Impact of coronavirus disease 2019 on the number of newly diagnosed cancer patients and examinations and surgeries performed for cancer in Japan: a nationwide study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has rapidly and dramatically influenced healthcare across Japan. However, the influence of the COVID-19 pandemic on the number of newly diagnosed cancer, surgical treatment, and diagnostic examination for cancer types have not been completely investigated all over Japan. This study aimed to analyze the number of cases before and during the COVID-19 pandemic. METHODS: This retrospective study was a survey that asked to provide the number of cases diagnosed with gastric, colorectal, lung, breast, and cervical cancer between January 2019 and December 2020. The survey was sent to tertiary healthcare hospitals, including national cancer institutions, university hospitals, and general hospitals, all over Japan. Data obtained from 105 of 486 surveyed hospitals were evaluated, and the number of cases in each quarter in 2020 was compared with that in the equivalent quarter in 2019. RESULTS: In the second quarter (Q2), significant reductions were observed in the median number of newly diagnosed cases from 2019 to 2020: gastric cancer, 26.7% (43 vs. 32, p <  0.001); colorectal cancer, 17.9% (52 vs. 40, p <  0.001); lung cancer, 12.3% (53.5 vs. 47, p <  0.001); and breast cancer, 13.1% (43 vs. 35.5, p <  0.001). A significant reduction of 11.4% (9 vs. 8, p = 0.03) was observed in the third quarter (Q3) for cervical cancer. In Q2, the number of cases decreased by 30.9% (25 vs. 15, p <  0.001) for stage I gastric cancer, by 27.3% (12 vs. 9, p <  0.001) for stage I colorectal cancer, and by 17.6% (13 vs. 10, p <  0.001) for stage II breast cancer. The magnitude of reduction was significant for the localized stages of gastric, colorectal, and breast cancer according to diagnostic examinations in Q2 and surgical and endoscopic treatment in Q3 rather than that for lung or cervical cancer. CONCLUSIONS: COVID-19 has prolonged collateral effects on cancer care, including examination, diagnosis, and surgery, with significant effects on gastric cancer, followed by colorectal, lung, breast, and cervical cancer in Japan.

Cecal Volvulus Resolved Spontaneously.

Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We herein report an extremely rare case of a patient with spontaneously resolved cecal volvulus; no recurrence occurred without elective surgery. A 47-year-old woman presented with acute lower abdominal pain. She was misdiagnosed with small bowel obstruction and treated conservatively. A few hours later, she was correctly diagnosed with cecal volvulus. Subsequently, her symptoms and computed tomography findings of cecal volvulus completely disappeared. She refused elective surgery, but no recurrence occurred during five months of follow-up.

[Non-surgical management of small bowel diverticulitis with localized perforation:a case report].

A 40-year-old man presented to the emergency department with periumbilical pain and fever. A computed tomographic scan confirmed multiple jejunal diverticulum with localized extraluminal air and panniculitis around it, and jejunal diverticulitis with localized perforation was suspected. His symptoms were mild, and extraluminal air was localized;therefore, he was advised bowel rest and administered only antibiotics. The patient's symptoms resolved without surgical treatment, and at the time of writing this report, there had been no recurrence. Small bowel diverticulitis is rare, and careful analysis of imaging studies is necessary for establishing a diagnosis. This was a rare case where small bowel diverticulitis was resolved without surgical treatment.

Cancer treatment and management for elderly patients 80 years of age or older with malignant solid tumors.

OBJECTIVE: We retrospectively analyzed the backgrounds, treatment and nursing care for 96 patients aged 80 years or more with malignant tumors. Twenty of them were hospitalized on an emergency basis. Sixty patients were male and 36 were female, with a median age of 83 years (range: 80-94 years). Twenty-seven had a PS of 3 or 4, and 41 were rated as not independent based on analysis of autonomy at hospitalization. Forty-seven patients had clinical stage III or IV malignancies. The proportions of patients with disease complications were 33.3% for neurological disease, 21.9% for respiratory disease, 70.8% for cardiovascular disease including hypertension, and 36.5% for metabolic disease. Thirty-nine patients underwent surgical or endoscopic resection of their tumors. Twenty-three patients received chemotherapy: hormonal treatment in 14, local injection of cytotoxic agent(s) in 6 and systemic anti-cancer therapy in 3. Thirty-nine patients received supportive care only. Forty-three patients newly required nursing care or an increased level of care at discharge. The median survival time was 10.9 and 15.3 months for stage III/IV and 0/I/II patients, respectively. In conclusion, most elderly patients with malignant tumors require full supportive care, including social nursing care, from the time of cancer diagnosis.

Peritoneal sarcoidosis:an unusual cause of ascites.

An 83-year-old male presented with distended abdomen. A computed tomography scan demonstrated pleural effusion, ascites, peritoneal thickness, and panniculitis. Multiple small white nodules of peritoneum were observed during a laparoscopy examination, and biopsy specimens revealed noncaseating granulomas. Gallium scintigram demonstrated an accumulation in the peritoneum and revealed a panda sign that has been described as an indication of sarcoidosis. Although sarcoidosis rarely induces peritonitis with ascites, peritoneal sarcoidosis was diagnosed and he began receiving steroid therapy. After primary steroid therapy, his ascites completely disappeared, and he has maintained a complete response with continuous low dose steroid therapy.