Recent Results in Cancer Research最新文献

Medullary thyroid cancer (MTC) is an infrequent calcitonin-secreting thyroid malignancy that can vary a great deal in tumor biology and progression. The most important determinant of distant metastases, which represents the single greatest risk factor of poor cancer-specific survival, is lymph node metastasis in the neck and mediastinum. In patients with node-positive MTC, systematic compartment-oriented dissection of central and lateral neck nodes at the initial operation promotes biochemical cure and decreases the risk of locoregional recurrence in previously dissected lymph node compartments. Routine calcitonin screening in nodular thyroid disease and genomic screening, flanked by advances in ultrasound and functional imaging modalities, have been pivotal in making the diagnosis early and enabling risk-reducing surgical interventions in patients with sporadic and hereditary MTC, without compromising clinical outcome. To assess a RET carrier's risk of medullary thyroid cancer, all that is needed is patient age, underlying RET mutation, and biomarker levels. Recently, risk-reducing surgery, consisting in hemithyroidectomy with or without diagnostic ipsilateral central lymph node dissection, has been advocated for sporadic MTC clinically confined to one thyroid lobe that is desmoplasia negative on intraoperative frozen sectioning. These recent developments reflect the current shift from reactive to increasingly preemptive, risk-reducing surgery for MTC.

Imaging plays an important role in the early detection and staging of medullary thyroid carcinoma (MTC), as well as in follow-up to locate early recurrence. MTC is a rare, calcitonin-secreting thyroid malignancy that is often diagnosed by ultrasound and calcitonin screening as part of the routine evaluation of any thyroid nodule. If serum calcitonin is elevated, imaging studies are needed for preoperative staging to guide surgical management. This may include ultrasound of the neck and abdomen. CT or MRI studies for more distant disease are performed preoperatively when calcitonin levels are greater than 500 pg/mL. Neither FDG-PET/CT nor F-DOPA-PET/CT is routinely being used for preoperative staging, but may be helpful in individual cases of doubt. Postoperative elevated calcitonin is associated with persistence or recurrence of MTC. Imaging studies to localize tumor tissue in postoperative follow-up include ultrasound, CT, MRI, and PET scans. However, they should be used judiciously, as the impact of treatment is often limited. In addition, even patients with persistent disease may survive long enough to accumulate significant radiation doses from CT or PET scans. Imaging studies are also useful in diagnosing associated components of hereditary MTC, such as pheochromocytoma and primary hyperparathyroidism.

Cholangiocarcinoma (CCA) is a diverse group of epithelial cancers that affect the biliary tree. The incidence of CCA is low in Western countries but significantly higher in endemic regions such as China and Thailand. Various risk factors contribute to the development of CCA. Recent studies have revealed molecular alterations in biliary tract cancers, providing insights into cholangiocarcinogenesis and potential targeted therapies. Surgical resection is the primary curative treatment for CCA. Adjuvant chemotherapy has been extensively studied, and some regimens have proven to be beneficial. Neoadjuvant chemotherapy has shown potential benefits in select cases, but its role remains controversial. In advanced stages, chemotherapy is the standard of care, and molecular profiling has identified potential targets such as FGFR, IDH1, HER2, and other tumor-agnostic therapies. Immunotherapy has demonstrated limited benefit in advanced CCA. This chapter provides an overview of the current evidence and ongoing research evaluating various chemotherapy regimens, targeted therapies, and immunotherapies across different stages of CCA.

It is known that Opisthorchis viverrini (OV) is the most significant risk factor for the development of cholangiocarcinoma (CCA); hence, it is also known as carcinogenic parasite. Effective control and elimination of OV infection should significantly reduce O. viverrini-related CCA. This chapter includes details of the three recently developed innovative tools, namely the Isan cohort database software, an OV-RDT for screening of O. viverrini, and an ultrasound telecommunication system. Past and current control programs, i.e., education, medication, and sanitation were discussed and stressed the need for a comprehensive control program which encompasses primary, secondary, and tertiary patient care programs for confirmation and management of suspected CCA cases. The approach of mathematical modeling for control of OV and CCA was also briefly described. Additionally, we highlighted the current progress toward control of OV and CCA in Thailand and potential for expansion into nearby countries in Southeast Asia.

This chapter details all aspects of the general principles of palliative care for advanced stage cholangiocarcinoma patients. These include symptoms management, communication guide, advance care planning, and management for bereavement. Surgical and intervention techniques of palliative biliary drainage are described in detail for patients with obstructive jaundice with advanced stage CCA. Additionally, details are provided regarding the establishment of a multidisciplinary palliative care team which is critical to provide the most appropriate multimodal treatment for good quality of life and survival of patients.

Raw attitudes relate to the food cultures, eating habits, and behaviours of people in relation to the consumption of raw, partially cooked, and fermented freshwater fish dishes, which puts people at risk of Ophistochis viverrini and other parasitic infections. The chapter reviews raw attitudes within the countries and across the borders of the greater Mekong region, particularly northeast Thailand, Lao PDR, Vietnam, and Cambodia. Rather than treat each nation-state as an isolated epidemiological box, the chapter explores transborder complexity in relation to multiple anthropogenic transformations to the landscapes of the region and developmental impacts upon ecosystems and life cycles. Economic projects such as multiple hydropower dams, irrigation schemes, water-diversions, roads, and aquaculture ponds have significant impacts on FTZ life-cycle dynamics. In addition, many ecological changes are transboundary ones, and there are added complications relating human mobility, altered agrarian landscapes, and significant numbers of migrant workers. The chapter also examines public health programmes and educational interventions which are altering perceptions of O. viverrini and cholangiocarcinoma over time. A key argument is the need for transdisciplinary scientific and social science strategies alongside multi-pronged health interventions, such as 'the CASCAP model'. There exist many unknowns and gaps relating to widespread anthropogenic modifications upon life cycles, upon lifestyles, livelihoods, and human behaviours, which require research projects that span socio-economic, ecological, geographical, and public health dynamics of disease.

The chapter discusses the advancement of new imaging techniques, the role of imaging in CCA diagnosis, anatomical and morphological classification, ultrasound screening of CCA, ultrasound findings of MF-CCA, PI-CCA, ID-CCA, the use of CT in CCA diagnosis, staging and treatment planning, CT volumetry and estimation of future liver remnant, post-treatment follow-up and surveillance, MRI imaging, Positron Emission Tomography (PET)/CT, limitations to contrast studies and resolution, internal receivers for CCA imaging, and in vitro imaging of CCA.

Opisthorchis viverrini plays a key role as the carcinogenic liver fluke causing bile duct cancer in Southeast Asia. A comprehensive understanding of its life cycle, distribution, systematics, and population genetics is critically important as they underpin the effective development and establishment of future prevention and control programs that center on opisthorchiasis and cholangiocarcinoma. This chapter provides detailed information concerning the basic biology and updated information of O. viverrini related to its host life cycle, transmission route via raw, partially cooked or fermented freshwater cyprinid fish, endemic areas, and the discovery of new foci. Previous sequential studies over the last two decades on the phylogenetic and systematic relationships, genetic variation, and population genetics of O. viverrini as well as its snail intermediate host Bithynia spp. are presented and discussed, which have led to the currently known complex species level systematics and population genetics framework of this host-parasite system. Additionally, further directions for comprehensive research are suggested to provide a more complete understanding of liver fluke, O. viverrini-related cholangiocarcinoma.

This chapter provides a comprehensive background from basic to applied knowledge of surgical anatomy which is necessary for the surgical treatment of cholangiocarcinoma (CCA) patients. Significant advances that have been made in the surgical treatment of CCA were examined. For instance, in-depth details are provided for appropriate preoperative assessment and treatment to optimize patient status and to improve the outcome of surgical treatment(s). Comprehensive details are provided for the surgical techniques and outcomes of treatments for each type of CCA with clear illustrations and images. This chapter also describes the role of minimally invasive surgery and liver transplantation in CCA treatment.

Although cholangiocarcinoma (CCA) or bile duct cancer is considered rare, worldwide it is the second most common primary liver cancer. The incidence is increasing globally, and mortality is high owing to its aggressiveness, late diagnosis, and refractory nature. In this chapter, the awareness of cholangiocarcinoma in the West and in Southeast Asia, particularly Thailand, is explored. The background to this cancer in each region is described, and the challenges faced by both by healthcare professionals and patients are uncovered. Although there is a growing number of organisations working at every level in each region to improve the situation for those with cholangiocarcinoma, there remains little awareness of the public health importance of this cancer. However, it is with health agencies and those at government level that hopes for an improved future for all those with cholangiocarcinoma must lie.