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Journal Issue: Vol.10, No.4 - October 2011

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Lymph Node Metastases in Oral Cancer: Clinical Implication of the Vascular Endothelial Growth Factor-C Expression by Malignant Cells

Dr Denise Tostes Oliveira, Dr Simone Eloiza Sita Faustino, Dr Maria Jaquelini Dias dos Santos, Dr Suely Nonogaki, Dr Gilles Landman, Dr Luiz Paulo Kowalski

  1. Dr Denise Tostes Oliveira
    Bauru School of Dentistry, Pathology Division of the Stomatology Department,
  2. Dr Simone Eloiza Sita Faustino
    Department of Stomatology, Area of Pathology, Bauru School of Dentistry - University of Sao Paulo,
  3. Dr Maria Jaquelini Dias dos Santos
    Department of Stomatology, Area of Pathology, Bauru School of Dentistry - University of Sao Paulo,
  4. Dr Suely Nonogaki
    Adolfo Lutz Institute, Patholofy Division,
  5. Dr Gilles Landman
    Department of Pathology, Cancer Hospital A. C. Camargo,
  6. Dr Luiz Paulo Kowalski
    Department of Head and Neck Surgery and Otorhinolaryngology, Cancer Hospital A. C. Camargo

The vascular endothelial growth factor-C (VEGF-C) overexpressed by malignant cells has been correlated to occurrence of lymph node metastases in patients with oral squamous cell carcinoma (OSCC). However, the lack of standardization of a microscopic evaluation of the VEGF-C expression in oral cancer that reflects more accurately the behavior of the tumor seems to be a factor that hinders the reproduction of some results in the literature. The objective of this study was to evaluate the different scoring systems used for microscopic analysis of immunohistochemical expression of VEGF-C by malignant cells and to establish a more reliable and reproducible methodology that enables contribute to the use of VEGF-C as an adjuvant in therapeutic strategy for adequate indication of the patients to the lymph node neck dissection, especially in early clinical stages of OSCC. Sixty four OSCC arising in the tongue or floor of mouth, clinically T1N0M0 and T2N0M0, with (pN+) and without (pN0) occult lymph node metastases were analyzed for VEGF-C immunoexpression using different methods of subjective scores. Chi-square test or Fisher’s exact test was used to analyze the association of VEGF-C expression with the clinical characteristics, treatment and outcome of the patients. No statistically significant association was observed among the VEGF-C expression by malignant cells, the clinical variables, the follow up informations and the occurrence of occult lymph node metastasis. These results reinforce that, regardless of the microscopic scoring system performed, the isolated immunoexpression of VEGF-C by malignant cells is not predictive factor for occurrence of occult lymph node metastases in early stages of OSCC.


New Approaches for Early Detection of Ulcerative Colitis (UC) Associated Cancer and Surgical Treatment of UC Patients

Dr Toshiaki Watanabe

  1. Dr Toshiaki Watanabe
    Department of Surgeryrn
    Teikyo University School of Medicine,

The number of ulcerative colitis (UC) patients in Japan has been increasing. Previous studies show colonoscopic surveillance to be useful for the early detection of UCassociated colorectal cancers. Recently, studies show that chromoendoscopy is useful for performing a targeted biopsy instead of a step biopsy to improve the efficacy of surveillance. Another approach to improve the efficacy of surveillance is to identify molecular markers for high-risk patients. A microarray analysis might be useful for the selection of highrisk patients. A prospective randomized controlled study is presently being conducted in Japan to compare the efficacy of a step biopsy and a target biopsy.


The Role of Chest Computed Tomography in Staging of Oropharngeal Cancer: A Systematice Review

Dr N.M.H. McLeod, Dr A Jess, Dr R Anand, Dr E Tilley, Dr B Higgins, Dr P.A Brennan

  1. Dr N.M.H. McLeod
    FDSRCSEd
    Department of Oral & Maxillofacial Surgery,
  2. Dr A Jess
    MFDS
    Department of Oral & Maxillofacial Surgery,
  3. Dr R Anand
    FRCS (OMF)
    Department of Oral & Maxillofacial Surgery,
  4. Dr E Tilley
    Department of Radiology,
  5. Dr B Higgins
    Department of Mathematics,
  6. Dr P.A Brennan
    MD
    Department of Oral & Maxillofacial Surgery,

Background: The prevalence of synchronous or metastatic tumours in patients with head and neck squamous cell carcinoma (HNSCC) ranges from 6-20 % and has implications for prognosis and management of the primary disease. There is no consensus about the role of CT chest prior to definitive treatment patients with HNSCC. Methods: A systematic review of all CT chest studies in relation to HNSCC was performed, together with a review of our local database. Results: 24 Studies were identified in addition to our local data. Prevalence of positive CT chest was 7.93 %. Patients were significantly more likely to have a positive CT chest with N2 or N3 neck disease (P=0.0062), stage III or IV disease (P=0.0001) and significantly less likely with tumours of the oral cavity (P=0.0007). Conclusions: We advocate CT chest as part of the initial investigations for patients with HNSCC.



Mammary Manifestations of Some Systemic Disorders

Prof Rasha M K Fouad

  1. Prof Rasha M K Fouad

A variety of benign and malignant pathologies affect the breast. These lesions may arise from the breast or from anatomically related tissues. Systemic disorders may infrequently affect the breast. Some of these lesions have characteristic mammography findings while others may mimic benign or malignant breast pathologies. These lesions pose a diagnostic challenge to clinicians and radiologists alike. In this review article, we will discuss the imaging features of some mammary lesions that are relevant to the clinical and pathologic presentations of some systemic disorders Awareness of the full clinical history and the characteristic imaging findings are the first step towards making a correct diagnosis. Diagnosis is usually confirmed after revision of pathology specimens.


Is Radiotherapy for Early Laryngeal Caner in Elderly a Safe and Effective Treatment Method

Dr Tomasz Skóra, Dr Bogumila Szyszka-Charewicz, Dr Katarzyna Pudelek, Dr Jan Skolyszewski

  1. Dr Tomasz Skóra
    M.D
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  2. Dr Bogumila Szyszka-Charewicz
    M.D
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  3. Dr Katarzyna Pudelek
    MD
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  4. Dr Jan Skolyszewski
    MD
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,

Purpose Evaluation of the results of radiotherapy in elderly patients with early laryngeal cancer, the relation between comorbidities and the overall treatment time, and the influence of treatment interruptions on the outcome of treatment. Materials and methods A clinical retrospective analysis of a group of 153 patients (≥70 years old) with laryngeal cancer stage I and II was carried out. Patients were irradiated between the years 1980 and 2005 in the Centre of Oncology in Cracow. The analysed group consisted of 134 men (88%) and 19 women (12%). Patients’ age ranged from 70 to 87 years, median – 74 years. Most of them had various comorbidities. Three different irradiation techniques and fractionation schemes were used according to the site, stage and grade of cancer: two oblique beams including the larynx with total dose of 60 Gy in 24 fractions (67 patients), two opposed parallel Cobalt 60 beams including the larynx and cervical lymph nodes with total dose of 60 Gy in 30 fractions (50 patients), and mixed photon-electron unilateral beam including the larynx with total dose of 60 Gy in 30 fractions (36 patients). Results The median follow-up was 52 months. During the followup period 105 patients (68.6%) died. Among them 31 patients (29,6%) died of laryngeal cancer, 13 (12,4%) patients of other malignancy, and 61 (58%) patients died of concomitant diseases without evidence of cancer. The actuarial 5/10-year overall survival (OS), disease specific survival (DSS) and local control (LC) were 48%/21% and 79%/72% and 75%/71% respectively. The overall tolerance of radiation therapy was good; only 6 patients had G3 early mucosal reaction, and 2 patient had G3 early skin reaction were observed. Comorbidities were not demonstrated to have statistically significant influence on DSS rate. In 10 (6,5%) from 153 patients complete tumor regression was not achieved after radiotherapy. During the follow-up period loco-regional relapse were observed in 31 patients (19,6%), and distant metastases in 4 patients (2,6%). Conclusions Radiotherapy of the elderly patients with laryngeal cancer is effective and well tolerated method. Comorbidities do not significantly influence the treatment results. T stage, age over 73 years, fractionation dose under 2 Gy and overall treatment time over 43 days are statistically significant negative prognostic factor for DSS rate.


'Who are our patients?' A Socio-Demographic Profile of Head and Neck Cancer Patients

Dr Anne Wilson, Mr H Holewa, Prof Pam McGrath

  1. Dr Anne Wilson
    c/- Social Work Department, Ground Floor, Building 1, Princess Alexandra Hospital, ,rnrn
  2. Mr H Holewa
    Research Associate, Institute of Health and Social Science, Central Queensland University,
  3. Prof Pam McGrath
    NH & MRC Senior Research Fellow, Director, International Program of Psycho-Social Health Researh (IPP-SHR), Griffith University

The purpose of this study was to address a significant need for baseline local, Australian specific sociodemographic data at the time of diagnosis for people presenting with head and neck cancer. The findings provide fresh insights that challenge the assumption with regards to the socio- economically challenged profile of head and neck patients. Also of significance, the socio-demographic profile deepens our understanding of the psychosocial impact of the disease on work and employment, especially for those of working age. All data was obtained through patient medical chart audit and retrospective analysis of psychosocial and demographic assessment interview practitioner notes on all new service users who completed that assessment (n=301) at or just prior to the point of first presentation at the Princess Alexandra Hospital, Brisbane, Australia Head and Neck Clinic in the calendar year 2008. Defined codes were developed through initial thematic analysis, team consensus and informed by current psychosocial health literature and health professionals working within the Clinic. Coded data was entered into SPSS to provide descriptive statistics such as frequency and percentage to provide a basis for analysis. With the exception of age and gender distribution, all other variables such as accommodation type, work and income, marital/partnered status and Indigenous representation reflected the Australian norm. Such comparisons were made across all subgroups (Advanced oral, pharyngeal, laryngeal cancer; other advanced cancer; non-advanced cancer; noncancer) and metropolitan/regional home address. The findings indicate the potential for psychosocial distress associated with a change in work and financial situation before treatment commences for many of those aged 64 years and under; an age group that constitutes 50.2% of the total cohort. Services need to be tailored towards persons who may be vulnerable to psychosocial distress and available in a form and at a time which suits their specific needs.


Therapeutic Relationships - Developing Partnerships in Diverse Settings.

Dr Karen Wright

  1. Dr Karen Wright
    Principal Lecturer
    School of Nursing & Caring Sciences, University of Central Lancashire, rn

The establishment of a positive therapeutic relationship (TR) has been widely acknowledged as an intrinsic part of therapy and caring services. The nature and purpose of therapeutic relationship is presented here in the context of contemporary theory which is critiqued in terms of its relevance in the context of ‘care’ rather than ‘therapy’. Assumptions about what constitutes a positive TR are considered in the light of the conflicting perspectives and the likely absence of previously accepted conditions of such a partnership/ alliance.


Smiling and Happiness in Cultural Perspective

Dr Piotr Szarota

  1. Dr Piotr Szarota
    Institute of Psychology, Polish Academy of Sciences

Three distinctive smile codes (American, Japanese, and Polish) have been analysed in detail. Smiling appears to be closely related to cultural norms and values, in Japan it would be social harmony, in US, cheerfulness and friendliness, and in Poland, sincerity. I discuss an idea that the way a given culture constructs a social act of smiling is related to the cultural ideas of “happiness”. While American ethic of cheerfulness is closely connected to the cultural preoccupation with happiness, which is construed as one of those internal attributes that are to be pursued and attained via personal striving, Japanese and Poles understand happiness as something ephemeral and temporary. I argue that the motivation for smiling differs from culture to culture, Americans usually smile to present themselves as happy and friendly, Japanese want to look agreeable and self-controlled, and Poles seldom engage in social smiling because in their view the smile should reflect the inner feelings.


TRPM8, A Calcium Permeable Non-selective Cation Channel

Dr Zhong-Ping Feng

  1. Dr Zhong-Ping Feng
    Department of Physiology, University of Toronto, , rn

TRPM8 is known as a cold-sensing channel, which is permeable to calcium and monovalent cations. It was originally identified in prostate cancer cells. The physiological and pathological functions of TRPM8 in prostate cells remain unclear, however, it has been suggested the channel may serve as a diagnostic and prognostic marker in prostate cancer. This mini-review highlights our current understanding of TRPM8.


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