Liver Lymphoma Research Articles

Diagnosis of hyponatremia and increased risk of a subsequent cancer diagnosis: results from a nationwide population-based cohort study

Background: Hyponatremia has recently been associated with subsequent cancer risk. This population-based nationwide study assessed whether the diagnosis of hyponatremia can predict a cancer diagnosis within most common cancers.Material and methods: Using Danish medical registries, we identified 16,220 patients with a first-time diagnosis of hyponatremia, without a cancer diagnosis, from January 2006 through November 2013. We quantified the relative risk of a subsequent cancer diagnosis by standardized incidence ratios (SIRs), comparing observed cancer incidence among patients diagnosed with hyponatremia to that expected, based on national cancer incidence during that period.Results: During 40,207 person-years of follow-up, we observed 1546 cancer diagnoses compared to 956 expected (SIR: 1.62; 95% confidence interval (CI), 1.54–1.70). The increase in risk of a cancer diagnosis following a hyponatremia diagnosis was most pronounced within 0–6 months of follow-up (SIR 4.16; 95% CI, 3.85–4.48) and in the younger age group; 0–29 years (SIR 8.71; 95% CI, 2.82–20.28), 30–49 years (SIR 3.16; 95% CI, 2.26–4.31), 50–69 years (SIR 2.29; 95% CI, 2.10–2.48) and 70 + years (SIR 1.35; 95% CI, 1.27–1.44). Within six months after a hyponatremia diagnosis, the SIRs increased 10-fold for cancers of the lung (SIR 17.14; 95% CI, 15.15–19.32), brain (SIR 13.52; 95% CI, 8.90–19.66) and liver (SIR 13.26; 95% CI, 7.57–21.53) and increased 5 to 10-fold for cancers of the pancreas (SIR 8.25; 95% CI, 5.72–11.53), esophagus (SIR 6.59; 95% CI, 3.15–12.12), kidney (SIR 6.36; 95% CI, 3.39–10.88), pharynx (SIR 6.15; 95% CI, 1.27–17.97) and non-Hodgkin lymphoma (SIR 6.10; 95% CI, 4.17–8.61). The rate increased across virtually all types of cancers, except melanoma and basal cell carcinomas.Conclusions: A diagnosis of hyponatremia may be a marker of occult neoplasms, especially cancers of the lung, brain, liver, pancreas, esophagus, kidney, pharynx and non-Hodgkin lymphoma. Hyponatremia may aid in early detection of cancer.

Primary Hepatic Lymphoma: A Complex and Challenging Diagnosis

Primary hepatic lymphoma is the rare condition affecting liver and presents to clinician as space occupying lesion and is an extranodal variety of non-Hodgkin lymphoma. The diagnosis is based on the suspicious eye with keen laboratory investigation after ruling out the other common pathologies of the liver which presents as space occupying lesion.Here we present a case who presented to us with dull pain and swelling right upper abdomen accompanied by prodromal symptoms which after proper work up was diagnosed as primary diffuse large B-cell non-Hodgkin lymphoma (NHL) of liver.

Longitude Position in a Time Zone and Cancer Risk in the United States.

Background: Circadian disruption is a probable human carcinogen. From the eastern to western border of a time zone, social time is equal, whereas solar time is progressively delayed, producing increased discrepancies between individuals' social and biological circadian time. Accordingly, western time zone residents experience greater circadian disruption and may be at an increased risk of cancer.Methods: We examined associations between the position in a time zone and age-standardized county-level incidence rates for total cancers combined and 23 specific cancers by gender using the data of the Surveillance, Epidemiology, and End Results Program (2000-2012), including four million cancer diagnoses in white residents of 607 counties in 11 U.S. states. Log-linear regression was conducted, adjusting for latitude, poverty, cigarette smoking, and state. Bonferroni-corrected P values were used as the significance criteria.Results: Risk increased from east to west within a time zone for total and for many specific cancers, including chronic lymphocytic leukemia (both genders) and cancers of the stomach, liver, prostate, and non-Hodgkin lymphoma in men and cancers of the esophagus, colorectum, lung, breast, and corpus uteri in women.Conclusions: Risk increased from the east to the west in a time zone for total and many specific cancers, in accord with the circadian disruption hypothesis. Replications in analytic epidemiologic studies are warranted.Impact: Our findings suggest that circadian disruption may not be a rare phenomenon affecting only shift workers, but is widespread in the general population with broader implications for public health than generally appreciated. Cancer Epidemiol Biomarkers Prev; 26(8); 1306-11. ©2017 AACR.

Effect of folic acid supplementation on cancer risk among adults with hypertension in China: A randomized clinical trial.

The relationship of folic acid supplementation with the risk of cancer remains inconclusive. We aimed to evaluate the effects of folic acid supplementation on cancer incidence among adults with hypertension without history of stroke or myocardial infarction (MI) in the China Stroke Primary Prevention Trial (CSPPT). A total of 20,702 hypertensive adults without history of stroke or MI, stratified by MTHFR C677T genotypes(CC, CT and TT), were randomly assigned to receive double-blind daily treatment with a single pill containing 10 mg enalapril and 0.8 mg folic acid(n = 10,348) or a pill containing 10 mg enalapril alone(n = 10,354). During a median treatment duration of 4.5 years, cancer occurred in 116 participants(1.12%) in the enalapril-folic acid group versus 116 participants(1.12%) in the enalapril group (HR, 1.00; 95%CI, 0.77-1.29). There was also no significant difference in the HRs for specific types of cancer(esophageal, gastric, breast, lung, colorectal, head and neck, liver and gynecologic cancer or lymphoma) or cancer mortality(HR, 1.05; 95%CI, 0.69-1.58). For participants not receiving folic acid treatment (enalapril only group), MTHFR 677 TT genotype was an independent predictor of total cancer risk compared to CC genotype (HR, 1.86; 95%CI, 1.07-3.22). Consistently, a beneficial effect was observed in participants with MTHFR TT genotype and low folate levels (<9.0 ng/mL; HR, 0.47; 95%CI, 0.24-0.94). There is no evidence that 0.8 mg daily folic acid supplementation can increase the risk of cancer incidence among adults with hypertension without history of stroke or MI in China. Our data suggest a protective effect in participants with MTHFR TT genotype and low folate levels.

Cancers Attributable to Infectious Agents in Nigeria: 2012-2014

Abstract 60 Background: Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In 2008, there were 12.7 million new cancer cases worldwide. About 2 million of these new cases were attributable to infections, which represent 16.1% of new cancer cases. The majority of these cancers occurred in less-developed regions of the world, where the Population Attributable Fraction (PAF) was estimated to be 23%. We carried out this study to evaluate the numbers of cancers in Nigeria from 2012-2014 that are attributable to infections using data from Population Based Cancer Registries (PBCR) in Nigeria. Methods: We considered cancers associated with Epstein-Barr virus (EBV), Human Papilloma Virus (HPV), Hepatitis B and C Virus (HBV/HCV), Human Immunodeficiency Virus and Human Herpes Virus 8 (HIV/HHV8), Helicobacter pylori, and Schistosoma haematobium that have been classified as oncogenic by IARC. We obtained data on the infection-associated cancers from registry databases of 3 PBCRs in Nigeria: Abuja, Enugu, and Calabar cancer registries. We used PAF for infectious agents associated cancers in developing countries, which were calculated using prevalence data and relative risk estimates in previous studies: EBV and Nasopharyngeal (90%), and Hodgkin's Lymphoma (80%); HPV and Cervical (100%), Vulval and Vaginal (40%), Anal (90%) and Oropharyngeal cancer (12%) in women; Penile (40%), Anal (90%) and Oropharyngeal cancer (12%) in men; HBV/HCV and Liver (92%), HIV/HHV8 and Kaposi sarcoma (100%), Non Hodgkin Lymphoma (100%); H. pylori and stomach (74%) and S. haematobium and Bladder cancer (56.6%). Results: The 3 PBCRs reported 4,861 cancer cases from 2012-2014: 1,875 male cases and 2,986 female cases. There were 412 infection-associated cancers in males accounting for 22% of total cancers in males, and 351 (85%) of these were attributable to infections. In females, there were 727 infection-associated cancers accounting for 24% of total cancers in females, and 674 (93%) of these were attributable to infections. Cancers of the Cervix (n=430), Liver (n=152), and Non-Hodgkin's Lymphoma (n=129) were the most common infection-associated cancers in both sexes. The most common infectious agents associated with cancers were HPV (n=453), HIV/HHV8 (n=199), HBV/HCV (n=143) and EBV (n=125). Conclusion: Our findings suggest that 85% of infection-associated cancers in males and 93% infection-associated cancers in females in Nigeria can be prevented with vaccination, safer risk behaviors, or anti-infective treatments. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Michael Kolawole Odutola No relationship to disclose Elima Jedy-Agba No relationship to disclose Emmanuel Oga No relationship to disclose Festus Igbinoba Travel, Accommodations, Expenses: AstraZeneca Theresa Otu No relationship to disclose Emmanuel Ezeome Honoraria: Roche Travel, Accommodations, Expenses: Roche Ima-Obong Ekanem No relationship to disclose Ramatu Hassan No relationship to disclose Clement Adebamowo Speakers' Bureau: Merck

Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan.

Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396), comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04). Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.

Cancer incidence in Italian contaminated sites.

The incidence of cancer among residents in sites contaminated by pollutants with a possible health impact is not adequately studied. In Italy, SENTIERI Project (Epidemiological study of residents in National Priority Contaminated Sites, NPCSs) was implemented to study major health outcomes for residents in 44 NPCSs. The Italian Association of Cancer Registries (AIRTUM) records cancer incidence in 23 NPCSs. For each NPCSs, the incidence of all malignant cancers combined and 35 cancer sites (coded according to ICD-10), was analysed (1996-2005). The observed cases were compared to the expected based on age (5-year period,18 classes), gender, calendar period (1996-2000; 2001-2005), geographical area (North-Centre and Centre-South) and cancer sites specific rates. Standardized Incidence Ratios (SIR) with 90% Confidence Intervals were computed. In both genders an excess was observed for overall cancer incidence (9% in men and 7% in women) as well as for specific cancer sites (colon and rectum, liver, gallblad-der, pancreas, lung, skin melanoma, bladder and Non Hodgkin lymphoma). Deficits were observed for gastric cancer in both genders, chronic lymphoid leukemia (men), malignant thyroid neoplasms, corpus uteri and connective and soft-tissue tumours and sarcomas (women). This report is, to our knowledge, the first one on cancer risk of residents in NPCSs. The study, although not aiming to estimate the cancer burden attributable to the environment as compared to occupation or life-style, supports the credibility of an etiologic role of environmental exposures in contaminated sites. Ongoing analyses focus on the interpretation of risk factors for excesses of specific cancer types overall and in specific NPCSs in relation to the presence of carcinogenic pollutants.

Synchronous occurrence of gastrointestinal stromal tumor and acute myeloid leukemia: A case report and review of the literature.

Gastrointestinal stromal tumors (GISTs) originate from the mesenchymal tissue of the gastrointestinal tract. The pathogenesis of GIST is associated with the mutational activation of the receptor tyrosine kinase cluster of differentiation (CD)117 or platelet-derived growth factor receptor-α. Overall, ~60% of GISTs occur in the stomach. Clinically, GISTs may coexist with various types of cancer, including liver cancer, pancreatic tumors and lymphoma, either synchronously or metachronously. The present study reports the case of a patient with the synchronous occurrence of a CD117-positive GIST and acute myeloid leukemia. A 69-year-old man was hospitalized for heart palpitations and dizziness, and was diagnosed with acute myeloid leukemia (AML) by bone marrow aspiration and flow cytometry analysis. An abdominal computed tomograpy and gastroscopy revealed the presence of GIST. The patient received chemotherapy in combination with imatinib (400 mg/day), and the mass was removed 2 months later. To the best of our knowledge, the present study is the first reported case of the synchronous development of a CD117-positive GIST and AML. Additional studies are required in order to understand the association between GIST and hematological malignancies.

Relationship Among Strongyloides stercoralis Infection, Human T-Cell Lymphotropic Virus Type 1 Infection, and Cancer: A 24-Year Cohort Inpatient Study in Okinawa, Japan.

This study evaluated the prevalence of Strongyloides stercoralis infection and human T-cell lymphotropic virus type 1 (HTLV-1) infection in the population. In addition, this study investigated the relationship between S. stercoralis infection or HTLV-1 infection and a patient's risk of developing related cancers. This is a retrospective cohort study of 5,209 patients. The prevalence of S. stercoralis infection was 5.2% among all patients. The prevalence among men (6.3%) was significantly higher than among women (3.6%, P < 0.001). The prevalence of HTLV-1 infection among this population was 13.6% and the prevalence among women (15.5%) was significantly higher than that of men (12.3%, P < 0.001). HTLV-1 seroprevalence was higher in patients with liver cancer (P = 0.003, odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.24, 2.95) and in those with lymphoma other than adult T-cell leukemia/lymphoma (ATLL) (P = 0.005, adjusted OR: 2.76, 95% CI: 1.36, 5.62) if compared with patients without any neoplasm. The prevalence of both S. stercoralis and HTLV-1 in the Okinawan population has been steadily decreasing over the past 24 years. HTLV-1 infection significantly increases the odds of developing liver cancer and lymphomas other than ATLL.

Demographic survey of four thousand patients with 10 common cancers in North Eastern Iran over the past three decades.

Cancer is a major cause of mortality in developing countries and correct and valid information about the epidemiology of this disease is the first step in the planning of health care in each region. The aim of this study was to determine the relative frequency, mean age and sex ratio of the most 10 common non-skin cancers in the world and Iran, among patients referred to an oncology clinic. This descriptive study was conducted in Mashhad, north east of Iran. The data obtained from the records of patients referred to the private oncology center between the years of 1985-2012." According to the latest report of GLOBOCAN study commonest malignancies included were lung, breast, colorectal, prostate, stomach, liver, cervix, esophageal, bladder cancers and Non-Hodgkin lymphoma. A total of 4,606 cases were analyzed. The mean age was 55.5±13.8years (male: 59.5±13.9, female: 52.6±12.9). Overall, breast cancer (1,264 cases, relative frequency of 27.4%) was the most prevalent cancer; however the mean ages of diagnosis were not significantly different between 5-year time period divisions (p=0.290). The most common cancer in men was esophageal cancer (26.3%).The lowest mean age was related to women diagnosed with breast cancer (48.5±11.8) and men with non-Hodgkins lymphoma (48.4±17.8). There were statistically significant differences between the mean age of men and women with gastric (p=0.003) and esophageal cancers (p<0.001). Male to female sex ratios in our study for bladder, lung and stomach cancers were 6.57, 2.60 and 2.50 respectively. The results showed that breast cancer tends to be found in younger female patients and bladder cancer appears more often in men. Screening in target population in addition to early diagnosis may reduce death and disability.

Primary non-Hodgkin’s lymphoma of liver

A 65-year-old male was presented his primary care physician with a two-month history of constipation, upper right abdominal pain and occasional right groin pain. His past medical history included hypertension and hepatitis B from which he had recovered (HBsAg negative). The biochemical analyses revealed alanine transaminase 35 U/L, aspartate transaminase 38 U/L and bilirubin level 26 mmol/L with normal blood count. The result of quantitative HBV DNA revealed an undetectable viral load which is generally lower than 300 copies/mL. Magnetic resonance imaging (MRI) scan of the abdomen showed a mass in the right lobe of the liver with a diameter of 10 cm, located on the right hemiliver (Figure 1A). The tumors markers CA19-9 was 57.3 IU/ mL (normal range <27 IU/mL), carcinoma antigen 15-3 was 29.6 IU/mL (normal range <5 IU/mL), and CA125 was 72.4 IU/mL (normal range <35 IU/mL). Alphafetoprotein and carcinoembryonic antigen were within normal range. Liver biopsy confirmed non-Hodgkin’s lymphoma, staining positive for CD20 lymphocytes.

Primary Liver Large B-Cell Lymphoma: A Rare Diagnosis

Primary liver lymphoma is extremely rare, in most of cases it is a B cell lymphoma. Usually the diagnosis is made in middle-aged individuals and most of them have a relatively short life expectancy. In this article, the authors present a case report of a 75-year-old woman with symptoms of three weeks of evolution of diffuse abdominal pain, asthenia and anorexia. The analysis showed cyto cholestasis and the radiological image with lush hepatomegaly because of a large hepatic mass. The patient started chemotherapy and actually is well twenty months after the end of the chemotherapy.

Questionnaire-based survey on chemotherapy-induced anemia

A questionnaire-based survey on chemotherapy-induced anemia (CIA) in cancer patients was conducted between September and November 2010. The number of patients treated with chemotherapy, rate of blood transfusion, volume of blood transfused, severity of anemia, and factors affecting blood transfusion were analyzed according to the type of cancer, in an attempt to clarify the current status of CIA in Japan. During the survey period, among the eight types of cancer analyzed (breast, lung, stomach, colorectal, liver, gynecologic cancer, urologic cancer, and malignant lymphoma), chemotherapy was given to 5.4-13.6 % (mean 9.2 %) of patients, among whom 1.6-24.0 % (mean 7.5 %) required blood transfusion. The number of units of red blood cells transfused was 3.9-7.3 units (mean 5.9 units) per patient. According to a nationwide patient survey conducted by the Ministry of Health, Labour and Welfare, it is estimated that approximately 146,000 units of red blood cells, which account for 2.2 % of the annual total supply of red blood cell products, are transfused to cancer patients with CIA yearly. In addition, it is estimated that annually approximately 172,000 cancer patients with CIA, accounting for 40 % of patients receiving chemotherapy, have hemoglobin (Hb) levels below 10 g/dL. Possible factors affecting blood transfusion include a history of chemotherapy and radiotherapy, as well as the use of platinum agents. In patients who received red blood cell transfusions, the average Hb level prior to chemotherapy was 9.5 g/dL, and the average lowest Hb level after starting chemotherapy was 6.9 g/dL. By contrast, in patients who did not receive transfusion, these values were 11.6 and 10.4 g/dL, respectively. Furthermore, in all cancer types, almost no red blood cell transfusion was performed in patients with an Hb level of 8.0 g/dL or higher, but also many patients with an Hb level of 6.9 g/dL or lower did not receive red blood cell transfusions. There was no significant difference in the ratio of adverse events following blood transfusion in this survey compared with that in the nationwide survey. The present results demonstrate the strict restriction of red blood cell transfusion to cancer patients with CIA. Therefore, there is a need to consider the use of alternative therapies to allogeneic blood transfusion, such as erythropoiesis-stimulating agents, to increase Hb levels, and consequently improve the quality of life in cancer patients with CIA.

Contrast-Enhanced Ultrasound (CEUS) in Hepatic Lymphoma: Retrospective Evaluation in 38 Cases

Description of contrast-enhanced ultrasound (CEUS) patterns of hepatic lymphoma. Over a period of 6 years and 1 month from January 2006 to January 2012, n = 38 patients with histological or clinically apparent hepatic lymphoma were studied by means of CEUS prior to B-mode imaging. Using B-mode imaging, lesions were hypoechoic in n = 37 (97.4 %) cases, while a focal lymphoma lesion was echo-rich in 1 case (2.6 %). For comparison, with CEUS, a hyperenhanced signal during the arterial phase was observed in n = 9 (23.7 %), an isoenhanced signal in n = 17 (44.7 %) and a hypoenhanced signal in n = 12 (31.6 %) cases. During the portal phase n = 2 (5.3 %) lesions were isoenhanced and n = 36 (94.7 %) were hypoenhanced followed by a hypoenhancement in n = 38 (100 %) cases in the late phase. Lymphomas of the liver can cause different contrast accumulation in the arterial phase of CEUS. Furthermore, a clear differentiation from other malignant liver lesions such as metastases is crucial as different contrast accumulation in the arterial phase of CEUS is observed. In the late phase, hepatic lymphomas lead to a hypoenhancement in CEUS, also known as a "wash-out" phenomenon. In conclusion, CEUS is helpful to differentiate hepatic lesions by means of evaluating the malignancy or benignancy. In this regard, the application of CEUS can help to find the right diagnosis. A final discrimination between malignant liver lesions, such as liver lymphomas, metastasis or HCC, remains impossible.

Clinical analyses of laparoscopic hepatectomy for liver neoplasms: a report of 21 cases

The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012. Among 11 cases of borderline hepatocellular carcinoma (HCC) (1.0-9.0 cm), 6 of them were of micro hepatocellular carcinoma (MHCC) with a diameter ≤2 cm. There were 10 cases of borderline hepatic benign tumor, including liver hemangioma (n=7), hepatic adenoma (n=1), liver lymphoma (n=1) and liver focal necrosis (n=1). According to Couinaud's liver segmentation method, neoplasm was located on segment Ⅲ (n=13), segment Ⅳ (n=6), segment Ⅴ (n=1) and segment Ⅵ (n=1). Laparoscopic hepatectomy was successful in all patients. There was neither conversion into open approach nor postoperative complications of bile leakage, air embolism or perioperative mortality, etc. The mean operative duration was (120 ± 30) minutes, average hemorrhagic volume (165±79) ml and normal diet & ambulation at Day 1-2 post-operation. The average postoperative hospitalization stay was (16±10)days and 1-year survival rate 100%. The parameters of leucocyte, liver enzymes, albumin and bilirubin returned to normal at Week 1 post-operation. Once a reasonable surgical indication is selected, laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma. Key words: Liver neoplasms; Laparoscopy

Proceedings of the International Workshop on Cancer Advocacy for African Countries

Proceedings of the International Workshop on Cancer Advocacy for African Countries

Primary liver lymphoma

Lymphomatous involvement of liver is common in lymphoma, but primary non Hodgkin's liver lymphoma is a rare entity. We present a case report of a middle aged male who was diagnosed with primary liver lymphoma after a long and exhaustive work up. Symptoms initially improved with chemotherapy but presented fifteen months later with central nervous system and vertebral dissemination. Primary liver lymphoma, even though rare should be kept in differentials of multiple space occupying lesions of liver with no evidence of vascular invasion, especially if there is no associated lymphadenopathy or spleen involvement.

English

Abstract Introduction Primary extranodal lymphomas of the liver are notably rare. A proportion of cases are associated with infection with hepatitis C or B, HIV, EBV or primary biliary cirrhosis. We report the case of a 45-year-old man who presented with abdominal pain and weight loss. Case report Physical examination revealed an enlarged liver, but ascites, jaundice, splenomegaly and peripheral lymphadenopathy were absent. Laboratory studies showed elevated hepatic enzymes. Tumour markers CEA and AFP were normal. Abdominal computed tomography revealed multiple hypodense lesions in both lobes of the liver. Liver biopsy examination confirmed a diagnosis of non-Hodgkin’s anaplastic large-cell lymphoma of T phenotype. Immunohistochemically, the neoplastic cells were positive for CD43, CD4, CD2, CD3, CD30, CD5 and granzyme B and negative for CD20, CD79a, CD10, EBV, CD15, CEA, EMA, CD56, CD57 and ALK1. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received combination chemotherapy, and he was alive 2 years after diagnosis. Conclusion Although primary lymphoma of liver is rare compared with secondary hepatic involvement by lymphoma, primary epithelial neoplasms and metastatic carcinoma, the diagnosis should be considered in certain clinical circumstances. The prognosis relates to the specific disease entity.

Infectious Causes of Malignancy and Their Potential Prevention

There are numerous infectious etiologies of malignancy, both as direct causation or co-factors, as well as infections causing reduced immunity, allowing malignancies to express. Many of these infections are a major source of morbidity and mortality as well as a huge economic burden in large areas of the world. These malignancies include cervix, oral/anal, liver, gastric, nasopharyngeal, bladder carcinomas, and certain lymphomas, caused by a variety of viral, bacterial, and parasitic agents. For most of these agents, effective methods of prevention, barrier and/or immunization, and/or treatment have been developed. Socioeconomic factors show that the most preventable cancers caused by infections are highest in developing countries, raising important public health and priority issues.

がん化学療法に伴う貧血に関する実態調査報告

A questionnaire-based survey on chemotherapy-induced anemia (CIA) in cancer patients was conducted between September and November 2010. The number of patients treated with chemotherapy, rate of blood transfusion, volume of blood transfused, severity of anemia, and factors affecting blood transfusion were analyzed according to the type of cancer, in an attempt to clarify the current status of CIA in Japan. During the survey period, among the eight types of cancer analyzed (breast, lung, stomach, colorectal, liver, gynecologic cancer, urologic cancer, and malignant lymphoma), chemotherapy was given to 5.4–13.6 % (mean 9.2 %) of patients, among whom 1.6–24.0 % (mean 7.5 %) required blood transfusion. The number of units of red blood cells transfused was 3.9–7.3 units (mean 5.9 units) per patient. According to a nationwide patient survey conducted by the Ministry of Health, Labour and Welfare, it is estimated that approximately 146,000 units of red blood cells, which account for 2.2 % of the annual total supply of red blood cell products, are transfused to cancer patients with CIA yearly. In addition, it is estimated that annually approximately 172,000 cancer patients with CIA, accounting for 40 % of patients receiving chemotherapy, have hemoglobin (Hb) levels below 10 g/dL. Possible factors affecting blood transfusion include a history of chemotherapy and radiotherapy, as well as the use of platinum agents. In patients who received red blood cell transfusions, the average Hb level prior to chemotherapy was 9.5 g/dL, and the average lowest Hb level after starting chemotherapy was 6.9 g/dL. By contrast, in patients who did not receive transfusion, these values were 11.6 and 10.4 g/dL, respectively. Furthermore, in all cancer types, almost no red blood cell transfusion was performed in patients with an Hb level of 8.0 g/dL or higher, but also many patients with an Hb level of 6.9 g/dL or lower did not receive red blood cell transfusions. There was no significant difference in the ratio of adverse events following blood transfusion in this survey compared with that in the nationwide survey. The present results demonstrate the strict restriction of red blood cell transfusion to cancer patients with CIA. Therefore, there is a need to consider the use of alternative therapies to allogeneic blood transfusion, such as erythropoiesis-stimulating agents, to increase Hb levels, and consequently improve the quality of life in cancer patients with CIA.