Tanta Cancer Center Research Articles

Multidetector computed tomography in detection of pulmonary complications in patients with hematological neoplastic disorders

Background Hematologic malignancy patients are liable to have pulmonary complications along the course of the disease due to the disease itself or its treatment. Aim Our study aimed to evaluate the role of multidetector computed tomography in detecting pulmonary complications in hematologic neoplasm patients. Patients and methods In all, 30 patients with hematological neoplastic disorders in this prospective study underwent radiological imaging for assessment of pulmonary complications at the Department of Radiodiagnosis and Medical Imaging, at Tanta University Hospitals and Tanta Cancer Center from 2019 to 2022. In all, 16 patients were males and 14 were females. Their age range was from 17 to 70 years with a mean age of 46.57 ± 13.56 years. Results Computed tomography showed an overall diagnostic accuracy of 100% in the diagnosis of amalgamated lymph nodes, pulmonary edema, and coronavirus disease 2019 pneumonia; otherwise, the least diagnostic accuracy was in the diagnosis of inflammatory conditions which was 90%. Thus, computed tomography showed very good results in almost all pulmonary complications except for inflammatory conditions. Conclusion Multidetector computed tomography is a very good modality in the early diagnosis of pulmonary complications in hematologic neoplasm patients.

Effect of Self-Care Strategies on Health Outcomes of Patients with Hepatocellular Carcinoma

Context: Hepatocellular carcinoma is the prevailing form of primary liver cancer among adults and currently ranks as the primary cause of mortality in cirrhosis individuals. Globally, hepatocellular carcinoma holds the sixth position in terms of cancer-related fatalities. Efforts are underway to leverage self-care approaches, combining local and regional treatments with systemic therapeutic protocols to enhance patient outcomes throughout various disease stages.
 Aim: Evaluate the effect of self-care strategies on patients with hepatocellular carcinoma health outcomes.
 Methods: A quasi-experimental research, specifically a one-group pre/post-test design, was employed in this study. The research was conducted in the internal medicine units of Tanta Cancer Center, Tanta, Egypt. The study included a purposive sample of 60 patients of both genders over nine months. Three assessment tools were utilized: A structured interview questionnaire for gathering personal information, medical history, and patient knowledge, a self-care practice assessment scale, and a health outcomes assessment scale.
 Results: Patients' knowledge scores regarding all the knowledge elements improved significantly post-implementation of self-care strategies compared with their pre-intervention levels. Total knowledge score improved post-self-care strategies implementation from 20% to 81.7% with a statistically significant difference between pre and post-implementation of the self-care strategies (X2=5.496, p=0.019). Also, the total self-care practice score increased from 16.7% to 68.3%, with a statistically significant difference between pre and post-implementation of the self-care strategies (X2=5.561, p=0.018). Regarding patients' health outcomes improved from experiencing severe symptoms among 53.4% to 6.7% post one month, respectively, with a statistically significant difference between pre and post-implementation of the self-care strategies regarding all assessed health outcomes (p<0.05).
 Conclusion: Self-care strategies have effectively enhanced patients' knowledge, self-care practice, and overall health outcomes. The study results recommend providing ongoing patient education regarding self-care management for patients with hepatocellular carcinoma to effectively address symptoms and enhance their quality of life.

Evaluation of Bone Mass Density in Children and Adolescents with Acute Lymphoblastic Leukemia

Background: Leukemia is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukaemia cells.
 Aim of Work: Our study aimed to evaluate bone density by DXA scan in children and adolescents with Acute Lymphoblastic leukaemia at diagnosis and after 6 m of treatment with chemotherapy.
 Subject and Methods: The study was conducted in the Pediatric Department Hematology and Oncology Unit of Tanta University and Tanta Cancer Center, From November 2020 to November 2022.
 Study Subjects: Evaluation of Bone Mass Density in Children and Adolescents with Acute Lymphoblastic Leukemia.
 Study design: observational cross-sectional. This study included 25 children diagnosed with Acute Lymphoblastic Leukemia (the same 25 Patients were examined at diagnosis and after 6 months of treatment with chemotherapy).
 Results: The mean age of this study children was 7.92+ 3.59 years in group I and 8.42+ 3.59 years in group II. The two groups were matched as regards weight, Height, and BMI.
 In the present study, Bone Mass Density was significantly lower in the leukaemia children after 6 months of treatment of chemotherapy (0.53±0.11), compared to leukaemia children at the time of diagnosis (0.59±0.11) (P<0.05). Also, bone mineral content and Z score were significantly lower in group II patients (20.5±7.82 and 1.120±0.37, respectively), compared to group I (23.13±9.18 and 2.25±0.45, respectively).
 Conclusion: Bone Mass Density, bone mineral content and Z score are significantly lowered after chemotherapy of ALL patients. Since a reduced BMD predisposes to osteopenia and osteoporosis, the use of DXA scanning to evaluate and monitor BMD in children with ALL may be useful to identify those patients at risk for developing osteopenia, osteoporosis, and pathological fractures.

Self-esteem of acute leukemic children undergoing chemotherapy

Background Acute leukemia is a major malignancy in children. Multiagent chemotherapy protocols are the main treatment option for acute leukemia. Still chemotherapy has a significant effect on children's well-being, improving the physical, psychological, and social status of children, and also, it has a remarkable effect on self-image and self-esteem. Aim The aim was to assess self-esteem of acute leukemic children undergoing chemotherapy. Patients and methods A descriptive exploratory research design was used. The study was conducted at two pediatric oncology outpatient clinics at Tanta Cancer Center and National Cancer Institute at Cairo University. A purposive sample of 80 children with acute lymphoblastic leukemia was recruited. Their ages were between 10 and 16 years old. A structured interview questionnaire and Coopersmith Self-esteem Inventory were used, and IRB approval was obtained from the National Cancer Institute for performing this study. Results The age of half of the children (50%) ranged between 14 and 16 years, with mean±SD age of 13.21±1.62 years. Overall, 61.3% were males. Less than half of the children (47.5%) received intravenous chemotherapy, whereas 46.2% of the children had both oral and intravenous chemotherapy. More than half of the children (62.5%) had low self-esteem regarding general self, whereas the vast majority of children (90%) had low self-esteem regarding their social self-peers. All children had low self-esteem toward their home parents, whereas the highest percent (98.8%) of children had low self-esteem regarding their school academic. The vast majority children (98.8%) had low self-esteem regarding the lie scale. All dimensions of self-esteem were significantly correlated with total score of self-esteem. Conclusion Children with acute leukemia undergoing chemotherapy had low self-esteem regarding general self, home parents, school academic, and social peers. Self-esteem was negatively affected among school age and adolescent children with acute leukemia who underwent chemotherapy. Regarding the lie domain, most children always told the truth. Recommendations Training programs should be designed and constructed for nurses in how to assess self-esteem for children with acute leukemia. Empowerment program should be directed to children with acute leukemia and their caregivers to improve their self-esteem.

Efficacy of Leadership Program for Head Nurses' Empowering and Supportive Role on Nurses' Work Engagement at Tanta Cancer Center

Efficacy of Leadership Program for Head Nurses' Empowering and Supportive Role on Nurses' Work Engagement at Tanta Cancer Center

Role of micropure ultrasound in the assessment of grouped breast microcalcifications with or without a mass lesion

Background Grouped microcalcifications are the tiny grouping of the many calcifications seen on mammography. For pathological examination of mass-free clustered microcalcifications, a mammography is considered because its visualization by conventional ultrasound is limited. Therefore, MicroPure imaging improves its detection and visualization. Objective This study aimed to evaluate the accuracy of MicroPure ultrasound in the diagnosis and characterization of breast microcalcifications with or without a mass in women undergoing-guided biopsies by ultrasound. Patients and methods Thirty women who were referred for breast imaging and diagnosis from Surgery and Oncology Departments to the Radiodiagnosis Department at Tanta Cancer Center were included in this study. Results In terms of diagnosis, 26 (86.7%) women had a mass, in two women (6.7%), a mass was discovered during screening and in two women (6.7%), a mass was discovered during follow-up. There were 26 (86.7%) women with a clustered distribution and four (13.3%) with a segmental distribution. The mean value of microcalcification detected by mammography was 12.87±6.64. Eleven women (36.7%) had benign masses and 19 (63.3%) had malignant masses. In terms of histopathology, 11 (36.7%) women were ductal carcinoma in situ, eight (26.7%) were invasive ductal carcinoma, six (20%) with distal hyperplasia without atypia, two (6.7%) with atypical ductal hyperplasia, two (6.7%) with sclerosing adenosis and one (3.3%) with fibroadenosis. Regarding ultrasound B (US B) mode, 17 (56.7%) women were visible and 13 (43.4%) were not visible. Regarding MicroPure, 25 (83.3%) women were visible and five (16.7%) were not visible. The mean value of microcalcification detected by MicroPure and US B mode are 8.8±6.61 and 5.97±6.7, respectively. Conclusions MicroPure scanning is a hopeful ultrasound tool that might enhance the sensitivity for diagnosis clustered microcalcifications which are not combined with breast mass on mammography.

Role of conservative breast surgery in locally advanced breast cancer after neoadjuvant chemotherapy

Background: Locally advanced breast cancer represents 20%-25% of breast cancer patients at diagnosis. The aim of this prospective study was to assess the feasibility and the oncologic outcome in the treatment of patients of locally advanced breast cancer that had been downstaged by neoadjuvant chemotherapy to the extent that makes them eligible for conservative breast surgery.Methods: This prospective study was done on 50 female patients who were diagnosed with locally advanced breast cancer and received neoadjuvant chemotherapy to downstage cancer making it eligible for conservation, managed and treated at El Menoufia University Hospital and Tanta Cancer Center from March 2017 to March 2018 after applying inclusion and exclusion criteria. The collected data were organized, tabulated and statistically analyzed using SPSS software.Results: Significant difference between pre and post-chemotherapy tumor size in patients with locally advanced breast cancer. Conservative breast surgery with intraoperative frozen section assured free margins in all of them with acceptable cosmetic outcome. No local recurrence recorded after one year of follow up.Conclusions: In the present study, it was observed that conventional neoadjuvant chemotherapy is effective in downgrading the tumor size and axillary lymph nodes in patients with locally advanced breast cancer. Breast conservation after neoadjuvant chemotherapy is safe in terms of local recurrence.

Obstacles' And Facilitators Facing Safe Administration Of Chemotherapy by Oncology Nurses

Aim of the study : This study aimed to determine obstacles' and facilitators facing safe administration of chemotherapy by oncology nursing staff .  Material and methods : Study design: descriptive study design (qualitative) was used . Setting: the study was conducted at Tanta cancer center affiliated to Ministry of Health at El Garbeia Governorate Egypt. Sample: All (55) nurses working in oncology medical department at Tanta cancer center and administer chemotherapy. Tools: five tools  was used to conduct this study . Tool one :  Structured interview questionnaire: It was developed by the research after review of related literature. It was consisted of two parts : First part: Socio-demographic characteristics of oncology nurses and Second part: Level of knowledge needed about cytotoxic chemotherapy) by nurses .The total responses was summed up and classified into three levels,  high ,moderate &Low .  Tool Two Obstacles' facing nurses for safe administration of hazardous drug. It was developed by the researchers in Arabic & consisted of 13 open ended questions.Tool Three: : Modified Nurses attitude toward safe administration of hazardous drug for cancer patients (chemotherapy) questionnaire . It was adapted and translated into Arabic by the researchers. It was consisted of 18 items & included both positive and negative item statements  Tool Four: Modified Nurses anxiety and fear to administer hazardous drug for cancer patient questionnaires.It was adapted and translated into Arabic by the researchers. It consists of 18 items, the responses were 4 response Statements .Total anxiety scores: divided into three levels high , moderate and low according to scores ..Tool Five : Facilitators' of safe administration of hazardous drugs (cytotoxic chemotherapy : It was developed by the researchers in Arabic after review of related literature. It consisted of 13 open ended questions.Method : 1. Permission was obtained from head of oncology department at main Tanta University Hospital .2. Ten experts in the field of oncology, five oncology experts affiliated to Faculty of Medicine Tanta University and five nurses revised the tool for content validity. 3. Each nurses interviewed individually and participated to fulfill the questions in the five tools. 4. Ethical considerations: Consent was obtained from nurses after explanation of the research study aims and content. Confidentiality of data was ensured using code number instead of their names and withdrawal from the study was reserved. 5. Pilot study was carried out on 10% of the study sample 10 nurses  working in outpatient clinics and administer chemotherapy and not included in the sample to test tool feasibility and applicability and the required modification was done.  Results :Oncology nurses age was from 21-55 and have years of experiences from 0-30 year and more than two third of them married with deplume of secondary school level of education with no training courses about safe chemotherapy administration. Obstacles' for safe chemotherapy administration as perceived by nurses working in oncology department and administer chemotherapy according to priority ranking related to patient and as well as nurses were the first priority  while the last priority was related to hospital system of care delivery. Nurses attitude affect their behaviors to administer chemotherapy safely since slightly more than half 52% of nurses working in oncology had positive attitude toward safe administration of chemotherapy needed high level of knowledge and more than two third 76.36 % had moderate level of anxiety respectively and the more oncology nurses had positive attitude and more than two third 70.9% expressed they are in need to increased knowledge to be at high level the more they feel higher anxiety level to administer chemotherapy safely .Also facilitators for according to priority ranking, environmental factors especially quite wide space with sufficient illumination were the first priority followed by time of the shift and the last priority facilitors was hospital system .Conclusion and Recommendation Recommendations : Strategies to improve medication safety also need to be targeted at  specific multiple points in addition to oncology nurses attitudes and feelings toward safe chemotherapy administration which in respect shaping their behavior of cancer patients' care.

Effect of a Clinical Pathway on Outcome of Children with Cancer Suffering from Neutropenia Undergoing Chemotherapy Treatment

The child suffering from neutropenia undergoing chemotherapy is demanding and requiring the integration of skills from numerous different specialties. These children often have prolonged hospitalizations, which may be marked by many complications. The aim of this study to design, implement and evaluate the effect of a clinical pathway for children with neutropenia undergoing chemotherapy.Quasi experimental research design was used. The study was carried out at Tanta Cancer Center Affiliated to the Ministry of Health. Out patient Clinic of Oncology and Inpatient Pediatric Oncology Department in Benha Children Hospital. 72 children with neutropenia undergoing chemotherapy was recruited for the study. Four tools were used for data collection, questionnaire sheet, Nutritional Assessment Sheets, Complication monitor sheet and follow pathway design for the study group. The result of the study revealed that there was no statistically significant difference between the study and control groups on admission but there was a statistically significant difference between the study and control groups after the implementation of the clinical pathway for the study group compared with the routine hospital policy care. Conclusion: Children with neutropenia undergoing chemotherapy to whom clinical pathway was applied fewer complications, less hospital stay and less readmission than those who received routine hospital care. Recommendations: Clinical pathway should be integrated into the routine nursing care for children with neutropenia undergoing chemotherapy.

Reliability of medical records in diagnosing inflammatory breast cancer in Egypt

BackgroundInflammatory breast cancer (IBC) is a rare, aggressive breast cancer diagnosed clinically by the presence of diffuse erythema, peau d’orange, and edema that arise quickly in the affected breast. This study evaluated the validity of medical records in Gharbiah, Egypt in identifying clinical signs/symptoms of IBC. For 34 IBC cases enrolled in a case–control study at the Gharbiah Cancer Society and Tanta Cancer Center, Egypt (2009–2010), we compared signs/symptoms of IBC noted in medical records to those recorded on a standardized form at the time of IBC diagnosis by clinicians participating in the case–control study. We calculated the sensitivity and specificity of medical records as compared to the case–control study for recording these signs/symptoms. We also performed McNemar’s tests.ResultsIn the case–control study, 32 (94.1%) IBC cases presented with peau d’orange, 30 (88.2%) with erythema, and 31 (91.2%) with edema. The sensitivities of the medical records as compared to the case–control study were 0.8, 0.5, and 0.2 for peau d’orange, erythema, and edema, respectively. Corresponding specificities were 1.0, 0.5, and 1.0. p values for McNemar’s test were <0.05 for all signs. Medical records had data on the extent and duration of signs for at most 27% of cases for which this information was recorded in the case–control study. Twenty-three of the 34 cases (67.6%) had confirmed diagnosis of IBC in their medical records.ConclusionMedical records lacked information on signs/symptoms of IBC, especially erythema and edema, when compared to the case–control study. Deficient medical records could have implications for diagnosis and treatment of IBC and proper documentation of cases in cancer registries.

Abstract 5590: Reliability of medical records in diagnosing inflammatory breast cancer in Egypt

Abstract Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer characterized by diffuse erythema and edema (peau d’orange) of the skin of the breast. It does not include neglected locally advanced cancer of the breast presenting late in the course of the disease. IBC is primarily a clinical diagnosis, but also requires pathologic confirmation of breast cancer. The purpose of this study was to examine the reliability of medical records for diagnosing IBC in patients at two centers in Tanta, Egypt (Gharbiah Cancer Society and Tanta Cancer Center) which participated in an epidemiologic case-case study of IBC and non-IBC in 2009-2010. IBC patients were recruited to the case-case study at diagnosis based on clinical examination; detailed information on the extent and duration of signs used for the diagnosis of IBC was recorded. Information on signs of IBC similar to those collected in the case-case study was abstracted from the medical records of the hospitals where case-case study patients were recruited during the same time period, then linked and compared to the signs observed from clinical examination for the case-case study. A total of 40 IBC cases were recruited into the case-case study during 2009-2010. Medical record information was available for 31 of these cases. Twenty-eight of these 31 cases were reported to have erythema and 28 edema/peau d’orange based on the clinical examination for the case-case study. Of those with erythema, 16 (57.1%) also had erythema/inflammation listed in the medical record; of those with edema/peau d’orange, 23 (82.1%) had this mentioned in the medical record. Erythema was noted on the medical record but not recorded in the case-case study for 2 cases; there were no cases in which edema/peau d’orange was present in the medical record and not in the case-case study. Our analysis indicates that medical records at these cancer centers often have missing information regarding the presence of signs that are necessary to the diagnosis of IBC. Overall, this study suggests that medical record review is not sufficient to identify IBC cases for an epidemiologic study. Citation Format: Lynne Le, Catherine Schairer, Ahmed Hablas, Mohamed Ramadan, Sofia Merajver, Ibrahim Seifeldein, Amr Soliman. Reliability of medical records in diagnosing inflammatory breast cancer in Egypt. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5590. doi:10.1158/1538-7445.AM2015-5590

Untreated hepatocellular carcinoma in Egypt: outcome and prognostic factors.

BackgroundHepatocellular carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis C and B, alcohol and aflatoxins being the commonest risk factors.AimThe objective of this study was to assess the prognostic factors affecting overall survival (OS) of untreated HCC in Egypt.MethodsThis retrospective study was conducted at Tanta Cancer Center, Egypt where 288 HCC cases who received no specific therapy and were followed-up until death were identified. The impact of possible prognostic factors on OS was assessed using the log-rank test (univariate analyses) and Cox regression method (multivariate analysis).ResultsThe median OS of untreated HCC was 2.3 months (95% confidence interval: 1.9–2.6). The 1, 3, 6, 12, 24 months OS rates were 84%, 42%, 21%, 9%, and 3%, respectively. All cases had died by 46 months. Male sex, advanced Child-Pugh class, the clinical presentation of ascites, cough, fatigue, and the presence of metastases were associated with poor survival (P<0.05 for all). In multivariate analysis; cough, presence of ascites, and Child-Pugh class were independent predictors of poor survival.ConclusionOS in untreated HCC in Egypt is very short. Many factors interact to produce this dismal survival.

Gastric carcinoma at Tanta Cancer Center: A comparative retrospective clinico-pathological study of the elderly versus the non-elderly

Background and aimsTo study the clinico-pathological features, treatments and outcomes of gastric carcinoma (GC) in the elderly (⩾65years) and the non-elderly Egyptian patients. MethodsThis retrospective cohort study included 168 patients with histologically confirmed GC treated at Tanta Cancer Center between 2003 and 2007. ResultsCompared to the non-elderly, elderly patients had significantly higher proportion of tumors involving the cardia (p=0.034) and of adenocarcinoma NOS histology (p=0.032). Treatments were largely comparable in the two groups. Response to palliative chemotherapy was achieved in 44.4% of the elderly and 25.5% of the non-elderly patients (p=0.417). The median overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were 6, 17 and 3months, respectively. The median OS was 4months in the elderly compared to 9months in the non-elderly (p=0.005). The median DFS was 4months in the elderly compared to 20months in the non-elderly (p=0.004). The median PFS was 2months in the elderly compared to 3months in the non-elderly (p=0.685). In multivariate analysis, poor performance status was an independent predictor of poor OS, DFS and PFS. Non-curative or no surgery and lack of chemotherapy use were independent predictors of poor OS. Age was an independent predictor of poor DFS. ConclusionsCompared to the non-elderly, GC in the elderly has similar clinico-pathological characteristics and exhibits comparable outcomes with the same treatment options. Treatments should be tailored to each patient.

Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study

BackgroundHepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit. ObjectiveTo study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC. MethodsThis retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC. ResultsThe median OS in the tamoxifen group was 9.3months (95% confidence interval [CI], 6.7–11.9months) compared to 8.7months (95%CI, 6.8–10.6) in the BSC group (p=0.758). With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts. Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS. Tamoxifen produced partial response and clinical stabilization in one% and 16% of cases, respectively. The median PFS with tamoxifen was 7.2months (95%CI, 5.2–9.5). ConclusionsTamoxifen did not show any OS advantage in Egyptian patients with advanced HCC. Use of this drug is discouraged.

Primary gastrointestinal lymphoma in an Egyptian district: A study using a population-based cancer registry

IntroductionGastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin’s lymphoma (NHL) with geographical and age variation of its various subtypes. AimTo study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival. MethodsThis is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC). ResultsGIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14months (95% CI, 13.2–48.7 and 6.4–21.6months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes. ConclusionsGILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.

Small intestinal cancers among adults in an Egyptian district: A clinicopathological study using a population-based cancer registry

BackgroundSmall intestinal cancers (SICs) are very rare all over the world and little is known about them in Egypt. MethodsThis a retrospective study. Between 2000 and 2002, 30 cases with SICs were identified in the Gharbiah population based cancer registry (GPBCR); 17 cases of whom were treated at Tanta Cancer Center (TCC). ResultsThe median age was 51years with female predominance. The duodenum was the commonest site (43%) followed by the ileum then the jejunum. Adenocarcinoma (AC), carcinoids, gastrointestinal stromal tumors (GISTs), lymphoma and sarcoma represented 50%, 10%, 17%, 13% and 10% respectively. Abdominal pain was the commonest symptom and localized disease was the commonest presentation. Surgery, chemotherapy and radiotherapy were employed in 65%, 35% and 0% of patients, respectively. The median overall survival and progression free survival (OS, PFS) were 18 and 15months (95% CI: 10.4–25.6 and 3.6–26.4), respectively. AC had inferior OS and PFS to other histologies (p=0.08 and 0.12, respectively). Also, duodenum subsite was inferior in OS and PFS to other sites (p=0.25 and 0.35, respectively). ConclusionsSICs in Gharbiah, Egypt are characterized by predominance of female gender and adenocarcinoma histology. One year survival is 64% with a poor outcome for adenocarcinoma and duodenal subsite.

Colorectal carcinoma in gharbiah district, Egypt: Comparison between the elderly and non-elderly

Objective: This work was conducted to study colorectal carcinoma (CRC) in Gharbiah district, Egypt and to verify the effect of age on the treatments and their outcomes. Methods: B etween 2000 and 2002, 293 cases with CRC were identified in the Gharbiah population based cancer registry (GPBCR); 159 of whom were treated at Tanta Cancer Center (TCC). Patients were grouped into elderly and non-elderly ( ≥ and < 65 years, respectively). Results: CRC was the 6th cancer in Egypt, representing 4% of the total cancers and 53% of GIT cancers. The median age was 53 years with male predominance. Colon cancers were more common than rectal cancers. Most patients had tumors that were localized, low grade and adenocarcinoma (AC). Constipation, abdominal pains and bleeding per rectum were the commonest complaints. Surgery, radiotherapy and chemotherapy were adopted in 84, 28 and 72% of patients, respectively. The median OS and PFS were 23 and 25 months (95%CI: 17-29 and 11.8-18.2), respectively. Compared to non-elderly, elderly patients were more likely to have rectal tumors, non-AC histology, non-metastatic disease; more comorbidities were less likely to receive chemotherapy particularly in the adjuvant setting ( P < 0.05 for all). The OS and PFS of elderly patients were not statistically different from the non-elderly. Conclusions: Within the limits of this retrospective trial, elderly patients with CRC tend to have more rectal and non-metastatic cancers. They were more likely to have comorbidities and less likely to receive chemotherapy. However, the OS and DFS were comparable to non-elderly.

Hepatitis C virus and other risk factors in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) increased in Egypt in the past years, becoming the most common cancer among men. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the known primary risk factors for HCC. This study describes the viral profile of HCC in a predominantly rural area in Egypt. We included 148 HCC cases and 148 controls from the Tanta Cancer Center and the Gharbiah Cancer Society in the Nile delta region. Serological (ELISA) and molecular (PCR) analysis for HBV and HCV infection were performed on plasma samples from each subject. Epidemiologic, environmental, and medical histories were collected by interviewing of subjects. Around 90.5% of cases and controls were from rural areas. HCV infection was high in both cases and controls (89.2% and 49.3%, for cases and controls respectively by serology). HCV was the most important HCC risk factor [OR 9.7 (95% CI: 3.3-28.0, P <0.01)], and HBV infection showed marginal tendency of increased risk [OR 5.4 (95% CI: 0.9-31.8, P <0.06)]. Ever worked in farming [OR 2.8 (95% CI: 1.1-7.2, P <0.03)] and history of cirrhosis [OR 3.6 (95% CI: 1.6-8.1, P <0.01)] or blood transfusion [OR 4.2 (95% CI: 0.99-17.8, P <0.05)] were also associated with increased HCC risk. This study in a predominantly rural area in Egypt supports previous reports from other parts of Egypt that HCV infection is the primary HCC risk factor in Egypt. Further understanding of the relationship between infection and other risk factors in the development of HCC could lead to targeted interventions for at-risk individuals. hepatocellular carcinoma; hepatitis; rural; risk factors; Egypt.

Evaluation of genotoxicity induced by exposure to antineoplastic drugs in lymphocytes of oncology nurses and pharmacists

The hazards of handling antineoplastic drugs have been raised and discussed in several studies. Introduction of new antineoplastics together with abuse of safety standards have contributed to the exposure risk for personnel who handle these substances. Interactions of antineoplastic drugs with biological structures vary according to the drug(s) and the individual's genetic susceptibility. This study was carried out to evaluate the genome damage induced by exposure to antineoplastic drugs in nurses (n = 20) and pharmacists (n = 18) working in the Oncology Department of Tanta Cancer Center. Thirty subjects matched in age, gender and smoking habit were selected as controls. Both chromosomal aberration analysis and micronucleus assay were used to evaluate genome damage in peripheral blood lymphocytes of the study subjects. The numbers of aberrant lymphocytes, as well as chromosomal aberration and micronuclei frequencies, were significantly increased in exposed personnel in comparison to matched controls. Compared with pharmacists, nurses showed notably higher level of chromosome damage. On the other hand, no significant difference in micronuclei frequency was observed between nurses and pharmacists. Correlation analyses pointed to the influence of age and duration of occupational exposure on the level of chromosome damage among exposed subjects. The results of this study confirmed that handling antineoplastic drugs without appropriate precautions imposed a genotoxic risk for exposed healthcare workers. These results address the need for regular biomonitoring of exposed personnel. In addition, they call attention to the need for proper implementation of intervention measures aiming to eliminate or significantly reduce worker exposure and prevent untoward biological effects.

Patterns of seeking medical care among Egyptian breast cancer patients: Relationship to late-stage presentation

Breast cancer is the most common cancer among Egyptian women, accounting for 37.6% of female tumors, and is often diagnosed at later stages. The objective of this study was to investigate breast cancer patient navigation through the health care system in the Nile Delta. Interviews were conducted with 163 newly diagnosed breast cancer patients at the Tanta Cancer Center (TCC), the major cancer center of the region. Patients described their medical care pathway from the initial symptom experienced until their arrival at TCC. Patients whose initial contact was with a general surgeon (OR: 7.6, 95% CI: 2.1, 27.6), primary care provider (OR: 12.2, 95% CI: 2.9, 51.0), or gynecologist (OR: 8.6, 95% CI: 1.4, 53.4) were significantly more likely to experience a delay in reaching the TCC as compared to those visiting a surgical oncologist. Overcoming health care system and patient navigation barriers in developing countries may reduce the time for breast cancer patients to reach a cancer center for early management.