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Journal Issue: Vol. 13, No. 2 - April 2014

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The Role of Insulin like Growth Factor-1 (IGF-1) in the Diagnosis of Colorectal Carcinoma. A Case Control Study

Dr. Iman Ramzy, Dr. Iman Hamza, Dr Dina Hamza, Dr Adel Aref, Dr Amira Hassouna, Dr Sameh Nabil

  1. Dr. Iman Ramzy
    Endemic Medicine Department, Cairo University, Egypt.
  2. Dr. Iman Hamza
    Endemic Medicine Department, Cairo University, Egypt.
  3. Dr Dina Hamza
    Oncology Department, Dubai Hospital, United Arab Emirates.
  4. Dr Adel Aref
    Oncology Department, Dubai Hospital, United Arab Emirates.
  5. Dr Amira Hassouna
    Medical Biochemistry and Molecular Biology Department, Cairo University, Egypt.
  6. Dr Sameh Nabil
    Internal Medicine Department, Helwan University Hospital.

BACKGROUND: IGF is a potent mitogen for normal and neoplastic cells. High plasma IGF and low IGF binding protein-3 (IGFBP-3) levels are associated with greater risk of breast cancer in pre-menopausal women, and colorectal cancer in men and women. Several prospective studies have shown a moderate positive association between increasing circulating insulin-like growth factor-I (IGF-I) levels and colorectal cancer risk. A number of prospective studies showed evidence that the (IGF) axis may be important in the development of colorectal cancer. This is a case control study that studies the relationship between insulin like growth factor-1 in serum and colorectal cancer among Egyptian patients. METHODS: This study included 68 patients (40 proved colorectal cancer patients and 28 volunteers with no endoscopic evidence of colorectal cancer). Serum IGF-1 was measured in both groups using enzyme-linked immunosorbent assay (ELISA). RESULTS: Circulating IGF-1 significantly increased in patients with colorectal cancer than controls. IGF-1 showed the highest diagnostic performance at cut off value of 208.5 ng/ml (area under ROC curve = 1, p = <0.01) at which sensitivity is 100% and specificity is 100%. CONCLUSION: The results of this study suggest a positive correlation between the increased levels of IGF-1 and colon cancer and are thus consistent with the hypothesis that the level of IGF-1 plays an important role in the development of colon cancer.


Perception of the Cancer Patients on Doctors’ Ability in Breaking Bad News – the Indigenous Adult Cancer Patients’ Perspective in Sarawak, Malaysia

Dr. Thon Chang Ching, Dr Cheah WL, Dr. Mathew GB

  1. Dr. Thon Chang Ching
    Department of Nursing, Faculty of Medicine & Health Sciences, UNIMAS.
  2. Dr Cheah WL
    Department of Community Medicine & Public Health, Faculty of Medicine & Health Sciences, UNIMAS.
  3. Dr. Mathew GB
    Department of Community Medicine & Public Health, Faculty of Medicine & Health Sciences, UNIMAS.

Background and Objectives: Delivering of bad news is an important component of cancer management that can cause long lasting devastating effects for patients and their families if done badly. Materials: This cross-sectional study was conducted among adult cancer patients in indigenous people in a rural community in Sarawak to assess the perceptions of their doctors’ ability in breaking of bad news of their diagnosis. Using snowball sampling method, patients was interviewed face-to-face using The Breaking Bad News Assessment Schedule (BAS). Data was entered and analyzed using SPSS version 19. Results: A total of 61 patients were recruited with majority were female (51.4%), mean age of 52.2 ± 8.0 years. More than half of them suffered from the nasopharynx (52.5%) cancer and 39.3% were in stage 4 of their disease. Mean score for the overall BAS questionnaire was 71.7 ± 14.85 with only 49.2% graded their doctors’ ability on breaking news as “pass” and “outstanding”. The top two questions (reflecting ability) that the respondents perceived as lacking in their doctors were the “use of appropriate body language during interview” (mean= 2.4±1.20), and “management of time available” (mean =2.7 ± 1.05). Conclusion: Structured training and standard protocol should be provided to help doctors to handle breaking of bad news more efficiently, which in return would help the patients to cope better.


Parameningeal Rhabdomyosarcoma: Single Institution Retrospective Study

Dr. Guruprasad B, Dr Suresh Babu, Dr. Tanvir Pasha, Dr Sandip Ganguly, Dr Kavitha Srivatsa, Dr Padma M, Dr Aruna Kumari B.S., Dr Appaji L.

  1. Dr. Guruprasad B
    MD (General Medicine)
    Post Graduate, Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.rn
  2. Dr Suresh Babu
    DM (Medical Oncology)
    Asst. Professor, Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  3. Dr. Tanvir Pasha
    MD (Radiation Oncology)
    Asst. Professor, Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  4. Dr Sandip Ganguly
    MD (General Medicine)
    Post Graduate, Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  5. Dr Kavitha Srivatsa
    Asst. Professor, Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  6. Dr Padma M
    Assoc. Professor, Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  7. Dr Aruna Kumari B.S.
    DM (Paediatric Oncology)
    Professor, Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.
  8. Dr Appaji L.
    DM (Paediatric Oncology)
    Professor & Head, Department of Paediatric Oncology Kidwai Memorial Institute of Oncology, Kidwai Memorial Institute of Oncology, DR MH Marigowda Road, Bangalore, Karnataka, 560029, India.

Background: Parameningeal RMS (PM-RMS) has distinctive clinical features, management and prognosis compared to RMS of other site. There is dearth of studies regarding the management and outcome of these tumors in Indian setting. Hence we conducted the present study. Material and methods: A five year retrospective study of PM-RMS diagnosed and treated at our centre was conducted. Fourteen patients with pathologically proven diagnosis were analyzed. These patients were staged based on IRS-TNM staging system and were treated using chemotherapy (IRS-IV protocol) and radiotherapy. Upfront radiotherapy was given for high risk patients. These patients were analyzed for event free survival, and their outcomes were correlated with histology, therapy, and stage of disease. Results: The median age of presentation was 4 years. Majority of patients presented with proptosis and stage III/IV disease. Positive cytology in CSF was the commonest site of metastasis. Embryonal histology was the common subtype. The mean dose of radiotherapy received was 54Gy/30# over 5-6 wks. Seven patients were disease free at median follow up of 30 months with the 3 year event free survival of 66.66% and 20% in non-metastatic and metastatic disease respectively. Favourable prognosis was also seen with embryonal and botryoid histology. Conclusion: Childhood PM-RMS presents with management challenges to both pediatric oncologist and radiation oncologist. These commonly present with proptosis and advanced stage in our scenario. Embryonal subtype is the commonest histology. Up front radiotherapy should be initiated in high risk group. Stage of disease and histology define prognosis.


First Line Treatment in Metastatic, EGFR Wild NSCLC, What We Know and What We Need to Know More. A Medicalsurveys-17 Research Group Review of Literature

Dr. Adel Aref, Dr Emad Dawoud, Dr. Dina Hamza, Dr Reham Fayed

  1. Dr. Adel Aref
    MSc. Clinical Oncology
    MedicalSurvey-17 Research Group Team Leader, Medical Oncology specialist, Dubai Hospital, Dubai, UAE.
  2. Dr Emad Dawoud
    PhD, Clinical Oncology
    MedicalSurveys-17 Research Group Member, Lecturer of Clinical Oncology , Al Azhar University, Cairo, Egypt.
  3. Dr. Dina Hamza
    MSc. Clinical Oncology
    MedicalSurveys-17 Research Group Scientific Coordinator, Medical Oncology specialist, Dubai Hospital, Dubai, UAE.
  4. Dr Reham Fayed
    MSc. Clinical Oncology
    MedicalSurveys-17 Research Group Scientific Coordinator, Medical Oncology specialist, Egypt Air Hospital, Cairo, Egypt.

Options of treatment in wild type EGFR, metastatic NSCL, is multiple but not clear. In this review article, we (MedicalSurveys-17 Research Group) try to review the data we have and highlight the points that need clarifications. From this review of literature, we can go to the conclusion that more trials and more data are needed to detect the optimal dose of bevacizumab, the best combination with bevacizumab as well as to clarify the actual activity of bevacizumab in maintenance treatment. The impact of combination of bevacizumab and pemetrexed in maintenance setting is not yet clear and the best regimen need to be known. We are in need to stratify patients for maintenance therapy. Taking in consideration the cost and toxicity burden of the treatment, the choice between continuation, switch or no maintenance need to be known based on the patient criteria, response to treatment as well the agent used.


Female Genital Cancer in Basrah, Iraq between 2005 – 2009

Dr. Maysoon Sharief, Dr Zainab Tahir Al-Timimy, Dr. Jasim Mohammad Al-Diab

  1. Dr. Maysoon Sharief
    D.O.G., C.A.B.O.G.
    Department of Gynecology & Obstetrics, College of Medicine, University of Basrah, Basrah, IRAQ.
  2. Dr Zainab Tahir Al-Timimy
    D.O.G.
    Department of Gynecology & Obstetrics, College of Medicine, University of Basrah, Basrah, IRAQ.
  3. Dr. Jasim Mohammad Al-Diab
    I.B.M.S.
    Department of Pathology, College of Medicine, University of Basrah, Basrah, IRAQ.

Objective: To determine the incidence of genital cancer among women in Basrah during 2005-2009 in comparison to previous incidence 10 years ago. Patients and Methods: Analysis of all new cases of cancer which were diagnosed by histopathologist in Basrah, Iraq during 2005-2009 and registered in the Oncology Center, Cancer Registration Section in the Department of Pathology and Cancer Control Center in Southern Iraq. Results: The highest incidence rate of genital cancer was observed during 2008. Ovarian tumour was the highest and commonest type of genital tumour (172 cases) followed by cervical cancer (108 cases) and the least determined incidence was the secondaries metastases during the period of study. Cervical cancer was higher at age group 45-49 years (15/100000), while both endometrial and ovarian cancers were higher at age group 65-69 years (33.4/100000 and 19/100000 respectively). Epithelial tumour composed the largest group of ovarian cancer (116 cases), germ cell tumour accounted for 36 cases while sex cord tumour 15 only. Conclustion: A remarkable decline can be seen in the incidence of all types of genital tumour during 2005-2009 in comparison with incidence between 1987-2000.


Synchronous Solitary Colon Metastasis from Gastric Signet Ring Adenocarcinoma; A Case Report.

Dr. Emad Dawoud, Dr Dalia El shourbagy, Dina Hamza, Adel Aref

  1. Dr. Emad Dawoud
    MD, PhD.
    Lecturer of Clinical Oncology, Al Azhar University, Egypt.rnrnMedical Oncology Department, Dubai Hospital, UAE.
  2. Dr Dalia El shourbagy
    MD, PhD.
    Medical Oncology Department, Dubai Hospital, UAE.
  3. Dina Hamza
    MSc.
    Medical Oncology Department, Dubai Hospital, UAE.
  4. Adel Aref
    MSc.
    Medical Oncology Department, Dubai Hospital, UAE.

Background Gastric cancer is one of the most common malignancies in the world and is the second most common cause of cancer-related death in Asian countries. Colorectal metastases from gastric adenocarcinoma are known to be very rare. To the best of our knowledge, there are less than 25 published case reports of metastatic gastric adenocarcinoma to the colon and rectum.. We present here what is to the best of our knowledge, a rare case of synchronous solitary colonic metastasis from gastric signet ring adenocarcinoma. Case presentation We report a case of a 43-year-old female patient with gastric cancer who first presented with epigastric pain. The endoscopic (figure 1) and radiologic findings were suggestive of advanced gastric cancer. Endoscopic biopsy (figure 2) confirmed the presence of signet ring adenocarcinoma, in the same time she developed bleeding per rectum that was investigated by PET/C-T scan (figure 3) that revealed increased FDG uptake in the coecum, subsequently colonoscopy(figure 4) was done and it revealed the presence of a coecal mass and biopsy was confirmed the presence of metastatic signet ring adenocarcinoma (figure 5) similar to the primary gastric signet ring adenocarcinoma which was confirmed by immunohistochemistry. Conclusion Synchronous colon metastasis from gastric cancer is known to be very rare. However, metastatic gastric adenocarcinoma should be considered as a differential diagnosis for patients presenting with a colorectal mass and history of gastric cancer. Even though it is very rare, signet ring adenocarcinoma of the stomach can metastasize to the colon. This unique case of a solitary colon metastasis from gastric adenocarcinoma has particular interest in medicine, especially for the specialties of surgical oncology, pathology, gastroenterology and medical oncology.


Bilateral Testicular Metastasis from Prostate Cancer: A Rare Case of Isolated Recurrence Mimicking Intratubular Seminoma

Dr. Deepti Gupta, Dr Shefali Agarwal, Dr. Nupur Trivedi, Dr Anjali Tewari, Dr Vikash Jhunjhunwala

  1. Dr. Deepti Gupta
    M.D, D. N. B (Pathology)
    Consultant Pathologist, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India.
  2. Dr Shefali Agarwal
    Diploma Pathology
    Consultant Pathologist, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India.
  3. Dr. Nupur Trivedi
    M.D. Pathology
    Consultant Pathologist, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India.
  4. Dr Anjali Tewari
    M.D. Pathology
    Consultant Pathologist, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India.
  5. Dr Vikash Jhunjhunwala
    MCH Urology
    Consultant Urosurgeon, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India.

Prostatic adenocarcinoma is the commonest malignancy afflicting the adult male population. Despite the high incidence of prostatic adenocarcinoma and its ability for wide dissemination, metastatic involvement of testis is rare. It is detected incidentally in the orchidectomy specimens. The pattern of metastasis may mimic a primary neoplasm of testis like seminoma (intertubular or intratubular type) or lymphoma and pose a diagnostic difficulty for the pathologist. Herein, we present an unusual case of metastatic prostate adenocarcinoma to bilateral testes, diagnosed on histopathology following a radical orchidectomy for hormone ablation.


An Unusual Case of Refractory Seizure Disorder; An Insight into the Cause of Delayed Presentation of Functional Insulinoma

Dr. Attili Suresh V S, Dr Mudhasir Ahmad, Dr. Chinnababu Sunkavalli, Dr Siddhartha , Dr Ravi Shankar

  1. Dr. Attili Suresh V S
    MD, DM
    Department of Medical Oncology, Apollo Hospitals, Hyderabad.
  2. Dr Mudhasir Ahmad
    MD
    Department of Medical Oncology, Apollo Hospitals, Hyderabad.
  3. Dr. Chinnababu Sunkavalli
    MS, MCh
    Department of Medical Oncology, Apollo Hospitals, Hyderabad.
  4. Dr Siddhartha
    MS
    Department of Surgical Oncology, Apollo Hospitals, Hyderabad.
  5. Dr Ravi Shankar
    MRCP
    Department of Endocrinology, Apollo Hospitals, Hyderabad.

Insulinoma is an uncommon tumor and may be misdiagnosed as a primary psychiatric or neurologic disorder. We describe a case of an Insulinoma initially seen as refractory late-onset epilepsy. The Insulinoma was confirmed biochemically and radiologically, with subsequent surgical excision. Many such cases have been reported so far. We present an insight into the potential cause of this delay in diagnosis and a potential role of medical therapy in patients unfit for surgery.


Pelvic Lymph Node Dissection in Prostate Cancer: Indication, Extent, and Therapeutic Role in the Contemporary Era

Dr. Kwang Hyun Kim, Dr Sung Joon Hong, Dr. Koon Ho Rha

  1. Dr. Kwang Hyun Kim
    Department of Urology, Ewha Womans University Mokdong Hospital.rnDepartment of Urology, Urologic Science Institute, Yonsei University College of Medicine.
  2. Dr Sung Joon Hong
    Department of Urology, Urologic Science Institute, Yonsei University College of Medicine
  3. Dr. Koon Ho Rha
    Department of Urology, Urologic Science Institute, Yonsei University College of Medicine

Recently, fewer pelvic lymph node dissections (PLNDs) have been performed in the treatment of prostate cancer; this decrease may be attributable to stage migration and an increased use of minimal invasive surgery. Nevertheless, PLND remains the most accurate methods for detecting lymph node metastasis; furthermore, patients with lymph node metastasis who undergo PLND demonstrate favorable long term outcomes. The decision to perform PLND is based on a predictive model. Current models rely upon various nomograms which originate from an extended series of PLNDs. Although recent imaging modalities have demonstrated improved diagnostic accuracy, PLND should not be omitted in patients showing negative results in image studies. To assess the adequacy of PLND, anatomical templates are more important than total lymph node counts. It is generally agreed that PLND should be performed in patients with risk of lymph node metastasis using extended templates; these templates include not only the external iliac and obturator area, but also the internal iliac area. Despite improved staging accuracy, removing lymphatic tissue from the presacral area may affect functional outcomes after surgery. Primary lymphatic landing sites also include the common iliac area, which can be a route to the retroperitoneal lymph nodes. A growing body of evidence suggests that PLND improves oncologic outcomes, and a recent randomized controlled trial demonstrated that PLND improves biochemical outcomes in patients with intermediate and high risk prostate cancer. The long term oncologic outcomes of PLND treatment should be investigated in further studies.


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