International Journal of Cancer Management
Volume:10 Issue: 1, Jan 2017

Context: Cancer generally is considered as a neoplastic disease with particular causative and etiologic factors as well as protective elements. Although it has remained difficult to treat, it is preventable. Recently, the interest in dietary phytochemicals intake has considerably increased for potential cancer chemoprevention.
Evidence Acquisition: This report reviews the role of phytochemical consumption in cancer prevention based on publications from PubMed, Science direct, Google Scholar, and Scopus from the year 1996 onward using cancer, chemoprevention, phytochemical keywords.
Regular intake of phytochemicals has been demonstrated to prevent cancer during its different stages including initiation, promotion and progression. Considering the animal models, the second step is the main stage for cancer chemoprevention.
The phytochemicals involved in chemoprevention can be categorized in different groups naming phenolics, carotenoid, alkaloids, organosulfur compounds and nitrogen-containing compounds. They are able to stop, postpone and reverse carcinogenesis by different mechanisms.

Context: Studies have shown that cancer is a multi-factorial disease in its pathogenesis, in addition to genetic disorders, the effect of environmental factors can also be pointed. Among all environmental factors, tobacco that is considered as the leading cause of respiratory and cardiovascular disease plays a key role in cancer pathogenesis and progression. More than 5,000 chemicals and 62 carcinogenes have been detected in tobacco, which could contribute to tumorgenesis through activating oncogenes, inhibition of tumor suppressor genes, genetic and epigenetic changes, alteration of growth pathways, angiogenesis and metastasis.
Evidence Acquisition: To access the articles, we used valid external and internal databases. In order to set the search formula with maximum collectivity, at the first step, the main keywords were characterized and then equivalent terms were identified using various sources. In order to retrieve the last research papers, searches were conducted constantly from 1970 until 2015. The obtained results were screened in terms of relevance and quality indicators such as proper research design, control groups, inclusion and exclusion criteria, and also the statistical analysis. Accordingly, 150 articles were obtained and finally 64 articles which were eligible and had high relevance to the topic were selected and reviewed.
This review explains the association between tobacco smoking and the incidence of different human cancers; also it focuses on molecular mechanisms through which carcinogenic chemicals in tobacco smoke promote cancer progression. Among multiple components of tobacco smoke, three carcinogens, including polycyclic aromatic hydrocarbons (PAH), nictotine and nicotin-derived nitrosamine ketone (NNK) convincingly play major roles in the pathogenesis of a wide range of cancers. In fact, these toxic and carcinogenic agents alter the expression of oncogenes, tumor suppressors, DNA repair, and last but not least, apoptosis-related genes through several mechanisms, such as point mutations, deletions, translocations and gene recombination. Moreover, implication of different tumorgenic signal transduction pathways, such as PI3K/AKT, STAT3, ERK1/2 and COX-2 in tobacco-induced tumorgenesis should not be underestimated.
Although many facts about the carcinogenic character of tobacco are yet unknown, understanding the molecular mechanisms of cancer development associated with smoking could be promising for early detection, treatment, and reducing metastasis of tobacco-related cancers.

Seroprevalence of Cytomegalovirus infection varies between 40% and 100% worldwide. Different studies carried out in Iran indicate this variation in this country. It is important to estimate the total infection prevalence using a reliable method such as meta- analysis in order to be applied by policymakers. This study aims to estimate the IgG and IgM seroprevalences of CMV infection among Iranian women and neonates.
We selected eligible articles for final meta- analysis by searching the national and international databases, excluding duplicates and irrelevant papers from primarily identified studies after abstract/full text review, implementing exclusion/inclusion criteria and quality assessment. Standard error of the prevalence was calculated according to binomial distribution formula. Based on the degree of heterogeneity, fixed or random effects models were applied for estimating the pooled prevalences.
In this study, 16 papers providing 20 evidences of CMV prevalence in Iran entered in the meta- analysis. CMV IgG and IgM seroprevalences as well as primary infection rate (95% confidence interval) among pregnant women were 92.8% (90.6 - 94.9), 6.4% (2.8 - 9.9) and 1.1% (0.7 - 1.5) respectively. CMV IgM seroprevalence among neonates were 0.6% (0.09 - 1.2), while CMV IgG and CMV IgM seroprevalences among non-pregnant women were 78.4% (70 - 86.8) and 4.6% (1.5 - 7.6) respectively.
This meta- analysis showed that the prevalence of CMV infection among studied population is relatively high. Therefore, mortality, complications, anomalies and injuries among fetuses, neonates and immunocompromized patients can be partially related to the CMV infection.

Context: To date, CSCs have been identified in a variety of hematopoietic and solid tumors. Applying CSC in clinical implication still depends on future studies to remove complexities including CSC heterogeneity and CSC similarity to normal stem cells. However, several potential clinical applications including therapeutic, diagnostic and prognostic implications have been introduced for cancer stem cells (CSC). In this review, we discuss previously considered and unconsidered potential clinical application of CSCs including how CSCs could be applied for pan-specific cancer screening and therapy.
Evidence Acquisition: We will first discuss the previously proposed CSC clinical implications using a brief review of the literature. Subsequently, we will discuss some theoretical potential CSC implications which have not been discussed before including pan-specific cancer screening and therapy, and present confirmatory references for each part of our hypothesis.
We hypothetically demonstrated the presence of similar markers in the CSC subset of different tumors and introduced it as a way to simultaneously screen several cancers using one CSC marker.
Simultaneous screening of several cancers applying one CSC marker could be regarded as a novel high-value cost-conscious cancer screening approach which might evolve cancer screening concept. However, this application remains to be explored in the future instigations.

Worldwide, colorectal cancer is the fourth most common cause of cancer-related deaths. Infectious agents have long been associated with development of gastrointestinal malignancies including colorectal cancer. Therefore, the aim of this study was to detect Streptococcus gallolyticus subsp. gallolyticus and Helicobacter pylori in colorectal cancer tissue specimens in comparison with healthy tissue specimens.
A total of 210 tissue samples including 70 adenocarcinoma colorectal tissue, 70 adenomatous polyposis colorectal tissues, and 70 normal colorectal tissues were subjected to DNA extraction. The quality of the extracted DNA was confirmed by the amplification of a β-globin fragment using polymerase chain reaction (PCR). The presence of sod and glm genes were evaluated as Streptococcus gallolyticus and H. pylori presence markers by PCR method, respectively.
Out of 210 subjects, 112 were male and the rest were female. The age of our patients ranged from 22 to 87 with an average of 54 years. None of the samples in two studied groups were positive for the sod and glm genes.
According to our results, S. gallolyticus subsp. gallolyticus and H. pylori might not be involved in colorectal cancer pathogenesis. More investigation on huge sample in different area might be clarified this results.

Breast carcinoma is not a homogenous disease. It is divided into 5 pathological subtypes of luminal1, luminal2, strongly Her2 positive, basal like, and normal breast like. Basal like breast carcinoma that accounts for about 15% of all breast cancers has an aggressive clinical behavior with the features of high nuclear grade, negative estrogen receptor, progesterone receptor, and Her2 reactivity (triple negative).
We aimed at identifying the prevalence of basaloid phenotype among triple negative (TN) cases in our region via immunohistochemistry (IHC) staining using basaloid markers.
We reviewed breast cancer patients in Omid and Imam Reza hospitals, Mashhad, Iran, between 2003 and 2007. We obtained the paraffin blocks from TN cases for immune-staining using cytokeratin 5/6 (CK5/6), cytokeratin 14 (CK14) and epidermal growth factor receptor1 (EGFR1) markers.
The incidence of TN disease among breast cancers was 21% (156/747). Based on IHC reactivity with at least one of the basaloid markers, from 59 available samples, 44 (75.4%) were basaloid.
In our region, most triple negative tumors were basal like breast cancer (BLBC). Among these cases, most immune-reactivity was observed for EGFR1, followed by CK14 and CK5/6.

Non-Hodgkin’s lymphoma (NHL) is the fifth most frequently diagnosed cancer whose incidence has risen by at least 100 percent over the past five decades especially in the West.
The aim of this study is to investigate Clinicopathology figures, overall survival (OS) and Progression-free survival (PFS) in patients with NHL in Iran.
In a descriptive study, 143 patients referred to Clinic of Hematology in two centers between 2005 and 2014. We checked age, sex, types and subtypes of NHL; recurrence, Ki-67, organomegaly, lymphadenopathy, radiotherapy, OS and PFS in the patients. The mean follow-up was 49 months. All patients received R-CHOP regimen for 6 to 8 cycles.
The mean age at diagnosis for the patients was 46 years (range, 16 - 82) and 76.9% had age Percentage of NHL in males is more than females and the median age is around 45 years. Also, the prevalence of nodal is more compared with extranodal in NHL patients.

The aim of this study was to investigate the benefits of the newly revised “The international federation of gynecology and obstetrics (FIGO), 2009” sytem and whether there was a difference in new system comparison to 1988 FİGO staging sytem for endometrial carcinoma.
A total of 132 patients who underwent complete surgical staging for endometrial cancer were enrolled retrospectively. Those patients’ overall survival and disease free survival were compared with 1988 and 2009 staging system.
The five year overall survival (OS) rates for patients with 1988 FIGO stage 1 and 2 were 97% and 100%, respectively. In 2009 system, the OS rates for 1 and 2 were 97% and 100%, respectively. There was no statistically significant differences between stage 1 and stage 2 for OS rates in 1988 and 2009 as well.
The newly revised system could be less complex for understanding, but it does not discriminate survival rates better, especially in earlier stages. A new staging system and uniform surgical staging could be discussed.

Breast cancer is the most common cancer among women in Iran. The aim of this study was to explore the spatial autocorrelation and the estimation incidence rates variance among Iranian provinces.
In this cross-sectional exploratory study, age-standardized incidence rates from 2004 to 2010 were analyzed in order to detect hot and cold spots map and estimate the rates using ordinary kriging
Mapping of clusters showed that hot and cold spots located in the East and North East regions of Iran. Maps of estimated values for 2004 were between 0.06 - 101.15 and for 2010 between 20.85 - 329.68, which indicate increase in incidence rates, especially in some areas.
There are relatively large differences between the geographic distribution of the breast cancer clusters in the East and North East regions of the country in comparison to other areas. Policy makers are advised to consider such provincial diversity for better understanding of factors affecting the incidence of breast cancer.

EGFR (Epidermal growth factor receptor) is overexpressed in a number of cancers and plays an important role in several phenomena such as aggressiveness of tumor, decreased survival of the patient, and resistance to treatments such as hormone therapy, chemotherapy, and also radiation.
The aim of this study is to produce specific human single-chain antibodies against EGFR and evaluate its specificity against the immunodominant epitope in order to offer a new and efficient way in the treatment of EGFR-expressing tumor tissues.
A phage antibody display library of scFv (single chain fragment variable) was panned against an immunodominant epitope of EGFR. In order to select the specific clones, DNA fingerprinting was performed and the common patterns were differentiated. ELISA (Enzyme linked immunosorbent assay) was done to confirm the panning results and show the specificity of the selected clones.
Two specific clones with the frequencies of 55% and 30% were differentiated. The clones showed positive ELISA with the corresponding epitope while no positive reaction was observed for negative controls: unrelated peptide, M13KO7 (helper phage), unrelated scFv and no peptide.
Immunotherapy against cancer has been a new treatment strategy in the recent years. Small and high affinity scFvs have had a crucial role in this regard. The specific human anti-EGFR scFvs that were selected in this study and reacted with the corresponding epitopehave the potential to be applied as a blocking antibody for interfering with tumor growth in EGFR-expressing tumors. Further studies are needed to evaluate the effects of these antibodies in vitro and in vivo.

Colorectal cancer is one major health problem and cancer-related cause of death in cancer patients in countries such as Iran where the most cases are diagnosed in advanced stages.
To evaluate the incidence and severity of toxic effects in colorectal cancer patients who have been treated with two different schedules of combination of oxaliplatin and bolus/infusional 5-fluorouracil with leucovorin (FOLFOX) and to compare them.
Medical records of 458 patients with colorectal cancer treated with FOLFOX 4 and modified FOLFOX 6 regimen between 2005 and 2014 were reviewed. Data from 96 eligible patients were analyzed. Fifty-six patients (58.3%) received FOLFOX 4 and 40 patients (41.7%) received modified FOLFOX 6.
The study included 96 patients, 39 of whom were males (40.6%) and 57 of whom were females (59.4%). The median age was 62 years (range: 38 - 87 years). The follow up duration was between 16 - 109 months with a median of 62 months. There was a statistically significant incidence rate of grade ≥ 1 toxicity of diarrhea as gastrointestinal (GI) toxicity between FOLFOX 4 and modified FOLFOX 6 as the two regimens (P = 0.034), but there was not a statistically significant incidence rate of grade ≥ 1 toxicity of stomatitis as GI toxicity between the two regimens (P = 0.27). We observed a highly statistically significant incidence rate of grade ≥ 1 toxicity of neutropenia as hematologic toxicity between FOLFOX 4 and modified FOLFOX 6 as the two regimens (P We showed that in colorectal cancer patients treated with modified FOLFOX6. Some of hematological and non-hematological complications were more than FOLFOX4 and they can be concerned.

Chemotherapy-resistance of melanoma has led to poor prognosis and decreased survival in the patients. Therefore, the addition of adjuvant therapies to the conventional chemotherapy regimens has been taken into consideration to improve the clinical treatments efficiency. In this study, the effect of microwave (MW) Hyperthermia has been evaluated on the toxicity of cisplatin on the MM200 cell line in the presence and without gold nanoparticles (GNPs).
Cells incubation was performed with and without cisplatin in the presence and absence of GNPs. To induce hyperthermia, the cells were immediately placed under MW irradiation for 25 and 30 minutes (41- 43°C) following the addition of the drug and GNPs, then they were incubated for 24 hours. Finally, cell survival was determined by MTT assay.
GNPs (up to 6.6 µg/mL) showed no toxicity. GNPs at the concentration of 13.2 and 26.4 µg/mL caused 13% and 20.7% drop in cell survival rate, respectively. IC50 of cisplatin decreased from 4 to 2 µg/mL in the presence of GNPs. Hyperthermia (43°C) plus chemotherapy (2 µg/mL) resulted in no significant enhancement in cisplatin cytotoxicity relative to chemotherapy alone whereas by adding GNPs, an increase in cell mortality up to 15-fold in comparison to cisplatin alone was observed.
There is a synergistic effect between cisplatin and GNPs, this could be due to the facilitated entrance of cisplatin in the presence of GNPs. MW exposure improves the efficacy of cisplatin therapy in the presence of GNPs on MM200 cells.

Conjugated linoleic acid (CLA) is an unsaturated fatty acid that after the discovery of its anti-cancerous properties numerous researches conducted to increase its concentration in the food products. The current study aimed to review researches in the field of milk enrichment with CLA to identify the main actors and highlight the achievements in the field; therefore, the effectiveness of these researches for producing anti-cancer milk was surveyed.
The journal of dairy science was selected for data extraction and related papers were identified via review of all published papers during years 2003 - 2013 and then were subjected into content analysis. Statistical analysis was done with the MEANS procedure of SAS software (Version 9.1).
Among all collected papers, only 72 were eligible. Data analysis showed that the USA, Canada and France were the most productive countries in the field of milk enrichment with CLA. Surprisingly, Iran did not have any paper in this field in the journal of dairy science. The supplements that were added to the animal diets were enriched by linoleic or linolenic acids. Enhancing the milk cis-9, and trans-11 CLA content were the main objectives of researches. More than 70% of treatments led to the supply of the minimum amount of CLA to prevent cancer with serving milk twice a day.
Considerably, milk enrichment with CLA mostly has being attracted by developed countries. Enriching milk with CLA is a suitable scientific strategy to fight against cancer. It is important to increase researches in increasing trans- 10, and cis- 12 CLA.

As a hormone-dependent cancer, estrogen is involved in the development of breast cancer. CYP1B1 belongs to the P450 superfamily of enzymes and is involved in the metabolism of estrogen. The present study investigates the relationship between CYP1B1*3 rs1056836 polymorphism and breast cancer in Iranian women.
The present case-control study was conducted on 79 women with breast cancer and 79 healthy women admitted to Shohadaye Tajrish hospital in Tehran. Blood samples were taken from all the participants and their leukocyte DNA was extracted. The PCR-RFLP method was used for genotyping the participants based on the size of the pieces on the gel. Based on Hardy-Weinberg equilibrium model, the frequency of alleles was calculated.
The mean age of participants was 48 ± 8 years old in the cancer group and 43±6 years old in the control group. After counting the genotypes, their percentages were calculated as 30.38% for the GG genotype, 37.97% for the GC/CG and 31.65% for the CC in the cancer group and as 32.91% for the GG genotype, 53.16% for the GC/CG and 13.93% for the CC in the control group. Based on Hardy-Weinberg equilibrium model, the frequency of the G allele and C allele was 49.37% and 50.63 in the cancer group, and about 59.49% and 40.51% in the control group. A statistically significant difference was observed between the two groups in terms of the CC homozygotes (P = 0.008).
The results obtained showed possibility of a significant relationship between CYP1B1 rs1056836 polymorphism and the risk of developing breast cancer, and the polymorphism can, therefore, be said to be involved in the development of this condition.

Breast cancer is the second most common malignancy in women, worldwide. Several etiologic factors may cause anemia in a patient with breast cancer. Anemia is a prevalent complication in patients with breast cancer who undergo chemotherapy which affects the health status and quality of life in these patients. The aim of this study was to evaluate the prevalence of anemia in patients with non-metastatic breast cancer who underwent adjuvant chemotherapy.
In this cross-sectional study, 144 women with non-metastatic breast cancer who referred to radiotherapy and oncology department of Imam Reza hospital and met inclusion criteria were included. Data were obtained from patients’ archived documents and were analyzed by SPSS software (version16).
In this study, 41% of patients were anemic before the chemotherapy and 43.1% of patients became anemic during and after treatment. The prevalence of post-chemotherapy anemia was significantly higher in advanced stages of cancer (P = 0.01). The chance of developing anemia were more in patients who underwent 8 cycles and AC paclitaxel regimen, compared to the ones with 6 cycles and other regimens. There was no significant relationship between the prevalence of anemia and type of chemotherapy regimen, number of chemotherapy cycles, positive lymph nodes, co-morbidities, menstrual status, and body mass index (BMI).
Due to the high prevalence of chemotherapy-induced anemia and its effects on quality of life, even mild degrees of anemia should be detected and evaluated before treatment. Considering early interventions is of cardinal importance, especially in the elderly.

Most cytotoxic drugs are unable to discriminate normal cells from cancer cells and they interfere with cell division and could lead to harmful effects such as carcinogenicity, genetic mutation, and teratogenicity. In order to assess dermal occupational exposure to cytotoxic drugs, surface sampling was used to determine the residual drugs on the working surfaces, as well as the effectiveness of the procedures for cleaning the treatment area.
This study was designed with the aim to investigate the contamination of surfaces and hand skin of the oncology staff with cyclophosphamide drug.
Environmental and personal monitoring were performed by collecting wipe and dermal samples over the span of a month at two different times of handling of cytotoxic drugs or other work like cleaning and patient admission. Samples were taken from exposed oncology staff after administering cyclophosphamide to patient.
The method of sampling and analysis of cyclophosphamide over a linear range surface density of 30 - 180 ng/cm2 was validated. Cyclophosphamide was detected on some wipe samples at two hospitals. Results of this study demonstrated that some staff had dermal exposure to cyclophosphamide and it was also revealed that working surfaces were also contaminated with this drug.
Health workers with present work practice are at risk with cytotoxic drugs. Therefore, adequate training and control measures are justified.

Desmoid tumors, also known as aggressive fibromatosis, grow slowly but are locally aggressive. The therapy strategy consists of surgery, and radiation. Systemic therapy with non-steroidal anti-inflammatory drugs, antiestrogen compounds, cytotoxic chemotherapy and protein kinase inhibitors are recommended for recurrence, unresectable, advanced disease and failure to response to primary treatment.
We report on a 35-year-old female patient with advanced fibromatosis of the soft tissue of neck who has been treated with triple therapy including 8 cycles of Doxorubicin, Tamoxifen daily, and Imatinib daily. Tumor response was evaluated clinically and by enhanced CT SCAN imaging.
90% reduction in tumor size occurred after 6 months of treatment. The response continued and after 8 courses of doxorobicine treatment switched to triple therapy with imatinib , tamoifen and celexocib.

Phyllodes tumor (PT) is not a common phenomenon and its coexistence with ductal carcinoma in situ (DCIS) is extremely rare. A few of these cases have been reported in the literatures.
We report a case of PT that a DCIS tumor has arisen from its epithelial component in a 26 year-old woman. The patient was referred to a surgeon with a palpable mass in her left breast. Ultrasonography failed to distinguish between fibroadenoma and PT. Excisional biopsy was performed for her and after pathologic study, the above - mentioned diagnosis was reported. Histologically stroma showed moderate cellularity with few mitoses. The epithelial component consisted of foci of ductal hyperplasia with comedo necrosis. After consultation with oncologists, simple mastectomy and reconstruction was performed for her. The patient was satisfied with the results.
Diagnosis of DCIS within a PT before surgery is impossible and pathologist should confirm it. Different plans for their treatment have had good short term results.

Fetography has named the radiography of the fetus in utero. Due to the potential risk of radiation-induced cancers and other malignant effects, this procedure has avoided and has completely replaced by ultrasonography. However it has observed that this invasive procedure has still followed in some clinical departments.
The aim of this study was to assess the current status of the fetography and its prevalence as an un-recommended diagnostic procedure in teaching hospitals of Ahvaz, Iran.
The radiology and ultrasonography reception systems of two teaching hospitals of Ahvaz have investigated to identify pregnant patients who has undergone fetal presentation imaging (cephalic or breech) between 21 March 2013 and 21 March 2015.
In general 3741 pregnant women who have undergone fetal-presentation imaging during two past years have identified. There was significant statistically differences between X-ray and ultrasonography examinations (2528 vs. 1213; P value Women of the investigated hospital have received avoidable fetal irradiation due to fetography then it was a reason for concern. Ultrasonography should be the first-line imaging modality for pregnant women, especially in the case of fetal-presentation.