Incidence Of Occult Cancer Research Articles

The Novel Use of Magtrace in Chest Masculinizing Transgender Top Surgery

Summary: Chest masculinization is the most common surgery performed in transgender men, and although incidence of occult cancer is lower than in cis-gender women receiving mastectomy or reduction mammoplasties, the incidence of high-risk lesions is comparable. In patients with concerns for occult malignancy, Magtrace is a nonradioactive tracer available to assist management for its delayed sentinel lymph node mapping capabilities. We present the first case report using Magtrace before masculinizing mastectomies in a transgender man.

The living donor evaluation as a life‐saving event

As a population, living kidney donors have a longer life expectancy than the general population. This is generally thought to be an artifact of selection, as only healthy individuals are allowed to donate, and the operative mortality and risk of subsequent renal failure are very low. However, there may also be an additional benefit to the process, as the donor evaluation may uncover an early occult cancer or a potentially serious medical problem. While these problems may preclude donation, they may be lifesaving, as they are likely to be diagnosed and treated before the donor develops symptoms. We looked at the incidence of occult cancer and other previously undiagnosed medical problems including renal disease, diabetes, hypertension, cardiac disease, and hepatitis C, in individuals volunteering to become a kidney donor at our center who proceeded with the evaluation between January 1, 1996 and May 31, 2011. Of 4088 potential donors, 19 (.46%) were discovered to have an unsuspected cancer, and 286 (7%) were found to have a previously undiagnosed medical problem. The living donor evaluation may lead to the early diagnosis of a life-threatening illness. This should be considered as one of the potential benefits of living donation.

A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism

The association between venous thromboembolism (VTE) and occult cancer is well established. However, the benefit of cancer screening in all VTE patients remains controversial. The Registro Informatizado Enfermedad TromboEmbólica (RIETE) score is a recently proposed risk score to identify VTE patients at high risk of occult cancer. We evaluated the performance of the RIETE score in a routine clinical setting comprising patients presenting with VTE between January 1 and December 31, 2014, at Danderyd University hospital. Out of 488 VTE patients, 47 (9.6%) patients received a new cancer diagnosis during a 24-month follow-up. After exclusion of patients with cancer diagnosed at baseline (≤ 10 days after VTE, n = 16), 472 patients were considered eligible for cancer screening. Among these 472 patients, 31 (6.6%) received a cancer diagnosis during follow-up. The cumulative incidence was high after both unprovoked (8.5%) and provoked (4.8%) VTE. The RIETE score was evaluated in 467 of these patients. Interestingly, a high RIETE score was not significantly associated with cancer diagnosis during follow-up (OR 1.78; 95% CI 0.85–3.63), which was mainly due to a poor performance in women (OR 1.04; 95% CI 0.30–2.83). In summary, we observed a relatively high incidence of occult cancer in both unprovoked and provoked VTE. The RIETE score performed poorly in identifying patients at high risk of occult cancer in our VTE population. Additional risk assessment models are warranted to identify VTE patients who would benefit from extensive cancer screening.

Occult thyroid cancer vs preoperatively diagnosed thyroid cancer; How different they really are?

Background: Total thyroidectomy is the most common procedure for patients with malignant as well as benign thyroid disease. The workup of patients with thyroid nodules aim to identify or exclude malignancy and this can be well achieved with the combination of US and FNA cytology. In the literature it is reported that in the specimens for benign thyroid disease there is a 5-10% incidence of occult cancer. In reality this incidence seems to be higher, at least in Greece. Our aim was to compare the pathology specimens of occult well differentiated thyroid cancer with those of cancers diagnosed preoperatively and assess if there are any similarities, differences or peculiarities.

Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions

IntroductionContralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Materials and methodsThe study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammaplasty between 1/2007 and 12/2011. The data was retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and postoperative follow-up. ResultsReduction mammaplasty specimens revealed abnormal findings in 68 (21.5%) patients. High-risk lesions (ADH, ALH, and LCIS) were revealed in 37 (11.7%), and cancer in six (1.9%) patients. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Abnormal histopathological findings were more frequent in patients with reduction mammaplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). ConclusionThe incidences of malignant and high-risk lesions are doubled compared to patients without prior breast cancer. Patients with abnormal histopathology cannot be preoperatively identified based on demographics. If reduction mammaplasty is performed before oncological treatment, the incidence of abnormal findings is higher. In the light of our results, contralateral reduction mammaplasty with histopathological evaluation in breast cancer patients offers a sophisticated tool to catch those patients whose contralateral breast needs increased attention.

Body CT in unprovoked PE – a worthwhile fishing trip?

Purpose Cancer and pulmonary embolism (PE) have an established causal relationship but there is a paucity of data on the incidence of occult cancer in patients with PE and no other risk factors. The National Institute of Health and Care Excellence (NICE) guidelines recommend further investigation with abdomino-pelvic computed tomography (CT AP) increasing demand on radiology departments. We aimed to determine if this is an appropriate use of resources by ascertaining occult cancer prevalence, type and stage at diagnosis in such cases. Methods and materials Patients with unprovoked PE diagnosed on CTPA and who subsequently had CT AP were identified from the radiology information system (RIS)/picture archiving and communication system (PACS) for the two-year period January 2013 to December 2014. The following were recorded: age, sex, diagnosis of a cancer, and if present the type and stage. Results Of patients with a positive CTPA and subsequent CT AP, 7.4% had occult cancers (ten cancers in 135 patients). The detected cancers were pancreatic, colonic, bladder, prostate, hepatic, pelvic soft tissue sarcoma and haematological. Of these, 70% were locally advanced or metastatic cancers. Age range: 64–92. No specific factors were identified to enable risk stratification of these patients. Conclusion Occult cancers in patients with PE are often advanced with a poor two-year survival rate. However, a small proportion are treatable and investigation in PE patients with no provoking factors should be considered. No risk factors are identified to risk stratify the cancer detection scans.

Type of operation for multinodular goitre and solitary nodule

Many countries and medical associations have developed guidelines for the management of benign thyroid conditions, including the surgical management of multinodular goitre and the non-toxic solitary thyroid adenoma. It is clearly stated in most guidelines that the aim of the surgical procedure is the safe and definite management of the thyroid pathology. Our aim is to provide evidence to support or reject different kinds of surgical procedures used for the management of non-toxic thyroid conditions i.e. multinodular goitre and solitary nodule. Thyroid nodules are common in the general population. Only 4–8% are clinically detectable, but US has shown the incidence to be 13–67%. Many studies have reported that malignancy can be found in 5% of these nodules. The aim of this paper is to present the facts, the pros and cons of each operation used for the management of these thyroid conditions, and provide evidence concerning the ideal procedure that combines safety with the most definite results. Despite the fact that most authors, experts and relevant medical associations currently consider total thyroidectomy (TT) as the gold standard for the management of benign goitre, there is still debate in the literature. It seems that when compared to less radical operations, TT has a lower recurrence rate, and hence a lower risk for complications associated with a reoperation. Moreover, in expert hands, it is equally as safe as less radical procedures in terms of permanent complications (i.e hypoparathyroidism and recurrent laryngeal nerve injury). Nevertheless, subtotal thyroidectomy (ST) has been found to be safer in terms of temporary complications since lower rates have been recorded. The incidence of “occult thyroid cancers” ranges from 3% to 16.6% (level II–III); therefore, if initial surgery is anything less than TT or near-total thyroidectomy, a reoperation is indicated. Obviously, the high recurrence rate along with the significant rate of occult thyroid cancers increases the need for necessary reoperations after a ST; as a result, associated morbidity increases. The incidence of occult cancer in benign solitary non-toxic nodules is 5%, irrespective of the size of the nodule. The literature describes two acceptable surgical options, each with its pros and cons: an upfront TT or a total lobectomy, and in the case of an occult cancer, a completion total thyroidectomy. Both approaches are acceptable to the surgical community and are included in the national guidelines.

Quality of life and female sexual function after skinning vulvectomy with split-thickness skin graft in women with vulvar intraepithelial neoplasia or vulvar Paget disease

Vulvar intraepithelial neoplasia (VIN) and vulvar Paget disease are managed with either vulvectomy, destructive treatments (laser, antimitotic drugs) or immunostimulants. All these options are associated with functional complications. The purpose of this study was to evaluate the surgical technique consisting of skinning vulvectomy with split-thickness skin graft, and its effect on overall quality of life and sexual function. A retrospective study was conducted on thirteen patients who underwent skinning vulvectomy with split-thickness skin graft between 1999 and 2009. Overall quality of life and sexual function were assessed with the Medical Outcome Study Short Form 36 (MOS SF-36) and Female Sexual Function Index (FSFI), respectively. The median age of patients was 54 (range: 33-77) years. Three patients had Paget disease and 10 patients had VIN lesions. The excision margins were clear in 46% of cases. The incidence of occult cancer was 31%. The mean follow-up period was 77 (±35) months. Four patients experienced a relapse of their intraepithelial disease. The mean disease-free survival was 58 (±44) months. There was no significant difference in MOS SF-36 scores between the study population and the general population. The patients assessed with the FSFI regained normal sexual function after the surgical procedure. Skinning vulvectomy with split-thickness skin graft is a feasible technique yielding good results in terms of quality of life and sexual function. It enables occult cancer to be diagnosed in patients with VIN or Paget disease.

The incidence of occult cancer in specimens from patients with genetic predisposition to ovarian and fallopian tube cancer

The incidence of occult cancer in specimens from patients with genetic predisposition to ovarian and fallopian tube cancer

Indications for Sentinel Lymph Node Biopsy in the Setting of Prophylactic Mastectomy

Bilateral/contralateral prophylactic mastectomy (PM) is offered to high-risk women to decrease their actual or perceived breast cancer risk. When an invasive occult cancer is identified, prevailing wisdom suggests that an axillary dissection be performed. This single-institution study aims to identify patients who may benefit from sentinel node biopsy (SLNB) at the time of prophylactic mastectomy. We performed a retrospective review of a prospective database of patients treated at our institution with bilateral/contralateral PM between 1995 and 2006. We examined patients' clinicopathologic characteristics in comparison with their incidence of occult cancer in the contralateral breast or axilla. There were 449 patients who underwent PM and SLNB. Twenty-eight underwent bilateral PM. Of the 28, no occult cancers were identified. Occult cancers were identified in 18 of 420 (4.3%) contralateral prophylactic specimens; they were invasive in 6 (1.4%). In cases of occult carcinoma, the primary established tumor was more likely to be of invasive lobular histology. Eight of 420 (2%) patients had a positive contralateral sentinel node, and within this subset of 8 patients the majority had locally advanced disease on the known tumor side. Other features associated with a positive contralateral sentinel node included the presence of lymphovascular involvement or skin or nipple involvement and grade 2 to 3 invasive primary established tumors. Overall, SLNB in patients undergoing bilateral PM or contralateral PM associated with early-stage disease is not indicated. But patients with locally advanced primary breast cancers have a significantly increased risk of occult cancer in the contralateral axilla, likely due to crossover metastasis; this select group of patients may benefit from SLNB at the time of surgery.

Prostate cancer risk in testosterone-treated men

Men with classical androgen deficiency have reduced prostate volume and blood prostate-specific antigen (PSA) levels compared with their age peers. As it is plausible that androgen deficiency partially protects against prostate disease, and that restoring androgen exposure increases risk to that of eugonadal men of the same age, men using ART should have age-appropriate surveillance for prostate disease. This should comprise rectal examination and blood PSA measurement at regular intervals (determined by age and family history) according to the recommendations, permanently revisited, published by ISSAM, EAU, Endocrine Society…. Testosterone replacement therapy is now being prescribed more often for aging men, the same population in which prostate cancer incidence increases; it has been suggested that administration in men with unrecognised prostate cancer might promote the development of clinically significant disease. In hypogonadal men who were candidates for testosterone therapy, a 14% incidence of occult cancer was found . A percentage (15.2%) of prostate cancer has been found in the placebo group (with normal DRE and PSA) in the prostate cancer prevention study investigating the chemoprevention potential of finasteride. The hypothesis that high levels of circulating androgens is a risk factor for prostate cancer is supported by the dramatic regression, after castration, of tumour symptoms in men with advanced prostate cancer. However these effects, seen at a very late stage of cancer development, may not be relevant to reflect the effects of variations within a physiological range at an earlier stage. Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer . A study on a large prospective cohort of 10,049 men, contributes to the gathering evidence that the long standing “androgen hypothesis” of increasing risk with increasing androgen levels can be rejected, suggesting instead that high levels within the reference range of androgens, estrogens and adrenal androgens decrease aggressive prostate cancer risk. Indeed, high-grade prostate cancer has been associated with low plasma level of testosterone. Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels. During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.

Incidence of occult cancer in children presenting with musculoskeletal symptoms: A 10-year survey in a pediatric rheumatology unit

Objectives: To assess the frequency and types of cancer found in children presenting to our Unit with musculoskeletal symptoms over a 10-year period. Methods: The medical records of patients with musculoskeletal symptoms and a final diagnosis of cancer were reviewed. In each case age, gender, presenting symptoms, laboratory data, diagnostic procedures, provisional and final diagnoses, and time between clinical onset and correct diagnosis were reviewed. Results: An underlying neoplasia was found in 10 of 1,254 patients (<1%) complaining of musculoskeletal symptoms. The types of malignancies found included acute lymphocytic leukemia (ALL) (6 cases), lymphoma (2 cases), neuroblastoma (1 case), and Ewing's sarcoma (1 case). The mean time between disease onset and final diagnosis was 3.2 months. The most common presenting feature was monoarthritis, involving the larger joints such as the elbows, knees or ankles. Juvenile idiopathic arthritis (JIA) was the most frequent provisional diagnosis. In the preliminary hematologic evaluation, eight patients had an increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) value. White blood cell (WBC) count was normal in almost all children, with a normal differential count. Lactic dehydrogenase (LDH) was raised in all children. Bone marrow aspirates and lymph node or bone biopsies were necessary to reach the final diagnosis. Conclusions: A malignancy should always be excluded in children with musculoskeletalsymptoms, especially when the clinical pattern is not characteristic of a specific rheumatic disease. Routine laboratory tests may be misleading. The simultaneous presence of high LDH or α-hydroxybutyric dehydrogenase (α-HBDH) levels and raised ESR or CRP, even with normal blood cell counts, should lead to additional investigations. Relevance: All patients presenting with arthritis or other musculoskeletal symptoms should have a thorough clinical examination. Disproportionate pain levels and an atypical pattern of “arthritis,” especially in the presence of systemic manifestations, suggest a possible underlying malignancy.

Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence

Objective: To determine the impact of margin status on disease recurrence and the incidence of occult cancer in women diagnosed with vulvar intraepithelial neoplasia (VIN) III and treated with surgical excision. Methods: Between 1989 and 1995, 73 women were diagnosed preoperatively with VIN III by vulvar biopsy and were treated with surgical resection. Patients were examined postoperatively, and recurrence was diagnosed when a biopsy of suspicious lesions confirmed VIN III. Results: The mean age was 45 years; 81% of the patients were white, and 18% were black. Eighty-two percent of the women had used tobacco, 56% had prior cervical dysplasia, and 37% had prior genital warts. An underlying squamous vulvar cancer was found in 22% of patients at initial treatment for VIN III. Fifty-nine women had follow-up of at least 7 months. Of these, 66% (39 of 59) had positive surgical margins, 31% (18 of 59) had negative margins and 3% had unknown margins (two of 59). With positive margins, 46% (18 of 39) suffered recurrent disease; with negative margins, only 17% (three of 18) had recurrent disease ( P = .03). Multifocal disease and a history of genital warts also correlated with VIN III recurrence ( P = .03 for both). Conclusion: A significant number of women diagnosed initially with VIN III on a vulvar biopsy harbored occult vulvar cancer. Recurrences were almost threefold higher when margins were positive for residual VIN III. We conclude that surgical resection is an appropriate method of treatment of VIN III for both diagnostic and therapeutic purposes.

The incidence of occult cancer in patients with deep venous thrombosis: a prospective study.

This study was undertaken to assess a potential relationship between idiopathic deep venous thrombosis (DVT) and occult cancer. Prospective study with a 2-year follow-up. The Angiology Unit of the First Department of Surgery, University of Athens, Greece, a tertiary referral centre. Two hundred and ninety-three patients with a first episode of venographically or Doppler-proved DVT were included in the study, of whom 264 were followed up for 2 years. After an initial extensive diagnostic workup, including routine blood counts and chemistries, erythrocyte sedimentation rate, CEA levels, chest X-ray and abdominopelvic CT scan, all patients were closely followed up and periodically examined. The incidence of cancer amongst patients with idiopathic and secondary DVT, and the validity of our screening programme. Cancer was diagnosed in 21 out of 84 patients with idiopathic DVT (25%) as compared with eight out of 202 patients with secondary DVT (4%). In 22 out of the 29 cases, cancer was detected during the initial admission, and the remaining seven cases were detected during follow-up. Cancer was diagnosed in 15 asymptomatic, healthy individuals, but only in seven of them was the diagnosis made by CT scan. Occult cancer is fairly common in patients with idiopathic DVT, but the routine use of extensive diagnostic studies for its detection remains to be validated by further prospective studies.

Rheumatic manifestations of occult cancer.

The frequency with which rheumatic disorders occur when malignant neoplasms first present is unknown, and the significance of rheumatic conditions as cancer markers is unappreciated. Patients admitted to a medical ward of a general hospital (Bnai Zion Medical Center, Haifa, Israel) during a 10-year period were surveyed. The frequency of the diagnostic evaluation of rheumatic disorders resulting in uncovering occult neoplasia at the time of index hospitalization and during the 2-year follow-up period was assessed. The incidence of occult cancer among patients admitted to a general medical ward with previously unclarified rheumatic disorders was 23.1%. Seventy-two percent of the group of patients with rheumatic diseases and occult cancer were male; 69% with rheumatic disease without cancer (control group) were female. The median age in the group with occult cancer was an average of 10 years older than the group without cancer, 67 versus 57 years (P < 0.001). Weight loss or anemia occurred in 52% of the group with occult cancer and in 37.3% of the control cases (not significant). Typically, there were no distinguishing features of the rheumatic syndromes suggesting the coexistence of cancer. In 19 of 25 cases, the malignancy was uncovered by routine examinations. In four instances, neoplasia was not immediately apparent but was identified in a specific search. In two cases, no search for malignancy initially was undertaken, and Hodgkin's lymphoma was diagnosed 6 and 12 months later. In 9 of 25 cases, long term remission of neoplasia was achieved by cancer therapy with improvement of rheumatic manifestations coinciding with regression. A significant number of patients who are referred to a general medical ward for evaluation of previously unclassified rheumatic disorders may be found to have a previously undetected malignancy. For most patients, the symptoms of cancer are found by routine physical and laboratory examinations. The importance of the association of rheumatic disorders and malignancy requires greater awareness, appreciation, and clinical study.

The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus.

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32-41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48-57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14-16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20-38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.