World journal of clinical oncology最新文献

Background: Although the occurrence of multiple primary cancers (MPC) is not exceedingly common, it is not rare in clinical practice. In recent years, there has been a notable increase in its incidence. The frequent confusion between MPC and tumor metastasis or recurrence often leads to delays in diagnosis and treatment. This study aimed to enhance understanding of MPC, improve diagnostic accuracy, guide precise clinical treatment, and implement a case management nursing model (CMNM) to facilitate quick patient recovery.

Case summary: A 61-year-old female patient presented with persistent upper abdominal pain lasting over 2 months. Gastroscopy revealed the presence of both gastric and duodenal cancers. Following a thorough evaluation, the patient underwent pancreaticoduodenectomy, cholecystectomy, and total gastrectomy. Post-surgery, an individualized case management nursing approach was applied, leading to a successful recovery. Three months after the surgery, follow-up examinations showed no signs of recurrence.

Conclusion: The CMNM effectively promoted rapid patient recovery, enhanced the quality of orthopedic nursing services, and accelerated postoperative recovery, ultimately leading to increased patient satisfaction with nursing care.

Background: In patients with human epidermal growth factor receptor 2 (HER2)-overexpressing gastric cancer (GC), the combination of HER2 targeting and a standard first-line chemotherapy regimen has been demonstrated to significantly improve their prognosis. However, in a proportion of patients, cancer progresses within a short period of time, and there is currently no standard treatment after disease progression.

Case summary: This study presents a case of a 51-year-old male with advanced GC who underwent radical resection (Billroth type II subtotal gastrectomy and gastrojejunostomy) and resection of liver metastases. Immunohistochemical staining revealed a HER2 score of 2+, a dMMR status, and a Ki67 proliferation index of 30% to 40%. The gene test results indicated the presence of ERBB2 amplification and a PD-L1 expression level of less than 5%. Since December 2021, the patient has experienced disease progression during both first-line (two cycles of KN026 combined with KN046) and second-line (five cycles of nivolumab combined with trastuzumab and SOX chemotherapy) treatment regimens. The patient's prognosis following the first and second lines of treatment was unfavorable, with progression occurring in a relatively short time. For third-line therapy, disitamab vedotin (RC48) plus apatinib was used. At the time of this report, the patient had achieved a progression-free survival (PFS) of 25.8 months, which exceeded the median survival time for patients with advanced GC.

Conclusion: Despite the unfavorable prognosis associated with advanced GC, the implementation of personalized treatment approaches may still prove beneficial for select patients. In patients with HER2-positive GC with extensive metastatic involvement, the use of the HER2-targeted combination with apatinib has demonstrated the potential to prolong both PFS and overall survival.

Gut dysbiosis, a phenomenon in which the existing commensal microbiome changes to an adverse microenvironment in the colon, is thought to lead to altered cellular signals. How this is involved in producing mucosal outgrowths such as polyps in the colon is intriguing. Deciphering the various mechanisms involved provides an in-depth understanding of the link between gut dysbiosis and colonic polyps.

The prognosis of colorectal cancer (CRC) patients with peritoneal metastasis remains poor despite advancements in detection and treatment. Preoperative inflammatory and nutritional markers have emerged as significant predictors of prognosis in CRC, potentially guiding treatment decisions and improving patient outcomes. This editorial explores the prognostic value of markers such as the neutrophil-to-lymphocyte ratio, hemoglobin, and serum albumin levels. By integrating these markers into prognostic models, clinicians can better stratify patients, personalize treatment strategies, and ultimately enhance clinical outcomes. This review highlights the importance of these markers in providing a comprehensive assessment of patient condition and underscores the need for further research to validate their clinical utility and uncover underlying mechanisms.

Background: Herlyn-Werner-Wunderlich (HWW) syndrome is a rare Müllerian duct anomaly, characterized by a combination of urogenital abnormalities. The occurrence of primary cervico-vaginal carcinomas in patients with HWW syndrome is exceptionally rare, posing significant challenges for screening, early diagnosis, and effective management.

Case summary: We report a rare case of primary clear cell carcinoma of the vagina complicated in a 40-year-old woman with HWW syndrome. The patient presented with irregular vaginal bleeding for 4 years. On gynecological examination, an oblique vaginal septum was suspected. Surgical resection of the vaginal septum revealed a communicating fistula and a tumor on the left vagina and the left side of the septum, which was confirmed as clear cell carcinoma. One month later, she underwent a radical hysterectomy, vaginectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. Due to significant side effects, she completed only one course of chemotherapy. A year later, lung metastasis was detected and continued to grow. A thoracoscopic wedge resection of the right upper lobe was performed 4 years after the initial surgery. We also conducted a systemic review of the literature on primary cervical or vaginal carcinoma in HWW syndrome to explore this rare entity.

Conclusion: Cervico-vaginal adenocarcinomas in patients with HWW syndrome are occult, and require early surgical intervention and regular imaging surveillance.

Background: Robotic-assisted partial splenectomy (RAPS) is a superior approach for treating splenic cysts and splenic hemangiomas, as it preserves the immune function of the spleen and reduces the risk of overwhelming post splenectomy infection. Currently, there are no standardized guidelines for performing a partial splenectomy.

Case summary: Four patients with splenic cysts or splenic hemangiomas were treated by RAPS. Critical aspects with RAPS include carefully dissecting the splenic pedicle, accurately identifying and ligating the supplying vessels of the targeted segment, and ensuring precise hemostasis during splenic parenchymal transection. Four successful RAPS cases are presented, where the tumors were removed by pretreating the splenic artery, dissecting and ligating the corresponding segmental vessels of the splenic pedicle, transecting the ischemic segment of the spleen, and using electrocautery for optimal hemostasis. Four patients underwent successful surgeries with minimal bleeding during the procedure, and there were no signs of bleeding or recurrence postoperatively.

Conclusion: Four cases confirm the feasibility and superiority of RAPS for the treatment of benign splenic tumors.

Small cell lung carcinoma (SCLC) is an aggressive malignancy known for its propensity for early and extensive metastatic spread. Gastric metastasis, where cancer cells disseminate from the lung to the stomach, is a rare but increasingly recognized complication of SCLC. This review provides a comprehensive overview of gastric metastasis in SCLC, addressing its clinical significance, diagnostic challenges, management strategies, and prognosis. Additionally, it examines the broader metastatic patterns of SCLC and compares them with other malignancies known for gastric metastasis. Gastric metastasis in SCLC, though infrequent, is clinically significant and often indicates advanced disease with a poor prognosis. SCLC typically metastasizes to the liver, brain, bones, and adrenal glands, with the stomach being an unusual site. The incidence of gastric metastasis ranges from 1% to 5% in autopsy studies, although this may be underestimated due to diagnostic difficulties and asymptomatic early lesions. Diagnosing gastric metastasis presents several challenges, including the asymptomatic nature of many cases, limitations of conventional imaging techniques, and difficulties in distinguishing metastatic lesions from primary gastric cancer via endoscopy. Histopathological diagnosis requires careful examination to identify SCLC cells through their characteristic small cell morphology and neuroendocrine markers. Management of gastric metastasis in SCLC typically involves a multidisciplinary approach. Systemic therapy, primarily chemotherapy, remains the cornerstone of treatment, with palliative care addressing symptoms and complications. Surgical intervention is usually reserved for specific cases requiring symptomatic relief. The prognosis for patients with gastric metastasis from SCLC is generally poor, reflecting the advanced stage of the disease. Median survival is significantly reduced compared to patients without gastric metastasis. This review emphasizes the need for enhanced awareness and early detection to improve patient outcomes and highlights the importance of ongoing research into better diagnostic and therapeutic strategies.

Background: Liver cancer treatment is characterized by multidisciplinary participation and coexistence of multiple treatment methods. Hypofractionated and intensity-modulated radiotherapy is a new precise radiotherapy technique applied to the treatment of systemic malignant tumors. There is a lack of understanding of hypofractionated and intensity-modulated radiotherapy combined with systemic therapy in metastatic hepatocellular carcinoma (HCC).

Case summary: We report a case of metastatic HCC treated with hypofractionated and intensity-modulated radiotherapy combined with systemic therapy. A 41-year-old man was diagnosed with metastatic HCC (T3N1M1 stage IVB). Because it was found to be in the late stage of cancer and had already metastasized, it was impossible to undergo surgical treatment. In addition to aggressive comprehensive treatment for the primary lesion, local treatment for metastatic cancer can improve the patient's survival potential. Hypofractionated and intensity-modulated radiotherapy can provide a larger single treatment dose within a shorter overall treatment time, and improve the local control rate of the tumor. Follow-up examination demonstrated that the tumor and metastatic lesions had shrunk after therapy. The treatment has showed good efficacy. The patient survived for 18 months without disease progression and stable disease persisted for > 38 months.

Conclusion: Targeted therapy and immunotherapy followed by hypofractionated and intensity-modulated radiotherapy are also effective for advanced metastatic HCC.

In their recent study published in the World Journal of Clinical Cases, the article found that minimally invasive laparoscopic surgery under general anesthesia demonstrates superior efficacy and safety compared to traditional open surgery for early ovarian cancer patients. This editorial discusses the integration of machine learning in laparoscopic surgery, emphasizing its transformative potential in improving patient outcomes and surgical precision. Machine learning algorithms analyze extensive datasets to optimize procedural techniques, enhance decision-making, and personalize treatment plans. Advanced imaging modalities like augmented reality and real-time tissue classification, alongside robotic surgical systems and virtual reality simulations driven by machine learning, enhance imaging and training techniques, offering surgeons clearer visualization and precise tissue manipulation. Despite promising advancements, challenges such as data privacy, algorithm bias, and regulatory hurdles need addressing for the responsible deployment of machine learning technologies. Interdisciplinary collaborations and ongoing technological innovations promise further enhancement in laparoscopic surgery, fostering a future where personalized medicine and precision surgery redefine patient care.

Background: Large abdominal wall defect (LAWD) measures > 20 cm in width. LAWD can easily lead to intestinal necrosis, peritonitis, other complications, and even multiple organ dysfunction syndrome. Multiple intestinal fistulas are high-flow fistulas that can cause severe water-electrolyte imbalance and malnutrition, as well as inflammation, high metabolic status, and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.

Case summary: This article summarizes the nursing experience of a patient with sigmoid carcinoma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications. The key points of care: Scientific assessment of nutritional status, dynamic adjustment of nutritional support programmes, comprehensive adoption of enteral nutrition, parenteral nutrition and combined nutrition of enteral and parenteral; taking good care of abdominal wall defects and intestinal fistulas; continuous flushing of the abdominal drainage tube and low negative pressure drainage; prevention of venous thrombosis; strengthening of physical exercise; implementation of positive psychological interventions.

Conclusion: After more than 7 months of careful care, the patient's physical fitness has been well recovered, local inflammation is well controlled, which wins the opportunity for the operation, and the postoperative recovery is good.