Cases Of Early Cancer Research Articles

Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects

Introduction: The early cancer of gallbladder is an entity which is not well recognized currently. It is a cancer which does not extend beyond the muscularis layer of the gallbladder and it is characterized in almost of cases by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of all our cases of early gallbladder cancer treated in our surgical unit. We have studied these through clinical, morphological, therapeutical and evolutionary aspects. Results: Of 202 gallbladder carcinoma, 33 cancers were classified as early cancer. 25 were females and 8 were males. The mean age was 56.4 years (41 - 70 years). All patients were free of gallbladder cancer symptoms and all except one had normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer and one rectal cancer). For 16 patients, the diagnosis was done by ultrasonography and 17 by histological examination of the specimen removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For 19 patients who benefited from extensive lymphadenectomy, only one (5.3%) had lymph node infiltration. 16 patients had a simple cholecystectomy and in two cases, the cholecystectomy was associated with bile duct resection. 17 patients had hepatectomy with extensive lymphadenectomy. 2 patients had a simultaneous right colectomy and abdominoperineal resection and another one benefited from choledocal cyst resection. 3 patients benefited from stone removal from bile duct and two had tumor removal from bile duct (ruptured tumor in the bile duct). 1 patient (3.7%) died in postoperative course (hospital mortality). In the follow-up period, 4 patients died from intercurrent causes. Two patients presented a recurrence at 14 and 36 months and died respectively at 19 and 42 months. One patient presented a bile duct cancer at 66 months. She died at 78 months after palliative treatment. Currently, 22 patients (66.7%) are still alive without recurrence with mean and median survival of 53 and 31 months. Conclusion: Early gallbladder cancer is an entity which must be known by the radiologist and the surgeon. Recognized on time and well treated, early gallbladder cancer can be cured and its prognosis is excellent.

残胃に発生した早期胃未分化癌の1例

残胃に発生した早期胃未分化癌の1例

A case of early duodenal cancer observed during follow-up of intraductal papillary mucinous neoplasm

Duodenal cancer is a rare disease that accounts for 0.3％ of all primary gastrointestinal tract cancers. We report the case of an elderly patient diagnosed with and treated for early duodenal cancer detected during follow-up after resection of intraductal papillary mucinous neoplasm (IPMN). An 82-year-old man was diagnosed with IPMN during hospitalization for acute pancreatitis in 2004 and underwent pancreatic resection. In 2008, an elevated lesion measuring 15 mm in size was detected at the anterior wall of the duodenal bulb during gastroscopy. A mucosal lesion was also noted during endoscopic ultrasonography. Histopathological examination of a biopsy specimen identified well-differentiated adenocarcinoma. On the basis of these findings, endoscopic mucosal resection was performed. Although the tumor was resected in two parts, no residual malignancy was noted. Histopathological examination of the resected specimen revealed a 20×18 mm well-differentiated adenocarcinoma, pT1a (m), med, INF-α, ly (-), v (-), pHMx, pVM0. Gastrointestinal endoscopy performed two months after surgery and in 2013 did not show any obvious signs of tumor recurrence. IPMN is sometimes reported to occur in combination with cancers of other organs. However, to our knowledge this is the first case report of early duodenal cancer occurring in a patient with IPMN.

Safety, efficacy, and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer

Early esophagogastric junction (EGJ) cancer is currently being treated in the same way as early gastric cancer, by endoscopic submucosal dissection (ESD), but long-term outcomes are still unknown. Our aim was to retrospectively evaluate the safety and efficacy of ESD in treating early EGJ cancer and compare risk factors in curative and non-curative resection cases. Forty-four cases of early EGJ cancer, defined as a Siewert's type II tumor, in 44 patients with a mean age of 70.0 years and a male/female ratio of 90.9:9.1 % were treated by ESD between January 2004 and June 2010. There were 30 standard indication cases; the remaining 14 cases were expanded indication cases. Mean resected specimen and tumor sizes were 35 and 17 mm, respectively, and median procedure time was 121 min, with no bleeding or perforation complications. All cases were resected en bloc with an 84.1 % curative resection rate (37/44). The curative resection rates in the standard and expanded indication cases were 90.0 % (27/30) and 71.4 % (10/14), respectively. There were no significant differences in tumor location, tumor morphology, tumor size, histology of biopsy specimens, or standard versus expanded indication cases with regard to risk factors for curative and non-curative resections. However, submucosal invasion, positive tumor margins, lymphovascular invasion, and some components of poorly differentiated adenocarcinomas in just the submucosal layer were significantly more common in the non-curative resection cases. ESD was a safe, effective, and minimally invasive treatment for early EGJ cancer. For tumors without any submucosal invasion findings, therefore, ESD is an acceptable treatment option, in addition to also being suitable for diagnostic purposes in evaluating the need for surgery.

Fertility-preserving surgical procedures, techniques

As a result of the trend toward late childbearing, fertility preservation has become a major issue in young women with gynaecological cancer. Fertility-sparing treatments have been successfully attempted in selected cases of cervical, endometrial and ovarian cancer, and gynaecologists should be familiar with fertility-preserving options in women with gynaecological malignancies. Options to preserve fertility include shielding to reduce radiation damage, fertility preservation when undergoing cytotoxic treatments, cryopreservation, assisted reproduction techniques, and fertility-sparing surgical procedures. Radical vaginal trachelectomy with laparoscopic lymphadenectomy is an oncologically safe, fertility-preserving procedure. It has been accepted worldwide as a surgical treatment of small early stage cervical cancers. Selected cases of early stage ovarian cancer can be treated by unilateral salpingo-ophorectomy and surgical staging. Hysteroscopic resection and progesterone treatment are used in young women who have endometrial cancer to maintain fertility and avoid surgical menopause. Appropriate patient selection, and careful oncologic, psychologic, reproductive and obstetric counselling, is mandatory.

Heritability of radiation response in lung cancer families.

Radiation sensitivity is assumed to be a cancer susceptibility factor due to impaired DNA damage signalling and repair. Relevant genetic factors may also determine the observed familial aggregation of early onset lung cancer. We investigated the heritability of radiation sensitivity in families of 177 Caucasian cases of early onset lung cancer. In total 798 individuals were characterized for their radiation-induced DNA damage response. DNA damage analysis was performed by alkaline comet assay before and after in vitro irradiation of isolated lymphocytes. The cells were exposed to a dose of 4 Gy and allowed to repair induced DNA-damage up to 60 minutes. The primary outcome parameter Olive Tail Moment was the basis for heritability estimates. Heritability was highest for basal damage (without irradiation) 70% (95%-CI: 51%–88%) and initial damage (directly after irradiation) 65% (95%-CI: 47%–83%) and decreased to 20%–48% for the residual damage after different repair times. Hence our study supports the hypothesis that genomic instability represented by the basal DNA damage as well as radiation induced and repaired damage is highly heritable. Genes influencing genome instability and DNA repair are therefore of major interest for the etiology of lung cancer in the young. The comet assay represents a proper tool to investigate heritability of the radiation sensitive phenotype. Our results are in good agreement with other mutagen sensitivity assays.

First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study

We sought to assess feasibility and perioperative outcomes for laparoendoscopic single-site surgery (LESS) in early endometrial cancer. This was a retrospective multicentric study of 100 early endometrial cancer cases undergoing LESS from July 2009 through July 2011. All patients underwent total hysterectomy and bilateral salpingo-oophorectomy by LESS. Pelvic and paraaortic lymphadenectomy were performed in 48 and 27 patients, respectively. A median of 16 pelvic lymph nodes (range, 1-33) and 7 paraaortic lymph nodes (range, 2-28) were retrieved. Both median operative time (129 minutes; range, 45-321) and estimated blood loss (70 mL; range, 10-500) were greater when staging lymphadenectomy was performed (P values = .001). Four intraoperative and 4 postoperative complications were observed. Conversion to standard laparoscopy and laparotomy was necessary for completion of 1 case each. Patients responded positively regarding cosmetic result and minimal postoperative pain control. LESS further minimizes the invasive nature of surgery and is feasible for treatment of early-stage endometrial cancer.

A Case of Early Stage Central Lung Cancer Treated by Microwave Coagulation Therapy

A Case of Early Stage Central Lung Cancer Treated by Microwave Coagulation Therapy

The Prognostic Value of Adaptive Nuclear Texture Features from Patient Gray Level Entropy Matrices in Early Stage Ovarian Cancer

Background: Nuclear texture analysis gives information about the spatial arrangement of the pixel gray levels in a digitized microscopic nuclear image, providing texture features that may be used as quantitative tools for prognosis of human cancer. The aim of the study was to evaluate the prognostic value of adaptive nuclear texture features in early stage ovarian cancer.Methods: 246 cases of early stage ovarian cancer were included in the analysis. Isolated nuclei (monolayers) were prepared from 50 μm tissue sections and stained with Feulgen-Schiff. Local gray level entropy was measured within small windows of each nuclear image and stored in gray level entropy matrices. A compact set of adaptive features was computed from these matrices.Results: Univariate Kaplan-Meier analysis showed significantly better relapse-free survival (p < 0.001) for patients with low adaptive feature values compared to patients with high adaptive feature values. The 10-year relapse-free survival was about 78% for patients with low feature values and about 52% for patients with high feature values. Adaptive features were found to be of independent prognostic significance for relapse-free survival in a multivariate analysis.Conclusion: Adaptive nuclear texture features from entropy matrices contain prognostic information and are of independent prognostic significance for relapse-free survival in early stage ovarian cancer.

2 cases of early hypopharyngeal cancer observed over 2 years

2 cases of early hypopharyngeal cancer observed over 2 years

A case of early duodenal cancer detected at screening upper gastrointestinal endoscopy

A case of early duodenal cancer detected at screening upper gastrointestinal endoscopy

若年者早期空腸癌の1例

症例は29歳，男性．食欲不振，全身倦怠感，嘔気を主訴に受診した．血液検査で貧血を認め，上部消化管内視鏡検査を行ったが，出血源は特定されず．腹部CTで先進部に腫瘍が疑われる空腸の腸重積を認め，腹腔鏡補助下空腸部分切除術を施行した．口側空腸が肛門側空腸に陥入し，腸重積の先端部にやわらかい腫瘍を認めた．腫瘍は，Treitz靱帯から肛門側30cmの空腸にあり，空腸部分切除を施行した．55×40×35mmのIsp腫瘍で，病理組織学的検査所見では大部分は管状腺腫であったが，粘膜内高分化腺癌を認めた．29歳と若年発症であり，Lynch症候群の可能性を考え，マイクロサテライト不安定性検査を施行したが，不安定性は認めなかった．小腸癌においてもadenoma-carcinoma sequenceによる癌化を示唆する貴重な症例であると思われた．

The prognostic value of adaptive nuclear texture features from patient gray level entropy matrices in early stage ovarian cancer.

Background: Nuclear texture analysis gives information about the spatial arrangement of the pixel gray levels in a digitized microscopic nuclear image, providing texture features that may be used as quantitative tools for prognosis of human cancer. The aim of the study was to evaluate the prognostic value of adaptive nuclear texture features in early stage ovarian cancer. Methods: 246 cases of early stage ovarian cancer were included in the analysis. Isolated nuclei (monolayers) were prepared from 50 μm tissue sections and stained with Feulgen-Schiff. Local gray level entropy was measured within small windows of each nuclear image and stored in gray level entropy matrices. A compact set of adaptive features was computed from these matrices. Results: Univariate Kaplan-Meier analysis showed significantly better relapse-free survival (p < 0.001) for patients with low adaptive feature values compared to patients with high adaptive feature values. The 10-year relapse-free survival was about 78% for patients with low feature values and about 52% for patients with high feature values. Adaptive features were found to be of independent prognostic significance for relapse-free survival in a multivariate analysis. Conclusion: Adaptive nuclear texture features from entropy matrices contain prognostic information and are of independent prognostic significance for relapse-free survival in early stage ovarian cancer.

The statin-low cholesterol-cancer conundrum

Hundreds of millions of people all over the globe are currently being administered statins because it is believed that their lipid lowering actions provide cardioprotective benefits. Adverse effects are considered uncommon and mild, and authors of numerous case–control studies of patients on statin treatment and matched, untreated individuals have even suggested a protective effect against numerous non-cardiovascular diseases, including cancer. In contrast, four controlled, randomized statin trials have resulted in a statistically significant increase of cancer in the treatment group; and several case–control and cohort studies have also shown a significant risk of cancer associated with statins. To add further confusion to this issue, meta-analyses of controlled, randomized statin trials have shown neither an increased nor a decreased risk of cancer.1 Some of these discrepancies may result from the failure to recognize that the recordings of cancer in statin trials are biased for several reasons. Several cohort studies of healthy people have shown that low cholesterol is a risk marker for future cancer. The usual interpretation has been that the association is secondary, because in most studies the association disappeared after having excluded early cancer cases. A common explanation has been that preclinical cancers might use cholesterol, which would lead to lower levels. However, when searching Pubmed with the words ‘cancer AND cholesterol’ we identified nine cohort studies including more than 140 000 individuals, where cancer was inversely associated with cholesterol measured 10–30 years earlier, and where the association persisted after exclusion of cancer cases appearing during the first 4 years (Table 1).2–10 It seems unlikely that the liver would be unable to produce the extra cholesterol necessary for early tumor growth, considering that much larger amounts are steadily made for the constant renewal of our cells. Moreover, none of these cohort studies has been corrected …

Clinical outcomes and factors related to resectability and curability of EMR for early colorectal cancer

EMR has emerged as an alternative therapeutic option for selected cases of early colorectal cancer (ECC). However, the factors associated with resectability and curability of EMR for ECC remain unknown. To investigate clinical outcomes and factors related to resectability and curability in ECC cases treated with EMR. Retrospective study. Tertiary-care academic medical center. This study involved all patients in whom EMR was performed for ECC at Severance Hospital between March 1997 and August 2007. A total of 236 cases of ECC occurring in 231 patients (66.2% men) were enrolled. EMR. Curative surgical resection and lymph node dissection were used in cases that were incompletely cured by EMR. Resectability, curability, and recurrence. Complete cure was achieved for 162 lesions (68.6%). Of the remaining 74 cases (31.4%), 69 (29.2%) were incompletely cured, and the other 5 (2.1%) had an undetermined resection status and ultimately required supplementary surgical resection for curative treatment. Location on the right side of the colon, piecemeal resection, and submucosal carcinoma were independently associated with incomplete resection, whereas depressed tumor type was independently related to incomplete cure. Among the ECC cases completely cured by EMR and followed for more than a year (n = 118), local recurrence was observed in one case (0.8%) during the median follow-up period of 39.4 months (range 12.4-123.1 months). Single-center, retrospective study. Our data show that EMR is feasible and could be an effective option for treatment of ECC if the technique is applied with the appropriate indications.

Endometrial cancer - reduce to the minimum. A new paradigm for adjuvant treatments?

BackgroundUp to now, the role of adjuvant radiation therapy and the extent of lymph node dissection for early stage endometrial cancer are controversial. In order to clarify the current position of the given adjuvant treatment options, a systematic review was performed.Materials and methodsBoth, Pubmed and ISI Web of Knowledge database were searched using the following keywords and MESH headings: "Endometrial cancer", "Endometrial Neoplasms", "Endometrial Neoplasms/radiotherapy", "External beam radiation therapy", "Brachytherapy" and adequate combinations.ConclusionRecent data from randomized trials indicate that external beam radiation therapy - particularly in combination with extended lymph node dissection - or radical lymph node dissection increases toxicity without any improvement of overall survival rates. Thus, reduced surgical aggressiveness and limitation of radiotherapy to vaginal-vault-brachytherapy only is sufficient for most cases of early stage endometrial cancer.

A case of early stage lung cancer detected by repeated cancer screening with positron emission tomography

There has been an increase in the detection rate of small early lung cancer due to recent improvements in imaging technology. However, conventional imaging modalities such as computed tomography (CT) alone are not capable of differentiating small pulmonary nodules. New modalities such as F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with CT (PET/CT) have contributed to the evaluation of lung cancer staging, although the differential diagnosis of pulmonary nodules showing ground-glass opacity (GGO) with PET/CT is controversial. In Japan, cancer screening with whole body FDG-PET has been available for asymptomatic individuals, and it has been reported that a wide variety of cancer types are detectable by FDG-PET at potentially curable stages. We present the case of a 62-year-old male with early lung cancer, which was revealed by repeated health screening. A PET/CT scan revealed definite intense FDG uptake (SUVmax 1.2) in the pulmonary nodules of the right upper lobe, while no definite FDG uptake was observed in the lesion in the previous annual screening. Right upper lobectomy was performed, and the pathological diagnosis was well-differentiated adenocarcinoma. Five-year survival has been noted since the thoracotomy, and the patient is doing well without recurrence. This is a significant case of early lung cancer with GGO lesions, which revealed intense FDG uptake during an annual repeated health screening with FDG-PET/CT.

Abstract SS03-03: The ITALUNG study and the state of art of randomized screening trials in Europe

Abstract SS03-03: The ITALUNG study and the state of art of randomized screening trials in Europe

Measurement of functional outcomes and quality of life scores in completed resected early SCC of tongue and floor of mouth which are reconstructed using loco-regional techniques

Aim: Free flap for defects post resection of SCC of oral cancers is the currently accepted mode of treatment. We have studied our results of 25 cases of early oral cancer involving the tongue and floor of mouth which were completely resected pathologically and reconstructed using local and regional flaps only. The patient demographics, primary site involved, TNM staging and method of reconstruction used were documented. Post operative adjuvant therapy was commenced as per multi disciplinary team decision.

Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment

The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth >1,000μm should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas. Endoscopic images of colorectal adenomas and early cancer cases with type V(I) pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard. In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively. Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with V(I) pit pattern indicating submucosal cancer infiltration of more or less than 1,000μm with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.