Helicobacter pylori: Microorganismo patógeno o mutualista en poblaciones colombianas / Helicobacter pylori: Pathogenic or mutualistic microorganism in Colombian populations / Helicobacter pylori: microrganismo patógeno ou mutualista em populações Colombianas

Introducción: El riesgo de desarrollar cáncer gástrico varía entre continentes, países y regiones. A pesar de que existe una alta prevalencia de Helicobacter pylori su rol como patógeno o mutualista define el riesgo de cáncer gástrico en las regiones de Colombia. Objetivo: Discutir el rol de Helicobacter pylori en el riesgo de cáncer gástrico en Colombia. Materiales y métodos: Revisión de literatura mediante la búsqueda, en las bases de datos LILACS, SciELO, PubMed. Resultados: La coevolución del humano y de Helicobacter pylori; la virulencia de genes cagA, vacA; el tipo de respuesta inmune inflamatoria a Helicobacter pylori (Th1) o antinflamatoria (Th2) y la susceptibilidad humana a cáncer gástrico (IL1β, IL10), junto a la dieta y factores ambientales explican el papel de Helicobacter pylori como patógeno o mutualista asociado al riesgo de cáncer gástrico en Colombia. Conclusiones: Helicobacter pylori tiene un rol mutualista principalmente en poblaciones de bajo riesgo de cáncer gástrico (costas), no obstante, en poblaciones con alto riesgo de cáncer gástrico (andes), su papel como patógeno amerita la erradicación; única estrategia para mitigar la alta incidencia de este cáncer en Colombia.

Introduction: The risk to develop gastric cancer varies between continents, countries and regions. Although there is a high prevalence of Helicobater pylori, its role as either pathogen or mutualistic bacteria defines the risk of gastric cancer in Colombian regions. Objective: To discuss the role of Helicobacter pylori in the risk of gastric cancer in Colombia. Materials and methods: A literature review based on searching LILACS, SciELO, and PubMed databases. Results: Helicobacter pylori role as either a pathogen or mutualistic microorganism associated with gastric cancer risk in Colombia can be explained by analyzing elements such as: human and Helicobacter pylori coevolution; cagA and vacA gene virulence; inflammatory (Th1) or anti-inflammatory (Th2) responses induced by Helicobacter pylori; human susceptibility to gastric cancer (IL1β, IL10); diet; and environmental factors. Conclusions: Even though Helicobacter pylori has a mutualistic role in populations at low gastric cancer risk (coastal regions), its role as a pathogen in populations at higher risk (Andean regions) justifies its eradication as a key strategy to mitigate the incidence of this cancer in Colombia.

Introdução: O risco de desenvolver câncer gástrico varia entre continentes, países e regiões. Embora haja uma alta prevalência de Helicobacter pylori, seu papel como patógeno ou mutualista define o risco de câncer gástrico nas regiões da Colômbia. Objetivo: Discutir o papel do Helicobacter pylori no risco de câncer gástrico na Colômbia. Materiais e métodos: Revisão da literatura por meio da busca, nas bases de dados LILACS, SciELO e PubMed. Resultados: A coevolução de humanos e Helicobacter pylori; a virulência dos genes cagA, vacA; o tipo de resposta imune inflamatória ao Helicobacter pylori (Th1) ou anti-inflamatório (Th2) e a suscetibilidade humana ao câncer gástrico (IL1β, IL10), juntamente com a dieta e fatores ambientais explicam o papel do Helicobacter pylori como patógeno ou mutualista associado ao risco de câncer gástrico na Colômbia. Conclusões: Helicobacter pylori tem um papel mutualista principalmente em populações de baixo risco de câncer gástrico (litoral), porém, em populações com alto risco de câncer gástrico (andes), seu papel como patógeno justifica a erradicação; única estratégia para mitigar a alta incidência deste câncer na Colômbia.

Experimental carcinogenesis with 7, 12-dimethylbenz(a)anthrazene (DMBA) and its inhibition with isothi-ocyanates / Carcinogénesis experimental con 7, 12-dimetilbenzantraceno (DMBA) y su inhibición con isitiocianatos

Introduction: DMBA is a chemical carcinogen that induces carcinomas within a few weeks of its application. We developed an experimental model of carcinogenesis induced by DMBA dissolved in 0,5% paraffin oil (DMBA-PO), verifying the inhibitory effect of the carcinogenicity of phenyl isothiocyanate (PhITC), phenethyl (PhnITC) and benzyl isothiocyanate (BITC). Material and Methods: For this, 88 hamsters were distributed into three groups: one exposed to DMBA-PO (Group 1, n=12), three subgroups (n=12) exposed to PhITC, PhnITC, BITC and DMBA-PO (Group 2, n=36) and four control subgroups (n=10) that were not exposed to the carcinogen in which PO (paraffin oil) and isothiocyanates were applied (Group 3, n=40). Results: The experiment had a duration of 20 weeks, at the end of which the inhibitory effect was established by comparing the lesions developed in the groups that received isothiocyanates with the group that was only treated with DMBA-PO. The carcinogenic effect of DMBA-PO is 100% (35 carcinomas) and the inhibitory effect was 0, whereas in the presence of isothiocyanates the carcinogenic effect decreases, with an inhibitory effect of 86% for BITC (5 carcinomas) and 74% for PhITC (9 carcinomas). Conclusion: The inhibitory effect for PhnITC is 80% in relation to invasive OSCC (1 carcinoma).

Introducción: El DMBA es un carcinógeno químico que induce carcinomas a las pocas semanas de su aplicación. Desarrollamos un modelo experimental de carcinogénesis inducida por DMBA disuelto en aceite de parafina al 0,5% (DMBA-Ap) comprobando el efecto inhibidor de la carcinogénesis de los isotiocianatos fenil (PhITC), fenetil (PhnITC) y bencil isotiocianato (BITC). Material y Métodos: Para ello, se distribuyeron 88 hámsteres en 3 grupos: uno expuesto al DMBA-Ap (Grupo 1, n=12), tres subgrupos (n=12) expuestos a PhITC, PhnITC, BITC y DMBA-Ap (Grupo 2, n=36) y cuatro subgrupos controles (n=10), no expuestos al carcinógeno en el que se aplicaron Ap e isotiocianatos (Grupo 3, n=40). Resultados:El experimento tuvo una duración de 20 semanas, al final de la cual se establece de forma comparativa el efecto inhibidor comparando las lesiones desarrolladas en los grupos que recibieron isotiocianatos con respecto al grupo tratado sólo con DMBA-Ap. El efecto carcinógeno del DMBA-Ap es del 100% (35 carcinomas) y el efecto inhibidor 0, mientras que en presencia de isotiocianatos el efecto carcinógeno disminuye, con un efecto inhibidor del 86% para BITC (5 carcinomas) y del 74% para el PhITC (9 carcinomas). Conclusión:El efecto inhibidor del PhnITC es del 80% en relación con el COCE invasivo (1 carcinoma).

Helicobacter pylori: novedades, genes de virulencia y resistencia a los antibióticos en Colombia / Helicobacter pylori: novelties, virulence genes and antibiotic resistance in Colombia / Helicobacter pylori: novidades, genes de virulência e resistência aos antibióticos na Colômbia

Helicobacter pylori es un carcinógeno tipo I resistente a múltiples antibióticos y con alta prioridad en salud pública. La infección por este microorganismo está influenciada por una interacción compleja entre la genética del huésped, el entorno y múltiples factores de virulencia de la cepa infectante. Afecta al 50 % de la población mundial, provocando afecciones gastroduodenales graves, la mayoría de forma asintomática. El 20 % de los individuos con H. pylori pueden desarrollar a través del tiempo lesiones gástricas preneoplásicas y el 2 % de ellos un cáncer gástrico. Las manifestaciones clínicas gastrointestinales y extragastrointestinales están asociadas a su virulencia y a la respuesta del sistema inmunológico con la liberación de citosinas proinflamatorias, tales como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamación aguda y crónica. Múltiples factores de virulencia han sido estudiados como el gen A asociado a la citotoxina (CagA) y la citotoxina vacuolante (VacA), los cuales juegan un rol importante en la aparición del cáncer gástrico. Dada la resistencia cada vez mayor a los antibióticos utilizados, las líneas de estudio en el futuro inmediato deben estar encaminadas en establecer la utilidad de los nuevos antibióticos y la determinación de profagos colombianos en todo el país. Esta revisión tiene como objetivo hacer una puesta al día sobre las características del H. pylori, los mecanismos patogénicos, genes de virulencia, su asociación con el mayor riesgo de cáncer gástrico, farmacorresistencia microbiana y su erradicación.

Helicobacter pylori is recognized as a class I carcinogen resistant to multiple antibiotics and with high priority in public health. The infection caused by this microorganism is influenced by a complex interaction between host genetics, environment, and multiple virulence factors of the infecting strain. It affects 50% of the world population, causing severe gastroduodenal conditions, most of them asymptomatic. Through time, 20% of individuals with H. pylori may develop preneoplastic gastric lesions and 2% of them develop gastric cancer. The gastrointestinal and extra-gastrointestinal clinical manifestations are associated with its virulence and the response of the immune system with the release of pro-inflammatory cytokines, such as TNF-alpha, IL-6, IL-10 and IL-8, which cause acute and chronic inflammation. Multiple virulence factors have been studied, such as cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA), which play an important role in the development of gastric cancer. Due to the increasing antibiotics resistance, the research in the immediate future should be aimed at establishing the usefulness of the new antibiotics and the determination of Colombian prophages throughout the country. This paper aims to update the characteristics of H. pylori, its pathogenic mechanisms, virulence genes, its association with the increased risk of gastric cancer, microbial drug resistance, and eradication.

Helicobacter pylorié um carcinógeno tipo I resistente a múltiplos antibióticos e com alta prioridade na saúde pública. A infecção por este microrganismo está influenciada por uma interação complexa entre a genética do hospede, o entorno e múltiplos fatores de virulência da cepa infectante. Afeta a 50% da população mundial, provocando afeções gastroduodenais graves, a maioria de forma assintomática. 20% dos indivíduos com H. pylori podem desenvolver através do tempo lesões gástricas pré-neoplásicas e 2% deles um câncer gástrico. As manifestações clínicas gastrointestinais e extragastrointestinais estão associadas à sua virulência e à resposta do sistema imunológico com a liberação de citocinas pró-inflamatórias, tais como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamação aguda e crónica. Múltiplos fatores de virulência hão sido estudados como o gene. A associado à citotoxina (CagA) e a citotoxina vacuolante (VacA), os quais jogam um papel importante no aparecimento do câncer gástrico. Dada a resistência cada vez maior aos antibióticos utilizados, as linhas de estudo no futuro imediato devem estar encaminhadas em estabelecer a utilidade dos novos antibióticos e a determinaçãode profagos colombianos em todo o país. Esta revisão tem como objetivo fazer uma atualização sobre as características do H. pylori, os mecanismos patogénicos, genes de virulência, sua associação com o maior risco de câncer gástrico, farmacorresistência microbiana e sua erradicação.

Carcinoma urotelial del tracto urinario superior: a propósito de un caso y revisión de la literatura / Upper urinary tract urothelial carcinoma: case report and review of the literature

El carcinoma urotelial (CU) del tracto urinario superior es infrecuente y representa solo del 5%-10% de todos los CU. Estas neoplasias crecen a partir del urotelio de los cálices renales hasta el tercio distal del uréter. Se reporta el caso de un paciente masculino de 68 años de edad quien presenta enfermedad actual de 3 meses de evolución caracterizada por dolor lumbar izquierdo, tipo cólico, de leve a moderada intensidad, el cual atenúa parcialmente con el uso de AINES, asociado a hematuria visible total de predominio nocturno. El uroanálisis mostró hematuria macroscópica y la citología urinaria evidenció atipias sugerentes de carcinoma. La TAC abdomino-pélvica contrastada evidenció un defecto de llenado en relación al cáliz inferior de riñón izquierdo y plastrón ganglionar paraaórtico izquierdo. Se practicó nefroureterectomía radical izquierda evidenciando tumor de 3 x 3 x 1 cm en relación a pelvis renal extensiva a cáliz inferior invadiendo parénquima renal. El estudio histopatológico mostró un carcinoma urotelial papilar infiltrativo de alto grado con márgenes sin lesiones y ganglios linfáticos con metástasis. El paciente evoluciona satisfactoriamente durante el período postoperatorio y actualmente recibe terapia adyuvante. A pesar de ser una patología poco frecuente, puede presentarse y el urólogo debe estar en capacidad para poder enfrentarla(AU)

Upper urinary tract urothelial carcinoma (UC) is infrequent and represents only 5%-10% of all UCs. These neoplasms grow from the urothelium of renal calyces to the distal third of the ureter. A case of UC of the upper urinary tract is reported in a 68-year-old male patient with a 3-month history of left lumbar mild to moderate pain, which partially mitigates with the use of NSAIDs associated with visible total predominantly nocturnal hematuria. Macroscopic hematuria was evident and urinary cytology reported carcinoma suggestive atypias. Contrasted CT of abdomen and pelvis showed filling defect in relation to lower calyx of the left kidney and left para-aortic ganglion plastron. Radical left nephroureterectomy was performed showing a 3 x 3 x 1 cm tumor in relation to the renal pelvis extending to the lower cavity and invading renal parenchyma. Histopathology showed high grade infiltrative papillary CU with margins without lesions and lymph nodes with metastasis. Patient evolves satisfactorily in the postoperative period and is currently in adjuvant therapy. Although this pathology is rare, it can occur and the urologist must be able to face it(AU)

Revisión: Factores asociados a cáncer colorrectal / Review: Associated factors with colorectal cancer

Resumen Introducción: El cáncer colorrectal (CCR) es la neoplasia de mayor frecuencia en vías digestivas, constituyendo del 9 al 10% de todos los cánceres en el mundo. Se considera que es multicausal, pues abarca factores intrínsecos del huésped como mutaciones genéticas, hormonales y condiciones inmunológicas; además de factores externos como dietas poco saludables, consumo de alcohol, obesidad, sedentarismo, tabaquismo y la exposición ambiental a carcinógenos. Las manifestaciones clínicas son poco específicas, razón por la cual el diagnóstico está enfocado en grupos de riesgo relacionados con la edad e historia familiar demostrada. Objetivo: Identificar los factores genéticos y de estilos de vida predisponentes al desarrollo de CCR. Metodología: Se realizó una búsqueda de la bibliografía respectiva en las bases de datos ScienceDirect, Google académico, Redalyc, Scielo, Proquest publicada durante el período 2004- 2019, mediante las palabras clave: Colorrectal cancer, risk factors, epidemiology, mortality, mutation, incidence. Resultados: Se observaron factores genéticos predisponentes entre un 20% a 25% de las personas con CCR asociados principalmente con la mutación de gen APC. En relación al cáncer esporádico, se identifica hasta en un 80% de los casos, relacionado con el consumo no controlado de alimentos como carnes rojas, embutidos, café, además de hábitos como el consumo de cigarrillo y alcohol conjuntamente con el estrés y comorbilidades como la obesidad y la diabetes. Conclusión: La multicausalidad del CCR está centrada en factores tanto internos como externos siendo de relevancia el seguimiento para personas genéticamente predispuestas y la implementación de estilos de vida saludables que reduzcan la mortalidad por esta causa.

Abstract Introduction: Colorectal cancer (CRC) is the most frequent neoplasm in the digestive tract; it constitutes 9 of 10% of all cancer cases in the world. This type of cancer is considered multicausal since it is associated with intrinsic and extrinsic factors. Among the internal factors, there are genetic, hormonal mutations, and immunological conditions. On the other hand, the external factors are composed of unhealthy diets, alcohol consumption, obesity, sedentary lifestyle, smoking habits, and environmental exposure to carcinogens. The clinical symptoms are not very specific; that is why the diagnosis is focused on risk groups related to age and proven family medical history. Objective: To identify genetic factors and lifestyle factors related to the development of Colorectal cancer (CRC). Methodology: A literature search was carried out in databases such as ScienceDirect, Google Scholar, Redalyc, Scielo, Proquest, in a range of time between 2004 and 2019. The keywords: colorectal cancer, risk factors, epidemiology, mortality, mutation, and incidence were used as helpers for the search. Results: Predisposing genetic factors were observed in about 20% to 25% of people with CRC associated primarily with the APC gene mutation. In terms of sporadic cancer, the results showed that 80% of the cases were related to the uncontrolled consumption of red meat, sausages, and coffee. Additionally, smoking and alcoholic behaviors, stress, and comorbidities, such as obesity and diabetes, were also the cause of the development of this issue. Conclusion: CRC could be caused by internal and external factors. Based on this, the people with a genetic predisposition to this issue should monitor themselves frequently and implement a healthy lifestyle that reduces the probability of suffering from this type of cancer.

Biomarkers of susceptibility and effect in car painters exposed to organic solvents / Biomarcadores de susceptibilidad y efecto en pintores de carros expuestos a solventes orgánicos

Abstract Introduction: Car painters are routinely exposed to organic solvents classified as carcinogenic and mutagenic substances. Objective: To characterize the population susceptibility and evaluate the genotoxic effects of exposure to organic solvents. Methods: A cross-sectional study comparing a group of car painters exposed to organic solvents with a non-exposed group. CYP2E1 polymorphisms and the presence of micronuclei in lymphocytes were determined. Results: One hundred twenty-two workers participated in the study: 62 who worked in car paint shops and were exposed to solvents, and 60 who were not exposed. There were statistically significant differences between the two groups regarding micronucleated cells and nucleoplasmic bridges frequencies (p=0.042 and p=0.046, respectively; exact likelihood ratio). Significant differences were found at the interaction between the CYP2E1 genotype c1c1 and occupational exposure to solvents, with higher frequencies of micronuclei (p= 0.013) and micronucleated cells (p= 0.015). However, when the frequencies of micronuclei, micronucleated cells and nucleoplasmic bridges in the exposure group were compared between the c1c1 and c2c2/c1c2 allele groups of the CYP2E1 polymorphism, statistically significant differences were found. Conclusions: This study confirms that when workers with CYP2E1 polymorphisms, specifically the c1c1 genotype, are exposed to organic solvents, they are more likely to have somatic cell mutations, a condition associated with increased susceptibility to diseases such as cancer

Resumen Introducción: Los pintores de vehículos automotores están rutinariamente expuestos a agentes como los solventes orgánicos, capaces de producir efectos mutágenos y carcinógenos. Objetivo: Caracterizar la susceptibilidad poblacional y evaluar los efectos genotóxicos debidos a la exposición a solventes orgánicos. Métodos: Estudio de corte transversal que comparó a un grupo de pintores de carros expuestos a solven tes orgánicos con un grupo de personas no expuestas. Fueron determinados tanto los polimorfismos de CYP2E1 como la presencia de micronúcleos en linfocitos. Resultados: Participaron 122 personas, 62 trabajadores de talleres de pintura de autos expuestos a solventes y 60 personas no expuestas. Con relación al cuestionario Q 16, 32% de los expuestos refirieron síntomas sugestivos de neurotoxicidad. Las frecuencias de células micronucleadas y de puentes nucleoplásmicos fueron significativamente mayores en los expuestos que en los no expuestos: p= 0.042 y p= 0.046, respectivamente, Razón de verosimilitud exacta). Fueron halladas diferencias significativas en la interacción de CYP2E1 (c1c1) y la exposición ocupacional a solventes, con mayores frecuencias de micronúcleos (p= 0.013) y de células micronucleadas (p= 0.015). Conclusiones: Este estudio reafirma que los trabajadores expuestos a solventes orgánicos con polimorfismos de CYP2E1, específicamente con genotipo c1c1, tienen mayor probabilidad de presentar mutaciones en las células somáticas, condición asociada con una mayor susceptibilidad a enfermedades como el cáncer

Lung cancer related to occupational exposure: an integrative review / Cáncer de pulmón relacionado con la exposición ocupacional: revisión integrativa / Câncer de pulmão relacionado à exposição ocupacional: revisão integrativa

ABSTRACT Objective: To identify in the literature the carcinogenic agents found in the work environment, the occupations and the risk for lung cancer. Method: A descriptive and analytical study of the Integrative Literature Review type was carried out in national and international databases from the last ten years in the period from 2009 to 2018, concerning 32 studies referring to association between carcinogenic substances to which the worker is exposed and lung cancer. Results: Nine (28.1%) publications originated in China and only one in Brazil. The most exposed workers were from the secondary sector, 50% being from industry and 6.2% from construction, mostly male. Asbestos and silica stood out among the carcinogenic substances most associated with lung cancer risk, accounting for 37.5% and 28.1%, respectively. Conclusions: The association between occupational exposure and the risk for lung cancer was characterized in this research by the substantial scientific evidence from the described studies that confirm this association.

RESUMEN Objetivo: Identificar en la literatura los agentes cancerígenos presentes en el entorno laboral, las ocupaciones y el riesgo de cáncer de pulmón. Método: Estudio descriptivo y analítico de una revisión integradora realizada en una base de datos nacional e internacional de los últimos diez años, entre 2009 y 2018, que comprende 32 estudios referidos a la vinculación entre el cáncer de pulmón y las sustancias cancerígenas de exposición ocupacional. Resultados: Nueve (28,1%) publicaciones tuvieron su origen en China y solo una en Brasil. Los trabajadores más expuestos pertenecían al sector secundario, el 50% a la industria y un 6,2% a la construcción, siendo en su mayoría hombres. El asbesto y la sílice se destacaron entre las sustancias cancerígenas más asociadas con el riesgo de cáncer de pulmón, con índices de 37,5% y el 28,1%, respectivamente. Conclusiones: La vinculación entre la exposición ocupacional y el riesgo de cáncer de pulmón se caracterizó en esta investigación por la evidencia científica sustancial de los estudios descriptos que confirman esta asociación.

RESUMO Objetivo: Identificar na literatura os agentes carcinogênicos presentes no ambiente ocupacional, as ocupações e o risco do câncer de pulmão. Método: Estudo descritivo e analítico de revisão integrativa realizada em base de dados nacionais e internacionais dos últimos dez anos, entre 2009 e 2018, compreendendo 32 estudos referentes à associação entre câncer de pulmão e substâncias carcinogênicas de exposição ocupacional. Resultados: Nove (28,1%) publicações originadas na China e apenas uma brasileira. Os trabalhadores mais expostos foram do setor secundário, sendo 50% da indústria e 6,2% da construção civil, em sua maioria do sexo masculino. O amianto e a sílica sobressaíram-se entre as substâncias carcinogênicas mais associadas ao risco de câncer de pulmão correspondendo a 37,5% e 28,1%, respectivamente. Conclusões: A associação entre a exposição ocupacional e o risco de câncer de pulmão ficou caracterizada nesta pesquisa pelas substanciais evidências científicas dos estudos descritos que confirmam essa associação.

Carcinógenos ambientales asociados a cáncer infantil / Environmental carcinogens associated with childhood cancer

Resumen Introducción: La Sociedad Americana de Cáncer indica que al año se diagnostican 163.300 casos de cáncer infantil en el mundo. En Colombia fueron reportadas 300 muertes por esta causa en menores de edad durante el año 2015. Actualmente, las principales asociaciones etiológicas de cáncer infantil son la radiación ionizante y exposición a pesticidas, convirtiéndose en una prioridad emergente en la agenda mundial de salud infantil. Objetivo: Identificar factores carcinogénicos asociados al incremento de riesgo en la aparición de cáncer infantil. Materiales y métodos: Se realizó una revisión de artículos científicos en inglés y español en la base de datos PubMed, ScienceDirect, SciELO, y publicaciones estadísticas de la Organización Mundial de la Salud, Asociación Americana de Cáncer y el Instituto Nacional de Cancerología de Colombia. Resultados: Se describieron diferentes factores carcinogénicos como radiación ionizante, agentes biológicos, patrones dietéticos, exposición a pesticidas, tabaco y asbesto, destacando su asociación en el desarrollo de cáncer infantil. Conclusión: El reconocimiento de los agentes carcinogénicos frecuentemente asociados con cáncer infantil, permite identificar el impacto de estos sobre la salud, y generar medidas preventivas más eficaces que puedan reducir la carga global de la enfermedad.

Abstract Introduction: The American Cancer Society indicates that each year 163,300 cases of childhood cancer are diagnosed worldwide. In Colombia, 300 deaths were reported from this cause in minors during 2015. Currently, the main etiological associations of childhood cancer are ionizing radiation and exposure to pesticides, making it an emerging priority in the global agenda for children's health. Objective: To identify carcinogenic factors associated with the increased risk in the onset of childhood cancer. Materials and methods: A review of scientific articles in English and Spanish was carried out in PubMed, ScienceDirect, SciELO, and statistical publications of the World Health Organization, American Cancer Association and the National Cancer Institute of Colombia. Results: Different carcinogenic factors were described as ionizing radiation, biological agents, dietary patterns, exposure to pesticides, tobacco and asbestos, highlighting their association in the development of childhood cancer. Conclusion: The recognition of the carcinogenic agents frequently associated with childhood cancer, allows the identification of their impact on health, and generates more effective preventive measures that can reduce the worldwide burden of the disease.

Effect of Arrabidaea chica extract against chemically induced breast cancer in animal model

Abstract Purpose: To examine the effects of Arrabidaa chica (Bignoniacea) extract, a native plant of the Amazon known as crajiru, on a 7,12-dimethyl-1,2-benzanthracene (DMBA)-induced breast cancer model in Wistar rats. Methods: We compared the response of breast cancer to the oral administration of A. chica extract (ACE) for 16 weeks, associated or not with vincristine. Groups: normal control; DMBA (50mg/kg v.o,) without treatment; DMBA+ACE (300 mg/kg); DMBA+vincristine. 500μg/kg injected i.p; DMBA+ACE+Vincristine 250μg/kg i.p. Imaging by microPET and fluorescence, biochemistry, oxidative stress, hematology and histopathology were used to validate the treatments. Results: All animals survived. A gradual weight gain in all groups was observed, with no significant difference (p>0.05). The oral administration of ACE and ACE+vincristine 50% significantly reduced breast tumors incidence examined with PET-18FDG and fluorescence (p<0.001). Significant reduction of serum transaminases, oxidative stress and hematological toxicity were observed in these groups. Antioxidant enzyme levels in breast tissue were significantly higher compared to the DMBA and DMBA+vincristine groups. Conclusion: These results demonstrate for the first time that ACE positively influences the treatment of DMBA-induced breast cancer in animal model, inducing a reduction in oxidative stress and chemotherapy toxicity, meaning that ACE may have clinical implication in further studies.

Pollution in the Americas: a leading cause of disease burden and an opportunity for cancer prevention / Contaminación en las Américas: causa principal de carga de la enfermedad y una oportunidad para prevención del cáncer

Abstract: Objective: Environmental and occupational agents are causes of cancer and disease worldwide while their control and the reduction of the associated disease burden remains complex. Materials and methods: This paper summarizes the current status of the burden of environmental and occupational causes of disease in the Americas based on presentations from a panel on environment, occupation and other environmental risk factors for cancer in the Americas, delivered in Panama, at the international conference Promoting Health Equity and Transnational Collaborations for the Prevention and Control of Cancer in the Americas. Results: Three case studies are presented to illustrate the impact of specific environmental and occupational agents and the challenge of control. Conclusions: There are still fully avoidable exposures to carcinogens, as well documented in the case of asbestos in Brazil. Thus, there are abundant targets for intervention to reduce cancer in the Americas.

Resumen: Objetivo: Los agentes ambientales y ocupacionales son causas de cáncer y enfermedades en todo el mundo, mientras que su control y reducción de la carga de enfermedad asociada siguen siendo puntos complejos. Material y métodos: Este documento resume el estado actual de la carga de las causas ambientales y ocupacionales de las enfermedades en las Américas a partir de las presentaciones de un panel sobre medio ambiente, ocupación y otros factores de riesgo ambientales para el cáncer en las Américas, realizado en Panamá, en la conferencia internacional Promoviendo la Equidad en Salud y las Colaboraciones Transnacionales para la Prevención y el Control del Cáncer en las Américas. Resultados: Se presentan tres estudios de caso para ilustrar el impacto de agentes ambientales y ocupacionales específicos y el desafío del control. Conclusiones: Todavía hay exposiciones totalmente evitables a los carcinógenos, como está bien documentado en el caso del asbesto en Brasil. Hay abundantes puntos estratégicos de intervención para reducir el cáncer en las Américas.

Mecanismo carcinogénico asociado a la exposición al Bisfenol A / Carcinogenic mechanism associated of Bisphenol A exposure

Resumen Introducción: El Bisfenol A (BPA) es un producto químico al que los seres humanos están expuestos ampliamente por la vía oral, inhalación y transdérmica. Justificación: Dada la importancia de la patología oncológica que puede estar asociada a exposición a este químico, resulta imprescindible comprender mejor sus posibles mecanismos de acción asociados a carcinogénesis. Objetivo General: Investigar el mecanismo carcinogénico asociado a la exposición a BPA. Resultados: Aunque la mayoría de las investigaciones se han orientado hacia el efecto disruptor endocrino, con la limitante que los estudios in vivo son realizados en animales, existen estudios recientes que muestran su posible efecto carcinogénico en tejidos humanos. Sin embargo, se requiere más investigación sobre el papel del BPA de dosis baja (como ocurre en condiciones ambientales normales) y su efecto en la regulación de los cambios globales de expresión génica y las alteraciones epigenéticas en las células, que permitan establecer vínculos con carcinogénesis; esta revisión demuestra que los estudios realizados hasta la fecha señalan varios factores que pueden estar involucrados, como efectos mutagénicos que incluyen cambios en la transcripción génica y enzimáticos que promueven la proliferación celular limitando la apoptosis y favorecen la angiogénesis y migración de células tumorales. Conclusión: Si bien en la actualidad se reconoce que la célula cancerígena adquiere características patológicas que le ayudan a sobrevivir en el organismo, estas características obedecen a mecanismos moleculares genéticos y epigéneticos, muchos de los cuales han sido descritos para el caso de la exposición humana al BPA.

Abstract Introduction: Bisphenol A (BPA) is a chemical to which humans are extensively exposed orally, inhaled and transdermally. Justification: Given the importance of the oncological pathology that may be associated with exposure to this chemical, it is essential to better understand its possible mechanisms of action associated with carcinogenesis. Objective: To investigate the carcinogenic mechanism associated with BPA exposure. Results: Although the majority of investigations have been oriented towards the endocrine disrupting effect, with the limitation that in vivo studies are carried out in animals, recent studies have shown that they can be carcinogenic in human tissues. However, more research is required on the role of low-dose BPA (as occurs under normal environmental conditions) and its effect on the regulation of global changes in gene expression and epigenetic alterations in cells, which allow establishing links with carcinogenesis; this review shows that the studies carried out to date point to several factors that may be involved, such as mutagenic effects that include changes in gene transcription and enzymes that promote cell proliferation, limiting apoptosis and promoting angiogenesis and migration of tumor cells. Conclusion: Although it is currently recognized that the cancer cell acquires pathological characteristics that help it to survive in the organism, these characteristics are due to genetic and epigenetic molecular mechanisms, many of which have been described for the case of human exposure to BPA.

To be or not to be a carcinogen; delving into the glyphosate classification controversy

The International Agency for Research on Cancer (IARC) placed the most widely used herbicide glyphosate (GLY) into the category 2A (probably carcinogenic to humans), a classification questioned by experts from academia and industry. This article critically appraised the epidemiological and experimental data that led the IARC working group (WG) to consider GLY a probable human carcinogen and the ensuing controversy. An association of GLY with non-Hodgkin lymphoma was suggested by some observational studies. A non-causal explanation for this weak association, however, cannot be excluded. Contrary to WG's view, long-term rodent assays yielded no convincing evidence that GLY is carcinogenic. The mechanistic evidence remains elusive as well. Bacterial reverse mutation tests (including tester strains sensitive to oxidative mutagens) were clearly negative, and so were rodent genotoxicity assays by oral route. Tests with mammalian cells in vitro yielded conflicting results at high (cytotoxic) concentrations of GLY-based formulations. Conflicting results were also obtained when high doses of GLY-based herbicides were administered to rodents by the intraperitoneal route. Such high doses are unlikely to be attained in realistic scenarios of exposure. Finally, the IARC classification is based on a conjectural hazard, and rational public health interventions must be based on estimated risks.

Gum arabic and red propolis protecteting colorectal preneoplastic lesions in a rat model of azoxymethane

Abstract Purpose: To evaluate red propolis, gum arabic and L-lysine activity on colorectal preneoplastic lesions induced by azoxymethane (AOM). Methods: The study featured 4 control groups (I-IV) and 4 experimental groups (V-VIII), totaling 48 rats. Once a week for 2 weeks, animals on control groups received saline, while animals in experimental groups received azoxymethane (15 mg/kg i.p.). The follow up along 16 weeks included daily oral gavage to administer water (I and V), L-lysine (150 mg/kg)(II and VI), própolis (100mg/5ml/kg)(III and VII), or gum arabic (5ml/kg)(IV and VIII). Was performed surgery on the animals in the end of this time in order to collect blood for biological assays (TBARS, GSH), followed by their sacrifice to tissue extract. Results: Oxidative stress (TBARS) and the number of aberrant crypt foci (ACF) in distal colon were lower using própolis (p<0.01 for both parameters). Gum arabic reduced preneoplastic lesions (ACF ≤ 4 crypts) on distal colon and on the entire colon (p<0.05). Conclusions: Red propolis reduced AOM-induced oxidative stress (TBARS) and total number of ACF in the distal colon. L-lysine neither protected against nor enhanced AOM-induced ACF. Gum arabic reduced the number of ACF.

Splicing isoform-specific functional genomic in cancer cells

Alternative splicing is a regulated process whereby one gene can generate multiple mRNA isoforms susceptible to be translated into protein isoforms of various functions. Several publications report the aberrant expression of splicing isoforms in cancer cells and tissues. However, in most cases, their function remains to be established. In this review article, I will discuss the molecular tool available to perform isoform-specific functional genomics, the methodologies to quantify their effectiveness and the resulting isoform-specific phenotype in human cancer cell lines (AU)

Legislación del benceno y el cadmio en la calidad del aire entre países / Legislation of benzene and cadmium in air quality between countries / Legislação do benzeno e do cádmio na qualidade do ar entre países

Introducción: la Agencia Internacional de Investigación del Cáncer (IARC) clasifica al benceno y al cadmio como agentes que se asocian al cáncer en seres humanos dentro del grupo 1, con mayor solidez y evidencia. Objetivo: comparar las concentraciones atmosféricas legisladas en siete países con la legislación colombiana para generar recomendaciones frente a esta. Método: se realizó una búsqueda en Internet con palabras clave en español, inglés, alemán y portugués, sobre la legislación en calidad del aire en países con mayor desarrollo económico e industrial en el mundo: Brasil, Estados Unidos, Alemania, Reino Unido, Nueva Zelanda y Japón. Resultados: se encontraron los siguientes valores parabenceno: Japón, 3 µg/m³; Nueva Zelanda, 3,6 µg/m³; Colombia, Reino Unido y Alemania, 5 µg/m³; ni Estados Unidos ni Brasil tienen legislación al respecto, y la Organización Mundial de la Salud (OMS) no recomienda valor límite. Para cadmio se encontraron los siguientes valores: OMS, 0,001µg/m³; Reino Unido, Alemania y Colombia, 0,005 µg/m³; ni Estados Unidos, ni Brasil, ni Japón ni Nueva Zelanda tienen reglamentación al respecto. Conclusión: la regulación de los mencionados contaminantes es necesaria, por sus efectos en la salud; los procesos históricos, el grado de desarrollo socioeconómico y las diferencias culturales influyen en la legislación de cada país; Colombia debe propender por una legislación estricta para que las concentraciones sean cero, pues en la toxicología ambiental nunca se especifica que una dosis es inofensiva para sustancias cancerígenas

Introduction: The International Agency for Research on Cancer considers as Group 1 carcinogens to air pollutants to the benzene is a volatile organic compound and the cadmium is a heavy metal. Objective: To compare the atmospheric concentrations legislated in seven countries with the Colombian laws to generate recommendations on current regulations. Methods: A search conducted online with keywords in English, Spanish, German and Portuguese of legislation on air quality in countries with greater economic and industrial development: Brazil, USA, Germany, United Kingdom, New Zealand and Japan. Results: The values for benzene were: Japan 3 µg/m³, New Zealand 3.6 µg/m³, Colombia, United Kingdom and Germany 5 µ g/m³; United States and Brazil do not have legislation and World Health Organization not have recommendation over limit value, and for cadmium the World Health Organization say 0.001 µg/m³, United Kingdom, Germany and Colombia 0.005 µg/m³; United States, Brazil, Japan and New Zealand have no legislation. Conclusion: The rules this contaminants is necessary for yours effects for the human health; the historical, socio-economic and cultural development influence the legislation differences of each country; Colombia must tend to have strict legislation that commits governmental entities and work in terms of time so that the concentration to zero, as in environmental toxicology never specifies that a dose harmless to carcinogens

Introdução: A Agência Internacional de Pesquisa sobre o Câncer considera os carcinogênicos do grupo 1 como poluentes atmosféricos ao benzeno, que é um composto orgânico volátil e ao cádmio como metal pesado. Objetivo: Comparar as concentrações atmosféricas legisladas em 7 países com a legislação colombiana para gerar recomendações contra ela. Métodos: Foi realizada uma pesquisa na Internet com palavras-chave em espanhol, inglês, alemão e português da legislação sobre qualidade do ar em países com maior desenvolvimento econômico e industrial: Brasil, Estados Unidos, Alemanha, Reino Unido, Nova Zelândia e Japão. Resultados: Os seguintes valores foram encontrados para o benzeno: Japão µ g/, Nova Zelândia 3,6 µg/m³, Colômbia, Reino Unido e Alemanha 5 µg/m³; Os Estados Unidos e o Brasil não possuem legislação e a Organização Mundial da Saúde não recomenda um valor limite; para o cádmio foram encontrados os seguintes valores: Organização Mundial de Saúde 0,001 µg/m³, Reino Unido, Alemanha e Colômbia 0,005 µg/m³; Os Estados Unidos, o Brasil, o Japão e a Nova Zelândia apresentam ausência de regulamentação. Conclusão: A regulação destes poluentes é necessária devido aos seus efeitos na saúde; Processos históricos, desenvolvimento socioeconômico e diferenças culturais influenciam a legislação de cada país; A Colômbia deve se esforçar para ter uma legislação rígida para que as concentrações sejam zero, já que na toxicologia ambiental nunca especifica que uma dose é inofensiva para substâncias carcinogênicas

Cigarrillo electrónico: ¿otra herramienta para ayudar a dejar de fumar o una nueva estrategia para promover la adicción a la nicotina? / Electronic cigarette: another tool to help quit smoking or a new strategy to promote nicotine addiction?

Los autores de este artículo describen las principales características del cigarrillo electrónico y sus componentes, anali-zan la controversia sobre su potencial uso como terapia de sustitución del tabaco y describen las experiencias regulato-rias de Argentina y de otros países. (AU)

The authors of this article describe the main features of electronic cigarettes and its components, analyze the controversy about its potential use as tobacco substitution therapy, and summarize the regulatory experiences in Argentina and other countries. (AU)

Manual de prevención de cáncer ocupacional. Documento técnico / Occupational cancer prevention manual. Technical document

La publicación contiene información técnica, y que busca fortalecer las medidas de prevención y control en un entorno laboral donde hay exposición a sustancias y mezclas que están considerados como cancerígenos para el hombre. Es importante desarrollar, estrategias e instrumentos orientadas a los empleadores y trabajadores, para crear una mejor conciencia sobre la salud de los trabajadores y ambientes de trabajo saludables; por lo que se ha determinado identificar y evaluar, cada agente cancerígeno en tres actividades ocupacionales, como Agricultura, Minería, y Salud

Uma proposta de criação de um sistema para monitoramento dos casos de mesotelioma maligno em Curitiba, Paraná, Brasil / A proposal for the creation of a system to monitor cases of malignant mesothelioma in Curitiba, Paraná, Brazil / Una propuesta de creación de un sistema para la supervisión de los casos de mesotelioma maligno en Curitiba, Paraná, Brasil

Este estudo objetivou propor a criação de um sistema de monitoramento dos casos de mesotelioma maligno no Município de Curitiba, Paraná, Brasil, desenvolvido com base no modelo italiano. Trata-se de uma pesquisa-ação tipo diagnóstica, que utiliza as fases exploratória e de planejamento, desenvolvida no período de julho de 2015 a maio de 2017. Utilizaram-se como ferramentas de busca os seguintes instrumentos: Integrador de Registro Hospitalar de Câncer, com as morfologias específicas para mesotelioma; Registro Hospitalar de Câncer, com os códigos C38.4 e C45, da Classificação Internacional de Doenças, 10ª revisão, e/ou registros codificados pelo CID-O, com as topografias C38 e C48; Registro de Câncer de base populacional da Secretaria Municipal de Saúde de Curitiba, com os mesmos códigos. Também foram conhecidos, analisados e adaptados para a realidade brasileira o modelo, os questionários e o software de registro de mesotelioma da Lombardia, na Itália. Observou-se que, no Integrador de Registro Hospitalar de Câncer, foram registrados 15 casos de mesotelioma. No Registro Hospitalar de Câncer do hospital universitário, foram dois. No hospital oncológico, 16. Os dados do Registro de Câncer de Base Populacional, por sua vez, indicaram 317 registros relativos ao período. Apesar de algumas informações estarem mais completas, existe a falta de dados relacionados à história laboral, impossibilitando estabelecer o nexo causal. Com o aumento do número de casos de mesotelioma previstos para as próximas décadas e o atendimento às demandas legais, a implantação de registros torna-se essencial para auxiliar no conhecimento, no acompanhamento, na determinação de nexo causal e nas fontes de contaminação específicas no país.

The study proposes the creation of a system to monitor cases of malignant mesothelioma in the municipality of Curitiba, Paraná State, Brazil, based on the Italian model. This diagnosis-type action-research project featured exploratory and planning phases conducted from July 2015 to May 2017. The following search tools were used: Hospital-Based Cancer Registries Integrator with specific morphologies for mesothelioma; Hospital-Based Cancer Registry with codes C38.4 and C45 of the International Classification of Diseases, 10th revision, and/or records coded by the ICD-O with topographies C38 and C48; Population-Based Cancer Registry of the Curitiba Municipal Health Department, with the same codes. The study also identified, analyzed, and adapted to the Brazilian reality the model, questionnaires, and registry software for mesothelioma from Lombardy, Italy. Fifteen cases of mesothelioma were recorded in the Hospital-Based Cancer Registries Integrator. Two cases were recorded in the University Hospital-Based Cancer Registry and 16 in the Cancer Hospital. There were 317 cases recorded in the Population-Based Cancer Registry during the same period. Although some information was complete, data were lacking on patients' occupational history, thereby preventing the determination of a causal nexus. Given a predicted increase in cases of mesothelioma in the coming decades and the response to court cases, the implementation of registries has become essential to facilitate knowledge and follow-up on the determination of the causal link and specific sources of asbestos exposure in the country.

El objetivo de este estudio fue proponer la creación de un sistema de monitoreo de casos de mesotelioma maligno en el municipio de Curitiba, Paraná, Brasil, desarrollado en base al modelo italiano. Se trata de una investigación-acción de tipo diagnóstica, que usa fases de carácter exploratorio y de planificación, desarrolladas durante el período de julio de 2015 a mayo de 2017. Se utilizaron como herramientas de búsqueda los siguientes instrumentos: Integrador del Registro Hospitalario de Cáncer con morfologías específicas para mesotelioma; Registro Hospitalario de Cáncer con los códigos C38.4 y C45, procedentes de la Clasificación Internacional de Enfermedades décima revisión, y/o registros codificados por el CID-O con topografías C38 y C48; Registro de Cáncer de base poblacional de la Secretaría Municipal de Salud de Curitiba con los mismos códigos. También se presentaron, analizaron y adaptaron a la realidad brasileña el modelo, los cuestionarios y el software de registro de mesotelioma de Lombardía, en Italia. Se observó que, en el Integrador de Registro Hospitalario de Cáncer, se registraron 15 casos de mesotelioma. En el Registro Hospitalario de Cáncer del hospital universitario, fueron dos. En el hospital oncológico, 16. Los datos del Registro de Cáncer de Base Poblacional, a su vez, indicaron 317 registros relacionados con este período. A pesar de que algunos datos estaban más completos, existe una falta de datos relacionados con la historia laboral, imposibilitando establecer el nexo causal. Con el aumento del número de casos de mesotelioma previstos para las próximas décadas, y la atención a las demandas legales, la implantación de los registros se convierte en esencial para apoyar el conocimiento, el seguimiento, así como la determinación del nexo causal y las fuentes de contaminación específicas en el país.

O itinerário terapêutico revelado pelo familiar da pessoa com mesotelioma maligno: estudo de casos múltiplos / The therapeutic itinerary revealed by the relative of the person with malignant mesothelioma: multiple case study

Conhecer o itinerário terapêutico revelado pelo familiar da pessoa com mesotelioma maligno. Trata-se de uma pesquisa qualitativa, de natureza descritiva, exploratória, utilizando o método de estudos de casos múltiplos. Aprovada pelo Comitê de Ética em Pesquisa em Seres Humanos, parecer favorável nº 677.015. Definiu-se a proposição do estudo com a questão norteadora: como ocorreu o itinerário terapêutico da pessoa com mesotelioma maligno revelado pelo familiar? O referencial teórico adotado foi o Sistema de Cuidado à Saúde de Arthur Kleinman, constituído por três subsistemas: o profissional, popular e folclórico. Participaram do estudo seis casos de pessoas que adoeceram e foram a óbito por mesotelioma, assistidas em uma Instituição de Saúde referência no tratamento do câncer e seus familiares, no estado do Paraná. A coleta de dados ocorreu de janeiro a junho de 2016.Os dados foram coletados do prontuário por meio de formulário estruturado, sobre o perfil sócio demográfico e clínico das pessoas com mesotelioma e da narrativa do familiar que acompanhou o itinerário terapêutico percorrido por essa pessoa, através da técnica de entrevista. Para análise dos dados documentais utilizou-se a análise comparativa proposta por Robert Yin e para as narrativas dos familiares a análise de conteúdo de Lawrence Bardin. Dos seis casos descritos nas unidades de análise, quatro eram do sexo masculino e dois do sexo feminino; quatro com diagnóstico de mesotelioma pleural, e dois com mesotelioma peritoneal. As idades variaram entre 44 a 69 anos. Os principais sintomas identificados foram: febre, dor nas costas, dor no estomago, emagrecimento e derrame pleural. A terapêutica instituída foi: quimioterapia e radioterapia. A exposição ao amianto confirmado em um caso. A sobrevida dos primeiros sintomas ao óbito ocorreu de cinco meses a oito anos; e, do diagnóstico de mesotelioma ao óbito variou de quatro meses a cinco anos. Da análise das narrativas dos familiares emergiram sete categorias: reconhecimento do adoecer; cuidados populares e a tentativa de escapar do adoecimento; subsistema popular direciona ao profissional; subsistema profissional: desvendar o mistério da doença; família: supremacia do cuidado; religião: esperança e alento; e, o adoecimento por mesotelioma pela lente do familiar. O inicio do itinerário terapêutico foi marcado pela identificação dos sintomas, com as primeiras práticas populares adotadas. A familia foi a unidade central do cuidado. O subsistema profissional carregou o desafio de desvendar o mistério da doença, com a dificuldade de um diagnóstico acertado. A religião foi a fonte de esperança para as pessoas durante o processo de adoecimento, e a familia carrega o fardo de enfrentar as dificuldades da agressidade da doença, do tratamento até optar por interromper a terapêutica. Os cuidados à saúde adotadas são representadas pela forte ação dos conceitos sócio culturais de cada pessoa.

Knowing the therapeutic itinerary revealed by the relative of the person with malignant mesothelioma. It is a qualitative research, of descriptive nature, exploratory, using the method of multiple case studies. Approved by the Ethics Committee on Research on Human Beings, favorable opinion nº 677.015. The study proposition was defined with the guiding question: how did ocurr the therapeutic itinerary of the person with malignant mesothelioma revealed by the relative? The theoretical reference chosen was the Arthur Kleinman Health Care System, made up of three subsystems: the professional, popular and folkloric. Participated in the study six cases of people who fell ill and died due to mesothelioma, attended at a Health Care Institution which is a reference in the treatment of cancer and their relatives, in the state of Paraná. The data were collected from January to June 2016. The data were collected from the medical record by means of a structured form, about the socio demographic and clinical profile of people with mesothelioma and the narrative of the family member who accompanied the therapeutic itinerary lived by this person through the technique of interview. For the analysis of the documentary data was used the comparative analysis proposed by Robert Yin and for the narratives of the relatives the content analysis of Lawrence Bardin. Of the six cases described in the units of analysis, four were male and two female; Four with diagnosis of pleural mesothelioma and two with peritoneal mesothelioma. The ages ranged from 44 to 69 years. The main symptoms identified were: fever, back pain, stomach pain, weight loss and pleural effusion. The therapy instituted was: chemotherapy and radiotherapy. Exposure to asbestos confirmed in one case. The survival of the first symptoms at death occurred from five months to eight years; and from the diagnosis of mesothelioma to death varied from four months to five years. From the analysis of the family narratives emerged seven categories: recognition of the illness; popular care and the attempt to escape from illness; popular subsystem directed to the professional; professional subsystem: unveil the mystery of the disease; family: care supremacy; religion: hope and encouragement; and mesothelioma sickness by the relative view. The beginning of the therapeutic itinerary was marked by the identification of the symptoms with the first popular practices adopted. The family was the central care unit. The professional subsystem carried the challenge of unraveling the mystery of the disease with the difficulty of a correct diagnosis. The religion was the source of hope for people during the process of becoming ill and the family carries the burden of facing the difficulties of the aggression of the disease, from the treatment until to choose stopping the treatment. The health care adopted is represented by the strong action of the socio-cultural concepts of each person.