International Journal of Cancer Management
Volume:6 Issue: 1, Winter2013

Malignancy and its treatments could cause disturbance in homeostasis of body such as cortisol secretion. The present study has investigated the effects of cortisol level imbalance in behavioral and emotional adjustments. Seventy-eight children with Acute Lymphoblastic Leukemia (ALL) have involved in this study. Their salivary cortisol level, which were sensitive to pain and disruptive behaviors, have measured. Cortisol level effect in different periods: within duration of reaction to pain, sensitivity to pain and disruptive behaviors have evaluated. In addition abnormal regulation of cortisol levels have shown a very strong relationship between sensitivity to pain and the disruptive behaviors. Cortisol suppression was responsible for adjustment by the participants to stressful conditions. Previous investigations have shown that there is a low reaction to stressor which decreases the vitality as well as impairing a negative memory in low cortisol levels. The findings of the present study demonstrated a nonlinear relation between cortisol level and sensitivity to pain as well as disruptive behaviors. Therefore, regulation of cortisol- up and down- is predisposed to maladjustment.Keywords:

Surgery is one of the important palliative methods for patients with esophageal cancer. In addition to concerns related to clinical decision making, various moral challenges are encountered in palliative surgery. Some of them are related to patients and their illness, others to surgeons, their attitudes, skills and knowledge base. Pertinent moral challenges are addressed and analyzed with respect to prevailing perspectives in normative ethics (Ross style pluralism). Demands regarding sensibility and precaution in this clinical setting represent substantial challenges with regard to the beneficence, non-maleficence, justice, autonomy and proper patient information. Moreover, variations in definition of palliative surgery as well as limited scientific evidence in efficacy, effectiveness and efficiency pose methodological and moral problems. We have shown that ethical principles (beneficence, non-maleficence, and justice) in all procedures and treatments in esophageal cancer, including psychological problems of the patients are effective in improving their quality of life. Both surgical skills and moral sensibility are required to improve surgical palliative care in esophageal cancer, and should be taken into account not only in clinical practice but also in education and research.

The symptoms related to depression in patients with cancer are a major problem and could influence the treatment and survival of patients. This disorder is varied in different populations and in different studies. We evaluated the prevalence of depression with Beck Depression Inventory (BDI) scale in 400 patients with cancer. This measurement was after the diagnosis of malignancy and before chemotherapy or radiotherapy. The mean age of patients was 45 ±8.5 years, and female to male ratio was 45/55. The prevalence of depression was 24.8 % and 28% in males and females. All patients with depression had mild to moderate depression. Prevalence of depression was significantly higher in younger cases (P<0.0001). According to the site of malignancy, prevalence of depression was significantly highest in patients with breast cancer, following metastatic of unknown origin and gastrointestinal cancer and the lowest prevalence was observed in patients with hematologic malignancy (p <0.0001). Also, we observed a significant higher prevalence of depression in single versus married patients (p <0.0001), in patients with higher education (p <0.0001) and patients who had knowledge about their disease in comparison with those who had no knowledge (p <0.0001). The prevalence of depression and its severity in cancer patients in South east of Iran was lower than other studies and it seems that this situation may be related to high religious beliefs in this region, high prevalence of illiteracy and lack of knowledge about their underlying disease.

The beginning of metastasis poorly affects the prognosis of breast cancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray (CXR) could play a role for early detection of lung metastasis, during the prognosis of these patients. The files of the breast cancer patients between 1996 to 2006 (1739 patients) have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy (LAP) was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in 77.4% and patients'' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients (50%), other sites of metastasis (bone, liver, and brain) have discovered.The most frequent pattern of lung recurrence was pulmonary nodule (44.6%), followed by pleural effusion (28.6%). Median survival was 27.5; median survival from pulmonary metastasis was 8 m. Early detection of pulmonary metastasis by CXR did not affect patients'' endpoints. None of the probable prognostic factors have shown a significant effect on patients'' outcome. Despite systemic treatment, survival after metastasis is low.

The marginal length from main tumor in esophageal cancer is a considerable issue regarding surgical management and adjuvant treatment; so we decided to study the contractility effect on the proximal surgical margin after immersing it in10% buffered formalin as a fixative. The proximal marginal length of ten sequential patients with esophageal cancer who underwent transhiatal esophagectomy were studied, on the operating table as fresh specimens, immediately after resection, and next 24, 48 and 72 hours after immersing in 10% buffered formalin. The contraction continued through the day 3, the mean contractility after one day was about 27%, after two days was 33% and after three days was 38%. This study shows how the proximal esophageal margin can vary by the time, after immersing in 10% buffered formalin and should be considered in every settings and reporting documents by pathologists.

Physical Examination (PE) and breast MRI are two of the current methods which have usually used in diagnosis of primary breast cancer. Their accuracy in detection of: either complete response or presence of residual tumor, however, has not yet been established in patients who have been received Neoadjuvant Chemotherapy (NAC).The purpose of this study was to evaluate the diagnostic accuracy of breast MRI in assessment of residual neoplastic tissue after NAC in patients with Locally Advanced Breast Cancer (LABC). Twenty patients with LABC have undergone contrast-enhanced MRI before and after the NAC. Considering histology as the gold standard, the tumor sizes in MRI and PE have compared with the histology results. We have calculated for all below: the accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for each of MRI and physical examination, as well as Pearson''s correlation coefficients between the results of MRI and PE, and their histology results. We have found an accuracy of 85% for MRI with a sensitivity of 100%, a specificity of 50%, a PPV of 83.3%, and an NPV of 100%. In addition, the accuracy for PE was 70% with a sensitivity of 71.4%, a specificity of 66.6%, a PPV of 83.3%, and an NPV of 50%. In this study, the calculated Pearson''s correlation coefficient for MRI and histology was 0.817 (p<0.0001) versus 0.26 (p=0.26) for correlation between PE and histology. MRI has higher sensitivity but less specificity than PE for detection of residual tumor after NAC in locally advanced breast carcinoma. Also, the tumor size that has measured by MRI had highly correlation with the histology.

Hedgehog signalling pathway has not only a critical role in cell proliferation, differentiation and tissue polarity at embryonic period but also has a vital role in stem cell proliferation, tissue healing and carcinogenesis. Recent research has increased our understanding of this pathway and its relation to other signalling pathways. In addition, a large number of studies confirmed the alteration of Hh signalling pathway in various types of human malignancies including basal cell carcinomas, medulloblastomas, lung, gastrointestinal, ovarian, breast, prostate cancers and leukemia. More than 50 small biomolecules have been introduced which have inhibitory effects on Hh signalling pathway. Although, in many tumors some acceptable results have been showed in phase I clinical trial, closer studies are required to improve drug bioavailability, to decrease the side effects and to find the right small molecules for specific types of cancers, considering patients overall benefits as well.

Optical mammography is a new diagnostic method that uses Near-infrared for detection of functional abnormalities and shows tissue activities by measuring absorption and scattering of Near-infrared light. This study aims to evaluate the safety and effectiveness of this technology. Cochrane Library (Issue 10, 2012) and Medline (Nov 2012) were searched using free text and Mesh. Studies that compared optical mammography with other diagnostic methods and used outcomes such as sensitivity, specificity and safety were included. Twelve studies were included in this review. A multicenter RCT showed that among 875 biopsied lesions, suspicion index led to 97% sensitivity, 14% specificity, 95% negative predictive value and 24% positive predictive value. In terms of oxygenation index, the included studies found that the process should be used with various wavelengths compared to single wavelength technique (690, 750, 788, 856 nm or 683, 912, 975nm). In terms of sensitivity and specificity, Diffuse Optical Tomography Computer Aided Detection is capable of distinguishing healthy tissues from malignant ones with 89% sensitivity and 94% specificity. Also, this technology could show increased blood flow around the tumor tissue compared to the healthy tissue effectively. Included studies did not report any information about the effects of technology on changing the treatment process or the final health outcomes. Optical mammography is a safe, noninvasive, non-ionized diagnostic technology that can be used as a diagnostic supplement alongside conventional mammography for differentiating benign and malignant tumors. Women with higher breast density should be screened at younger ages and with more persistence than those who have lower densities.

Simultaneous proptosis and facial palsy as the clinical presentation of childhood Acute Myeloid Leukaemia (AML) is very rare. To date, no case have been reported anywhere to the best of our knowledge. Extra medullary leukemic deposits or Granulocytic Sarcoma (GS) is a rare manifestation in about 3% of childhood AML, 9.3% of GS manifested as orbit deposits causing proptosis in one or both eyes. CNS infiltration or acute otomastoiditis subsequent to leukemic infiltration of the temporal bone may be implicated with facial paralysis. We are here with reporting the case in a 3-year-old boy who presented with proptosis and facial palsy in a case of AML. The purpose of reporting this case is to emphasize the need of examining the peripheral blood and bone marrow in children presenting as proptosis and facial palsy for early diagnosis of childhood AML.

Simultaneous a collision tumor of stomach consisting of adenocarcinoma and Gastrointestinal Stromal Tumor (GIST) is very rare based on our knowledge. This coexistence has rarely been reported in literatures.We report a case of 64-year-old woman who has diagnosed with prepyloric poorly-differentiated diffuse signet-ring cell type adenocarcinoma and has undergone an elective D2 total gastrectomy. During operation another mass in fundic body region has found.The pathologic examination of the mass has shown GIST. Immunohistochemical staining for CD117 and Desmin was positive whilst that for S100 was negative.This case reports the simultaneous two tumors development of different histotypes and natures in the same organ.