International Journal of Cancer Management
Volume:10 Issue: 11, Nov 2017

Context: Breast cancer is the most common cancer among women, worldwide. Both genetic and environmental factors are involved in the risk of breast cancer. Folate is an essential nutrient that is involved in DNA synthesis, repair, and methylation. Single nucleotide polymorphisms (SNPs) in folate related genes, such as methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C are suitable candidates for investigation the role of these variants in susceptibility to breast cancer.
Evidence Acquisition: Using the relevant English language studies from the search engines, such as MEDLINE/PubMed, EMBASE, and Scopus from 2005 to 2016, the present review looks at the role of MTHFR C677T and A1298C variants, synergism between these gene variants along with folate intake in susceptibility to breast cancer.
It seems the MTHFR C677T polymorphism is associated with the risk of breast cancer among Asians but not in Caucasians. However, the MTHFR A1298C polymorphism might not be a susceptibility factor for breast cancer. The MTHFR haplotypes alone or along with low dietary intake of folate were not involved in susceptibility to breast cancer.
Association between MTHFR C677T polymorphism with the risk of breast cancer could be attributed to the lower activity of the MTHFR enzyme in the presence of 677T allele with reduced availability of folate that may result in uracil misincorporation in the DNA and cancer development. The absence of establishment of a role for MTHFR haplotypes and a synergism between low dietary intake of folate along with MTHFR polymorphisms in susceptibility to breast cancer might be due to differences in allelic frequency of MTHFR variants in various populations, stage of cancer, the familial and early onset cancer, and the influence of environmental factors. To establish the role of MTHFR haplotypes in relation to folate intake in susceptibility to breast cancer, more studies with adequate sample size that investigate the role of MTHFR gene polymorphisms along with dietary intake of folate in the risk of breast cancer are necessary.

Context: Treatment outcome for locally advanced squamous cell carcinoma of the head and neck is poor. Recently, anti-epidermal growth factor monoclonal antibodies, such as cetuximab have been used to improve outcome.
Evidence Acquisition: Medline, EMBASE, and SCOPUS were searched to identify published studies that evaluated cetuximab for loco regionally advanced and metastatic/recurrent squamous cell carcinoma of head and neck. Only published studies in English between 1990 and 2016 were included.
Cetuximab may be administered concomitantly with radiation alone or in combination with chemotherapy during the induction phase of sequential modalities. Also, it has been used in combination with chemotherapy as first line or second line for treatment of metastatic/recurrent patients.
Cetuximab can be incorporated at some points in the course of treatment of patients with squamous cell carcinoma of the head and neck. The best protocols and the appropriate patients remain to be defined.

Salivary gland carcinomas are uncommon tumors and the parotid gland is the most frequent site for them. The incidence of salivary gland cancers vary from different geographic areas and ethnic groups. In this report, we evaluated the pattern of parotid cancer in the Iranian population.
In this multicenter retrospective cross sectional study, the documents of parotid malignant tumors in Shahid Beheshti University of Medical Sciences cancer research center were extracted. The patient records and their microscopic reports were retrieved from the archives and age, gender, and microscopic type were evaluated.
Parotid cancers accounted for 0.97% of head and neck malignancies during a 6-year period. The male to female ratio was 1.28 and the majority of the patients were in the 6th decade of their life. Epithelial tumors were the most prevalent malignancies (83.41%), of which mucoepidermoid carcinoma made up 35.57% of all lesions, followed by acinic cell carcinoma (13.94%), and carcinoma ex pleomorphic adenoma (12.5%). In non-epithelial groups, lymphomas accounted for 13.7% of the total lesions and sarcomas constituted 2.88% of the lesions. Of cases, 5.52% were detected within age ranges below 20.
In Iranian population, mucoepidermoid carcinoma is the most prevalent malignancy of parotid gland in adults and children. Lymphoma was the most prevalent non-epithelial malignancies in this location. These epidemiologic finding about parotid cancers may improve the knowledge about rare malignancies in adult and younger age range group.

Cancer is one of the most significant causes of death. Plants with anti-cancer effects have shown to eliminate tumor cells by the induction of apoptosis.
The present study aimed at investigating the apoptotic effects of 3 Euphorbia native species (E. microciadia Boiss, E. osyridea Boiss, and E. heteradenia Jaub. & Sp.).
Cell lines with the strongest sensitivity to the extracts including HeLa for E. microciadia, K562 for E. heteradenia, and Fen for E. osyridea were investigated for the effects of the plants’ hexane extracts on the induction of apoptosis, according to annexin V/propidium iodide staining by flow cytometry. We used real-time PCR to evaluate the changes in expressions of genes related to the intrinsic and extrinsic apoptosis pathways.
Flow cytometry results indicated that 50 μg/mL of all the extracts induced apoptosis in more than 60% of treated cells. Administration of the extracts resulted in increased caspase-3 activity for all treated cell lines. Real-time PCR results showed decreased B-cell lymphoma-2 (Bcl-2) and increased Bax and Fas mRNA levels in cells treated with the extracts. The Bax/Bcl-2 ratio in cells treated with 50μg/mL of E. microciadia was 29.25 ± 12.0 (P The studied plants have shown remarkable apoptosis-inducing effects on tumor cell lines by affecting both the extrinsic and intrinsic apoptosis pathways. Additional studies in terms of their beneficial effects as natural sources of potential anti-cancer agents will be necessary.

Prostate cancer (PC) is a malignant disease, which is common in men. Interleukin‑6 (IL-6) mediates the progression of PC through PI3K/AKT, JAK-STAT, and ERK1/2 MAPKs signaling pathways. Gallic acid, a phenolic compound, has anti-oxidant, anti-proliferative, and anti‑tumorigenic properties.
This study was undertaken to evaluate the effects of gallic acid on DU-145 cell viability, proliferation, invasion, IL-6 gene expression, and the cellular levels of phosphorylated STAT3, ERK1/2, and AKT signaling proteins.
DU-145 cells were treated with gallic acid (0 - 100 µM). The 3- (4, 5-dimethylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide (MTT) assay was done in order to evaluate the cytotoxicity of gallic acid on DU-145 cells. IL-6 gene expression was investigated, using RT-qPCR. The levels of phosphorylated ERK1/2, AKT, and STAT3 signaling pathways were assessed by Western blotting technic. DU-145 cells invasion were measured by invasion assay test.
A significant reduction was observed in viability, proliferation, and invasion of DU-145 cells after treatment with gallic acid. Also, cellular levels of phosphorylated STAT3, ERK1/2, and AKT signaling proteins decreased after 48 hours in a dose-dependent manner by gallic acid. Secretion and gene expression of IL-6 were decreased in DU-145 cells treated with gallic acid.
The results of this study showed that gallic acid can lead to a reduction in survival, proliferation, and invasion in DU-145 cell line by reducing protein IL-6 and its gene expression, pSTAT3, pERK1/2, and pAKT signaling protein pathways. Therefore, it seems that gallic acid can be regarded as a potent agent in the treatment of prostate cancer.

Thyroid nodules are common in clinical practice. They are usually benign, but malignancy must be ruled out. Fine needle aspiration (FNA) biopsy of the thyroid is a rapid and cost-effective procedure in the initial evaluation of a thyroid nodule, but its results may be inaccurate in 10% to 30% of cases. This prospective observational study was conducted to determine the prevalence of thyroid cancer, its related findings, and the diagnostic accuracy of preoperative FNA in a tertiary care center.
We prospectively studied the medical records of 345 subjects, who underwent thyroid resection in the university hospital setting over a 4-year period. Age, gender, FNA and pathologic reports, and whether the lesion was multinodular or a solitary nodule were determined.
The sensitivity and specificity of FNA were 64.96% and 62.76%, respectively. The positive predictive value of the test for the diagnosis of malignant nodules was 59.30% and its negative predictive value was 68.20%. In 63.5% of the patients, the preoperative FNA matched the surgical histopathology results. The presence of multinodular goiter was an important risk factor for thyroid malignancy. Fifty-two subjects had papillary microcarcinoma and the rate of aggressive behavior was considerable in this group.
Although fine needle aspiration biopsy is the most important step in the workup of the thyroid nodules, it may miss a significant number of malignant lesions. Therefore, there is a mandatory need to evolve other clinical and laboratory adjuncts, which assists the clinicians with the interpretation of FNA more accurately.

Recognizing complications, survival rates, and contributing factors would result in better diseases control in patients with thyroid cancer under thyroidectomy. Accordingly, this study was performed to determine the overall survival and complications in patients with thyroid cancer under thyroidectomy procedure.
In this retrospective, 100 patients with thyroid cancer under thyroidectomy, who were admitted in the affiliated centers of cancer research centers at Shahid Beheshti University of Medical Sciences in recent 5 years from summer 2011 to summer 2016, were enrolled. Data collection was done by census sampling and the required data were collected via existing medical documents and were recorded by checklist from April 2016 to February 2017.
Thyroidectomy was total in 97% of the patients, and 3 were under subtotal thyroidectomy (two patients had anaplastic and 1 had micro papillary carcinoma). Twenty-four patients (24%) had some side effects, including no permanent nerve injury but transient nerve injury (Hoarseness) (14%), organ pressure due to hematoma (4%) and tracheal rupture (1%), and transient hypocalcaemia (5%). The recurrence and death were seen in 5% and 3%. The recurrence was related to side effects, but it was not related to death (P > 0.05).
We studied overall survival and complications of thyroidectomy in 100 patients with thyroid cancer from summer 2011 to summer 2016 and compared them with statistics on the articles. Thyroidectomy completion is an important procedure in the treatment of a malignant thyroid tumor because of the high rate of contralateral involvement (23.8%). It is a procedure with zero mortality and very low complication rate, not bearing relevant risks. Totally, according to the obtained results in current study, it may be concluded that thyroidectomy complications are seen in 1 out of 20 patients, especially neck hematoma (4%) and tracheal rupture (1%). The survival in current study is good.

Cancers depend on the patients’ lifestyles, including the use of tobacco and alcohol. Based on the available evidence, the majority of smokers form the habit when they are young adults. In fact, lifestyles are formed during the adolescence, but they can be modified by increasing the awareness of target groups.
The present study was undertaken to evaluate the effect of educational pamphlets on promoting the awareness of high school students in relation to oral cancers.
In the present cross sectional study, 400 male and 400 female high school students were evaluated. The students were asked to fill out a standard questionnaire on oral cancer awareness. Subsequently, the educational pamphlets were distributed among the students. Three months after the distribution of the pamphlets, the same questionnaire was filled out by the same subjects.
There were no significant differences in knowledge scores between male and female students before the distribution of pamphlets, with scores of 5.6 ± 4.3 and 5.6 ± 1.7 in females and males, respectively (P = 0.96). Three months after the distribution of pamphlets, the knowledge scores of males and females had increased, with statistically significant differences.
In the present study, despite the fact that the educational pamphlet was useful, it had low efficacy, which might be attributed to the more interesting nature of other more active educational methods, such as lectures or workshops for this age group.

Mohs’ micrographic surgery is a suitable treatment and frozen section (FS) examination is the “gold standard” of surgical margins in tumoral skins. This study compared the diagnostic accuracy between the Tzanck smear test (TST) and frozen section (FS) examination for margin control in surgery for basal cell carcinoma (BCC).
Fifty-nine patients with basal cell carcinoma (BCC) were included. The tumor was excised and the Tzanck smear test (TST) was taken for Papanicolaou staining (Pap staining) and reconfirmation of tumoral cells. Then a dermatologist took margins of tumoral mass. TST was taken from the margins and sent to the dermatopathologist for Pap staining. After dying, each marked fragment was sectioned separately with cryostat. Finally, diagnostic accuracy of TST compared with FS examination was analyzed.
The sensitivity and specificity of TST for the evaluation of margin were 0.28 and 0.95; whereas positive and negative predictive values were 0.54 and 0.85, respectively. Positive and negative likelihood values were 5.36 and 0.76, respectively. Diagnostic accuracy was 0.82. The kappa coefficient of agreement between the two methods was 0.28 (P Positive likelihood value and specificity of TST for the evaluation of margin were high; therefore, TST can be suitable in the diagnosis of BCC, but due to low sensitivity and kappa coefficient, TST alone cannot be a suitable alternative method compared to the FS examination for margin control in BCC.

Breast cancer is the most common cancer in women. The most important factor in determining the prognosis and treatment of invasive breast cancer is axillary lymph nodes involvement. It is possible not to detect micrometastasis with applying staining tissues by the Hematoxylin and Eosin (H & E) staining method. Therefore, this study was conducted to determine and compare the detection of axillary lymph node micrometastasis in breast cancer by H & E and immunohistochemical (IHC) method.
A cross sectional analytical study was carried out. By using census method, 80 female patients diagnosed with breast cancer and lymph node non-involvement were selected in Shahid Sadoughi General Hospital pathology ward, Yazd, up to 2016. IHC was performed to re-detect lymph node micrometastasis. The checklist was used to collect data of demographic, clinical, and pathological characteristics of the study population. The data collection was analyzed, using statistical software version SPSS-18, descriptive statistics, and Chi-Square analysis test. P value less than 0.05 was considered statistically significant.
Of the 80 samples using H & E staining method, no case was diagnosed with lymph node micrometastasis, but using IHC, 50 cases (62.5%) were found negative and 30 cases (37.5%) were found positive. The majority of tumors in the positive group had poorly differentiated grade and the difference between the tumor grade in both positive and negative group was statistically significant (P = 0.001). Also, the majority of tumors in the positive group were located in the upper-outer and lower-outer quadrant of breast and the difference between tumor locations in both positive and negative group was statistically significant (P = 0.001).
According to the results, IHC is more beneficial than the H&E method to detect micrometastatic cells and to examine tissues that have high-grade tumors and also tumors located in upper-outer or lower-outer more possibility of metastasis.

Colorectal cancer (CRC) is one of the most common cancers worldwide. Due to the high rate of mortality in advanced metastatic stages, finding new detecting techniques seems to be necessary.
This study aimed to investigate the immunohistochemical expression of Ki67 and human epidermal growth factor receptor 2 (HER2) in colorectal cancer compared to adenomatous and normal samples.
This case-control study was conducted to evaluate Ki67 and HER2 protein immunohistochemical (IHC) expressions in 137 colorectal formalin fixed paraffin-embedded tissue blocks. The blocks were classified into 3 groups; normal (n = 36), adenomatous (n = 38), and adenocarcinoma (n = 63). All tissue blocks were selected through convenience sampling method from the archive of pathology in Ali-Ebne-Abitaleb Hospital, Zahedan, Iran from 2010 to 2015. The sections were evaluated, using semi-quantitative scoring. Ki67 and HER2 expressions were reported as negative and positive. Clinicopathological characteristics were also assessed. The data was analyzed by Kruskal-Wallis and Chi-square or Fisher tests. The significance level set as P The expression of Ki67 in CRC, adenomatous, and normal colorectal tissues were 79.30%, 44.80%, 25.00%, and in HER2 were 54.00%, 36.80%, and 19.40%, respectively. Ki67 and HER2 overexpressions were significantly higher in CRC than the adenomatous and normal tissues (P Considering the significant overexpression of Ki67 and HER2 in CRC, it seems that these biomarkers can be used as useful predictors in primary screening and identifying of CRCs. Further research should be conducted on this matter.

Curcuma Longa (CL) extract is a natural compound derived from the roots of Curcuma Longa. Prednisolone is a synthetic glucocorticoid and one of the most important pharmaceutical agents used for treatment of acute lymphoblastic leukemia.
We investigated the cytotoxic effect of Curcuma Longa extract and the synergistic effect of Curcuma Longa extract in combination with Prednisolone on acute lymphoblastic leukemia Nalm-6 and REH cell lines.
The obtained results of this research revealed that CL extract led to the death of Nalm-6 and REH cells, while Prednisolone demonstrated cytotoxic effects solely on the Nalm-6 cells. In addition, after combining CL extract and Prednisolone, the synergistic effect was observed only on Nalm-6 cells. The outcome of treatment on normal MDBK cells was the viability of most of the cells. CL extract induced apoptosis and increased expression of the Bax gene and caspase-3 activity. It also reduced Bcl-2 gene expression in Nalm-6 cells, and the aforementioned effects were amplified in the presence of prednisolone. In REH cells, CL extract induced apoptosis and increased Bax gene expression and caspase-3 activity. It also reduced expression of the Bcl-2 gene.
In general, our findings suggest that CL extract has cytotoxic effects on acute lymphoblastic leukemia cells and it also amplifies the cytotoxic effect of prednisolone on Nalm-6 cells.

Chromophobe renal cell carcinoma (RCC) like other types of RCCs maybe asymptomatic but few of them existing with rare presentations.
A male patient attended the emergency department of our center with sudden right flank pain. According to investigations performed, he had a tumor mass measuring 75 mm with extracapsular extension and heterogeneous enhancement in lower pole of the right kidney and a perinephric hematoma secondary to rupture of capsular vessels.
Wunderlich syndrome can be the first presentation of chromophobe RCC.

Hypercoagulable state may be an important first presentation in malignancies especially pancreatic cancer. The trousseau syndrome is caused by venous thrombosis, non-bacterial thrombotic endocarditis and arterial thrombosis. We describe a patient who had the cerebral infarction as the initial manifestation of pancreatic cancer and we discuss that full work up for every patient with atypical stroke should be done.
We report a 67-year-old man who developed multiple cerebral infarctions as the initial manifestation of pancreatic cancer. Cancer antigen 19-9 (CA 19-9) was 52,065 U/mL (Normal value: 0 - 33 U/mL), computerized tomography (CT) scan of the abdomen showed multiple hypodensities in both lobes of the liver and Heterogeneous hypodensity was seen in the pancreas that was highly suggestive of pancreas adenocarcinoma and was confirmed with the biopsy.
In the case of multiple brain infarctions in both anterior and posterior circulation, without evidence of common cause, trousseau syndrome and hypercoagulability state should be considered.