Primary gastric lymphoma

To evaluate the clinico-pathological status of Primary Gastric Lymphoma [PGL] at presentation in King Fahad Hospital, Madina Munawra, Kingdom of Saudi Arabia [KSA]. A case series. Oncology Department of King Fahad Hospital, Madina Munawra, KSA, from 1990 to 1998. Case records of 22 patients with a histologically-confirmed diagnosis of PGL were analyzed. Tumors were staged according to the Ann Arbor Classification and divided according to the Rappaport working formulation. According to the treatment modality, different groups were established. Any other histopathological type was excluded from the study. Data were analyzed by frequency calculations. Survival was calculated from the date of surgery. All cases were Non-Hodgkin Lymphoma [NHL]. The peak age was in the sixth decades with a slight male preponderance. Most common presenting symptoms were epigastric or upper abdominal pain with or without mass. There were 10 [45%] patients with stage II, and 6 [27%] patients each with stage III and IV diseases. Diffuse large cell lymphoma was found in 12 [55%], poorly differentiated lymphoma in 3 [14%] and diffuse mixed in 7 [32%]. Helicobacter pylori infection was found in 2 [9%]. Sixteen [73%] patients underwent chemotherapy with some surgical resection, in 5 [23%] surgical procedure was palliative bypass and 11 [50%] had partial gastrectomy. Three [14%] had only chemotherapy after endoscopic biopsy. Two [9%] patients needed urgent surgical intervention. One [5%] patient had total gastrectomy followed by radiotherapy. Eleven [50%] had more than 3 years survival. PGL is usually of NHL type, presenting in the sixth decade, and can be successfully treated with both surgery and chemotherapy when patients presented at stage II. Chemotherapy after sub-total gastrectomy or biopsy was the best treatment option

Cancer esophagus: Treatment modalities

Therapeutic options for cancer esophagus have increased. Treatment for each patient should be individualized. Surgical resection is the mainstay of treatment for patients with curative intent. In those with more advanced disease where the aim of treatment is obviously palliative, surgical resection is less frequently performed, given the alternatives available. Successful resection however, still offers the most complete and lasting relief of dysphagia, providing it can be carried out safely in experienced centers. In selected patients, a bypass procedure is also an option. Chemoradiation therapy is widely adopted in patients who have good performance status. Good palliation can be obtained in those who respond without the development of a radiation stricture. In selected patients who demonstrate a positive response, surgical resection is sometimes warranted, especially when tumor downstaging makes a curative resection possible. In patients without a chance of cure or in poor health, placement of stents achieves rapid, safe and cost effective palliation

Doctors need enhanced oncology knowledge

To assess oncology knowledge among doctors, and suggestions to improve. Cross sectional analytical study. This study was carried out in the Department of Oncology, King Fahad Hospital, Madina Munawra, KSA and was completed in 8 months from November 2004 to June 2005. Series of five lectures were delivered on different subjects of oncology. Participants were asked to answer an MCQ type questionnaire, which was structured regarding the content of the lecture, before the lecture and after the lecture. Comparison was made by simple percentage calculation and statistical analysis, student's t-test. Knowledge of the doctors rose from average 37% to 74% after the lecture. Doctors need enhanced knowledge in oncology and simple lecturing can make an improvement

Advanced pancreatic cancer: past, present and future of treatment

Pancreatic cancer is highly lethal disease that is rising in incidence. Chemotherapy based on 5-fluorouracil [5-FU] has shown to prolong survival in advanced pancreatic cancer modestly. Gemcitabine improves major symptoms and survival outcomes compared with 5-FU. Many compounds have been investigated. These compounds are based on classical mechanisms of action as well as biological therapies targeting cellular pathways, and include fluoropyrimidines, nucleoside cytidine analogues, platinum analogues, topoisomerase inhibitors, antimicrotubule agents, proteasome inhibitors, vitamin D analogues, arachidonic acid pathway inhibitors, histone deacytylator inhibitors, farnesyltransferase inhibitors, epidermal growth factor receptor therapies and many more. Out of these some have shown their promise. Many more compounds are being tested and real advances are anticipated in the near future

Scope of growth factor in cancer patients

The growth factors [GFs] act at different stages of stem cell proliferation. Among them the most important ones found of clinical use are erythropoietin [EPO], granulocyte-colony stimulating factor [G-CSF], granulocyte macrophagecolony stimulating factor [GM-CSF], and thrombopoietin [TPO]. Their concomitant use makes treatment with chemotherapy or radiotherapy easier and cost-effective, with fewer side effects and better quality of life in highly selected patients. This is a review article

Gastric stump carcinoma

This case report describes the occurrence of carcinoma in gastric stump in a man who underwent partial gastrectomy with anastomosis 20 years back for duodenal ulcer. Surgical resection and anastomosis was followed by adjuvant chemotherapy

Screening for hepatocellular carcinoma

Liver cancer remains one of the most common causes of cancer death globally, and its cure rate has not improved for the past 20 years. Hepatocellular carcinoma develops in patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in screening program aiming to achieve early detection and effective treatment for HCC. Only those patients diagnosed with HCC who would benefit with the available treatment, should undergo the screening procedure. This is based on ultrasonography and alpha-fetoprotein every 3-6 months based on the prevalence and economic status of the community being tested

Fungal infections in neutropenic cancer patients

Invasive fungal infections are important causes of morbidity and mortality in cancer patients with prolonged neutropenia following chemotherapy. Recent trends indicate a change toward infections by Aspergillus species, non-albicans species of Candida, and previously uncommon fungal pathogens. These have decreased susceptibility to current antifungal agents. In the last decade there has been much effort to find solution for these changing trends. This article reviews current approaches to prevention and treatment of opportunistic fungal infections in postchemotherapy neutropenic patients and discusses future antifungal approaches and supportive methods. This is a review article

Pancreatic cancer: new strategies available, but long battle ahead

With the recent advancement in science some neoplasia, such as certain leukemia, are less lethal, but unfortunately this is not the case with all diseases. The art of diagnosis and treatment of certain tumors is still in a state of dormancy. Pancreatic cancer remains a notoriously difficult disease to treat. Pancreatic cancer is an aggressive tumor and unless complete surgical resection is possible, the disease is fatal. The diagnostic tools currently available usually do not detect early stage of this disease, and therefore most patients have metastasis at the time of diagnosis. Little is know regarding chemoprevention, and pharmacologic and surgical interventions are seldom curative. Thus, efforts to understand the molecular mechanism underlying the development of pancreatic cancer may lead to prevention or a better prognosis. This is an editorial

Role of COX-2 specific inhibitors in oncogenesis

Cyclooxygenase-2 [COX-2] is over expressed in a variety of premalignant and malignant conditions. It may contribute to carcinogenesis by modulating xenobiotic metabolism, apoptosis, immune surveillance, and angiogenesis. Selective COX-2 inhibitors suppress the formation of tumors in experimental models. Selective COX-2 inhibitors also suppress the growth and metastases of established tumors and enhance the anticancer activity of both radiotherapy and chemotherapy in experimental animals. This review aims at discussing evidence that inhibition of COX-2 represents a promising strategy to treat, prevent or possibly prevent human malignancies. Importantly, selective COX-2 inhibitors do not inhibit platelet function and cause fewer gastrointestinal side effects [peptic ulcer disease] than traditional nonsteroidal anti-inflammatory drugs [NSAIDS]. More clinical trials are warranted to define the role of selective COX-2 inhibitors in the prevention and treatment of cancer along with their assessment of toxicity

Present trends in the tareatment of advanced non-small-cell lung cancer

Lung cancer is the leading cause of cancer deaths all over the world. As most patients present with advanced disease, major efforts have been made in the treatment of such disease with systemic chemotherapy. Several new agents and new combinations of chemotherapy have been developed recently. This article reviews the randomized clinical trials investigating chemotherapy for advanced non'small-cell lung cancer [NSCLC] in relapse or progressive disease while being treated and in elderly patients. Therapies that incorporate new biological agents to target specific defects in lung cancer are also discussed. Several clinical trials have demonstrated improvement in overall survival as well as quality of life with presently available chemotherapy treatment of advanced NSCLC. Better options are available for the elderly as well as those having relapse after first-line chemotherapy. Despite all this progress the 5-year survival rate still remains at a dismal 14%. New therapies with good results are still desired

Effect of pamidronate on pain control in breast cancer patients

One of the common complaints in advanced breast cancer is pain. This is due to osseous metastasis. Analgesics, along with chemotherapy and hormonal therapy, are the mainstay of treatment. Multifocal bone disease that is refractory to above routine treatments can benefit from a series of agents like pamidronate. Design: Prospective comparative study. Place and Duration of Study: Study was carried out from February 1998 to January 2001 in the Department of Radiotherapy / Oncology, Services Hospital, Lahore. Subjects and Sixty patients suffering from metastatic breast cancer [mainly to bones] initially treated with chemotherapy or hormonal therapy and analgesics were treated with 60-90 mg of injection pamidronate by 4-hour intravenous infusion once a month for three or more months. The intensity of pain was assessed by the memorial symptom assessment scale and marked on the pain control performa according to frequency of pain, severity of pain or interference in daily activities due to pain at the start and after six months time of incluson in the study. Difference in frequency of pain, severity or interference in daily routine was measured for each patient individually. Marked pain relief was reported by 60% of patients who were additionally taking Pamidronate as compared to 43.3% patients who were not taking pamidronate. Reduction in pain and analgesic demand is noted more in chemotherapy group with pamidronate as compared to hormonal therapy group. Pamidronate can be additionally used in resistant cases for pain control

Knowledge, information and communication among cancer patients

Knowledge, information and communication, within oncology, are a core clinical strength for the outcome of the disease and inadequate communication can cause distress for the patient and their families. Design: A senior doctor conducted this study by filling in the performa after interviewing the subject of the study. Place and Duration of Study: This study was done in Oncology Department of Services Hospital, Lahore and was completed in four months. Subjects and One hundred cancer patients were interviewed regarding their knowledge about their disease, its causes, prognosis, and information supplied by the health-care providers. They were also asked about their satisfaction regarding this information, deficiencies and pitfalls in this information, need for more information, which should supply the information from among the hospital team or their relative, attitude of the family and their communication regarding the disease. Study revealed that the knowledge about the disease and its causes was present in 53% and 7% respectively. The patients [59%] wanted more information. Majority perceived that the information was not adequate and needed more information and 68% thought that more information would reduce their anxiety. The attitude of family was found encouraging in 87% of patients and 42% were communicating with other family members regarding their disease. Knowledge about the disease and its cause should be increasingly supplied by the doctors, as it will reduce the anxiety and have a good effect on health. Communication among the family members needs to be improved

Association of social class in HBsAg and hepatocellular carcinoma

To find out the social class difference in relation to frequency of HBsAg and hepatocellular carcinoma in our population: Design: An analytical study. Place and Duration of Study: This study was conducted in Oncology Department, Services Hospital, Lahore from December 1997 to December 2000. Subjects and The HBsAg positive voluntary and apparently healthy blood donors were grouped into three, based on 'monthly income. Lower socioeconomic group had monthly income less than 3,000 Pakistani rupees, middle socioeconomic group had monthly income between 3,000-10,000 rupees and upper socioeconomic group had income of more than 10,000 Pakistani rupees. On the same pattern patients suffering from hepatocellular carcinoma coming for treatment were also grouped. During this period, 1000 blood donors were screened for HBsAg and 95 biopsy proven liver cancer cases were treated. Medical and demographic data of all subjects were recorded. HBsAg test was performed by immuno-chromatographic technique using Daina Screen HBsAg kit manufactured by Dainabot Co. Ltd, Tokyo, Japan. Patients from lower and middle social class had higher percentage [80% and 75%] of hepatocellular carcinoma as compared to higher social class [66.6%]. In the healthy asymptomatic blood donors lower social class had higher [13.76%] HBsAg positivity as compared to middle social class [11.25%] and higher social class [8.06%]. Preventive measures should be taken in identifying and reducing factors predisposing high frequency of these conditions

Study of risk factors for carcinoma breast in adult female general population in Lahore

To evaluate some of the established risk factors for the breast cancer in adult female population. Design: It was a prospective study. Place and Duration: This study was conducted in Oncology Department, Services Hospital, Lahore, from August, 1999 to August, 2000. Subject and One hundred breast cancer patients and 100 control subjects enrolled for interview and the percentage of positives was analyzed. Proforma containing demographic characteristics and established risk factors for breast cancer was established. All the female subjects, above 15 years of age, were subjected to the questions in this proforma. To keep uniformity medical officers were briefed for filling this proforma. The data gathered was analyzed statistically. Out of established risk factors, family history of breast cancer and use of oral contraceptive pills were proved significantly positive with a value of p<0.001, infertility and history of early menarche was positive with statistically significant difference of p<0.05. Menstrual disturbance, late menopause, history of pregnancy after 30 years of age and history of breast-feeding had no statistically significant difference [p>0.05]. This study showed that there is a family tendency for breast cancer and estrogenic hormones are playing some role. More possibility of breast cancer was found in infertile and those having early menarche

Knowledge, attitude and preventive practices for breast cancer

To determine the knowledge and practice of breast cancer in medical community. Design: A cross sectional study. Place and Duration of Study: The study was carried out in the Department of Oncology, Services Hospital, Lahore and completed in one month. Subjects and About 200 female doctors and nurses of the Hospital were involved. Each subject was asked to fill up a proforma designed to assess knowledge, risk factors and preventive practices of the breast cancer. Using non-probability convenience sampling technique, breast self-examination [BSE] and mammography was performed as screening of breast cancer. A majority had good knowledge of the risk factors and screening method for the early detection of breast Cancer. Majority had the consensus on the benefit of mammography. Conclusions: The study shows that although medical professionals had fairly good knowledge about screening methods and risk factors of breast cancer their preventive practices were scanty in high risk population and, therefore, physicians and nurses need proper training