Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel

Abstract: Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). Objectives: To evaluate QoL in patients with primary cutaneous SCC. Methods: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. Results: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. Conclusion: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.

Características Sociodemográficas y Clínicas de los Pacientes Tratados por Primera Vez por Cáncer Escamocelular Oral. Medellín, Colombia / Sociodemographic and Clinic Characteristics of the Patients Threatened at First Time for Squamous Cell Oral Cancer. Medellín, Colombia

RESUMEN: Este estudio pretendió describir las características sociodemográficas y clínicas de los pacientes tratados por primera vez por cáncer escamocelular oral (CEB) en Medellín (Colombia). Para ello se realizó un estudio descriptivo anidado en una cohorte dinámica retrospectiva de casos de CEB, procedente de 9 centros oncológicos especializados de la ciudad entre 2000 y 2011, según la información de las historias clínicas y clasificadas según la CIE-10. Se recolectaron variables sociodemográficas y clínicas como: tratamiento recibido, localización del tumor, estadio del tumor, atención recibida (profesional), reporte de consumo de alcohol o cigarrillo, complicaciones asociadas al tratamiento de CEB. Se describieron las variables del estudio y pruebas Chi cuadrado para observar diferencias entre algunas características clínicas y el sexo. Se encontraron 778 casos de CEB en el periodo estudiado, con una edad promedio de diagnóstico de 63,5 (±13,6) años. Más de la mitad tenían estratos socioeconómicos y niveles educativos bajos. Un 56 % de las mujeres y un 63 % de los hombres fueron diagnosticados en un estadio IV del tumor. Los tratamientos más realizados fueron de tipo combinado o cirugía. Un 35% presentaron problemas cardiovasculares, aunque no se reportaron diferencias estadísticamente significativas entre la presencia de determinadas comorbilidades y el sexo. Se reportó el consumo de alcohol en un 19 % y de cigarrillo en un 51 % con mayor consumo en hombres en ambos casos y diferencias estadísticamente significativas (p<0,0001) con respecto a las mujeres. En cuanto a complicaciones asociadas al tratamiento para CEB, se reportaron con mayor frecuencia disfagia (47 %) y mucositis (24 %). Más de la mitad de los tumores de presentaron en la lengua. Se requieren estrategias que permitan sistemas de vigilancia epidemiológica para el CEB, así como mejorar los programas de prevención y tratamiento precoz para esta enfermedad en consonancia con las políticas y los planes nacionales y globales.

ABSTRACT: This study aimed to describe the sociodemographic and clinical characteristics of patients treated for first-time oral squamous cell carcinoma (OSCC), in Medellín (Colombia). For this purpose, a descriptive study was carried out within a retrospective dynamic cohort of OSCC cases from 9 specialized oncology centers in the city between 2000 and 2011, according to the information of the clinical records and classified according to the ICD-10. Sociodemographic characteristics were recorded and clinical variables were collected such as: Treatment received, tumor location, tumor stage, care received (professional), report of alcohol or cigarette consumption, complications associated with OSCC treatment. The study variables were described, and Chi square test was calculated in order to observe differences between some clinical characteristics and sex. In the study period 778 cases of OSCC were found, with an average age of diagnosis of 63.5 (± 13.6) years. More than half had low socioeconomic and educational levels. Fifty six percent of women and 63 % of men were diagnosed in stage IV of the tumor. Treatments performed most, were either combined or for surgery. Thirty five percent of the cases had cardiovascular problems, although no statistically significant differences were reported between the presence of certain comorbidities and sex. Alcohol consumption was reported in 19 % and smoking in 51 %, with higher consumption in men in both cases and statistically significant differences (p <0.0001) with respect to women. Regarding complications associated with treatment for OSCC, dysphagia (47 %) and mucositis (24 %) were reported more frequently. More than half of the tumors were presented in the tongue. Strategies are required that allow epidemiological surveillance systems for the OSCC, as well as to improve prevention and early treatment programs for this disease in line with national and global policies and plans.

Oral squamous cell carcinoma: a clinicopathological study on 194 cases in northeastern Brazil. A cross-sectional retrospective study

ABSTRACT BACKGROUND: Only a few studies have evaluated the clinicopathological features of oral squamous cell carcinoma (SCC) in Brazil, and most were conducted in the most industrialized region of the country, i.e. the southeastern region. The aim of this study was to evaluate the clinicopathological features of this malignant neoplasm in northeastern Brazil. DESIGN AND SETTING: Retrospective study performed in an oral pathology laboratory in Recife, Brazil. METHODS: All cases of oral SCC that occurred between 2000 and 2015 were studied. Clinical data were recorded and histological slides were reviewed. Statistical analysis was performed using the chi-square test (P ≤ 0.05). RESULTS: A total of 194 cases were evaluated. The male-to-female ratio was 1.5:1. The mean age was 65.4 years, and only 6.6% of the cases occurred in patients younger than 41 years. Most tumors consisted of well-differentiated SCC (54.6%). CONCLUSIONS: The findings of this study highlight the higher prevalence of oral SCC among women and the increasing number of cases among young patients. Thus there is no specific risk group for oral SCC, as in the past. This fact needs to be taken into consideration in clinical routine care, so that apparently innocuous malignant lesions do not go unnoticed in these individuals.

Espinalioma de lengua: informe de un caso clínico / Tongue spinalioma. clinical case report

Objetivos: concientizar sobre la importancia de la consulta estomatológica y educar en la autodetección de lesiones facultativamente cancerizables. Caso clínico: paciente con antecedentes traumáticos locales de larga data, producidos por piezas dentarias con bordes filosos, obturaciones desbordantes y el consumo de tabaco, factores predisponentes e incidentes en el desencadenamiento de la lesión neoplásica. Conclusión: el caso presentado pone en evidencia las deficientes medidas de prevención primaria y la falta de acciones conducentes a la práctica de autoevaluaciones orales periódicas.

Aim: To raise awareness about the importance of pathology consultation and patient education in self detection of potentially cancerous lesions. Clinical case: We report the case of a patient with along history of local traumatisms generated by tooth lesions with sharp edges, over contoured restorations and tobacco consumption, all of which are considered risk factors in the generation of neoplasic processes. Conclusion: The case that is reported shows lack of useof primary preventive and self detections conducts that could prevent the development of cancerous lesions.

Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores / Risk factors for the development of lung cancer in a cohort of adult smokers

Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT). Aim: To examine the risk factors of lung cancer in a cohort of adult smokers. Patients and Methods: An annual clinical and respiratory functional assessment, chest computed tomography for three years and clinical follow up for five years was carried out in 270 patients aged 65 ± 9 years, 55% males, active or former smokers of 10 or more pack-years. Results: Thirty seven percent of patients were active smokers, consuming 37 ± 26 packs/year, 85% had comorbidities, especially chronic obstructive pulmonary disease (COPD) (66%), hypertension (48%), diabetes (22%) and dyslipidemia (42%). Thirteen percent of patients had family history of lung cancer. Twenty-one cases of lung cancer were detected in the five years follow up, especially squamous cell carcinoma and adenocarcinoma. In the univariate analysis, the main risk factors for lung cancer identified were an age older than 60 years, history of COPD, family history of lung cancer, active smoking, tobacco consumption more than 30 pack/year and lung hyperinflation. In multivariate analysis, the three independent risk factors for lung cancer were a family history of lung cancer, active smoking and the number of packs per year of tobacco consumption. Conclusions: The identification of risk groups probably will improve the performance of programs for early detection of lung cancer.

Carcinoma escamoso de conducto auditivo externo: reporte de 3 casos / Squamous cell carcinoma of the external auditory canal: report of three cases

El carcinoma escamoso de conducto auditivo externo es poco frecuente. La sintomatología puede semejar una otitis externa u otitis media crónica, lo que puede retrasar el diagnóstico. La falta de un sistema de clasificación y el número limitados de casos hace difícil la elaboración de guías de tratamiento. Se describe una serie de casos de esta neoplasia, asf como una revisión de la literatura actual.

Squamous cell carcinoma of the external auditory canal is rare. The symptoms may resemble an external otitis or chronic otitis media, which can delay diagnosis. The lack of a classification system and the limited number of cases makes it difficult the development of treatment guidelines. We present a case series of this neoplasia, as well as a review of the literature.

Levantamento epidemiológico dos casos de câncer de boca em um hospital de referência em Campina Grande, Paraíba, Brasil / Epidemiological survey of oral cancer cases in a reference hospital of Campina Grande, state of Paraíba, Brazil

Objetivo: Determinar dados epidemiológicos e analisar variáveis relacionadas ao paciente, ao tipo histológico, localização anatômica da lesão, hábitos bucais, estadiamento clínico e à classificação do tratamento do pacientes com câncer de boca, atendidos num Hospital de referência, na cidade de Campina Grande-PB. Método: Foi realizada coleta de dados em prontuários de todos os pacientes portadores de neoplasia maligna de boca, diagnosticada entre 1999 e 2008, sendo submetidos à análise estatística descritiva. Resultados: Do total da amostra de 473 casos de câncer bucal foi observado que 62,71% eram do gênero masculino e 59,96% eram leucodermas. A idade dos pacientes variou de 07 a 90 anos, com média de 65,5±13. O carcinoma espinocelular foi o tipo histológico mais prevalente (86,20%), seguido por carcinoma mucoepidermóide (5,10%), adenocarcinoma (2,10%), carcinoma metastático e linfoma não Hodking com (1,70%) cada. A língua foi localização anatômica mais comum do carcinoma espinocelular (29,60%). A maioria das lesões foi diagnosticada em estádios clínicos III e IV. A presença de hábitos nocivos foi observada em 78,81% dos casos analisados, sendo a associação fumo/consumo de bebidas a mais prevalente (50,00%). O tratamento antineoplásico mais empregado foi a combinação cirurgia e radioterapia (38,10%). Conclusão: Diante dos resultados da amostra avaliada, conclui-se que o câncer bucal atinge preferencialmente indivíduos leucodermas, do gênero masculino, com hábitos de tabagismo e etilismo ou associação dos dois. O carcinoma espinocelular com localização lingual e diagnosticado em estádio clínico avançado foi o tipo histológico mais frequente. A combinação de cirurgia e radioterapia foi a terapia antineoplásica mais empregada.

Objective: To collect epidemiological data and analyze variables related to the patient, histological type, anatomical location of the lesion, oral habits, clinical staging and treatment classification of patients with oral cancer seen at a reference hospital in the city of Campina Grande, PB, Brazil. Methods: Data were collected from medical records of all patients with malignant neoplasm of the mouth diagnosed between 1999 and 2008, and subjected to descriptive statistical analysis. Results: The total sample consisted of 473 cases of oral cancer, 62.71% of which were male patients and 59.96% of which were Caucasians. The ages of the patients ranged from 7 to 90 years (mean age = 65.5 ± 13). Squamous cell carcinoma was the most prevalent histological type (86.20%), followed by mucoepidermoid carcinoma (5.10%), adenocarcinoma (2.10%), metastatic carcinoma (1.70%) and non-Hodgkin's lymphoma (1.70%). The tongue was the most common anatomical location of squamous cell carcinoma (29.60%). Most injuries were diagnosed in the stages III and IV. The presence of deleterious habits was observed in 78.81% of the cases, with the association of smoking / drinking being the most prevalent (50.00%). The most used anticancer treatment was the combination of surgery and radiotherapy (38.10%). Conclusion: Given the results of the studied sample, it can be concluded that oral cancer primarily affects Caucasian male individuals with smoking and drinking habits or the association of both. Squamous cell carcinoma of the tongue, diagnosed at an advanced clinical stage, was the most frequent histological type. Combination of surgery and radiotherapy was the most frequent anticancer therapy.

Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde / Strategies for management of oral cancer in primary and secondary healthcare services

O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária e, obviamente, aos avanços técnico-científicos que caracterizam a abordagem diagnóstica e terapêutica. Embora seja notável o reconhecimento de avanços no manejo de neoplasias malignas em todas as áreas citadas, o câncer da boca permanece com indicadores de morbidade e mortalidade que parecem não acompanhar o acúmulo científico no conhecimento da doença. O presente manuscrito objetiva discutir os motivos desse descompasso, a necessidade de reorientação de prioridades na abordagem do câncer da boca e sua efetivação como política pública de saúde.

Progress in cancer management by health systems involves improvements in surveillance, organization of healthcare services, specific programs focused on primary and secondary prevention, and scientific and technical advances in diagnosis and treatment. Despite well-known progress in the management of malignant neoplasms in all the above areas, oral cancer displays persistently high morbidity and mortality rates, apparently failing to reflect the accumulated scientific knowledge on the disease. The current article discusses the reasons for this mismatch, the need for redefining priorities in oral cancer management, and the implementation of such priorities as a public health policy.

Retardo diagnóstico e terapêutico em pacientes com câncer da laringe em hospital público de referência / Diagnostic and therapeutic delay in patients with larynx cancer at a reference public hospital

O carcinoma epidermoide da laringe, apesar dos sintomas precoces, ainda é frequentemente diagnosticado em estádio avançado. Apesar da demora até chegar ao atendimento especializado, o tempo despendido no diagnóstico e a espera para o tratamento definitivo também são importantes para o resultado final. OBJETIVO: Avaliar o intervalo de tempo entre a primeira consulta no especialista e o tratamento nos pacientes com carcinoma epidermoide da laringe. FORMA DE ESTUDO: Coorte histórica longitudinal. MATERIAL E MÉTODO: Estudo de 272 pacientes com carcinoma epidermoide da laringe atendidos consecutivamente entre janeiro de 1996 e dezembro de 2004. Avaliadas as características clínicas e epidemiológicas, assim como sua relação com o tempo despendido entre a consulta inicial e o tratamento. RESULTADO: O intervalo de tempo entre a primeira consulta e o início do tratamento apresentou mediana de 49 dias e média de 57 dias. Não houve diferença em relação ao estadiamento, faixa etária, sexo, naturalidade ou escolaridade. CONCLUSÃO: O tempo entre o atendimento inicial com especialista e o início do tratamento apresentou mediana de 49 dias, similar ao relatado em outros estudos.

Laryngeal squamous cell carcinoma is very often diagnosed at advanced stages. The time interval between the specialist consultation and the start of treatment may contribute to better outcomes. AIM: the interval assessment between the first specialist evaluation and the treatment of patients with laryngeal squamous cell carcinoma. STUDY DESIGN: longitudinal historical cohort. MATERIALS AND METHODS: 272 consecutive patients with laryngeal squamous cell carcinoma seen between January, 1996 and December of 2004. Clinical and epidemiological data were evaluated, as well as their association with the time interval between the first specialist visit and the start of treatment. RESULT: the median time between first evaluation and treatment was 49 days. There was no relationship with gender, age, birth place, disease stage or education. CONCLUSION: the treatment median delay was 49 days, similar to what has been reported in other studies.

Caracterização do diagnóstico tardio do câncer de boca no estado de Alagoas / Characterization of oral cancer diagnostic delay in the state of Alagoas

O câncer de boca, no Brasil, ainda apresenta altos níveis de incidência e mortalidade, com diferentes características da doença no território nacional. A maioria dos casos é diagnosticada tardiamente, porém há uma grande chance de cura quando tratado no início. OBJETIVO: Avaliar os fatores relacionados ao diagnóstico tardio do câncer de boca no estado de Alagoas. MATERIAL E MÉTODOS: Foi realizado um estudo prospectivo transversal em 74 pacientes portadores de carcinoma espinocelular da cavidade bucal diagnosticados em um hospital em Alagoas, no período de julho de 2007 a setembro de 2008. Foi realizada uma entrevista semiestruturada, obtendo-se dados sociodemográficos, profissional procurado, início dos sintomas, encaminhamento e estágio clínico do tumor no momento do diagnóstico. RESULTADOS: De acordo com os resultados obtidos neste estudo, os pacientes procuraram mais o médico que o dentista quando apresentaram uma lesão na boca, sendo encaminhados pelo dentista sempre em um estágio avançado da doença. CONCLUSÕES: Esse estudo sugere a necessidade de programas de educação continuada da população e profissionais para a identificação de sintomas precoces da doença, porém necessita de outras investigações.

Oral cancer in Brazil still presents high levels of incidence and mortality bearing different traits throughout the national territory. In most of the cases the diagnosis is late; however there is a great possibility for cure when treated early on. AIM: to assess factors associated with the late diagnosis of oral cancer in the state of Alagoas. MATERIAL AND METHODS: a prospective cross-sectional study was carried out in 74 patients, all of them diagnosed with oral squamous cell carcinoma in a hospital of Alagoas, between July of 2007 and September of 2008. A semi-structured interview was given, obtaining socio-demographic data, the type of professional help sought, symptom onset, referrals and tumor clinical stage at the moment of diagnosis. RESULTS: According to the results obtained in this study, the patients usually sought professional medical help, rather than dental help when a lesion in the mouth appeared, being always referred to a specialist by the dentist, in advanced stages of the disease. CONCLUSIONS: This study suggests the need for continued education programs for the population and professionals aiming at the early identification of symptoms of the illness; however needing further studies.

A importância da tríplice endoscopia no diagnóstico de neoplasias primárias múltiplas em pacientes com carcinoma epidermóide de vias aerodigestivas superiores / Importance of triple endoscopy in the diagnosis of multiple primary tumors in patients with upper aerodigestive tract squamous cell carcinoma

INTRODUÇÃO: Pacientes com carcinomas das vias aerodigestivas superiores (VADS) apresentam um alto risco de desenvolver outros cânceres tanto simultaneamente quanto subsequentemente. A maioria destes tumores ocorre nas VADS, pulmões ou esôfago. A tríplice endoscopia (laringoscopia, endoscopia digestiva alta e broncoscopia) possibilita o diagnostico de lesões precursoras e de tumores invasivos. No entanto, a maioria dos estudos limita-se a descrever a frequência de diagnósticos, mas não os resultados do tratamento e o impacto na sobrevida. OBJETIVOS: Avaliar a importância da tríplice endoscopia para o diagnóstico de neoplasias primárias múltiplas e as diferenças no estadiamento e nas taxas de sobrevida de pacientes com carcinoma epidermóide de VADS. Caracterizar o perfil e analisar fatores de risco para neoplasias primárias múltiplas. MÉTODOS: Trata-se de estudo caso-controle retrospectivo em que foram incluídos pacientes com carcinoma epidermóide de VADS, submetidos à tríplice endoscopia antes do início do tratamento (grupo tríplice endoscopia), pareados, por sexo, idade e localização, estádio clínico e tratamento do tumor primário, com pacientes não submetidos à tríplice endoscopia na avaliação inicial (grupo controle). RESULTADOS: Foram incluídos 135 pacientes em cada grupo. No grupo tríplice endoscopia ocorreram mais diagnósticos de segundo tumor primário (STP), 34 (17 simultâneos e 17 metacrônicos), do que no grupo controle, 20 (1 simultâneo e 19 metacrônicos). Não foi identificada diferença significativa entre o estadiamento dos tumores de grupo tríplice endoscopia e do grupo controle. As curvas de sobrevida global, específica por câncer, livre de doença e pós-STP foram semelhantes nos dois grupos. A sobrevida livre de STP foi maior no grupo controle. Na análise multivariada foram identificados como fatores prognósticos independentes para a sobrevida, o sexo (feminino, RR 0,51, IC 0,30 0,88), a idade (maior que 57 anos, RR 1,73, IC 1,29 2,31),...

INTRODUCTION: Patients with upper aerodigestive tract (UADT) carcinomas have a high risk of developing others cancers simultaneously or subsequently. Most of these tumors occur in UADT, lungs or esophagus. Triple endoscopy (laryngoscopy, endoscopy and bronchoscopy) enables the diagnosis of premalignant and invasive tumors. However, most of the studies describe only the frequency of the diagnosis, but not the results of treatment and its impact on survival. OBJECTIVES: To evaluate the importance of triple endoscopy for the diagnosis of multiple primary tumors and the differences in clinical stage and survival rates of patients with squamous cell carcinoma of the UADT. To characterize and to analyze the risk factors for multiple primary tumors. METHODS: This is a case-control study that included patients with squamous cell carcinoma of the UADT, that were submitted to a triple endoscopy before the first treatment (triple endoscopy group), matched by sex, age and location, clinical stage and treatment of primary tumor, with patients not undergoing triple endoscopy in the initial evaluation (control group). RESULTS: One hundred and thirty five patients were included in each group. The diagnosis of second primary tumor (SPT) was more frequent in the triple endoscopy group than in the control group, 34 (17 simultaneous and 17 metachronous) and 20 cases (1 simultaneous and 19 metachronous), respectively. No significant difference was found between the clinical stage of triple endoscopy group and the control group. The curves of overall survival, cancer specific, disease-free and after SPT were similar in both groups. The SPT free survival was higher in the control group. In the multivariate analysis were identified as independent prognostic factors for survival, sex (women, RR 0.51, CI 0.30 - 0.88), age (older than 57 years, RR 1.73, CI 1.29 - 2.31), the primary tumor site (larynx, RR 0.60, CI 0.39 - 0.93), N stage (N2 and N3, RR 1.78, CI 1.26 - 2.51) ...

Oral cancer public policies: is there any evidence of impact?

Investigation in oral cancer comprises many different fields such as epidemiology, risk factors, biological markers, diagnostic testing, screening, treatment and prognosis. Although many researchers have dealt with the oral cancer problem, it is unknown if any public policy is capable of reducing its incidence around the world under the scrutiny of the scientific method. This paper aims to briefly review and discuss the literature regarding oral cancer public policies and to screen the evidence of controlled implementations of oral health policies that have been able to diminish oral cancer incidence around the globe.

Contribuição da citopatologia para o diagnóstico de carcinoma de células escamosas oral / Contribution of cytopathology to the diagnosis of oral squamous cells carcinoma

A incidência de câncer tem aumentado significativamente em todo o mundo, configurando-se como um dos mais importantes problemas de saúde pública. Como conseqüência o câncer de boca também tem aumentado, com 94 por cento dos casos correspondendo ao carcinoma de células escamosas. O objetivo deste estudo foi atualizar o tema e documentar a experiência de cinco anos na utilização da citopatologia para avaliação de lesões orais suspeitas de malignidade. Realizou-se uma busca no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (HUAP/UFF), referente ao período de 2002 a 2007, de pacientes com lesões orais clinicamente suspeitas de carcinomas submetidos simultaneamente à biopsia incisional e a raspados da lesão para análise citopatológica. A amostra selecionada correspondeu a 50 casos, mas em 41 (82 por cento) pacientes, o diagnóstico histopatológico foi de carcinoma de células escamosas. Desses, a citopatologia foi conclusiva em 30 (73 por cento) e descreveu alterações suspeitas em 11 (27 por cento) pacientes. Os resultados revelaram que a citopatologia apresentou concordância diagnóstica de 74 por cento com a histopatologia (padrão-ouro) nos diagnósticos positivos para carcinoma de células escamosas, e negativos para malignidade. Os resultados obtidos indicam a necessidade de padronização da técnica e da avaliação de grandes casuísticas para definição da acurácia, pois, na casuística avaliada, a citopatologia apresentou-se como um método fidedigno, que poderá ser utilizado como recurso de diagnóstico suficiente para o imediato encaminhamento dos pacientes para o tratamento de carcinoma de células escamosas oral.

Cancer is one of the most important problems in public health and its incidence has risen significantly worldwide. Accordingly, the incidence of oral cancer has also increased and 94 percent of the cases are caused by squamous cell carcinomas. The objective of the present study was to provide an update on the subject and report our five-year experience in the use of cytopathology analyzing suspected malignant oral lesions. We searched the slide archives of the anatomic pathology service of Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), from 2002 to 2007. We selected patients with suspected carcinoma oral lesions who underwent incisional biopsy and were scraped for cytopathological analysis simultaneously. The sample consisted of 50 cases, of which 41 (82 percent) were diagnosed with squamous cell carcinoma. Among these, cytopathology was conclusive in 30 cases (73 percent) and suspected alterations were described in 11 (27 percent). Results indicated that cytopathology presented diagnostic concordance with histopathology in positive diagnosis for squamous cell carcinoma and in negative for malignancy in 74 percent of the cases (gold standard). Our findings demonstrate that the standardization of techniques and the evaluation of a larger number of patients are required to define the accuracy of the method. In the studied sample cytopathology was a reliable method that may be used as a sufficient diagnostic tool to refer patients for immediate treatment of oral squamous cell carcinoma.

Correlação entre os dados clínicos e histopatológicos dos casos de carcinoma espinocelular oral do Instituto Maranhense de Oncologia Aldenora Bello, em São Luís, MA / Correlation between the clinical and histologic data of oral squamous cell carcinoma from Instituto Maranhense de Oncologia Aldenora Bello, in São Luís, MA, Brazil

O objetivo deste estudo foi investigar a existência de correlação entre os dados clínicos e histopatológicos do carcinoma espinocelular oral. Foram avaliados 90 casos de pacientes com diagnóstico de carcinoma espinocelular oral dos arquivos do Instituto Maranhense de Oncologia Aldenora Bello (IMOAB) (São Luís, MA). Aplicou-se o teste de correlação de Pearson, em nível de significância de 5 por cento, não tendo sido revelada relação estatisticamente significante (r = 0,095, p = 0,375) entre a classificação clínica TNM (tumor, linfonodo, metástase) e a graduação histológica de malignidade (GHM) desenvolvida por Wahi (1971) e publicada pela Organização Mundial da Saúde (OMS). Mas houve relação significativa entre a referida graduação histológica de malignidade e o parâmetro clínico tamanho do tumor primário (T) (r = 0,229, p = 0,03).

The aim of this study was to investigate the existence of correlation between the clinical and histopathological data of oral squamous cell carcinoma. A total of 90 cases of patients diagnosed with oral squamous cell carcinoma were selected from the slide archives of Instituto Maranhense de Oncologia Aldenora Bello (São Luís, MA, Brazil). Pearson's correlation test was applied and did not reveal a statistically significant correlation (r = 0.095; p = 0.375) between TNM clinical classification and histologic malignancy grading, which was defined by Wahi (1971) and published by the World Health Organization (WHO). There was a significant correlation between the histologic malignancy grading and the size of the primary tumor as a clinical parameter (r = 0.229; p = 0.03).

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil / Papilomavírus humano e anormalidades cervicais em mulheres do sistema de saúde privado e público no Estado do Rio de Janeiro, Brasil

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4 percent presented HPV and nearly 90 percent of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3 percent. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3 percent), and invasive cervical carcinoma (16.3 percent). HPV infection was found in 93.1 percent and 94.4 percent of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions...

Este artigo analisa a infecção por HPV e anormalidades citológicas cervicais encontradas em pacientes atendidas em serviços ginecológicos dos sistemas de saúde público e privado do estado do Rio de Janeiro. O trabalho também avalia os testes utilizados para detecção de DNA do HPV em cada população estudada. Um grupo de 454 mulheres oriundas de serviços da rede privada de saúde foi testado por Captura do Híbrido II. Destas, 58,4 por cento apresentaram infecção por HPV e cerca de 90 por cento delas estavam infectadas por HPV de alto risco. Este grupo, entretanto, apresentava poucos casos de lesões cervicais pré-malígnas e nenhum caso de câncer. Estudamos, também, 220 mulheres de baixo nível econômico atendidas no serviço de saúde pública que foram testadas para HPV pela reação da polimerase em cadeia utilizando-se os oligonucleotídeos My09/My11. A identificação dos tipos foi efetuada por amplificação com oligonucleotídeos específicos para a região E6 do genoma viral. A prevalência de HPV nesta população foi de 77.3 por cento, observando-se uma alta porcentagem de casos de neoplasias intraepiteliais cervicais de alto grau (26,3 por cento) e de carcinoma cervical invasivo (16,3 por cento). A infecção por HPV foi achada em, respectivamente, 93,1 por cento e 94,4 por cento destes casos. A média de idade em ambos os grupos era de 31,5 e 38 anos, respectivamente. Na série 1, a prevalência da infecção por HPV decresce com a idade, enquanto na série 2 ela não desaparece, dando suporte não só à idéia de persistência viral neste grupo, mas também a variações epidemiológicas na mesma área geográfica. Diferenças significativas foram vistas nos dois grupos. Casos normais e benignos foram incidentes na série 1, enquanto as lesões malígnas predominaram na série 2. Ao contrário, casos normais infectados por HPV eram prevalentes na série 2 (p < 0.001), indicando maior exposição ao vírus. Embora as mulheres de ambos os grupos tenham sido incluídas no estudo por apresentarem citologia anormal, evidências sócio-demográficas demonstram que mulheres da série 1 tem acesso mais fácil e rápido ao tratamento do que as mulheres da série 2 antes que as lesões pré-malígnas se desenvolvam...

Carcinoma epidermóide: diagnóstico e conduta imediatas / Squamous cell carcinoma: diagnosis and first behavior

O carcinoma epidermóide apresenta moderada frequência na cavidade bucal, podendo ser considerado um problema de saúde pública. O escopo deste trabalho é apresentar o caso de um paciente portador de carcinoma epidermóide em lábio inferior, o qual foi submetido ao tratamento cirúrgico. Foram discutidas as características clínicas, radiográficas e histopatológicas, frequência, incidência e modalidades de tratamento

Comportamiento clínico y epidemiológico del cáncer de cavidad oral / Clinical and epidemiologic behavior of oral cancer

Se realizó un estudio descriptivo en el Hospital Oncológico Provincial Docente María Curie para caracterizar clínica y epidemiológicamente el cáncer de la cavidad bucal desde el año 1999 hasta el 2004. Se estudiaron 79 pacientes de un universo de 285 y se excluyeron 206 pacientes con cáncer del labio. Se analizaron las variables grupos de edades, sexo, factores de riesgo, manifestaciones clínicas, localización anatómica, tipo histológico, forma clínica, estadio clínico y modalidad terapéutica. El procesamiento estadístico se realizó mediante estadística descriptiva, tablas de contingencia y gráficos; como medida de resumen se utilizó el porcentaje y el test de proporción. Predominó la enfermedad en pacientes de 70-79 años con 24 (30,38 por ciento), y el sexo masculino, con 59 pacientes (74,68 por ciento). El tabaquismo se detectó en 38 de estos (48,10 por ciento), de los cuales 35 (44,30 por ciento) refirieron dolor como principal síntoma. El carcinoma epidermoide fue la variedad histológica más frecuente (76, para el 96,20 por ciento). Su localización prevaleció en la lengua (24 casos, para el 30,38 por ciento). El diagnóstico frecuentemente se realizó en un estadio III (en 42 pacientes, para el 53,16 por ciento) y predominó la forma clínica mixta (38 para el 48,10 por ciento). La radioterapia fue el tratamiento más utilizado en sus diferentes variantes con 64 casos (81,0 por ciento)

A descriptive study was conducted in "Maria Curie" Oncological Provincial Teaching Hospital in order to characterize oral cancer from the clinical and epidemiologic point of view between 1999 and 2004. 79 patients of a total of 285 were studied and 206 with lip cancer were excluded. Variables such as age groups, sex, risk factors, clinical manifestations, anatomical localization, histological type, clinical form, clinical stage and therapeutical modality were analyzed. The statistical processing was carried out by descriptive statistics, contingency tables and graphs. Percentage and proportion test were used as a summary measure. The disease predominated in patients aged 70-79, with 24 (30.38 percent), and in males, with 59 patients (74.68 percent). Smoking was detected in 38 of them (48.10 percent), of whom 35 (44.30) referred to pain as the main symptom. The epidermoid carcinoma was the most frequent histological variety (76, accounting for 96.20 percent). Its localization prevailed in the tongue (24 cases, 30.38 percent). The diagnosis was commonly made in stage III (42 patients, 53.16 percent), and the mixed clinical form predominated (38, 48.10 percent). Radiotherapy was the most used treatment in its different variants with 64 cases (81.0 percent)(AU)

Carcinoma epidermóide esofágico em paciente com esôfago de Barret: relato de caso / Squamous cell esophageal cancer in patient with Barret's esophagus: case report

O carcinoma epidermóide de esôfago é a neoplasia esofágica mais comum no nosso meio, tendo como principais fatores de risco o etilismo e o tabaco. Há um aumento na incidência de casos de adenocarcinoma esofágico em países ocidentais, e a sua associação com o esôfago de Barret é bem estabelecida. Nesse relato, apresentamos o caso de uma paciente com esôfago de Barret na qual foi diagnosticada a presença de carcinoma epidermóide associado à metaplasia intestinal. São raros os casos descritos na literatura com esse achado. Os autores apresentam o caso e revisam as publicações prévias de casos semelhantes.

Estudo retrospectivo e revisão de literatura dos tumores dos lábios: experiência de 28 anos / Lips' tumors retrospective study and literature review: a twenty-eight-year experience

Os tumores dos lábios correspondem a aproximadamente 15 por cento de todas as neoplasias do segmento cabeça epescoço e a 25 a 30 por cento de todos os tumores da cavidade oral. Correspondem ainda a 20 por cento dos tumores malignos do trato respiratório e digestivo alto. Acometem geralmente o lábio inferior e 90 por cento dos casos ocorrem no sexo masculino, com 5:1 em relação ao sexo feminino. São raros em negros e crianças. O objetivo do presente estudo retrospectivo é demonstrar o comportamento dos tumores benignos e malignos dos lábios de pacientes atendidos e tratados no Serviço de Cabeça e Pescoço do Centro de Oncologia (CEON) do Hospital Universitário Oswaldo Cruz (HUOC), Universidade de Pernambuco (UPE), de janeiro de 1975 a janeiro de 2003 (período de 28 anos), através do levantamento dos dados de seus prontuários, utilizando-se um formulário próprio para coleta. No total de 403 casos (100 por cento), foram analisados os indicadores gênero, faixa etária, aspectos clínicos, histopatológicos, diagnóstico, tratamento, prognóstico, e comparou-se os referidos indicadores com os apresentados na revisão da literatura realizada. Concluímos que os tumores malignos dos lábios apresentaram-se predominantes no sexo masculino (59 por cento), nas quintas, sextas e sétimas décadas de vida e o tratamento de eleição para a referida patologia foi o cirúrgico.

VEGF immunoexpression in penile carcinoma

Objective: To investigate the vessel endothelial growth factor (VEGF) as a risk factor in squamous cell carcinoma of the penis (SCCP). Methods: Forty seven patients with penile carcinoma were evaluated retrospectively. The mean age and standard deviation were 61.1ñ11.7 years. All of them were treated by penectomy and those with positive nodes underwent groin lymphadenectomy. Tumor grading was 35 G1 and 12 G2/3. Primary lesion stage was 24 pTl and 23 pT2-4. Positive inguinal nodes were observed in 15 patients. Selected paraffin embedded sections were submitted to VEGF immunohistochemical analysis by the avidin-biotin-immunoperoxidase method with antigen retrieval. All slides were examined using an automatic analyzer system and the proportion of labeled cells in 10 high magnification power fields (400X) were recorded in a blind analysis. Results - Median (percent) labeling index was 2.3 in Gl versus 2.2 in G2/3 tumors (p=0.60), and 4.0 in pTl versus 1.8 pT2-4 tumors (p=0.10). The respective data for pN0 patients was 2.8 and for pN+ was 2.1 (p=0.20). Survival curves showed no association with patients survival. Conclusion: In squamous cell carcinoma of the penis the VEGF immunoexpression has no association with tumor grade or stage, as well as with patient survival.