Health care system and patient-related factors affecting low cancer screening participation in Poland.

The level of participation in cancer screening is low in the Polish population. The aim of this study was to assess the opinions of centers providing cancer screening as to the reasons for the low frequency of cancer screening in Poland and possible methods to increase participation. In July 2020 433 centers in Poland carried out breast and/or cervical cancer screening. Of these, 136 centers decided to participate in the study. The study was conducted using an original questionnaire. The questions were addressed to opinion of centers about: reasons for the low frequency of cancer screening in Poland, methods to increase the frequency of cancer screening, pricing and motivating factors for providing cancer screening. Among opinions as to possible reasons for the low frequency of cancer screening in Poland related to the care-system, lack of encouragement from general practitioners, lack of invitations for cancer screening and lack of proper social advertising were most prevalent; whereas among reasons related to patients, a low awareness of cancer screening and fear of cancer diagnosis. The main methods that could potentially increase screening participation are considered to be the inclusion of cancer screening in mandatory periodic employee examinations, more activity by general practitioners, better promotion of screening by central institutions, and sending personal invitations. In conclude some interventions should be carried out to motivate people to break down barriers.

Loss of heterozygosity on chromosomes 2p, 3p, 18q21.3 and 11p15.5 as a poor prognostic factor in stage II and III (FIGO) cervical cancer treated by radiotherapy.

Loss of heterozygosity (LOH) has been shown to be an important prognostic factor in a variety of malignant neoplasm's. Cervical cancer develops as result of multiple genetic alterations. The aim of this study was to analyze presence of LOH in cervical cancer and to identify the correlation between LOH and survival and relapse-free survival time in patients treated with radiotherapy. Studies were performed on tumor specimens and venous blood from 20 patients with cervical cancer (squamous cell carcinoma G2 and G3) in stage II and III (FIGO) treated with radiotherapy. DNA was isolated using organic extraction. Additional microcolumn purification was performed. The fluorescent multiplex polymerase chain reaction (PCR) was used to amplify 10 microsatellite loci included in commercially available human identification kits. Microsatellite marker BAT 26 was amplified in separate PCR reactions. 75% cervical cancers manifested LOH. LOH in BAT 26 analysis (chromosome 2) was present in all these specimens. 60% of the cases showed LOH at one or more of other examined loci (mostly on 3p, 18q21.3, and 11p15.5). Eight of nine cervical cancers in clinical stage III showed LOH. All cases of G3 squamous cell carcinoma of the cervix manifested LOH on 2p. Patients with LOH have worse prognosis for survival and relapse-free survival compared to patients without LOH.

[Hemorrhagic cystitis related to the high-dose conditioning therapy in a bone marrow recipient]. / Krwotoczne zapalenie pecherza moczowego wywolane wysokodozowana chemioterapia kondycjonujaca przed przeszczepieniem szpiku kostnego.

Hemorrhagic cystitis (HC) is the syndrome of hematuria combined with symptoms of lower urinary tract irritation in the absence of bacterial infection or generalized hemorrhagic diathesis. HC often occurs as a difficult complication after autologous as well as allogeneic hematopoietic cell transplantation (HCT). It may be secondary to pretransplant preparative regimen (chemotherapy and/or radiation therapy) or viral infection by adenovirus, JC and BK viruses. The most effective treatment for HC has not been established yet. We report a case of a 17-year-old male with common acute lymphoblastic leukemia (cALL) in second CR, who was treated with high-dose chemotherapy (BuCy conditioning regimen) followed by autologous bone marrow transplantation (ABMT), complicated by hemorrhagic cystitis on day 0 (several hours after infusion of transplant material). The immediate use of increased dose of 2-mercaptoethane sulfonate sodium (mesna), bladder irrigation and intensive hydration with forced diuresis resulted in resolution of macroscopic hematuria on day +3 after the transplant and urinary tract recovery with normalization of urine analysis parameters on day +7.

Localization of blood coagulation factors in situ in pancreatic carcinoma.

Blood coagulation is activated commonly in pancreatic carcinoma but the role of the tumor cell in this activation is undefined. Immunohistochemical procedures were applied to fixed sections of 22 cases of resected adenocarcinoma of the pancreas to determine the presence of components of coagulation and fibrinolysis pathways in situ. Tumor cell bodies stained for tissue factor: prothrombin: and factors VII, VIIIc, IX, X, XII, and subunit "a" of factor XIII. Fibrinogen existed throughout the tumor stroma, and tumor cells were surrounded by fibrin. Staining for tissue factor pathway inhibitor, and plasminogen activators was minimal and inconsistent. Plasminogen activator inhibitors -1, -2, and -3 were present in the tumor stroma, and on tumor cells and vascular endothelium. Extravascular coagulation activation exists associated with pancreatic carcinoma cells in situ that is apparently unopposed by naturally occurring inhibitors or the plasminogen activator-plasmin system. We postulate that such local coagulation activation may regulate growth of this malignancy. These findings provide a rationale for testing agents that modulate the blood coagulation/fibrinolytic system (that inhibit tumor growth in other settings) in pancreatic carcinoma.

[Metastases of malignant melanoma of unknown primary site: an important diagnostic and therapeutic problem]. / Przerzuty czerniaka zlosliwego o nieznanej lokalizacji ogniska pierwotnego--istotny problem diagnostyczny i terapeutyczny.

Malignant melanoma of an unknown primary site remains a diagnostic and therapeutic challenge in clinical practice. With this in mind, we have presented 12 patients with malignant melanoma of an unknown primary site, diagnosed and treated in the Regional Cancer Center in Bialystok. This clinical presentation accounted for 2% of all malignant melanocytic lesions treated in our center during ten year period from 1987 to 1997.

Expression of prothrombin fragment 1+2 in cancer tissue as an indicator of local activation of blood coagulation.

Immunohistochemistry was applied to AMeX-fixed tissue sections of 12 adenocarcinomas of the stomach (seven intestinal adenocarcinomas and five diffuse carcinomas), 12 adenocarcinomas of the pancreas (nine ductal adenocarcinomas and three signet ring carcinomas), and 12 squamous cell carcinomas of the larynx obtained at surgical resection to examine the possibility of extravascular activation of blood coagulation in cancer tissues by exploring the in loco patterns of distribution of fibrinogen, a final product of blood coagulation, fibrin, and a by-product of coagulation reactions (prothrombin fragment 1+2). Gastric, pancreatic, and laryngeal cancers exhibited fibrinogen antigen in abundance throughout the tumor stroma. Fibrin was detected along the edges of nests of carcinoma cells and at the host-tumor interface. Prothrombin fragment 1+2 was present in the blood vessels in areas of neoangiogenesis at the host-tumor interface (gastric and pancreatic cancer tissues) and on the tumor cell bodies (pancreatic and laryngeal cancer tissues). The presence of prothrombin fragment 1+2 in cancer tissues appears to be a good indicator of coagulation activation and thrombin generation at the tumor burden.

Expression of tissue factor and tissue factor pathway inhibitor in situ in laryngeal carcinoma.

The blood coagulation mechanism may support tumor progression by several mechanisms including promotion of cell proliferation and angiogenesis. Immunohistochemical procedures were applied to AMeX-fixed sections of twelve cases of squamous cell carcinoma of the larynx obtained at surgical resection to determine the presence and distribution of tissue factor (TF), tissue factor pathway inhibitor (TFPI), other coagulation factors, fibrinogen, and fibrin in situ. TF antigen was present in normal squamous epithelial cells and tumor cells, predominantly in immature tumor cells in the vicinity of the host-tumor interface. Tumor cells stained also for factors VII and X. Staining for TFPI antigen was demonstrated in the connective tissue stroma adjacent to the tumor, in microvascular endothelial cells, and in normal squamous epithelial cells. Fibrinogen and factor XIIIa were distributed throughout the tumor connective tissue stroma. Fibrin (thrombin-cleaved fibrinogen) was detected at the host-tumor interface and along the margins of tumor nodules. Tumor cells in carcinoma of the larynx express a functional, TF-initiated pathway of blood coagulation. Interpretation of these findings together with the results of clinical trials of inhibitors of TF-induced coagulation activation versus effects of inhibitors of TF expression suggest novel approaches to the experimental therapy of laryngeal carcinoma.

[The role of autologous hematopoietic cell transplantation in adult acute myelogenous leukemia]. / Rola autologicznego przeszczepiania komórek hemopoetycznych w leczeniu ostrej bialaczki szpikowej u doroslych.

High dose chemotherapy with autologous hemopoietic cell transplantation (AHCT) is a common method of treatment of acute myelogenous leukemia (AML). AHCT is a treatment of choice for patients who have no matched family donor. AHCT is particularly recommended for older patients, excluded from allogeneic transplantation procedures. Prospective randomised trials have shown better efficacy of AHCT comparing with conventional chemotherapy in postremission treatment of AML. Both in vitro and in vivo bone marrow purging allow to achieve better transplantation results. Since two years peripheral blood instead of bone marrow is increasingly used as a source of transplant material. It allows more rapid hemopoiesis regrowth. Various methods of immunotherapy such as interleukin-2, Linomid and mixed hemopoietic cell transplantation (delayed donor lymphocytes transfusion) are used to evoke an autologous graft versus leukemia (GvL) phenomenon and to reduce AML relapse rate. Analysis of prognostic factors allows to identify a group of AML patients for whom AHCT is strongly recommended.

[Autologous transplantation in acute lymphoblastic leukemia in adults]. / Transplantacja autologiczna w ostrej bialaczce limfoblastycznej doroslych.

Over the past ten years considerable experience has been gained in autologous bone marrow transplantation (ABMT) for acute myelogenous leukemia and it is becoming possible to identify patients who may benefit from this approach. In acute lymphoblastic leukemia (ALL)the precise role of autologous transplantation particularly in first remission is much less clear than in AML. Formerly, most adult ALL patients who underwent ABMT did so in relapse or in second or subsequent remission. The fact that some of these patients could become long term survivors has encouraged the use of ABMT in first remission. In most studies 40-50% of first remission patients attained long term disease free survival (DFS). Relapse rates are considerably higher in patients receiving ABMT when compared to those receiving an allogeneic transplant, but the latter group of patients experience significant morbidity and mortality (15-30%) due to graft-versus-host disease and opportunistic infections. ABMT clearly has the potential to effect cures in ALL patients and its role and timing are now the subject of major clinical studies. As the mortality of ABMT for ALL rapidly decreases to approximately 5%, more widespread use of such a procedure may replace the protracted maintenance chemotherapy usually given in this disease.

[The effect of various occupational exposures to microwave radiation on the concentrations of immunoglobulins and T lymphocyte subsets]. / Wplyw promieniowania mikrofalowego na stezenie immunoglobulin i subpopulacje limfocytów T w róznych ekspozycjach zawodowych.

The immunoglobulins' concentrations and T lymphocyte subsets during occupational exposures to microwave radiation were assessed. In the workers of retransmission TV center and center of satellite communications on increased IgG and IgA concentration and decreased count of lymphocytes and T8 cells was found. However, in the radar operators IgM concentration was elevated and a decrease in the total T8 cell count was observed. The different behaviour of examined immunological parameters indicate that the effect of microwave radiation on immune system depends on character of an exposure. Disorders in the immunoglobulins' concentrations and in the T8 cell count did not cause any clinical consequences.

[Nonmyeloablative allogeneic hematopoietic stem cell transplantation: minitransplantation]. / Przeszczepianie allogenicznych komórek hemopoetycznych z zastosowaniem niemieloablacyjnego leczenia kondycjonujacego: minitransplantacja.

Allogeneic hematopoietic stem cell transplantation (alloHCT) is considered as a treatment of choice for many malignant hematologic disorders and genetic diseases. Unfortunately toxicities of conventional alloHCT remain a major limitation to successful application of the procedure. A radically new approach for alloHCT has been developed. Nonmyeloablative preparative regimen allows to establish mixed hematopoietic chimerism after alloHCT. A state of stable mixed chimerism may represent a starting point for induction of full donor derived hematopoiesis. A published results of several clinical trials have confirmed potential benefits of this new approach such as less procedure--related toxicity, protection from severe acute GVHD (graft versus host disease), lower TRM (transplant related mortality). Intensive investigations are done to replace in the future pretransplant chemotherapy and/or radiation by nontoxic anti-T-cell agents. These include antibody to the T-cell receptor alpha beta and blockers of T-cell costimulation (e.g. CTLA4lg).

[Hairy cell leukemia--a potentially curable malignancy. Selected aspects of purine analog therapy]. / Bialaczka wlochatokomórkowa--nowotwór potencjalnie wyleczalny. Wybrane aspekty zastosowania analogów purynowych.

Hairy-cell leukemia (HCL) is a lymphoproliferative B-cell malignancy--it represents about 2% of all adult leukemias. HCL is associated with pancytopenia and splenomegaly. In the late 1980s, introduction of new purine analogs such as 2-deoxycoformycin (pentostatin, DCF) and 2-chlorodeoxy-adenosine (2-CdA) significantly improved the prognosis of HCL patients. 33-89% patients can achieve a complete remission (CR) following DCF treatment and 85% CR after 2-CdA therapy. There is no cross-resistance between pentostatin and 2-CdA. Residual hairy cells are present in bone marrow of almost all patients after purine analogs therapy, detected by immunohistochemical methods. It is called minimal residual disease (MRD). The spleen may be the source of MRD after purine analogs therapy. Thus splenectomy could be a profitable approach after chemotherapy. Hairy-cell leukemia relapse appears in 47.8% of cases in 30 months after pentostatin treatment and in 23% of cases in 3 years after 2-CdA therapy. There is no perfect treatment of HCL relapse. Thanks to new purine analogs hairy-cell leukemia may be considered a potentially curable disease.

[The causes of treatment ineffectiveness in acute myelogenous leukemia--the role of blast resistance to cytotoxic drugs]. / Przyczyny nieskutecznosci leczenia ostrej bialaczki szpikowej--rola opornosci blastów na cytostatyki.

Acute myelogenous leukemia (AML) represents 80% of adult acute leukemias. A standard-dose chemotherapy allows to obtain 52% to 72% of complete remission (CR). A major limitation for success in chemotherapy of AML is dominance of drug-resistant subpopulations of cells. Cytosine-arabinoside (Ara-C) is a basic drug in AML treatment. Myeloblasts resistance to Ara-C could be kinetic or pharmacological. The classical multidrug resistance (MDR) depends on presence in resistant myeloblasts ATP-dependent drug-efflux pump with ability to remove cytotoxic drugs from the cells. It is a product of MDR1 gene called P-glycoprotein (Pgp). Pgp is responsible for cell resistance to cytotoxic compounds of natural origin, such as anthracyclines, vinca alkaloids, epipodophyllotoxins, taxanes, colchicine and amsacrine. There were also identified not Pgp-dependent multidrug resistance mechanisms (non-Pgp MDR) in AML. All mentioned above drugs are involved but not taxol. Non-Pgp MDR depends on topoisomerase II alfa activity alterations, multidrug resistance-associated protein (MRP) expression and lung resistance-related protein (LRP) expression. Pgp positive AML patients have poorer complete remission (CR) rate, decreased remission duration and overall survival. Pgp expression is detected among 70% AML patients older than 55. The most promising drugs in circumventing classical MDR seems cyclosporin A (CsA) and cyclosporin D (SDZ PCS 833). They are successfully used in refractory and relapsed AML.

Profiles of plasma serpins in patients with advanced malignant melanoma, gastric cancer and breast cancer.

Blood coagulation and fibrinolysis are activated systemically in patients with malignancy. The precarious balance between coagulation and fibrinolysis is modulated by serine proteinase inhibitors (serpins). Levels of selected serpins (alpha1-antichymotrypsin, alpha1-antitrypsin, alpha2-macroglobulin, antithrombin III, C1 inhibitor, alpha2-antiplasmin), substrates (factor XIIIa, fibrinogen, fibronectin) and endproducts (fibrin/fibrinogen degradation products) of coagulation reactions were measured in the plasma of 61 patients with common malignancies associated with a tendency to thrombosis (i.e. malignant melanoma, gastric cancer and breast cancer). The data revealed a heterogeneity in plasma levels of serpins between tumor types. The most profound differences between cancer and healthy subject groups were found in breast cancer patients. Levels of alpha1-antitrypsin were significantly higher and levels of alpha2-antiplasmin were significantly lower in all cancer groups, whereas there were no differences in antithrombin III levels.

[Activity of cathepsin D in some neoplasms of the gastrointestinal tract]. / Aktywnosc katepsyny D w niektórych nowotworach przewodu pokarmowego.

In the present paper we analyzed cathepsin D activity in digestive tract cancers. Cathepsin D activity was estimated in 10% homogenates of oesophageal cancer, gastric cancer and colon cancer tissues and in the blood serum and expressed as the amount of liberated tyrosine which was assayed acc. to Folin-Ciocalteau. Mean cathepsin D activities in neoplastic tissues and normal counterparts were as follows: oesophaged cancer (218.5 mM Tyr/1/2 h vs 145.0 mM Tyr/1/2 h), gastric cancer (285.4 mM Tyr/1/2 h vs 142.3 mM Tyr/1/2 h) and colon cancer (233.7 mM Tyr/1/2 h vs 159.5 mM Tyr/1/2 h). In all examined neoplastic tissues cathepsin D activity was almost too-fold higher than in the normal counterparts. Cathepsin D activity in the sera of cancer patients was too a lesser degree higher than in the sera of normal subjects. The data indicate that estimating of cathepsin D activity in the neoplastic tissues homogenates and in the blood serum may be of diagnostic value and may constitute an information which is complementary to the analysis of other tumor markers and histopathologic examination.

Activity of cancer procoagulant (CP) in serum of patients with cancer of lung, breast, oesophagus and colorectum.

Activity of cancer procoagulant (CP) was studied in blood serum of 90 patients with cancer of lung, breast, oesophagus and colorectum, and of 15 healthy people. The activity of CP was determined by the coagulation method. Sera of patients with cancer showed higher mean activity of CP than sera of healthy control. Of the 90 cancer patients 78 were identified correctly by this test as having cancer (sensitivity 85%). In the case of lung and colorectal cancers the higher CP activity was observed the more advanced was the clinical stage of cancer, and the test was positive in 100%. After radical removal of malignant tumor of lung, decreased CP activity was found.

Cancer procoagulant--CP.

A review of literature concerning cancer procoagulant (CP) has been carried out. This procoagulant directly activates coagulation factor X to factor Xa. Possibilities of utilising determinations of this activator in diagnostics and prognostics of the cancerous disease are discussed.

Cancer procoagulant (CP) in lung cancer.

Lung cancers (squamous cell carcinoma, microcellular carcinoma, macrocellular carcinoma and adenocarcinoma) show procoagulant activity. It mainly depends on the presence of cancer procoagulant (CP) in lung cancer cells.

[Activity of selected enzymes of peripheral blood erythrocytes and serum haptoglobin levels in workers occupationally exposed to styrene and formaldehyde]. / Aktywnosc wybranych enzymów erytrocytów krwi obwodowej oraz poziomy haptoglobin w surowicy krwi pracowników eksponowanych na dzialanie styrenu i formaldehydu.

In 48 and 30 workers exposed to styrene and formaldehyde respectively activities of erythrocyte acetylcholinesterase lactate dehydrogenase and glucose-6-phosphate dehydrogenase, were determined. Hematocrit, haemoglobin concentration, red blood cell count and serum haptoglobin levels were also determined. Significant decrease in erythrocyte acetylcholinesterase activity in workers exposed to styrene for 61-180 months was stated. Moreover, increased erythrocyte lactate dehydrogenase activity and decreased serum haptoglobin level was found in workers exposed to formaldehyde for 3-24 months. There were no differences in basic hematological parameters and erythrocyte glucose-6-phosphate dehydrogenase activity in both groups studied as compared to the control group.

[Effect of electromagnetic radiation on T-lymphocyte subpopulations and immunoglobulin level in human blood serum after occupational exposure]. / Wplyw promieniowania elektromagnetycznego na subpopulacje limfocytów T oraz poziom immunoglobulin w surowicy krwi u czlowieka w warunkach ekspozycji zawodowej.

The study was aimed at evaluation of the total lymphocyte, the T lymphocyte (T3), the T helper (T4) and the T suppressor (T8) count in the peripheral blood as well as of the IgG, IgA and IgM level in sera of 39 radar operators aged from 20 to 22 years. The operators were exposed to electromagnetic radiation at frequencies ranging from 390 MHz to 10.96 GHz and power from 500 kW to 1.5 MW for a period from 720 to 7560 hours. As compared to the control group in the radar operators a statistically significant decrease in the total T8 cell count and a significant increase in the IgM level was found pointing to the radiation induced disorders in lymphocyte system.