Middle East Journal of Cancer
Volume:15 Issue: 3, Jul 2024

Colorectal cancer (CRC) stands apart from other malignancies due to its pronounced association with dietary patterns. Approximately 70% of all CRC cases arise sporadically, and suboptimal dietary and lifestyle choices can override certain predisposing factors, including a family history of the disease. Hitherto, the most compelling evidence linking CRC risk has been attributed to heme iron, predominantly found in red and processed meats, although this form of iron constitutes a mere 20% of total dietary iron. The human organism maintains a remarkably intricate and tightly regulated iron homeostasis system owing to the deleterious consequences of both excessive and deficient serum iron levels. Dietary sources remain the sole means to replenish iron losses. Despite the abundant presence of iron in various food sources, its absorption, commonly referred to as bioavailability, is notably restricted due to an array of dietary inhibitors and homeostatic mechanisms.Consequently, a substantial 80% of ingested dietary iron is excreted in fecal matter, resulting in fecal iron concentrations that surpass those found in most body tissues by a tenfold margin. Prolonged exposure of the colorectum to excessive fecal iron, combined with concurrent physiological alterations, can instigate oncogenic processes leading to CRC. Notably, despite their recognized significance in CRC pathology, dietary habits, and lifestyle factors have been sporadically integrated into predictive models, primarily concerning CRC recurrence. Nonetheless, these models exhibit disparities in the dietary components, rendering them non-universally applicable. In light of these disparities, postulating that incorporating bioavailable iron, in conjunction with hepcidin levels, may offer superior predictive value for CRC risk assessment, and herein, elucidates the scientific foundation supporting this hypothesis.

This study investigates the relative expression of the Na+, HCO3- cotransport gene NBCn1, and caspase-3 within the tumor microenvironment of human breast cancer, considering the in vivo microenvironment.

In this experimental study, breast cancer MDA-MB-231 cells were cultured under normoxia/hypoxia conditions for 24, 48, and 72 hours with varying glucose concentrations (5.5, 11, and 25 mM). The mRNA expression of NBCn1 and caspase-3 was evaluated using real-time polymerase chain reaction. The stability and binding pocket of NBCn1 were assessed using DispHred and the Computed Atlas of Surface Topography of proteins (CASTp) servers, respectively. The location prediction of the protein was determined using the Transmembrane Helices; Hidden Markov Model (TMHMM) server.

Normoxia led to an increase in NBCn1 expression during all three time periods, displaying heterogeneity. The expression was particularly elevated at glucose concentrations of 25 and 5.5 mM. In hypoxic conditions, gene expression was reduced; however, an increase in glucose concentration enhanced SLC4A7 expression. Specifically, a glucose concentration of 25 mM led to decreased caspase-3 expression under hypoxic conditions. In silico studies revealed that SLC4A7 becomes disordered when the pH falls below 7, with most amino acids in the binding pocket being nonpolar.

The heightened risk of breast cancer metastasis may be linked to the upregulation of SLC4A7 and downregulation of caspase-3 expression, underscoring their fundamental roles in cancer treatment and prevention. SLC4A7 is a transmembrane protein, and its folding is pH-dependent.

GLUT1, a glucose transport protein, exhibits heightened expression in malignant cells, leading to increased glucose absorption. The detection of GLUT1 through immunohistochemical methods in these cancerous cells suggests elevated rates of cell proliferation, heightened energy requirements, and a more aggressive nature. The influence of GLUT1 on prognosis and its utility as a biomarker may manifest as tumour hypoxia and adaptive upregulation of anaerobic glycolysis, promoting tumour cell survival. Thus, GLUT1 may be considered a negative prognostic biomarker in patients with squamous cell carcinoma. We aimed to evaluate the expression of GLUT1 in typical and oral squamous cell carcinoma (OSCC) cases at different clinical stages and histopathological grades to ascertain its role as a prognostic marker.
A case-control study was conducted with a sample size of n = 25, comprising 20 biopsy specimens from OSCC patients and 5 from regular patients. Demographic patient details were recorded. Microscopically confirmed OSCC cases were selected, and immunohistochemical staining was performed using a GLUT1 antibody.
Significant expression and increased staining intensity and percentage of GLUT1 were observed in OSCC cases across different histological grades of OSCC. No significant expression was found in typical cases.
This study concludes that GLUT1 expression can be a biomarker for the early stages of OSCC. Elevated expression of this marker signifies the heightened energy demand of cancer cells for increased proliferation and division under hypoxic conditions. Further studies with larger sample sizes are essential to validate the clinical potential of GLUT1 as a prognostic marker for assessing the risk and prognosis of OSCC.

Colorectal cancer ranks as the third most prevalent cancer type globally. In addition to surgery, chemotherapy, and radiation therapy, being the foremost efficacious and all-encompassing treatment modalities for cancer, pelvic chemoradiotherapy is known to precipitate adverse effects, notably intestinal inflammation. This study delves into assessing the impact of curcumin on the prophylaxis and amelioration of chemoradiotherapy-induced enterocolitis in colorectal cancer patients.
This randomized study encompassed 44 colorectal cancer patients undergoing standard pelvic chemoradiotherapy, allocated to either curcumin treatment (22 patients) or placebo (22 patients) groups. Patients were administered oral curcumin capsules at a daily dosage of 500 mg commencing one week before baseline and extending throughout the standard treatment regimen, adhering to the same schedule. Subsequently, patients were subjected to biweekly evaluations encompassing demographics, clinical characteristics, and manifestations of enterocolitis, with statistical analysis employing Mann-Whitney and chi-square tests. A significance threshold of P < 0.05 was employed in the study for statistical significance.
The incidence of complications exhibited no statistically significant disparity between the two cohorts across diverse disease stages. Furthermore, there were no discernible discrepancies in the manifestation of varying grades of intestinal complications between the curcumin-treated and placebo groups. Predominantly, both groups experienced the most pronounced side-effects during the initial two weeks of treatment. Additionally, there was no statistically significant distinction in the prevalence of adverse drug reactions between the two groups, with figures standing at 31% versus 40% (P = 0.17).
Even though 500 mg/day of curcumin over a six-week duration did not engender a statistically significant reduction in the adverse effects of chemoradiotherapy, it was well-tolerated and deemed safe in this patient cohort.

Current data indicate that serum vitamin D and susceptible C-reactive protein (hs-CRP) levels, both indicative of the inflammatory state, have the potential to predict the onset and severity of chronic pain. Therefore, the objective was to assess the intensity of pain experienced after breast cancer treatment and its relationship with these two parameters.
In this cross-sectional study between 2019 and 2021, 201 patients were enrolled. The McGill Pain Questionnaire was employed to evaluate localized pain intensity at the site six months after the conclusion of cancer treatments. Patients were stratified based on the type of breast surgery, with or without a tissue expander, axillary region surgery, chemotherapy treatment, radiotherapy treatment, serum vitamin D levels, serum hs-CRP levels, and pain intensity. Data analysis was performed using SPSS 21 software with a significance level set at 0.05.
Among the patients, 67.6% (136 individuals) reported mild pain, 31.3% (63 individuals) reported moderate pain, and 1% (2 individuals) reported severe pain. The results of this study demonstrated a positive correlation between high serum hs-CRP levels and increased pain intensity, with serum marker levels being higher in patients experiencing more severe pain compared with those with milder pain. However, no statistically significant association was observed between various serum concentrations of vitamin D and pain intensity (P = 0.12).
Elevated levels of inflammatory factors, such as hs-CRP, are linked to a higher likelihood of developing chronic post-surgical pain.

The breast, being a highly radiosensitive organ, is exposed to scattered radiation during brain computed tomography (CT) scans. This study aims to estimate the lifetime attributable risk (LAR) of female breast cancer resulting from brain CT scans.
90 women participated in this cross-sectional study. The LAR of breast cancer incidence was estimated based on health risks associated with exposure to low levels of ionizing radiation, as per the BEIR VII Phase 2 guidelines. The absorbed dose to the breasts was measured using thermoluminescence dosimeters, and the effective dose was calculated from the dose length product. All brain CT scans were conducted using a 16-slice scanner (SOMATOM EMOTION). Statistical analysis involved the Mann-Whitney test to compare the means of breast dose, effective dose, and LAR at a significance level of 0.05.
The mean age of the participants was 40 ± 22 years, with an age range of 10 to 83 years. The average dose to the breasts without and with shielding was 0.26 ± 0.19 mGy and 0.096 ± 0.13 mGy, respectively (P < 0.05). The effective dose was 0.85 ± 0.35 mSv without shielding and 0.79 ± 0.32 mSv with shielding (P = 0.539). The maximum LAR was 5.41 cases per 100,000 persons aged 10-15 years without shielding. The average LARs were 1.16 and 0.41 breast cancer incidences per 100,000 persons with and without shielding, respectively (P < 0.05).
The LAR of breast cancer in brain CT scans is significant and should not be overlooked. The use of breast shielding can substantially reduce this risk. Therefore, it is recommended to employ radioprotective shields to cover the breasts during this type of scan.

Inflammation, when associated with cancer, has been shown to correlate with a worse prognosis. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) serve as markers of inflammation. This study aims to investigate the influence of pretreatment NLR, PLR, and MLR on treatment outcomes and their correlation with sarcopenia in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) undergoing definitive chemoradiotherapy.
In this retrospective study, 240 LA-HNSCC patients who received a radiotherapy dose of 70 Gy/35 fractions over 7 weeks in conjunction with chemotherapy were enrolled. Pretreatment NLR, PLR, and MLR were determined. Sarcopenia was evaluated by measuring skeletal muscle mass at the C3 level using radiotherapy planning computed tomography scans. The impact of NLR, PLR, and MLR on complete response rate and disease-free survival was calculated. The median follow-up duration for patients was 26 months.
Inflammatory markers were notably higher in elderly patients, females, and those with laryngeal primary tumours. Patients achieving a complete response exhibited lower values than those who did not. Patients with significant sarcopenia demonstrated elevated mean values of inflammatory markers. Patients with NLR<3, PLR<145, and MLR<0.4 experienced more favorable outcomes regarding complete response rate and disease-free survival.
Inflammatory markers such as NLR, PLR, and MLR are independent prognostic factors in HNSCC patients. Elevated values are associated with sarcopenia and inferior treatment outcomes, indicative of more aggressive tumour behavior. These markers are straightforward to calculate and should be routinely employed for early prognosis assessment.

Uterine sarcomas (US) represent a rare and heterogeneous spectrum of tumors characterized by diverse clinical behaviors and tumor responses. This study aims to assess patient and tumor characteristics and oncologic outcomes. This historical cohort study encompassed all patients with histologically confirmed diagnoses of the US who were referred to two oncology centers affiliated with Mashhad University of Medical Sciences (Iran) between March 2011 and April 2020. Data analyses were conducted using STATA version 14.02. Survival estimation was carried out utilizing the Kaplan-Meier method. The significance level was established at 0.05. A total of 33 patients were included in this study, comprising 23 with US and 10 with carcinosarcoma (CS). The mean age was 49.3 years for CS and 62.4 years for US (P = 0.0001). Nearly all patients were overweight, with a mean body mass index of 27.1 (confidence interval: 25.6-28.7). The majority of patients were diagnosed at an early stage. The Federation of Gynecology and Obstetrics (FIGO) stage, patient's anemia, and surgical resection were identified as significant prognostic factors. The median overall survival was 50.88 ± 5.7 months. The survival rates at 2, 3, and 5 years were 75%, 56%, and 41%, respectively. No significant difference was observed between CS and US regarding overall and disease-free survival. Despite the typical early-stage diagnosis for US patients, the 5-year survival rate remains low. This study underscores the pivotal role of FIGO stage, tumor size, and surgical resection as vital prognostic factors for survival.

Hepatocellular carcinoma (HCC) complicated by portal vein thrombosis presents significant clinical challenges. This study aims to retrospectively assess the feasibility of stereotactic irradiation for treating bulky HCC, with or without vascular invasion.

In this retrospective analysis, the radiotherapy treatment plans and clinical follow-up data of 22 patients diagnosed with HCC, with or without portal vein thrombosis, were reviewed. These patients underwent stereotactic body radiation therapy (SBRT) between September 2019 and September 2022. Treatment involved administering 40-50 Gy in 5 fractions using SBRT with volumetric modulated arc therapy (VMAT)/4D-computed tomography. Descriptive statistics were utilized without the application of statistical tests.

The mean age of the patients was 65 years, with 77% being male. Portal vein thrombosis was present in 73% of the cases, and the average tumor size was 7.2 cm (range 5-12 cm). 59% of patients were classified as Child-Pugh B. The median follow-up duration was 8 months (range 3-36 months). At 3 months, tumor response assessments revealed that 59% of patients had a partial response and 41% had stable disease; by 6 months, 37% achieved complete response, 26% maintained a partial response, and 37% had stable condition. Failure patterns included intrahepatic failure in two patients (at 7 and 9 months) and extrahepatic loss in two others (at 6 and 10 months). Radiation-induced liver disease occurred in two patients at 9- and 11-weeks post-treatment, respectively. Liver cancer-specific mortality was 13.6%, while non-liver cancer-specific mortality stood at 9%. The progression-free survival rate was 82%.

SBRT via VMAT represents a highly cost-effective, non-invasive local therapy with a favorable therapeutic ratio for treating bulky HCC cases, with or without vascular invasion.

Extra-nodal natural killer/T-cell lymphoma-nasal type (ENKTCL-NT) represents a rare clinical entity that often masquerades as benign lesions during its early stages, resulting in delayed diagnosis and appropriate treatment. The optimal management of this condition hinges on immunohistochemistry, disease stage, and risk stratification based on five critical prognostic factors, which encompass stage, age, performance status, lactate dehydrogenase levels, and primary tumor invasion. Radiation therapy is the cornerstone for achieving locoregional control in localized and advanced disease stages. In this case report, we present the case of a 49-year-old male, who sought medical attention at our center due to uncontrolled epistaxis following an interventional procedure for a suspected nasal polyp. Subsequent examination of histopathology slides and blocks, along with immunohistochemistry, confirmed the diagnosis of ENKTCL-NT, with residual disease evident on positron emission tomography-computed tomography. Following deliberation by the multidisciplinary tumor board, the decision was made to administer radical radiation therapy alone, with a total dose of 5940 cGy (centigray) delivered in 30 fractions employing intensity-modulated radiotherapy techniques, considering the patient's cardiac comorbidities.