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1.
Int J Nanomedicine ; 14: 9469-9482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819444

RESUMO

Premalignant lesions arise from cells that abnormally proliferate and have a tendency to become cancerous. Developing methods to specifically target and remove these premalignant lesions is imperative to the prevention of malignant progression into gastrointestinal (GI) tumors. However, accurate detection and diagnosis of GI precancerous lesions is challenging, as these lesions show little or no structural change. Thus, this prevents early intervention and reduces the success rate of therapy. In this review, we performed a systematic analysis of the technological advancements in the combined application of nanovesicles (NVs) and the human interstitial fluid (HIF) to specifically target GI premalignant lesions. NVs, which include quantum dots (QDs), are small membranous vehicles of a nanometer diameter that are widely used as drug delivery vectors, therapeutic effectors and diagnostic sensors. HIF is the fluid that is present in human interstitial tissues (HITs) in which signaling molecules and agents travel and can be found throughout the body. HIF is exploited by tumor cells for their invasion, migration and spread. Because the HITs span the entire submucosa of the gastrointestinal tract, they have been increasingly targeted in GI tumor therapy. The challenges involved in the combined application of NVs and HIF in the detection, diagnosis, prognosis and therapy of GI premalignant lesions are also discussed.


Assuntos
Líquido Extracelular/metabolismo , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Nanopartículas/química , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , Neoplasias Gastrointestinais/patologia , Humanos , Lesões Pré-Cancerosas/patologia , Prognóstico
2.
BMJ ; 366: l5016, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511230

RESUMO

OBJECTIVE: To assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer. DESIGN: Blinded randomized placebo controlled trial. SETTING: Linqu County, Shandong province, China. PARTICIPANTS: 3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design. INTERVENTIONS: H pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003). MAIN OUTCOME MEASURES: Primary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease. RESULTS: 151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease. CONCLUSIONS: H pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT00339768.


Assuntos
Infecções por Helicobacter/terapia , Lesões Pré-Cancerosas/terapia , Neoplasias Gástricas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiulcerosos/administração & dosagem , Biópsia , China/epidemiologia , Suplementos Nutricionais , Quimioterapia Combinada/métodos , Feminino , Seguimentos , Alho/química , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastroscopia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Lesões Pré-Cancerosas/microbiologia , Lesões Pré-Cancerosas/patologia , Inibidores da Bomba de Prótons/administração & dosagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/prevenção & controle , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Vitaminas/administração & dosagem
3.
World J Gastroenterol ; 25(34): 5082-5096, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558858

RESUMO

Managing familial pancreatic cancer (FPC) is challenging for gastroenterologists, surgeons and oncologists. High-risk individuals (HRI) for pancreatic cancer (PC) (FPC or with germline mutations) are a heterogeneous group of subjects with a theoretical lifetime cumulative risk of PC over 5%. Screening is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). The goal of screening is to identify early-stage operable cancers or high-risk precancerous lesions (pancreatic intraepithelial neoplasia or intraductal papillary mucinous neoplasms with high-grade dysplasia). In the literature, target lesions are identified in 2%-5% of HRI who undergo screening. EUS appears to provide better identification of small solid lesions (0%-46% of HRI) and chronic-pancreatitis-like parenchymal changes (14%-77% of HRI), while MRI is probably the best modality to identify small cystic lesions (13%-49% of HRI). There are no specific studies in HRI on the use of contrast-enhanced harmonic EUS. EUS can also be used to obtain tissue samples. Nevertheless, there is still limited evidence on the accuracy of imaging procedures used for screening or agreement on which patients to treat. The cost-effectiveness of screening is also unclear. Certain new EUS-related techniques, such as searching for DNA abnormalities or protein markers in pancreatic fluid, appear to be promising.


Assuntos
Carcinoma/prevenção & controle , Detecção Precoce de Câncer/métodos , Endossonografia , Programas de Rastreamento/métodos , Neoplasias Pancreáticas/prevenção & controle , Lesões Pré-Cancerosas/diagnóstico , Assistência ao Convalescente/métodos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Carcinoma/epidemiologia , Carcinoma/genética , Meios de Contraste/administração & dosagem , Mutação em Linhagem Germinativa , Humanos , Imagem por Ressonância Magnética , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/genética , Seleção de Pacientes , Lesões Pré-Cancerosas/genética , Lesões Pré-Cancerosas/terapia , Medição de Risco/métodos
4.
World J Gastroenterol ; 25(31): 4343-4359, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496617

RESUMO

the bile duct system and pancreas show many similarities due to their anatomical proximity and common embryological origin. Consequently, preneoplastic and neoplastic lesions of the bile duct and pancreas share analogies in terms of molecular, histological and pathophysiological features. Intraepithelial neoplasms are reported in biliary tract, as biliary intraepithelial neoplasm (BilIN), and in pancreas, as pancreatic intraepithelial neoplasm (PanIN). Both can evolve to invasive carcinomas, respectively cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC). Intraductal papillary neoplasms arise in biliary tract and pancreas. Intraductal papillary neoplasm of the biliary tract (IPNB) share common histologic and phenotypic features such as pancreatobiliary, gastric, intestinal and oncocytic types, and biological behavior with the pancreatic counterpart, the intraductal papillary mucinous neoplasm of the pancreas (IPMN). All these neoplastic lesions exhibit similar immunohistochemical phenotypes, suggesting a common carcinogenic process. Indeed, CCA and PDAC display similar clinic-pathological features as growth pattern, poor response to conventional chemotherapy and radiotherapy and, as a consequence, an unfavorable prognosis. The objective of this review is to discuss similarities and differences between the neoplastic lesions of the pancreas and biliary tract with potential implications on a common origin from similar stem/progenitor cells.


Assuntos
Neoplasias dos Ductos Biliares/etiologia , Carcinoma in Situ/etiologia , Carcinoma Ductal Pancreático/etiologia , Colangiocarcinoma/etiologia , Neoplasias Pancreáticas/etiologia , Lesões Pré-Cancerosas/etiologia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/terapia , Sistema Biliar/patologia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/metabolismo , Carcinogênese/patologia , Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/terapia , Colangiocarcinoma/patologia , Colangiocarcinoma/terapia , Progressão da Doença , Humanos , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Células-Tronco/patologia
5.
Int J Gynaecol Obstet ; 147(1): 4-18, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273785

RESUMO

BACKGROUND: Thermal coagulation is gaining popularity for treating cervical intraepithelial neoplasia (CIN) in screening programs in low- and middle-income countries (LMICs) due to unavailability of cryotherapy. OBJECTIVES: Assess the effectiveness of thermal coagulation for treatment of CIN lesions compared with cryotherapy, with a focus on LMICs. SEARCH STRATEGY: Papers were identified from previous reviews and electronic literature search in February 2018 with publication date after 2010. SELECTION CRITERIA: Publications with original data evaluating cryotherapy or thermal coagulation with proportion of cure as outcome, assessed by colposcopy, biopsy, cytology, and/or visual inspection with acetic acid (VIA), and minimum 6 months follow-up. DATA COLLECTION AND ANALYSIS: Pooled proportions of cure are presented stratified per treatment modality, type of lesion, and region. MAIN RESULTS: Pooled cure proportions for cryotherapy and thermal coagulation, respectively, were 93.8% (95% CI, 88.5-97.7) and 91.4% (95% CI, 84.9-96.4) for CIN 1; 82.6% (95% CI, 77.4-87.3) and 91.6% (95% CI, 88.2-94.5) for CIN 2-3; and 92.8% (95% CI, 85.6-97.7) and 90.1% (95% CI, 87.0-92.8) for VIA-positive lesions. For thermal coagulation of CIN 2-3 lesions in LMICs 82.4% (95% CI, 75.4-88.6). CONCLUSIONS: Both cryotherapy and thermal coagulation are effective treatment modalities for CIN lesions in LMICs.


Assuntos
Neoplasia Intraepitelial Cervical/terapia , Crioterapia/métodos , Eletrocoagulação/métodos , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/terapia , Neoplasias do Colo do Útero/terapia , Feminino , Humanos , Pobreza , Gravidez , Resultado do Tratamento
6.
Zhonghua Gan Zang Bing Za Zhi ; 27(7): 481-482, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357770

RESUMO

Liver cancer (HCC) holds third position for cause of cancer-related death worldwide. Therefore, it is urgent to explore new strategies for the diagnosis and treatment of liver cancer. Illustrating the successful experience of other tumors on precancerous lesions, this paper puts forward the idea of advance strategy for the diagnosis and treatment through dysplastic nodules, especially high-grade dysplastic nodules, which can reduce or delay the carcinogenesis of some patients with cirrhosis. It is hoped that this measure might improve the present situation of diagnosis and treatment of liver cancer in coming days in China.


Assuntos
Carcinoma Hepatocelular , Cirrose Hepática , Neoplasias Hepáticas , Fígado/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , China , Humanos
7.
Eur J Med Genet ; 62(8): 103706, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31233827

RESUMO

Constitutional Mismatch Repair Deficiency (CMMRD) is a rare cancer predisposition syndrome, presenting in childhood, in which affected patients develop various malignancies such as hematological, gastrointestinal and central nervous system tumors. Although guidelines are being increasingly developed for surveillance and early detection of cancers in affected families, there are no clear recommendations regarding choice of therapy and very scarce information about tolerance to chemotherapy and radiation in these patients. We report the pedigree of a consanguineous family with four affected children. Although clinical and molecular tests confirm CMMRD, genetic testing revealed heterogeneous mutations. The index case developed severe toxicity from therapy for glioblastoma and T-cell leukemia and died from an infection while in complete remission. His sister developed a malignant brain tumor while undergoing surveillance for a low grade brain lesion and is still undergoing follow-up. This family illustrates the difficulties and opportunities with challenging diagnosis, surveillance and choice of therapy for children with CMMRD and the need for increased awareness and more information about this rare but important syndrome.


Assuntos
Neoplasias Encefálicas/terapia , Neoplasias Colorretais/terapia , Testes Genéticos , Neoplasias/terapia , Síndromes Neoplásicas Hereditárias/terapia , Lesões Pré-Cancerosas/terapia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Consanguinidade , Feminino , Humanos , Masculino , Mutação , Neoplasias/complicações , Neoplasias/genética , Neoplasias/patologia , Síndromes Neoplásicas Hereditárias/complicações , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/patologia , Linhagem , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/genética , Lesões Pré-Cancerosas/patologia
8.
PLoS One ; 14(6): e0217331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170193

RESUMO

OBJECTIVES: To estimate the modified societal costs of cervical cancer treatment in Kenya; and to compare the modified societal costs of treatment for pre-cancerous cervical lesions integrated into same-day HIV care compared to "non-integrated" treatment when the services are not coordinated on the same day. MATERIALS AND METHODS: A micro-costing study was conducted at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital from July 1-October 31, 2014. Interviews were conducted with 54 patients and 23 staff. Direct medical, non-medical (e.g., overhead), and indirect (e.g., time) costs were calculated for colposcopy, cryotherapy, Loop Electrosurgical Excision Procedure (LEEP), and treatment of cancer. All costs are reported in 2017 US dollars. RESULTS: Patients had a mean age of 41 and daily earnings of $6; travel time to the facility averaged 2.8 hours. From the modified societal perspective, per-procedure costs of colposcopy were $41 (integrated) vs. $91 (non-integrated). Per-procedure costs of cryotherapy were $22 (integrated) vs. $46 (non-integrated), whereas costs of LEEP were $50 (integrated) and $99 (non-integrated). This represents cost savings of $25 for cryotherapy and $50 for colposcopy and LEEP when provided on the same day as an HIV-care visit. Treatment for cervical cancer cost $1,345-$6,514, depending on stage. Facility-based palliative care cost $59/day. CONCLUSIONS: Integrating treatment of pre-cancerous lesions into HIV care is estimated to be cost-saving from a modified societal perspective. These costs can be applied to financial and economic evaluations in Kenya and similar urban settings in other low-income countries.


Assuntos
Custos e Análise de Custo , Infecções por HIV , HIV-1 , Lesões Pré-Cancerosas , Neoplasias do Colo do Útero , Adulto , Feminino , Infecções por HIV/economia , Infecções por HIV/terapia , Humanos , Quênia , Lesões Pré-Cancerosas/economia , Lesões Pré-Cancerosas/terapia , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/terapia
9.
Gastrointest Endosc Clin N Am ; 29(3): 531-548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078251

RESUMO

This article begins with a brief overview of risk factors for colorectal neoplasia in inflammatory bowel disease to concretize the approach to risk stratification. It then provides an up-to-date review of diagnosis and management of dysplasia in inflammatory bowel disease, which integrates new and emerging data in the field. This is particularly relevant in an era of increased attention to cost- and resource-containment from the health systems vantage point, coupled with a heightened prioritization of patient quality of life and shared decision-making. Also provided is a brief discussion of the status of newer therapeutic techniques, such as endoscopic submucosal dissection.


Assuntos
Neoplasias Colorretais/terapia , Doenças Inflamatórias Intestinais/complicações , Intestinos/patologia , Lesões Pré-Cancerosas/terapia , Neoplasias Colorretais/etiologia , Gerenciamento Clínico , Humanos , Hiperplasia , Lesões Pré-Cancerosas/etiologia , Qualidade de Vida , Fatores de Risco
10.
Eur J Obstet Gynecol Reprod Biol ; 236: 205-209, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30965187

RESUMO

OBJECTIVE: To examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions. STUDY DESIGN: Observational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups. RESULTS: 209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well. CONCLUSIONS: Fear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.


Assuntos
Infecções por Papillomavirus/terapia , Lesões Pré-Cancerosas/terapia , Comportamento Sexual/psicologia , Estresse Psicológico/psicologia , Displasia do Colo do Útero/terapia , Conduta Expectante , Adulto , Ansiedade/psicologia , Progressão da Doença , Medo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/psicologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/psicologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/psicologia , Adulto Jovem
11.
Surg Clin North Am ; 99(2): 301-314, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30846036

RESUMO

Although the most common presentation of biliary disorder in North America is secondary to gallstone disease, an awareness of benign biliary cystic neoplasms is important because of the risk of malignant transformation. The incidence of premalignant cystic neoplasms of the bile duct is not well characterized and they often are detected incidentally for suspicion of other abdominal disorders. This article describes the 4 most common premalignant biliary cystic neoplasms: biliary mucinous cystic neoplasms, intraductal papillary mucinous neoplasms of the bile duct, intraductal tubular papillary neoplasms of the bile duct, and choledochal cysts.


Assuntos
Neoplasias do Sistema Biliar/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias do Sistema Biliar/terapia , Humanos , Lesões Pré-Cancerosas/terapia
12.
Gastroenterology ; 156(7): 2024-2040, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721664

RESUMO

Most patients with pancreatic ductal adenocarcinoma (PDAC) present with symptomatic, surgically unresectable disease. Although the goal of early detection of PDAC is laudable and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of at-risk individuals in the general population who would benefit from longitudinal surveillance programs and appropriate biomarker and imaging-based modalities used for PDAC surveillance in such cohorts. In recent years, various subgroups at higher-than-average risk for PDAC have been identified, including those with familial risk due to germline mutations, a history of pancreatitis, patients with mucinous pancreatic cysts, and elderly patients with new-onset diabetes. The last 2 categories are discussed at length in terms of the opportunities and challenges they present for PDAC early detection. We also discuss current and emerging imaging modalities that are critical to identifying early, potentially curable PDAC in high-risk cohorts on surveillance.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma Ductal Pancreático/diagnóstico , Diagnóstico por Imagem , Detecção Precoce de Câncer/métodos , Imagem Molecular , Neoplasias Pancreáticas/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Animais , Biomarcadores Tumorais/genética , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/terapia , Humanos , Incidência , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/terapia , Lesões Pré-Cancerosas/mortalidade , Lesões Pré-Cancerosas/terapia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
13.
Curr Opin Otolaryngol Head Neck Surg ; 27(2): 136-141, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30724766

RESUMO

PURPOSE OF REVIEW: To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer. RECENT FINDINGS: Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy. SUMMARY: The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Lesões Pré-Cancerosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Terapia Combinada , Previsões , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Imunoterapia/métodos , Margens de Excisão , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/patologia , Neoplasias Bucais/terapia , Recidiva Local de Neoplasia , Procedimentos Cirúrgicos Bucais , Procedimentos Cirúrgicos Otorrinolaringológicos , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Terapia de Salvação
14.
Dig Dis Sci ; 64(5): 1079-1088, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771043

RESUMO

Gastric intestinal metaplasia (GIM) is a premalignant condition that can lead to intestinal-type gastric adenocarcinoma. It is characterized by a change in the gastric mucosa to a small-intestinal phenotype. Infection with Helicobacter pylori is the most common factor associated with GIM. Although GIM is typically a histologic diagnosis, various techniques have been developed to enable the endoscopic identification of GIM. There are presently no widely accepted guidelines on screening and surveillance strategies in patients with GIM in the USA. The aim of this review is to provide an update regarding the problem, diagnosis, and management of GIM in the USA.


Assuntos
Gerenciamento Clínico , Mucosa Gástrica/patologia , Trato Gastrointestinal/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/terapia , Helicobacter pylori , Humanos , Metaplasia/diagnóstico , Metaplasia/epidemiologia , Lesões Pré-Cancerosas/terapia , Estados Unidos/epidemiologia
15.
JAMA Oncol ; 5(2): 181-186, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325982

RESUMO

Importance: As cervical cancer screening transitions to primary human papillomavirus (HPV) testing, effective triage and management of HPV-positive women is critical to avoid unnecessary colposcopy referral and associated harms while maintaining high sensitivity for cervical precancer. Triage with p16/Ki-67 dual-stain (DS) testing has shown high sensitivity and specificity for detection of cervical precancers; however, longitudinal studies are needed to determine the long-term risk of precancer following a negative DS result. Objective: To evaluate the longitudinal performance of p16/Ki-67 DS triage for detection of cervical precancer in HPV-positive women over 5 years of follow-up in the context of clinical management thresholds. Design, Setting, and Participants: Prospective cohort study of HPV-positive women 30 years or older undergoing routine cervical cancer screening in 2012 with HPV and Papanicolaou (hereinafter "cytology") co-testing within the Kaiser Permanente Northern California health care system. Follow-up of medical records was conducted through 2017. Exposures: All p16/Ki-67 DS testing was performed on residual SurePath material, and slides were evaluated for p16/Ki-67 positivity. Main Outcomes and Measures: Histological end points were ascertained from the clinical database through 2017. We estimated 5-year cumulative risks of cervical intraepithelial neoplasia grades of 2 or worse (≥CIN2) or grades 3 or worse (≥CIN3) by baseline DS and cytology at yearly intervals using Logistic Weibull models. Risks were compared with clinical management thresholds for colposcopy referral and a 1-year return interval. Results: Among the 1549 HPV-positive women in this study, the mean age at enrollment was 42.2 years, and the median follow-up time was 3.7 years (range, 0.2-5.4 years). Positive DS results were associated with significantly higher cumulative 5-year risks of ≥CIN2 compared with abnormal cytology (31.0%; 95% CI, 27.2%-35.3% vs 25.0%; 95% CI, 21.7%-28.7%; P = .03). Women with DS-negative findings had significantly lower 5-year risks of ≥CIN2 compared with women with normal cytology (8.5%; 95% CI, 6.5%-11.1% vs 12.3%; 95% CI, 9.8%-15.4%; P = .04). In DS-negative women, the risks of both ≥CIN2 and ≥CIN3 remained below the colposcopy referral threshold for all 5 years, crossing the 1-year return threshold at 3 years. Conclusions and Relevance: Triage with p16/Ki-67 DS provides better long-term risk stratification than cytology over 5 years. The low risk of cervical precancer in p16/Ki-67 DS-negative women permits safe extension of follow-up intervals for 3 years.


Assuntos
Neoplasia Intraepitelial Cervical/química , Inibidor p16 de Quinase Dependente de Ciclina/análise , Detecção Precoce de Câncer/métodos , Imuno-Histoquímica , Antígeno Ki-67/análise , Infecções por Papillomavirus/metabolismo , Lesões Pré-Cancerosas/metabolismo , Triagem , Neoplasias do Colo do Útero/química , Adulto , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/terapia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Estudos Longitudinais , Teste de Papanicolaou , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/virologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Lesões Pré-Cancerosas/virologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Neoplasias do Colo do Útero/virologia
16.
Turk Patoloji Derg ; 35(3): 247-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28832082

RESUMO

We describe an unusual case of a Peutz-Jeghers syndrome associated with a composite synchronous cervical neoplasia comprising precursor "lobular endocervical glandular hyperplasia (LEGH)", "minimal deviation adenocarcinoma (MDA)" and "gastric-type adenocarcinoma (GTA)" along with a serous tubal intraepithelial lesion (STIL) in the right fallopian tube. A 24-year-old woman presented with a white mucoid discharge and bleeding per vaginum for one year. Histopathological evaluation showed MDA & GTA in FIGO grade III with pelvic lymph node metastasis despite a deceptively bland tumour morphology and low Ki-67 index, indicating an aggressive tumour course and poor prognosis. Diagnostic marker profile in the cervix showed gastric type mucin and positive expression of CK-7, CK-20 (patchy), CEA, and negative CDX-2, p16, ER and PR. Further an attempt at eliciting the oncogenesis pathway in view of the p16 and HPV negative nature of the gastric type cervical adenocarcinoma showed negativity for p53 but activation of cyclin D1. Growth factors including Her2 and EGFR were negative while VEGFR was over-expressed. She was treated by radical hysterectomy and pelvic radiation. She was free from recurrence at the 12-month follow-up. This is a first-time report of a STIL in the fallopian tube which was validated by a unilateral mutant type p53 expression and increased Ki67 index, associated with synchronous gastric type adenocarcinoma of the cervix in all stages of evolution.


Assuntos
Adenocarcinoma/patologia , Hiperplasia Endometrial/patologia , Neoplasias das Tubas Uterinas/patologia , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Primárias Múltiplas/patologia , Síndrome de Peutz-Jeghers/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/química , Adenocarcinoma/genética , Adenocarcinoma/terapia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Biópsia , Hiperplasia Endometrial/genética , Hiperplasia Endometrial/metabolismo , Hiperplasia Endometrial/terapia , Neoplasias das Tubas Uterinas/química , Neoplasias das Tubas Uterinas/genética , Neoplasias das Tubas Uterinas/terapia , Feminino , Humanos , Histerectomia , Imuno-Histoquímica , Imagem por Ressonância Magnética , Gradação de Tumores , Neoplasias Císticas, Mucinosas e Serosas/química , Neoplasias Císticas, Mucinosas e Serosas/genética , Neoplasias Císticas, Mucinosas e Serosas/terapia , Neoplasias Primárias Múltiplas/química , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/terapia , Síndrome de Peutz-Jeghers/genética , Síndrome de Peutz-Jeghers/metabolismo , Lesões Pré-Cancerosas/genética , Lesões Pré-Cancerosas/metabolismo , Lesões Pré-Cancerosas/terapia , Radioterapia Adjuvante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias do Colo do Útero/química , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/terapia , Adulto Jovem
17.
Int J Dermatol ; 58(7): 777-781, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30315576

RESUMO

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.41 There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.


Assuntos
Balanite Xerótica Obliterante/terapia , Circuncisão Masculina , Glucocorticoides/administração & dosagem , Pênis/patologia , Lesões Pré-Cancerosas/terapia , Administração Tópica , Balanite Xerótica Obliterante/complicações , Balanite Xerótica Obliterante/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Dermatologia/métodos , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Penianas/patologia , Neoplasias Penianas/prevenção & controle , Fimose/etiologia , Fimose/cirurgia , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Transtornos Urinários/etiologia , Transtornos Urinários/prevenção & controle
18.
Ned Tijdschr Geneeskd ; 1622018 12 05.
Artigo em Holandês | MEDLINE | ID: mdl-30570951

RESUMO

The incidence of malignant and premalignant skin lesions has been increasing in recent decades. It concerns a spectrum of lesions, from relatively benign to highly malignant disease. The nomenclature does not always do justice to the biological character of the specific condition. We have to pay attention to avoid unnecessary diagnostics, overtreatment of conditions with little chance of progression of disease, and unnecessary follow-up. Besides better understanding about the biology of the various premalignant and malignant skin lesions, renaming of some of the conditions can be of help. The concept of applying the term 'indolent lesion of epithelial origin' for this purpose may be beneficial.


Assuntos
Sobremedicalização , Lesões Pré-Cancerosas/terapia , Neoplasias Cutâneas/terapia , Humanos , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/patologia , Terminologia como Assunto
19.
Gac Med Mex ; 154(Supp 2): S41-S49, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30532114

RESUMO

Introduction: T-cell lymphoid dyscrasia is a group of different, infrequent, epitheliotropic inflammatory dermatosis that precede cutaneous T-cell lymphomas. Treatment with ultraviolet radiation is safe and efficacious. Objective: To describe responses to treatment, secondary effects and complications. Method: Eleven patients with different T-cell lymphoid dyscrasias were treated. Two received psoralens plus ultraviolet A radiation (PUVA) and nine narrow band ultraviolet B radiation (NB-UVB). Results: Seven women and four men from 5 to 30 years-old and phototypes III and IV were included. They had hypopigmented epitheliotropic lymphoid dyscrasia, chronic pityriasis lichenoides, hypopigmented parapsoriasis and pigmented purpuric dermatoses. Two received PUVA and 9 NB-UVB. Eight achieved complete response and three partial response with 10 to 119 sessions. Any patient presented neither relapse nor progression to cutaneous T-cell lymphoma during treatment or in the follow up period after 34 to 247 sessions. Secondary effects were xerosis and mild pruritus. Conclusions: The majority of patients with T-cell lymphoid dyscrasias can be successfully and safely treated with minimal secondary effects after a variable number of sessions and periods of time with ultraviolet radiation.


Assuntos
Linfoma Cutâneo de Células T/prevenção & controle , Lesões Pré-Cancerosas/terapia , Linfócitos T/imunologia , Terapia Ultravioleta/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia PUVA/métodos , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/prevenção & controle , Resultado do Tratamento , Adulto Jovem
20.
Zhonghua Yu Fang Yi Xue Za Zhi ; 52(12): 1281-1286, 2018 Dec 06.
Artigo em Chinês | MEDLINE | ID: mdl-30522231

RESUMO

Objective: To account the direct cost of uterine cervix carcinoma treatment in China and to explore the related factors which influence the direct financial burden of the disease. Methods: Data was collected through the medical record system and telephone interviews in 14 county-level hospitals and 9 provincial and municipal hospitals from 14 provinces/municipalities enrolled in the Chinese National Health Industry Research Project in 2015. The direct financial burden of uterine cervix carcinoma treatment consisted of the direct medical cost and the direct non-medical cost of treatment in different pathological cervical cancer stages and precancerous lesions. Multiple liner regression method was used to analyze the factors affecting the costs. Results: The age of the 3 246 patients was (46.40±10.43) years, including 2 423 patients from provincial and municipal hospitals and 823 patients from county-level hospitals. The direct financial burden for one patient of pathological uterine cervix carcinoma stage or precancerous lesion ranged from 10 156.3 yuan to 75 716.4 yuan in provincial and municipal hospitals, and for patients from county-level hospitals, the cost was between 4 927.9 yuan and 47 524.8 yuan per person. There was a wide gap between the direct financial burden of patients in different disease stages. The direct financial burden of patients with precancerous lesions ranged from 4 927.9 yuan per person to 11 243.0 yuan per person, as for patients of pathological uterine cervix carcinoma stages, the direct financial burden was between 29 274.6 yuan and 75 716.4 yuan per person. The factors which influence direct financial burden would include: the levels of the hospital, pathological period, medicare reimbursement, days of treatment, and the methods of treatment (P<0.001). Conclusion: The direct financial burden of diseases in patients with pathological uterine cervix carcinoma stage or precancerous lesion differed in different levels of hospital and pathological periods. In addition, medicare reimbursement, days of treatment, and the methods of treatment all had impact on it.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Lesões Pré-Cancerosas/economia , Neoplasias do Colo do Útero/economia , Adulto , China , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
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