Application of a WHO protocol on medical therapy for oncologic pain in an internal medicine hospital.

Pain symptomatology is present in 60% - 80% of patients affected by advanced cancer, but in most cases it is not adequately treated. Our series, composed of 45 patients affected by cancer in an advanced stage, demonstrates how the application of common concepts of pharmacotherapy, standardized according to a sequential scheme proposed by the WHO, makes it possible to reach total control (in 24.4% of our cases) or only slight residual persistence (in 68.8% of our cases) of pain from cancer, with scarce side effects that are easily controlled with symptomatic therapy. According to the type of pain, its behavior in relation to the therapy effected and any previous pharmacologic treatment, the proposed pharmacologic scheme foresees, as the first step, the use of non-narcotic drugs, eventually associated or substituted with weak narcotics or finally with strong narcotics. Attention is given to modulation of the administration, to guarantee an analgesic effect throughout the day, thus preventing the pain. Irrespective of the analgesic scheme employed, it is more effective if patients affected by chronic oncologic pain (who present an important emotional component) are treated contemporaneously with anxiolytic and antidepressive drugs and those in which nerve structures are involved are treated with steroids. In conclusion, pain of an oncologic patient in an advanced stage can almost always be alleviated or often eliminated by the rigorous application of therapeutic concepts well known by physicians but for various reasons often neglected in clinical practice.

[Importance of bone biopsies in the diagnosis of cancer metastases]. / Importanza della biopsia ossea nella diagnosi delle metastasi carcinomatose.

A 39-year-old woman was hospitalized at our Institute following a diagnosis of "suspected systemic lymphopathy". The patient exhibited mediastinal tumefaction, moderate anemia, thrombocytopenia, leucoerythroblastic streak in peripheral blood, diffuse bone pain, slight fever, cough and dyspnea. The clinical picture, radiological findings and hematochemical data apparently suggested a diagnosis of epithelial neoplasia of bronchial origin, or a primary hemopathy. Only by means of an osteomedullary biopsy was it possible to establish that the disease was actually a bronchogenic carcinoma invading the marrow. In conclusion, both for a correct staging of patients with carcinoma, and for histological diagnosis, when the primary side can not be identified or attacked, the osteomedullary biopsy, if feasible carried out at different sites, proves to be the test of choice.