = 0.008) and fewer breast symptoms (p = 0.011); however, economic status was negatively associated with employment status (p = 0.043). Worsening arm symptoms were associated with prolonged illness (p = 0.022). Surgical intervention was associated with higher body image (p = 0.010) and lower systemic side effects (p = 0.023). Traditional medicine was associated with lower arm symptoms (p = 0.026). Economic/occupational status explained 10.5% of sexual functioning scores.

Conclusion: Poor QoL in LABC patients overall was associated with low sociodemographic conditions, late presentation and chemotherapy-related side effects.

Background: The treatment of choice as the first line for patients with metastatic breast cancer (MBC) who are hormone receptor-positive (HR+)/HER2-negative (HER2-) is the combination of endocrine therapy (ET) with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Identifying prognostic or predictive factors of response could have important clinical implications. This study analysed the prognostic value of Ki-67 and progesterone receptor (PR) expression on progression-free survival (PFS) in this population.

Methods: A retrospective cohort study was conducted in patients with HR+/HER2- MBC, who had received first-line treatment with CDK4/6i combined with ET. For the PFS analysis, the log-rank test was used and for the multivariate analysis, a Cox regression analysis was performed.

Results: A total of 155 patients were analysed. Patients with PR values <20% showed a trend in univariate analysis towards shorter PFS, with a median of 20.7 months compared to those with a value ≥20%, with a median PFS of 33.0 months (p = 0.090). The Ki-67 value showed no statistically significant association with PFS. The prognostic role of PR was confirmed in the multivariate analysis with an HR of 0.59 (95% CI 0.36-0.98, p = 0.041) in patients with PR >20%.

Conclusion: Patients with PR values <20% tended to have shorter PFS, unlike the Ki-67 value, which did not demonstrate an impact on PFS. This suggests a prognostic value of PR expression levels in this scenario.

Clear cell renal cell carcinoma (ccRCC) is a malignancy with a diverse clinical presentation, often characterised by its resistance to conventional therapies. We present the case of a 53-year-old Indian male diagnosed with ccRCC, pT3aN0M1exhibiting lymphovascular invasion and non-contiguous tumour deposits in the left adrenal gland. Following an initial course of Pazopanib and subsequent Everolimus, the disease progressed. Notably, just 3 months after receiving fractionated stereotactic radiosurgery (FSR) for a cerebellar metastasis, spontaneous regression was observed at a distant skeletal site. This case highlights the significance of considering FSR as a therapeutic option for selected patients with ccRCC, as well as the potential role of an abscopal effect to impact the course of this aggressive malignancy.