How Grim is Pancreatic Cancer?

Pancreatic ductal carcinoma continues to be the most lethal malignancy with rising incidence. It is the fourth most common cause of cancer death in the western world due to its low treatment success rate. In addition, because of its rapid growth and silent course, diagnosis is often only established in the advanced stages. As one of the most aggressive malignancies, the treatment of this disease is a great challenge to clinicians. This paper reviewed the natural history of pancreatic cancer, the current clinical practice and the future in pancreatic cancer management.

Familial hepatocellular carcinoma in an endemic area: two case reports.

BACKGROUND: Hepatocellular carcinoma (HCC) usually affects patients aged 50-70 years but earlier onset (25-40 years) may occur in hepatitis B endemic areas. 70-90% of HCC develop on a background of cirrhosis. However, hepatitis B virus is directly oncogenic and can cause HCC in the absence of cirrhosis. This may represent a major cause of death from late diagnosis in resource-limited areas. CASE PRESENTATION: We report a black African family in which clinical diagnosis of HCC was made on two male siblings in the south west region of Cameroon. CONCLUSIONS: The highest risk for HCC may occur in families in which a hereditary component may be acting in concert with hepatitis B virus. In all cases of HCC, it is important to screen all first degree relatives to detect early and asymptomatic disease.

Gastrointestinal surgery and the acquired immune deficiency syndrome.

Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation.

Gastric leiomyosarcoma as a rare cause of gastric outlet obstruction and perforation: a case report.

BACKGROUND: Gastrointestinal stromal tumours are the most common mesenchymal malignancies of the gastrointestinal (GI) tract and gastric leiomyosarcoma represent 1-3% of gastric malignancies. CASE PRESENTATION: We report a case of a 69-year-old black African man who presented with a rare cause of gastric outlet obstruction and duodenal perforation. A Billroth-II gastrectomy was performed and histology confirmed a gastric leiomyosarcoma. CONCLUSIONS: It is important to identify the gastric leiomyosarcoma which is a variant of the more common malignant gastrointestinal stromal tumours as the pathogenesis and management are currently well established. As the facilities for differentiating these are not easily available in resource-limited areas gastrointestinal stromal tumours may remain underdiagnosed and undertreated.