Obesity as a tumour development triggering factor.

INTRODUCTION: The overweight and obesity epidemic represents a rapidly growing threat to the health of populations in an increasing number of countries. Nearly one-third of the world's population has excess adipose tissue. Nowadays, obesity occurrence is so common that it is replacing more traditional problems, such as an undernutrition and infectious diseases, as the most significant causes of ill health. If the current trend continues, almost half of the world's adult population will be overweight or obese by 2030. OBJECTIVE: The aim of this study is to show the connection between recent trends in body mass index, and the globally changing cancer profile. STATE OF KNOWLEDGE: A range of clinical and epidemiological studies have shown the relationship between excess body fat and the most frequently occurring malignancies. Obesity is associated with many cancers, such as: breast, colorectal, liver, lung, kidney, oesophageal, pancreatic, endometrium, ovarian, prostate, thyroid, and gallbladder cancer. CONCLUSIONS: In the light of this information, the study supports the claimed statement that obesity is one of the major health problems of the 21st century. Considering the increase in the number of obese people worldwide, it is necessary to develop a strategy allowing to prevent it. Fighting against unhealthy lifestyle in order to reduce overweight and obesity in society may have an essential impact on decreasing the number of incidences of cancer.

Imbalance in circulatory iNKT, Th17 and T regulatory cell frequencies in patients with B-cell non-Hodgkin's lymphoma.

T cells are important in B-cell non-Hodgkin's lymphoma immunity, however the function of T cell subsets, including natural killer (iNKT), T helper (Th)17, and T regulatory cells remains to be elucidated. The present study analyzed the frequencies of iNKT, Th17 and T regulatory cells in the peripheral blood of 41 patients with B-cell non-Hodgkin lymphoma at diagnosis, then during and following immunochemotherapy R-CHOP/R-CVP. At lymphoma diagnosis, iNKT and Th17 frequencies were decreased and T regulatory cell frequencies were increased compared with healthy control group. The Th17 cell percentage was lower in patients with a worse prognosis and at a more advanced clinical stage and in contrast, the percentage of T regulatory cells was increased in patients at advanced stages of lymphoma, compared to earlier stages. There was an increase of iNKT and Th17 cells following R-CHOP/R-CVP therapy. In patients that responded, both prior to and following-treatment, percentages of iNKT and Th17 were higher and T regulatory cells were lower compared with patients with subsequent disease progression. Taken together, the results obtained demonstrated the opposing effects of T cell subsets in B-cell lymphoma immunity, with iNKT and Th17 inhibiting and T regulatory cells enhancing tumor growth. These alterations may be caused by malignant B-cells, however there may also be an axis of inverse feedback between T regulatory cells and their interaction with Th17 and iNKT cells.

Primary and secondary prevention of breast cancer.

INTRODUCTION: Breast cancer is the most common cancer among women and is the second cancer frequently occurring worldwide of newly-diagnosed cancers. There is much evidence showing the influence of life style and environmental factors on the development of mammary gland cancer (high-fat diet, alcohol consumption, lack of physical exercise), the elimination of which (primary prevention) may contribute to a decrease in morbidity and mortality. Secondary prevention, comprising diagnostic tests (e.g. mammography, ultrasonography, magnetic resonance imaging, breast self-examination, as well as modern and more precise imaging methods) help the early detection of tumours or lesions predisposing to tumours. OBJECTIVE: The aim of this study paper is to review current knowledge and reports regarding primary and secondary prevention of breast cancer. STATE OF KNOWLEDGE: It is estimated that nearly 70% of malign tumours are caused by environmental factors, whereas in breast cancer this percentage reaches 90-95%. There are national programmes established in many countries to fight cancer, where both types of prevention are stressed as serving to decrease morbidity and mortality due to cancers. CONCLUSIONS: Cancer prevention is currently playing a key role in the fight against the disease. Behaviour modification, as well as greater awareness among women regarding breast cancer, may significantly contribute towards reducing the incidence of this cancer. Another important aspect is the number of women undergoing diagnostic tests, which still remains at an unsatisfactory level.

[Epidemiology and risk factors of hepatocellular carcinoma]. / Epidemiologia i czynniki ryzyka rozwoju raka watrobowokomórkowego.

Primary liver neoplasms occurs relatively rarely in Poland. The most frequently occurring type of cancer is hepatocellular carcinoma (HCC), which globally constitutes 7% of all the occurrences of cancer. The incidence increases with age and is the highest in patients around the age of 70. It also varies significantly depending on the geographic location. The main factors that cause HCC are infection of HBV and HCV, whose genome integrates into the DNA of the host, causing mutations. The other factors include excessive alcohol consumption, contact or consumption of Aspergillus toxins as well as various metabolic disorders, such as α1-antitrypsin deficiency, hemochromatosis, tyrosinemia, porphyria, von Gierke disease and in person with gene mutation p.I148M of adiponutrin. HCC is usually detected incidentally, during ultrasound examination or during clinical diagnosis of liver failure. HCC can be diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI), which is considered the most accurate diagnostic method. A core needle biopsy or the examination of the level of markers such as: alpha-fetoprotein (AFP), D-gamma-carboxy prothrombin (DCP), tumourassociated glycoprotein 72 (CA 72-4, TAG-72), are advised for a complete diagnostics.

The problem of fatigue in patients suffering from neoplastic disease.

Modern therapeutic management of patients with cancer is associated with many adverse side effects, including fatigue defined as weariness, burnout, lassitude, malaise, apathy, impatience, and/or inability to perform daily activities. It occurs frequently before the diagnosis of cancer and may persist for a long time after the end of cancer therapy. It is a common problem that occurs regardless of the type of cancer and applied therapeutic procedure. The appearance of this symptom significantly affects the quality of life of patients and often reduces the effectiveness of implemented treatment. The symptom of fatigue occurs among approximately 80% of patients treated with chemotherapy and/or radiotherapy, as well as among more than 75% of patients with metastatic disease. Causes of fatigue include metabolic and immune system disorders as well as increased level of tumour necrosis factor α (TNF-α). Recent studies also indicate a significant contribution of other cytokines, especially pro-inflammatory ones, i.e. interleukin-1 (IL-1), interleukin-6 (IL-6), soluble tumour necrosis factor receptor type II (sTNF type II) and C-reactive protein (CRP). A patient reporting fatigue should be properly diagnosed and thoroughly interviewed by doctors. Patients are mostly treated non-pharmacologically (by means of physical exercise and psychotherapy) and pharmacologically (by applying methylphenidate and methylprednisolone). What is also extremely important is proper education of the patient and their closest family/friends on the symptoms, which significantly reduces anxiety and stress. On the other hand therapeutic management hinders the subjectivity of feeling and lack of standardised scales to rate symptoms.

Life quality of women with breast cancer after mastectomy or breast conserving therapy treated with adjuvant chemotherapy.

INTRODUCTION: Breast cancer is the most frequent malignant neoplasm in women. The evaluation of the quality of life has become a treatment parameter as important as survival. OBJECTIVE: The aim of the study was evaluation of the quality of life among women treated for breast cancer who underwent surgical procedures using two alternative methods: mastectomy or breast conserving therapy (BCT). MATERIALS AND METHOD: 85 patients treated with BCT and 94 patients who underwent mastectomy were evaluated. Standard questionnaires for the evaluation of the quality of life of cancer patients were used - QLQ-C30 (Quality of life questionnaire - core 30) with QLQ-BR23 (Breast Cancer Module). The Hospital Anxiety and Depression Scale was also applied. RESULTS: Social and demographic factors (age, education, marital status) influenced the evaluation of the life quality among both groups. Obtained data was also dependent on the type of surgical procedure and chemical treatment. The level of anxiety and depression also influenced the general quality of life and was higher in women who underwent mastectomy. CONCLUSIONS: Quality of life plays an important role in the treatment process. Women after BCT declared a higher quality of life compared to patients after mastectomy. The process of making the decision concerning the planned surgical procedure should take into consideration the influence of the intervention on the quality of patients' future life.

Breast cancer risk factors.

Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women's ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neoplasm. Taking the possibility of influencing the neoplastic transformation process in individuals as a criterion, all the risk factors initiating the process can be divided into two groups. The first group would include inherent factors such as age, sex, race, genetic makeup promoting familial occurrence of the neoplastic disease or the occurrence of benign proliferative lesions of the mammary gland. They all constitute independent parameters and do not undergo simple modification in the course of an individual's life. The second group would include extrinsic factors conditioned by lifestyle, diet or long-term medical intervention such as using oral hormonal contraceptives or hormonal replacement therapy and their influence on the neoplastic process may be modified to a certain degree. Identification of modifiable factors may contribute to development of prevention strategies decreasing breast cancer incidence.

[Ten years progression-free survival obtained in a patient with mantle cell lymphoma]. / Dziesiecioletnie przezycie wolne od progresji u pacjentki z chloniakiem z komórek plaszcza.

Mantle cell lymphoma is a rare aggressive lymphoma derived from B cells, characterized by rapid progression and subsequent recurrence. It is considered to be an incurable disease, with exception of a certain group of patients treated with an autogenic stem cell transplantation. The mean survival time is three years, after applying the conventional regimen based on COP (cyclophosphamide, vincristine, prednisone) or CHOP chemotherapy (COP + doxorubicin). An addition of rituximab to CHOP regimen significantly prolongs progression-free survival. The present case reports ten years progression-free survival in a female patient with mantle cell lymphoma with baseline clinical stage IVB (MIPI 5), treated with nine courses of CHOP chemotherapy. Rituximab was added from 3 to 8 course. The complete clinical, radiological and histopathological response has been obtained.

Evaluation of symptoms of anxiety and depression in women with breast cancer after breast amputation or conservation treated with adjuvant chemotherapy.

OBJECTIVE: Evaluation of the presence of symptoms of anxiety and depression in women treated for breast cancer who underwent surgical procedure using one of two alternative methods, either radical mastectomy or breast conserving treatment (BCT). METHODS: A questionnaire survey involved 85 patients treated in a conservative way and 94 patients after breast amputation. Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and depression degree evaluation questionnaire were used in the study. The patients' esponses were statistically analyzed. RESULTS: Based on the HADS questionnaire, the total anxiety level in the group of women treated with BCT was 6.96 points, while in the group of patients who had undergone mastectomy the value was 7.8 points. The observed results were statistically significant. In the case of depression, the following values were found: patients after amputation had 8.04 scale value points, and those after BCT had 6.8 scale value points. The observed differences were statistically significant. Negative correlation was found between the level of anxiety and depression. The total level of depression evaluated using the Beck scale was 16.3 points in the BCT group, which means that they suffered from mild depression, while in the mastectomy group the level was 19.6 points, which corresponds to moderate depression. CONCLUSIONS: The level of anxiety and depression among women with breast cancer was influenced by the type of the applied surgical procedure and adjuvant chemotherapy. Demographic variables did not influence the level of anxiety and depression.

Quality of life and occurrence of depression under chemotherapy in patients suffering from lung carcinoma.

INTRODUCTION AND OBJECTIVE: In Poland, lung carcinoma is the most frequent malignant neoplasm in men and the third most frequent in women. The neoplastic disease causes enormous psychic stress and may lead to depressive reactions. The purpose of this research was to assess the quality of life and the occurrence of depression in patients suffering from lung neoplasms and undergoing chemotherapy. MATERIALS AND METHOD: The research covered 102 patients (test group TG) with lung carcinoma and undergoing chemotherapy. In the research, standardised questionnaires: EORTC-QLQ-C30, Beck Depression Inventory and a matrix developed by the researcher were applied. The control group (CG) consisted of 60 healthy people who were examined by the Beck Depression Inventory. RESULTS: A highly statistically significant dependency was found (p<0.01) between the general quality of life and the occurrence of depression. 51.5% of those examined with a very low level of general quality of life had the symptoms of severe depression. Those examined who had a very high level of general quality of life did not have features of severe depression. A statistically significant dependency (p<0.01) was ascertained between the occurrence of depression and the health condition of those examined. CONCLUSIONS: Depression symptoms occur more frequently and with greater intensity in patients suffering from lung neoplasm, compared to the group of healthy people (p<0.01). A statistically significant connection between marital status, place of residence, and assessment of quality of life was found out (p<0.05).

Comparison of biopsychosocial functioning of women of different nationalities in the perimenopausal period.

INTRODUCTION: The perimenopausal age is a time of many changes in women's health. Changes in women's health affect all spheres of life, because health is not merely the absence of disease or infirmity but full psychological, physical and social well-being. Presentation and comparison of the biopsychosocial functioning of women of different races and nationalities in perimenopause, identification of the most common menopause symptoms occurring among women and their needs. MATERIAL AND METHODS: Work supported with research examples. Using the PubMed database, the medical literature was searched for works that contain the key words menopause and race or ethnicity published between 1996 and 2013 and available in English. Literature in Polish is a supplementary issue. RESULTS: Various demographic processes taking place in the countries of Africa, North and South America, Asia and Europe are the basis for observing the situation in perimenopausal women in these countries. Caucasian women living in North America and Europe most often experience the negative symptoms of menopause, hindering daily functioning, and women living in urbanized countries in Asia best assess their health condition, both psychosocial and physical. CONCLUSIONS: Biopsychosocial functioning of women varies among countries. Developing countries should be given the necessary support and financial information to ensure the health and quality of life in perimenopausal women. In most countries of the world there has been observed the need to promote women's health, particularly research aimed at prevention, increasing physical activity and attention to nutrition.