International Journal of Cancer Management
Volume:14 Issue: 7, Jul 2021

Context:

 Metastasis is a main cause of death in patients with cancer, whereby tumor cells withdraw from the primary site of the tumor mass and produce secondary tumor mass in new sites. Primary tumor cells depart collectively and individually to invade closed and distant sites.

Evidence Acquisition: 

This review considers TME-derived factors that actuate signaling pathways to induce epithelial-mesenchymal transition (EMT). National Center for Biotechnology Information (NCBI) was the main resource. Google Scholar and Scopus were other databases for finding articles. Keywords that were inserted into the search box of databases to identify related articles were ‘metastasis’, ‘invasion’, ‘epithelial-mesenchymal transition’, ‘EMT’, ‘tumor microenvironment’, ‘TME’, ‘TME cells’, and ‘signaling pathway in EMT’. Titles and abstracts of the articles were studied to choose the right articles. Finally, 107 articles were selected to study in detail and use as references.

 EMT is a type of metastasis that deprives epithelial single-cells of their characteristic features and acquires mesenchymal features facilitating the departure from the primary tumor mass. During EMT, cell-adhesion and apical-basal polarity rapture and cells obtain movement capability. The tumor microenvironment (TME) leads EMT through secretion factors and signaling pathways. As a result of activating these pathways, transcription factors that abolish epithelial gene expressions and augment mesenchymal gene expression are induced.

 In this review, recent research published in TME and EMT fields were highlighted and critically appraised. Effect of factors-derived TME cells on EMT were manifested that propose favorite targets for a therapeutic goal to inhibit metastasis. However, data about the effect of the combination of TME cells on metastasis have a small part in the literature.

 Due to the growing prevalence of cancer globally, the disease is considered one of the most important sources of stress, disability, and reduced life satisfaction. Although life satisfaction is supposed to be a relatively stable psychological construct, it may change in response to life events. Life-satisfaction is the assessment of the quality of life according to one’s chosen criteria.

 The purpose of this research is the psychometric evaluation of the Persian version of “Brief Multidimensional Life Satisfaction Scale” (BMLSS) in Iranian patients with cancer.

 The present study was a methodological research, during which the BMLSS was translated and the Farsi version was validated for patients with cancer.

 The fit indices of confirmatory factor analysis confirmed the dual dimension of the BMLSS. Regarding the convergent validity of the BMLSS, the total score of the instrument had a positive and significant relationship with age and the sense of religiosity. Cronbach's alpha and Intraclass Correlation were calculated.

 The findings indicated that this Persian version has good validity and reliability and can be used as a comprehensive instrument in Iran.

 The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate.

 Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance.

 We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis.

 According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total.

 Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.

 Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. This tumor originates from the epithelial cells of the renal tubules and is located mainly in the cortical region of the kidney. It constitutes approximately 90% of all kidney malignancies and 2% of all cancers in adults.

 The present study was conducted to determine the prevalence of RCC and its histological subtypes in samples sent to the Pathology Department of Kabul University of Medical Sciences and City Laboratory.

 This is a retrospective cohort study of 81 nephrectomy and partial nephrectomy samples registered in the laboratory of the Pathology Department of Kabul University of Medical Sciences and City Medical laboratory database from March 2016 to August 2020.

 A total of 81 samples were included in this study. The mean and standard deviation (SD) age of the patients was 44.4 ± 20.5. Of 81 samples, 62 (76.6%) were malignant kidney tumors, 13 (16.0%) were inflammatory kidney disease, 4 (4.9%) were polycystic kidney disease, and 2 (2.5%) were benign kidney tumors. Among 62 cases of malignant kidney tumor, 53 (85.48%) were RCC. The high incidence of RCC was in the age group of 56 to 65 years with a mean of 52.2 years; 56.60% of RCC cases were male and 43.39% were female. Based on the histological studies, 75.47% were clear cell renal cell carcinoma (ccRCC) type, followed by 18.86% papillary renal cell carcinoma (PRCC), and 6% chromophobe renal cell carcinoma (ChRCC).

 Most common malignant tumor of the kidney in the samples included in this study was RCC in the age group of 56 to 65 years and it was more frequent among men compared to women, whereas the most common histological subtype was ccRCC. The findings are in concordance with international literature.

 Colorectal cancer (CRC) is among the most common and preventable cancers, the incidence and risk factors of which are different in various populations.

 The present study aims at assessing incidence rate, risk factors, and symptoms of CRC among the populations aged 50 to 70 years old covered by the health centers in Arak, as well as evaluating participation rate in the CRC screening program.

 The present cross-sectional study was conducted from 2016 to 2019 among all of the individuals aged 50 to 70 years old, who were referred to rural, urban, and suburban health centers in Arak for CRC screening, and their data were recorded in the Sib system. The participation rate, risk factors (family and individual history of CRC, colorectal adenoma, and inflammatory bowel disease), symptoms (lower gastrointestinal bleeding, constipation with or without diarrhea, and weight loss), and crude incidence rate of CRC were calculated in the age range.

 The mean (SD) age of the CRC was 59.72 (5.56) years. In addition, the individuals’ participation rate in the program was about 44.2%, which was more among women (55.5%) and villagers (93.7%). Most subjects complained of constipation in the last month and CRC family history. The CRC crude incidence rates were 35.93 (95% CI: 25.55 - 50.54), 40.96 (95% CI: 29.81 - 56.29), 43.76 (95% CI: 32.22 - 59.43), and 52.84 (95% CI: 40.05 - 69.71) per 100000 individuals during 2016, 2017, 2018, and 2019, respectively.

 The participation rate in the CRC screening program was low, and the trend of the cancer crude incidence rate increased among the populations aged 50 to 70 years. Finally, informing about the recognition of the risk factors and symptoms of cancer, as well as the timely referral for screening was considered essential.

 Bladder cancer is the second most common cancer of the genitourinary system and the eighth cause of cancer death. In addition to known risk factors such as smoking and urinary stones, trace elements are also effective in causing bladder cancer and other cancers.

 This study was conducted to determine the association between bladder cancer and the carcinogens cadmium and arsenic.

 This case-control study was conducted on 40 patients with bladder cancer admitted to Shahid Bahonar Hospital and a control group of 40 healthy individuals in Kerman, Iran, in 2018. The serum levels of arsenic and cadmium were measured by atomic absorptiometry. The paired t-test and chi-square tests were employed to assess the difference between cases and controls groups. An unadjusted and 2 multivariable conditional regression models were separately adjusted on sex, family cancer history, residence, occupation, and smoking and were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to assess the association between arsenic and cadmium levels and bladder cancer. The statistical software SPSS version 26 and R software version 3.6.3 were used to perform the statistical analyses.

 The mean cadmium level was 2.99 ± 1.45 and 2.59 ± 0.46 in the case and control groups, respectively, with no statistically significant difference between the groups (P = 0.100). The mean arsenic level was 2.12 ± 1.04 and 1.43 ± 0.73 in the case and control groups, respectively, demonstrating a statistically significant difference between the groups (P = 0.001). Unadjusted and adjusted conditional logistic regression models indicated significant association between arsenic levels and bladder cancer (unadjusted: odds ratio (OR) (95% CI): 0.66 (0.46 - 0.94), P-value = 0.022; adjusted: OR (95% CI): 0.64 (0.44 - 0.92), P-value = 0.018).

 Overall, cadmium and arsenic levels are higher in patients with bladder cancer, with a statistically significant difference for arsenic. However, these elements are not interrelated and are not related to other factors.
 

 Metanephric adenoma (MA) is a rare benign kidney tumor with an excellent prognosis, which is usually diagnosed incidentally with no symptoms. The mean age of patients with MA is about 41 years, ranging from 5 months to 83 years in previous studies.

 In this study, we present the case of a 29-year-old woman with a diagnosis of MA after nephrectomy. The ultrasound study showed a hyperechoic mass. The intravenous (IV) contrast-enhanced abdominopelvic computed tomography (CT) scan showed a hypodense mass. Based on the results of pathological features and immunohistochemistry (IHC) (positive vimentin, WT1, and PAX8), the diagnosis of MA was established.

 The diagnosis of MA is commonly based on pathological findings. Therefore, if MA is suspected, renal biopsy, partial nephrectomy, or follow-up of the patient can be used. However, further studies are needed to differentiate MA from papillary renal cell carcinoma and nephroblastoma before taking aggressive measures.