Pre Malignancy Research Articles

Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study

BackgroundSurgical resection is currently the cornerstone of hepato-pancreato-biliary (HPB) cancer treatment. A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. A person’s aerobic fitness is influenced by performing moderate to vigorous physical activity (MVPA). This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes.MethodsA prospective, observational multi-center cohort pilot study was conducted. Patients enlisted for resection surgery on suspicion of HPB (pre)malignancy were enrolled. Performed MVPA was measured by an Actigraph wGT3X-BT. Additionally, aerobic fitness was measured via the Incremental Shuttle Walk Test, and (post)operative variables were collected from the electronic patient files. The association between MVPA and the pre- and postoperative variables was determined by univariate and multivariable (logistic) robust regression.ResultsA total of 38 participants, median age 66.0 (IQR 58.25–74.75) years, were enrolled. The median daily MVPA was 10.7 (IQR 6.9–18.0) min; only 8 participants met the Dutch MVPA guidelines. Participant’s age and aerobic fitness were associated with MVPA by multivariable statistical analysis. Time to functional recovery was 8 (IQR 5–12) days and was associated with MVPA and type of surgery (major/minor) in multivariable analysis.ConclusionSeventy-six percent of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery.

The risk of endometrial (pre)malignancy in women having postmenopausal uterine bleeding at Tu Du Hospital

Endometrial cancer and endometrial atypical hyperplasia, futher referred to as endometrial (pre)malignancy in approximately 8.3-17.6% of cases depending on different studies. The incidence of abnormal endometrium increases during the postmenopausal period, especially endometrial (pre)malignancy. There are limited data regarding endometrial (pre)malignant disorders in patients with postmenopausal uterine bleeding. The aim of this study is to investigate the risk of endometrial cancer and atypical hyperplasia in the women who had postmenopausal uterine bleeding (PUB) and assess the risk factors associated with such cases. A cross-sectional study was conducted on 164 women with PUB used vacuum aspirator with Karman canula to evaluate endometrial pathology, underwent treatment at deparment of Gynaegology, Tu Du hospital through a set of questionaires and case file reports completed from February to June of 2020. In Bayesian inference, the risk of endometrial (pre)malignancy was 17.5%, CI (credible interval) 95% of 14.1 to 21.1%. There was a significant association between the risk and the duration of bleeding (OR = 1.02, CI 95% 1.01 to 1.03, LR+ 1.96, LR-0.37), number of live births (OR = 0.79, CI 95% 0.66 to 0.95, LR+ 2.41, LR- 0.76), endometrial thickness (OR = 1.08, CI 95% 1.01 to 1.16, LR+ 1.16, LR- 0.77) and the presence of abnormal intracavitary mass in transvaginal ultrasound (OR = 9.12, CI 95% 4.09 to 20.33, LR+ 3.65, LR- 0.4). Using manual vacuum aspirator with Karman canula showed the risk of (pre)malignancy in women having PUB and this risk depends on the presence of the risk factors.

Perform Pap smear test and Factors affecting on the prevalence of cervical cancer in women at Qazvin, Iran

Background: After breast, skin and long cancers, cervical cancer is the most common cancer in women and is a kind of cancer that can be diagnosed with Pap smear method in pre malignancy stage. Awareness of screening methods of this cancer, have great influence in reducing the incidence and mortality of it. The aim of this project was to determine awareness, attitude and function of married women, who referred to health centers of Qazvin, about Pap smear and cervical cancer in 2018. Method and Material: In this cross-sectional study (descriptive-analytical), 300 married women, who referred to health centers of Qazvin in 2018, were selected by classified sampling method and then simple random selection. The study was a questionnaire with 4 part including demographic questions, functional test, attitude and awareness resulting from national Pap smear plan of health minister, which was distributed and completed after confirming the validity and reliability with coordination centers with the help of trained people. The data were analyzed with SPSS 22 software. Result: In this project that the highest age group were women with 35-45 years (58%) with the average age of (36±8) years, awareness about introducing and recognition of pap smear and cervical cancer were 41% and 46% respectively.44% of them have at least once experienced pap smear.24% of this number have followed up again after one year.73% of participants of this project were agree with the test and early diagnosed of cervical cancer. Conclusion: In order to assess the effect of factors influencing awareness, attitude and function of the women about the cervical cancer and pap smear test, using multiple regression model, it was determined that there is a significant relation between level of awareness and factors including: age, economic situation, job and education (p=.05).also there is a significant relation between function and attitude and factors including education, age and awareness about disease. This represents a change in policy and education and health infrastructure in the field of knowledge of cancer and the use of modern methods of teaching.

Implication of Serum and Salivary Levels of Albumin as a Diagnostic Tool in Oral Premalignancy and Malignancy

Background: Reactive oxygen and nitrogen species are involved in the initiation and promotion of the multistep carcinogenesis. In neoplastic conditions many biochemical substances many biochemical substances including albumin show altered values .The aim of the present study was to investigate whether serum and salivary albumin levels can be used as diagnostic tools in oral premalignant and malignant leisons. Methods: The study includes a total of 45 subjects with 15 each of normal healthy, pre-malignancy and malignancy. Five milliliter of venous blood was drawn and unstimulated saliva was collected in the early morning. Albumin levels were estimated by Bromocresol Green Method. Results: Serum albumin levels were found to decrease in pre-malignancy and malignancy as compared to healthy individuals. Salivary Albumin levels were increased in pre-malignancy and malignancy as compared to healthy individuals. Conclusion: Tobacco consumption is one of the most important risk factors for the development of oral cancer. Burst of reactive oxygen species which cause oxidative stress in tobacco users is prime form of damage brought to the genetic material leading to non-lethal mutations causing pre-malignancy and malignancy. Serum protein has long been implicated to have anti-oxidant properties due to rich concentration of free thiol group. Albumin is a potent extracellular anti oxidant defense and a reliable marker of oxidative stress in the body. It could be helpful in the early identification of various oral pre malignancy and malignant leisons.

Retrospective Study on Upper Gastrointestinal Endoscopic Findings in Patients with Dyspepsia without Alarm Features in International Islamic University Malaysia Medical Centre

Introduction: The purpose of this study was to review the significance of oesophago-gastroduodenoscopy (OGD) findings in patients with dyspepsia but without alarm features. Materials and Methods: OGD data from January 2017 to December 2017 were collected from ipesakit. The demographic details, indications and findings were reviewed. Results: OGDs were performed. Among these 56 (49%) were performed on dyspeptic patients with no alarm features. This subgroup was further analysed. Thirty two (57%) patients in this subgroup were female and 24 (43%) were male. 33 (59%) were 50 years and younger. Twenty (36%) patients were between 51 and 70 years old, while 3 (5%) patients were above 70 years of age. The commonest finding was gastritis (70%, n=39), followed by F3 gastric ulcer (3.5%, n=2), F3 duodenal ulcer (3.5%, n=2), gastric fundic polyp (1.8%, n=1), and hiatus hernia (1.8%, n=1). 11 (20%) patients had normal finding. No malignancy or pre malignancy lesion were found in this cohort. Two patients had positive CLO test. Conclusion: OGD in patients with dyspepsia but without alarm features has low yield of significant findings. This procedure may unnecessarily expose patients to the associated potential risks and may not be cost effective. This can be addressed by introducing a hospital guideline for OGD referral. Low positivity of CLO test may also need further evaluation with regards to its sensitivity and specificity. Alternative tests for H Pylori detection such as stool antigen test or urea breath test may need to be adopted.

Abstract A064: Modeling checkpoint blockade inhibitor resistant immunoregulation induced by squamous epithelial cancers

Abstract Aim: Squamous epithelial cancers are immunogenic, as demonstrated by an increased risk of development in immunosuppressed patients. Some however evade host immunity, and establishing the mechanism of immune evasion could assist with squamous cancer immunotherapy. Method: We have used a model of squamous epithelial pre malignancy, in which HPV16 E7 transgenic and hyperproliferative mouse skin is transplanted to naïve mice, and have explored local regulation of effector T cell function by E7 transgenic epithelial cells through manipulation of the graft donor immune system. Results: E7 transgenic skin is not rejected by naïve recipient mice, or by mice immunised with E7 protein and expressing E7 specific cytotoxic T cells. E7 expressing hyper proliferative epithelium demonstrates caspase-1 activation, production of IL-1β, IL-18, and CCL2, and attraction and activation of NKT cells and mast cells. Rejection of E7 transgenic skin grafts can be observed following depletion from the donor skin of bone marrow derived cells, of NKT cells or of mast cells, whereas adjacent E7 transgenic grafts, otherwise unmanipulated, are not rejected. E7 graft rejection can also be induced by suppression in the donor skin or recipient animal of NKT cell secreted IL-17 or IFN-γ, or by depletion of the soluble IL-1 receptor IL-1R1 or blockade of Arginase activity in the recipient. Inhibition of graft rejection is not overcome by antibody to PD-1, PD-L1, or PD-L2. Hyperproliferative cervix epithelium in patients with CIN3 expresses the factors identified as inhibitory to E7 transgenic skin graft rejection, whereas skin from E7 transgenic mice with a mutated Rb gene preventing E7 induced epithelial proliferation lacks the inhibitory factors. Conclusion: Epithelial hyper proliferation induces immunosuppressive mechanisms that locally prevent cytotoxic T cell function through mechanisms independent of checkpoint blockade. We hypothesise from our data that the local balance of production of IL-1β and Il-18 locally determines cytotoxic T cell effector function targeted at epithelial antigens. Citation Format: Stephen Mattarollo, Graham Leggatt, James Wells, Paul Lambert, Ian H. Frazer. Modeling checkpoint blockade inhibitor resistant immunoregulation induced by squamous epithelial cancers. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A064.

Pseudoneoplastic lesions of the uterine cervix

The differential diagnosis of malignant and premalignant lesions of the uterine cervix includes numerous non-neoplastic conditions which may show overlapping morphological features. Recognizing these mimics is crucial in order to spare the patient unnecessary surgical procedures with potential side effects, as well as the psychosocial consequences associated with the diagnosis of HPV-infection and/or (pre)malignancy. This article reviews benign entities that may be mistaken for neoplastic lesions of the cervix. Conditions of the ectocervical squamous epithelium, the endocervical glandular epithelium and the cervical stroma are systematically discussed in the context of the respective (pre)malignant lesion that they may be confused with, including low and high-grade squamous intraepithelial lesions, invasive squamous cell carcinoma, adenocarcinoma in-situ, various types of invasive adenocarcinomas, and sarcomas. Emphasis is placed on those features that help distinguish pseudoneoplastic lesions from true neoplasms, including clinical information, morphologic findings and ancillary studies.

Pancreaticoduodenectomy without Preoperative Radiological and Histological Diagnosis Diagnostic strategy/management

Introduction: Controversy exits about the diagnostic strategy/management of patients with clinical suspicion of a periampullary tumour but without a 'visible mass' noticed on US/CT/MRCP. In these patients EUS/brush/biopsy might be helpful in deciding whether surgery is indicated. Objective: The present study evaluated the additional value of EUS/brush/biopsy in the diagnostic workup of patients with inconclusive radiological imaging. Pathology after resection was correlated with preoperative diagnostics. Methods: A consecutive cohort of 303 patients, suspected to have a periampullary malignancy, underwent pancreaticoduodenectomy from Jan 2000-Oct 2005. Patients were classified by results of preoperative diagnostic workup: (A) visible mass on US/CT/MRCP, (B) no visible mass, conclusive additional EUS/brush/biopsy, (C) no mass, inconclusive results of additional diagnostic workup. Pathological findings after resection were correlated with preoperative diagnostic results. Results: A visible mass was found in 231 patients (group A: 76%). Of the 72 patients without a visible mass in 62 (86%) EUS/brush/biopsy had led to a preoperative diagnosis (group B: 21%). Remaining 10 patients had inconclusive results of additional diagnostic workup or no further diagnostics performed (group C: 3%). Pathological findings after resection were, overall & each group separately (A/B/C): (pre)malignancy 85% (85/87/60), benign cystic 5% (7/0/0), focal pancreatitis 10% (8/11/30), no tumour 1% (-/2/10). Conclusions: In patients clinically suspected to have a periampullary tumour, 76% has a visible mass of which 85% had a (pre)malignancy at pathology. Additional diagnostic workup (EUS/brush/biopsy) leads in 86% of the cases of the remaining group to a preoperative diagnosis. In the small subgroup without conclusive preoperative diagnostics, 60% has a (pre)malignancy after resection.

986 Chemoprevention of (pre)malignancy of the upper aerodigestive tract with retinoids

Of the various possible level of risk at which chemoprevention can be applied 1) premalignant conditions (in the oral cavity: leukoplakia) and 2) patient who have been treated for cancer, but who are at risk to develop a new cancer, are for the upper aerodigestive tract the most important. Studies in oral leukoplakia as well as in the second primary tumors group will be discussed, with emphasis on EUROSCAN. EUROSCAN is an European Organization of Research and Treatment of Cancer (EORTC) chemoprevention study in curatively treated patients with oral cancer, laryngeal cancer and lung cancer which started in 1988; the end of the accrual phase was in 1994. The end of the intervention period is in 1996.