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Journal Issue: Vol.7, No.4 - October 2008

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Editorial

Editorial: Cancer Burden and Control Measures in Africa

Daniel Asrat (MD, M.Sc, PhD) Honorary Vice Chairman of IRPC for African Chapter Department of Microbiology, Immunology & Parasitology Faculty of Medicine, Addis Ababa University Addis Ababa, Ethiopia Both developed and developed countries are suffering from growing and increasingly non-communicable diseases such as cardiovascular diseases, diabetes and cancer. According World Health Organization (WHO), the International Atomic Energy Agency (IAEA), the International Agency for Research on Cancer (IARC), cancer is accounting for 12.5% of all death worldwide and 4% deaths in Africa. By 2020 there are expected to be 15-16million new cases of cancer every year, 70% of which will be in developing countries where governments are least prepared to address the growing cancer burden which are mainly affecting their middle-aged adult population. It is estimated that in the year 2020 there will be 804,000 new cancer cases and 626,400 cancer-related deaths in Africa. Cancer is a hidden epidemic in Africa. The reported commonest cancers seen in Africa are cervical cancer (12%), breast cancer (10%), liver cancer (8%), Kaposi's sarcoma (5%), non-Hodgkin lymphoma (5%) and prostate cancer(5%). Chronic infections with hepatitis B-virus, HIV/AIDS and human papilloma virus increases the risk of developing liver cancer, Kaposi's sarcoma and cervical cancer, respectively. Other risk factors include widespread cigarette smoking, poor environmental sanitation; unhealthy diet, excessive alcohol intake, old age, and lack of physical exercise. Most African countries are unable to handle the cancer problem effectively due to factors like having few cancer care facilities, lack of resources and basic infrastructure which help the people getting access to cancer screening, early diagnosis, treatment or palliative care, limited data on cancer incidence and mortality due to lack of functioning cancer registries and limited death certification, poor referral system, lack of effective anticancer treatment, lack of awareness about cancer among the population and health care workers and lack of funding. Currently the world is working on controlling the spread of HIV, TB and malaria, which are all acknowledged to be major killers in the developing world. Larger amount of money are currently available from donors to help combat these diseases. But not much attention is given for non-communicable diseases and even for neglected diseases in neglected population such as leishmaniasis, schistsomiasis and filariasis. This is the time to act now!! The only ways to prevent, detect and treat the rising number of cancers in Africa are as follows a) initiating cancer surveillance programs, including cancer registries that provide essential information on the incidence, prevalence, trends, mortality,and survival rates in the country b) launching vaccination programs against Hepatitis B virus, and human papilloma virus. These should be made widely available in cost effective manner. It is already documented one third of cancers in developing are preventable by vaccination. In addition reducing tobacco consumption will also prevent many cancer related deaths mainly due to lung cancer c) developing screening and early diagnosis programs d) provision of adequate anticancer treatment. It is postulated that in developing countries one third of cancer cases are curable by providing effective anticancer treatment e) provision of palliative care, an essential part of the continuous of care of terminal cancer patients with special emphasis in managing pain and total care of patients and family and f) establishing cancer centers having full capacity of handling all cancer related activities and conducting training and research. In order to achieve the aforementioned goals the African Government should play a leading role with commitment by encouraging their Ministry of Health, Teaching and Research Institutions to establish partnerships with donors such as WHO, IARC, IAEA, the World Bank, Pharmaceutical Industries and other non governmental organizations (NGO's) and Cancer Associations to develop adequate and sustainable cancer care system for the needy people. Sincerely, Daniel Asrat (MD, M.Sc, PhD) Honorary Vice Chairman of IRPC for African Chapter REFERENCES 1. Moeti M. Non-communicable Diseases: An overview of Africa's new silent killers. African Health Monitor, January 2008 to June 2008; 1-4 2. WHO, Cancer prevention and control in the WHO African Region (AFR/RC57/RT/1), Brazzaville, World Health Organization, Regional Office for Africa, 2007. 3. Afrox: Building Sustainable Cancer Capacity in Africa: Prevention, Treatment and Palliation. London Declaration, 2007 http://www.afrox.org/docs/Final%20Report.pdf


Profile

Profile: Dr. Joachim Schuz

Dr. Joachim Schuz Dr. Joachim Schuz, renowned expert in the field of Medical Epidemiology is presently working as the Head of the Department of Biostatistics and Epidemiology at the Institute of Cancer Epidemiology, Copenhagen, Denmark. He was born in 1967 in Darmstadt, Germany. Dr. Joachim Schuz, studied in Medical Informatics at the University of Heidelberg, Germany, and graduated at the Institute of Biostatistics at the same University in 1993. From 1993 to 1997 he was employed as a research fellow at the Tumour Center Rhineland-Palatinate in Mainz, Germany, and registered as a doctoral student at the University of Mainz, where he received his PhD in May 1998. From 1998 to March 2005 he worked at the Institute of Medical Biostatistics, Epidemiology and Medical Informatics (IMBEI) of the University of Mainz, first as a post-doc researcher, then as private lecturer (from December 2002) and later Associate Professor of Epidemiology, Biostatistics and Medical Informatics (from September 2003). From December 2001 onwards he was the Head of the Unit of Epidemiology at the IMBEI. He received his venia legendi ('Habilitation', qualification for professorship in Germany) in December 2002 for his research on the topic of epidemiology of childhood leukaemia. In April 2005 he moved to Copenhagen. His main research fields are epidemiology of childhood cancer, radiation epidemiology (particularly non-ionising radiation), and statistical methods in cancer epidemiology. Joachim Schuz has 68 peer-reviewed publications (53 original articles, 6 reviews, 6 letters, 3 book chapters) and is first author of 38 of them. He attended more than 100 conferences and in the last two years was invited speaker at 13 conferences. From 1996 to 2000, Joachim Schuz was the first representative of the German Network of Population-Based Cancer Registries, established in 1996, and current professional affiliations include: Board of Directors of the Bio-electromagnetic Society, EMF expert group member of the Scientific Committee on Emerging and Newly Identified Health Risks (European Union), EMF expert group member of the German Commission on Radiation Protection, EMF expert group member of the UK Childhood Cancer Study Investigators, member of the International Childhood Cancer Cohort Consortium and the Childhood Leukemia International Consortium. He was invited as consultant at various meetings of the World Health Organisation and participated in the writing of the International Agency of Research on Cancer (IARC) monography on carcinogenic risks of static and extremely low-frequency electric and magnetic fields.


Manuscript

Sentinel Node Biopsy for Oral and Oropharyngeal Squamous Cell Carcinoma of the Head and Neck

Dr Sandro J. Stoeckli

  1. Dr Sandro J. Stoeckli
    MD
    Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurichrnrn

Objectives: The objective of this prospective series of patients is to present the experience in a large consecutive cohort undergoing sentinel node biopsy (SNB) for early (T1 and T2) squamous cell carcinoma of the oral cavity and oropharynx. The aims were to assess the technical feasibility of SNB, to validate SNB against elective neck dissection, and to report the results of the clinical application of the SNB concept. Study design: prospective consecutive cohort analysis Patients and methods: Between 2000 and 2006 a total number of 79 patients were included for this study. Lymphatic mapping was performed with preoperative lympho-scintigraphy and intra-operative use of a hand held gamma probe. Twenty-eight patients were assessed for feasibility and validation. The SNB was done in context with an elective neck dissection in these patients. Fifty-one patients were evaluated in an observational trial. These patients underwent SNB, and elective neck dissection only in case of positive SNB. Results: Feasibility and validation: The sentinel node detection rate with the lympho-scintigraphy was 93%, with the gamma probe 100%. The negative predictive value of a negative SNB was 100%. Thirty-two percent of the patients were upstaged as a result of a positive SNB. Clinical application: Forty percent of the patients were upstaged as a result of a positive SNB. Intra-operative frozen section analysis showed a negative predictive value of 83%. Only two patients (6%) with negative SNB experienced a neck recurrence, the negative predictive value of SNB for the remaining neck was therefore 94%. Patients with positive SNB were treated successfully with elective neck dissection and no postoperative radiation employed. Conclusions: SNB is technically feasible and reproducible with a high sentinel node detection and excision rate. Validation against the standard of reference revealed a perfect negative predictive value of 100%. Application of the SNB concept in clinical practice was very successful. The recurrence rate within the neck was very low and the morbidity and cost of an elective neck dissection could be spared to 60% of the patients with a clinically negative neck. There is increasing evidence supporting the concept of SNB for early oral and oropharyngeal carcinoma. SNB may become the standard of care in the near future.


Complications of Esophageal Cancer Surgery in Yazd, Iran

Dr Ali Akbar Salari, Mohamed Zare, Sayed Mostafa Shiryazdi, Mansour Moghimi, Hedayat Karimi

  1. Dr Ali Akbar Salari
    Associate Professor of Surgery, Department of Surgery, Shahid Sadoughi Hospital
  2. Mohamed Zare
  3. Sayed Mostafa Shiryazdi
  4. Mansour Moghimi
  5. Hedayat Karimi

Background: Cancer is one of the most unknown diseases of human and there are many researches in this field. Gastrointestinal cancers especially esophageal cancer threats lives of many people in the world. This study determines the complications of esophageal operation performing for cancer of the esophagus. Methods: This retrospective cross-sectional descriptive study was done on 94 patients with esophageal cancer was admitted in Shahid Rahnemoon and Afshar hospitals Yazd, Iran who had esophageal surgery from 1996 to 2001. Results: From total of 94 patients with cancer of the esophagus, 40 patients were male and 54 were female .the age range of patients was 25-90 years old. The complications rate of cancer was age-dependent and increased in older patients. Also bleeding rate, infection, hemothorax and leakage of anastomosis were more in older ones.It was concluded that complications of the disease was increased in higher stages as stages III and IV have more complications. The most complications were related to Ivor Lewis operation. Although mortality rate was higher in men, but there was no significant differences. Some complications such as bleeding, abscess, pain and leakage of anastomosis site were higher in male patients. Conclusion: Some post surgical complications of esophageal cancer are bleeding, abscess and leakage of anastomosis. The rate of complications is higher in the lower third of the esophagus. Although the rate of bleeding and abscess are higher in the upper third, but others occurred more frequently in other parts of the esophagus.


Oral Cancer Prediction Model for Malaysian Sample

Dr Rosma Mohd Dom, Sameem Abdul Kareem, Basir Abidin, Raja Latifah Raja Jallaludin, Sok Ching Cheong, Rosnah Binti Zain

  1. Dr Rosma Mohd Dom
    MARA University of Technology
  2. Sameem Abdul Kareem
  3. Basir Abidin
  4. Raja Latifah Raja Jallaludin
  5. Sok Ching Cheong
  6. Rosnah Binti Zain

Artificial intelligence prediction provides an alternative to existing statistical prediction models. In this paper the prediction of oral cancer susceptibility as a function of demographic profiles (age, gender, ethnicity), risk habits (cigarette smoking, alcohol drinking, tobacco chewing) and genetic markers (GSTM, GSTT1) were done using statistical logistic regression and fuzzy regression models on a sample of 84 oral cancer patients and 87 controls. Descriptive analysis including the odds ratios of predictor variables is described. "Optimal" input predictor set was determined based on standard variable selection techniques. Prediction performance and interpretation of the prediction equations generated by both regression models are analyzed.


The Overview of the PHC Therapeutics in China

Dr Gong Li, Shuai Jin, Wenjiang Shen

  1. Dr Gong Li
    M.D
    Department of Radiation Oncology, Chinese People?s Armed Police General Hospital
  2. Shuai Jin
  3. Wenjiang Shen

International agency for cancer research has estimated that 5.69 hundred thousand new HCC patients are being reported annually, including new 300 thousands in China, and the incidence increases 5% every year. In China, HCC has the second highest mortality rate of all of cancers. In more than 75% of cases the diameter exceeds 5cm. Cases of small HCC are in 25% of all the HCC patients. HCC of China has a strong relation with type B hepatitis. The area of high incidence is located in the South-eastern part of China.


Squamous Cell Carcinoma of the Lung Presented as a Lung Abscess: A Case Report

Dr Che Wan A. Hashim, P Nurbaya M. Ismail

  1. Dr Che Wan A. Hashim
    Senior Lecturer, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia
  2. P Nurbaya M. Ismail

Squamous cell carcinoma of the lung accounts for approximately 30% of all cases of bronchogenic carcinomas. The association of lung abscesses and underlying lung cancer has long been recognized. Patients presenting with a symptomatic abscess have an associated malignancy in 7% to 18% of cases, but other reports indicate that the incidence may be as high as 36%. We report here a case of advanced squamous cell carcinoma of the lung presented as a lung abscess.


How is Radiofrequency Ablation Going in Treating Hepatocellular Carcinoma in China?

Dr Wenbing Sun

  1. Dr Wenbing Sun
    Department of Hepatobiliary Surgery, West Campus, Affiliated Beijing Chaoyang Hospital, Capital University of Medical Science

Hepatocellular carcinoma (HCC) is a common disease in China. Being the "second killer" in China, its mortality rate (age-standardized) is 34.7/100 000, alone accounting for 53% of all liver cancer associated deaths worldwide.1 When feasible, surgical resection or liver transplantation should be considered first for the treatment of HCC. Unfortunately, in only about 20% of patients surgery is feasible. In patients with unresectable disease, several nonsurgical procedures have been assessed in order to provide local control of the disease. For these settings, tumor ablative techniques such as percutaneous ethanol injection (PEI), radio-frequency abalation (RFA), Cryo-therapy, laser hyper-thermia and others have been developed in recent years. Among these techniques, RFA has become the most widely used ablative technique for tackling HCC. This paper will review the recent advances and current status of the RFA application in the management of HCC in China.


Recurrent Thymoma with Chest Wall Metastasis: A Rare Presentation

Dr M Sreekumar, Khaleda Bader Boarki, Issam Francis, Weal Moftah

  1. Dr M Sreekumar
    Dept. of. Radiology, Kuwait Cancer Control Centre
  2. Khaleda Bader Boarki
  3. Issam Francis
  4. Weal Moftah

Occurrence of metastasis to the chest wall from malignant thymoma is a rare entity. A very few cases have only been published in the literature regarding the same. We report a case of a 64 yrs old Kuwaiti female patient who presented with swellings in the Lt anterior chest wall of short duration. She had past history of surgery for anterior mediastinal mass, which was diagnosed as non-invasive thymoma - medullary type. She subsequently underwent radiological and histopathological evaluation and were proven as metastases from recurrent malignant thymoma. This case signifies the fact that the chest wall is a probable site for metastasis from malignant thymoma, though the occurrence is rare.


Measurement of Naturally Occurring Radionuclides with Several Detectors: Advantages and Disadvantages

Dr C Papastefanou

  1. Dr C Papastefanou
    Aristotle University of Thessaloniki, Atomic and Nuclear Physics Laboratory

Measurement of naturally occurring radio-nuclides in fields (in-situ) or in Lab (in-vitro) is made by sodium iodide thallium activated, NaI(Tl) detectors and or solid state (semiconductor diode) Ge high purity detectors coaxial, planar or well type by using various spectroscopic systems linked with accumulation data processing units. For spectral analysis of gamma-ray photon peaks, various libraries with softwares have been developed and established and are available to the users. Those gamma-ray spectrometers are classified according to their resolution and the efficiency in detecting and measuring the radionuclide concentrations through the gamma-ray peaks of the gamma-ray photons emitted by the naturally occurring and or man-made produced radio-nuclides in various kinds of environmental samples. This article is designed to remove the "black box" approach to gamma-ray spectroscopy results, i.e., Put the sample on the detector Push the button Read the printed report Accept the results. A solid basis is provided in the fundamentals of gamma-ray spectroscopy while focusing on the areas that permit the operator and or user to: Prepare a representative sample Optimize system parameters Understand the effects of cascade summing, interference peaks, geometry, and libraries parameters Class exercises guide the student through the interpretation of results with consideration of peak fit, source term and process knowledge of the sample. Laboratory quality assurance, QA and good practices are also discussed. The users might be introduced to the concepts and benefits of modeled geometries and field (in-situ) or in Lab (invitro) measurements. The article will review the interaction of radiation with matter to explain spectral features and their interpretation, including peak identification and energy determination, back-scattering peaks, single and double escaping peaks and proper use of control charts of radio-nuclides. It is designed to provide a practical introduction to gamma-ray spectroscopy for those new to the field of gamma-ray spectroscopy, but also provide practical applications to those who are currently performing gamma-ray spectroscopy. It is intended for anybody who will be doing routine and specialized gamma-ray spectroscopy, as well as quality assurance officers and data validators who may have a need to understand gamma-ray spectroscopy measurements.


Abdominal and Scrotal Mass Associated with Calcium Replacement Therapy in L-Asparaginase-Induced Pancreatitis

Dr Tiraje Celkan, Safa Baris, Durmus Dogan, Sebuh Kuruoglu

  1. Dr Tiraje Celkan
    Associate Professor, Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul
  2. Safa Baris
  3. Durmus Dogan
  4. Sebuh Kuruoglu

Although it has many causes in adults; such as alcohol, cholelithiasis, hyperparathyroidism, drugs, and trauma, acute pancreatitis is an uncommon disease at childhood period. Pancreatitis, resulting from any reason, lead to auto-digestion of this organ. Pancreatitis following administration of asparaginase has been reported for over 30 years, treating these patients is a dilemma. Here, reporting an 8-years-old patient with abdominal and scrotal mass due to calcium replacement in L-asparaginase induced pancreatitis, we want to emphasize that sometimes, correction of plasma calcium levels with replacement therapy, would be problematic, as calcium will deposit in necrotic tissue of pancreas and omentum, mimicking a mass.


Cutaneous Metastasis in a Case of Carcinoma Stomach

Dr AVS Suresh, PP Bapsy, D Lokanatha, H Rajashekar, C Ramachandra

  1. Dr AVS Suresh
    Dept of Medical Oncology, Kidwai Memorial Institute of Oncology
  2. PP Bapsy
  3. D Lokanatha
  4. H Rajashekar
  5. C Ramachandra

Background: Isolated cutaneous metastasis is quite uncommon in patients with gastric cancer. Presence of generalized disease is further rare and whenever present, it confers poor prognosis. Aim: To report a case of carcinoma stomach with extensive skin metastasis and review the literature. Methods: We are presenting a case of carcinoma stomach, who presented in follow up with generalized skin metastasis without visceral involvement. Conclusion: The clinicians should be aware of the various patterns of skin metastasis, and should look for them in follow up as the treatment in patients with isolated skin metastasis carries a better prognosis.


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